May 18, 2020

 

In less than a year, the Member Services team at Texas Children’s Health Plan has completely transformed the way they work, the way they win, and the way they are regarded across the system. A true Cinderella story.

Once known for struggling to meet performance expectations, Member Services now shines in team spirit, employee performance, and the delivery of services to members and providers.

April 2020 marked the most successful performance month for the department in over four years – an accomplishment that is beyond remarkable considering the changes they’ve faced during the current global pandemic.

A comparison of May 2019 and April 2020 demonstrates a number of key accomplishments including but not limited to an increased answer rate of 19 percent, decreased abandonment rate of 7 percent, and a decreased rollover rate of 22 percent to our back up vendor.

“I am so proud of my team and what we have been able to accomplish together. Most importantly, I am especially pleased that our improvements are having a positive impact on the members and providers that depend on us,” said Opera Wagner-Ross, director of Member Services.

Wagner-Ross, who joined the Health Plan in May of 2019, is the undeniable linchpin who has made this transformation possible; however, she doesn’t see it that way. She readily credits her team and the incredible leadership she has received from Richelle Fleischer, senior vice president; and Mark Mullarkey, president of Texas Children’s Health Plan and executive vice president of Texas Children’s Hospital.

“Even the best leaders benefit from good leadership,” she said. I feel incredibly lucky to have the opportunity to work with both Richelle and Mark. They are both dynamic leaders with high expectations. I have learned a great deal over the past year and feel lucky to be a part of the team.” Wagner-Ross went on to say that having great coworkers and a friendly dose of competiveness is also a great motivator. She credits the Claims department at the Health Plan as being an inspiration and a motivator.

“April Riggs, director of Claims, and her team have been very successful in turning things around in the Claims Department. She has been a great partner in that she challenges me, holds me accountable, and can be counted on to make me laugh when faced with challenging situations. She’s the best!”

So how did they do it? How exactly did they spark this kind of change within the department?

Here are the major keys:

  • A defined career path for members of the team. By creating a clear career path, employees understood what their options were for growth. With increased opportunity for growth, department retention improved.
  • An increase in the number of Spanish speaking agents. A large percentage of health plan members speak Spanish; however only 16 percent of our agents spoke the language. Today, that number sits at 46 percent.
  • Appropriate span of control for managers. With a more appropriate span of control, managers are now able to provide better support, coaching and accountability to their teams.
  • Improvement in the training of employees. Staff members received an increased amount of training including a special course taught by the Patient Experience staff, which specifically focused on customer service.
  • Allowing data to drive change. Whether it was a process to improve, a system to introduce or a technology to enhance, all decisions were made based on information.
  • Improvement in the quality of all phone calls. Increased quality review and monitoring of phone calls and improved handling of escalations with a focus on customer satisfaction.
  • Celebrating the small wins. The team looks for every reason to celebrate and highlight accomplishments.

Wagner-Ross says that as a leader she really doesn’t have a secret sauce. She simply believes in finding the right people and always looking for opportunities to improve.

As the COVID-19 pandemic continues to dominate the news and impact our normal way of life, there is one thing that has not changed – our commitment to ensuring our patients and families have convenient access to the care they need, when they need it, while also continuing to protect their health and safety.

As we begin to adapt to this new normal, more in-person visits are being converted to video or phone appointments. Texas Children’s e-Health team, in collaboration with multiple departments across the system, has rapidly expanded and enhanced these e-Health services to make it easier and more convenient for patients to connect with a Texas Children’s provider without leaving their home.

In less than three months, the organization has seen a rapid growth in e-Health visits across the system. On March 2, Texas Children’s completed 39 video and telephone appointments. As of May 8, our providers had completed 72,285 telephone and video visits across Texas Children’s Hospital, Texas Children’s Pediatrics, Texas Children’s Urgent Care, Texas Children’s Health Plan and Texas Children’s® Anywhere Care. Along with this impressive milestone, over 1,000 providers have been trained to provide care through video visits to their patients across the system.

The Health Plan’s e-Health platform, Texas Children’s® Anywhere Care, which has been a major focus in the organization’s e-Health efforts, has seen an uptick in patient visits. Since launching the platform last summer, over 1,520 video appointments have been completed. A total of 750 e-Health visits were completed from March 1 to May 5 of this year.

“Our recent successes are attributed to the collaborative efforts that went into building the infrastructure that has enabled us to expand our e-Health capabilities more broadly across the system,” said Laura Laux Higgins, director of strategic projects in Information Services and member of the e-Health Executive Steering Team. “Not only did we investigate the technology solutions and invest in them, we had a team of e-Health experts in place across information security, EPIC, MyChart, billing, compliance, legal, credentialing, risk, and administrative and physician leadership who were able to help us move forward quickly because of the work they had done over the past year.”

With the demand for e-Health services on the rise due to COVID-19, Texas Children’s Heart Center, like many other subspecialties across the system, are leveraging the mutual benefits of e-Health services.

Shortly after the COVID-19 pandemic set in and local, state and federal governments asked non-essential businesses to close and residents to stay home, the Heart Center worked swiftly with physicians and staff to engage e-Health services for new and existing patients 6 months old and older who did not need to be seen in person.

Within about a week, the Heart Center was booking about half of its appointments at the Texas Children’s Medical Center Campus via video or phone. Although that number has decreased since Gov. Greg Abbott has started to reopen parts of the state, the Heart Center is still using e-Health services and is dedicated to the virtual patient care model for the foreseeable future.

“Our will to continue to work hard and keep our patients, families and staff safe has never been stronger,” said Chief of Pediatric Cardiology Dr. Daniel Penny. “e-Health is a way we can continue to serve our patients without putting them at unnecessary risk.”

All potential e-Health appointments at the Heart Center are reviewed by a pediatric cardiologist or advanced practice provider to determine whether it is clinically appropriate for a child’s appointment to be completed using one of these modes of virtual visit. If the cardiologist considers that a child’s appointment can be completed in this way, the clinic staff will contact the child’s family to provide more details and guide them through the new system.

Dr. Jeffrey Kim, director of the Arrhythmia and Pacing (Electrophysiology) Service at Texas Children’s Hospital, said his patients are good candidates for e-Health visits because they typically don’t need surgical intervention. For about a month during the pandemic, Kim said almost all arrhythmia and pacing patients were utilizing e-Health visits. Now, about half are using the service.

“Patients are very appreciative of the virtual visits,” Kim said, adding he conducted an appointment with a patient while they were standing in the middle of a field on their ranch. “They are thankful they don’t have to come in and expose themselves if they don’t have to.”

In addition to safety, Kim said e-Health services can be used to treat people in areas where there are limited pediatric cardiology services. Patients in these areas might not be able to drive into places like Houston for an appointment forgoing care altogether or seeking it in less-than-ideal places. e-Health would bring the visit to them, allowing our experts to reach more children and families.

“e-Health has a lot of benefits and possibilities,” Kim said. “I’m excited to see how it develops.”

May 4, 2020

Texas Children’s Health Plan is continuing its pursuit of an accreditation from the National Committee for Quality Assurance (NCQA). This is the most widely-recognized accreditation program in the United States and going through the process demonstrates the health plan’s commitment to quality.

“The fact that we are continuing our process in the face of COVID-19 demonstrates the high level of commitment we have to our members,” said Emmalou Torres Cabrera, Director of Quality Management at Texas Children’s Health Plan. “The quality of our care isn’t wavering due to this pandemic. In fact, we are working to ensure that we raise the bar even more so.”

The first big milestone in the process was completed on April 14 with the submission of 262 documents. The next step is preparing for the file review that surveyors will focus on during the virtual audit, which replaces the onsite visit on June 1 and June 2.

Cabrera extends appreciation to everyone involved in the process, with special recognition to Quality Improvement Specialists Rosendo Cardoso Gonzalez, Jeremiah Judkins and Joshua Fernelius.

NCQA surveyors will ensure that the health plan is meeting quality standards in the following areas:

  • Quality Management and Improvement
  • Population Health Management
  • Network Management
  • Utilization Management
  • Credentialing and Re-credentialing
  • Members’ Rights and Responsibilities
  • Member Connections

For more information about the National Committee Quality for Assurance, visit NCQA.org

April 27, 2020

 

With the global pandemic resulting in a rapid increase to the nation’s unemployment rate, more Americans may now qualify for Medicaid — a government-funded health insurance program that provides coverage for low-income children, pregnant women, and disabled adults in Texas.

Texas Children’s Health Plan serves children and women in the Medicaid program, therefore, an increase in Medicaid recipients will likely result in an increase in Texas Children’s Health Plan members.

And we are ready to serve.

”We are closely collaborating with the state of Texas as we collectively respond to the evolving COVID crisis,” said Johnna Carlson, director of Government Programs. “We are anticipating a surge and know we will have the ability to serve these new members well.”

Why is it important that the health plan is ready?

Texas Children’s Health Plan is a health plan much like Blue Cross Blue Shield, United Healthcare, Cigna or many others. The difference is that it manages the health care of low-income families who receive government-funded insurance.

Even outside of a pandemic, health plan employees are skilled at caring for families that are living through challenging and stressful life circumstances. “This is what we do,” Carlson said. “We care for the families that need us most. We answer the call all of the time – but especially in times like these.”

The Texas Health and Human Services Commission has indicated that it saw a 47 percent increase in Medicaid application submissions in March 2020 compared to March 2019. While not all applicants may qualify for Medicaid coverage, we can expect to see an ongoing increase in Medicaid applications in the coming months.

What does the national picture look like for the low-income?

Health Management Associates, an independent firm that is consulting with health plans across the country, recently published some high-level observations and predictions:

  • The number of people receiving health insurance coverage from an employer could decline by 12 to 35 million, including both workers and family members.
  • Medicaid enrollment could increase from 71 million to 82-94 million.
  • Medicaid enrollment could grow by 5 million regardless of the number of people who lose their jobs.
  • Uninsured numbers could increase to 40 million.

Based on these and other projections there will be a national need for affordable and quality health care; and Texas Children’s Health Plan will be positioned to meet the need. If you or anyone you know would like more information about Texas Children’s Health Plan, visit texaschildrenshealthplan.org.

April 7, 2020

As COVID-19 continues to dominate the news, cause widespread closures and cancellations, and disrupt our normal way of life, it can be especially challenging for patients and their families who depend on us for their care. As we adjust to this new change, there’s one thing that has not changed – our commitment to ensuring our patients and families have convenient access to the care they need, when they need it.

One of the ways to help stop the spread of COVID-19 is to limit the number of patients and visitors at all of our locations across Texas – including hospitals, specialty care clinics, Pavilion for Women community clinics, Texas Children’s Pediatrics, Texas Children’s Urgent Care and The Centers for Children and Women. To keep everyone safe, many in-person visits can now be converted to a phone or video appointment. Texas Children’s e-Health team – in collaboration with other departments across the system – has rapidly expanded and enhanced e-Health services to make it easier and more convenient for patients to connect with a Texas Children’s provider without leaving their home.

“Providers are very eager and excited to offer virtual visits to ensure the continuity and convenience of care to children and women especially during these challenging times,” said Dr. Robert Ball, maternal fetal medicine physician and medical director of e-Health. “As more physicians are trained and enabled to provide virtual care to their patients, we are rapidly transforming the landscape across Texas Children’s.”

Texas Children’s providers and patients are taking advantage of the benefits of e-Health capabilities. On March 23, providers began having telephone appointments with patients. In the first three days alone, almost 2,500 patients were able receive care via telephone from the safety of their home across Texas Children’s Hospital, Texas Children’s Pediatrics and Texas Children’s Health Plan. On March 26, almost 1,000 providers across the hospital were introduced to training to be able to give face to face care through video visits to their patients. This is also expected to take off rapidly and be a “customer obsessed” solution for our patients. The roll out of video visits across care locations change how Texas Children’s delivers care, not just during this emergent time, but for the long-term.

With the demand for e-Health services on the rise due to COVID-19, our e-Health team, nurses and leaders have worked collaboratively to develop other strategies to meet our patients’ needs. Below is an overview of some of the enhancements that have been recently implemented:

COVID-19 Nurse Triage Line – This new feature allows parents of current patients to call 832-822-6843 (832-82COVID) if they think their child has symptoms or has been exposed to COVID-19. The line is available 24 hours a day, 7 days a week and operated by specially trained pediatric nurses. The nurses will triage calls, provide basic COVID-19 information, or schedule a video visit with a provider for further evaluation. The COVID-19 nurse triage line is for pediatric patients only.

Virtual Visits – To keep our patients, their families and our staff safe, many pediatric and women’s services in-person visits are now being converted to a phone or video appointment. If a patient’s appointment is a fit for either option, clinic team members will contact patients directly to provide more details. We encourage patients to continue to schedule appointments with their Texas Children’s providers, and to visit texaschildrens.org/appointment for more information about current options.

Texas Children’s Pediatrics (TCP): TCP has changed its scheduling work flow to have a physician review all appointment requests for the health and safety of all patients arriving at TCP locations across Houston, Austin and College Station. If a patient’s health screen indicates symptoms or exposure to COVID-19, TCP will convert the patient to a phone or video appointment. e-Health options are new for TCP practices and is growing quickly. Between March 12 and March 27, TCP completed 567 video and 1,653 phone appointments.

Texas Children’s Health Plan (TCHP): TCHP has also been focused on getting key provider communications pushed out, with the most important messaging being around supporting the delivery of telemedicine services. The Centers for Children and Women are conducting their visits via phone and have added nine trained providers to the ranks of approved physicians licensed to conduct video visits. Additionally, Texas Children’s telemedicine platform Anywhere Care has seen an uptick in patient visits. For more information about Anywhere Care, click here.

“The COVID-19 pandemic has really impacted the way we provide care,” said Texas Children’s Chief Information Innovation Officer Myra Davis. “This health crisis has presented an opportunity for us to leverage the benefits of e-Health. Historically our outpatient care has been provided at Texas Children’s locations, and e-Health has created a paradigm shift where we our meeting patients where they are.”

Ball has seen the benefits that e-Health offers to our providers and patients, especially those patients and families where physical access to a Texas Children’s facility can be difficult.

“I think e-Health has been an incredible game changer for us,” Ball said. “Everybody deserves a Texas Children’s provider, and this is an effective tool that we can use to create this opportunity for them.”

E-health Resources

Please visit Texas Children’s Coronavirus Connect page where you will find links to internal documents with updated information about COVID-19, as well as our e-Health Training and Resource page that includes information on telephone and video visit requirements, consenting, and FAQs.

March 9, 2020

Training for Epic Tapestry is set to roll out this fall!

Epic Tapestry – launching in February 2021 – will allow Texas Children’s Health Plan to better integrate data for an improved member and provider experience. Customer-facing employees will have access to more information and will be better prepared to offer comprehensive service.

Training will take place in a combination of ways:

  • E-Learning Courses
  • Quick Start Desk Reference Guides
  • Detailed Self-Guided Exercise Booklets
  • In-Person Classroom Training

“Your training will be determined by your role within the organization and which portions of the module you must access,” said Elydia Villanueva, Information Services educator.

Villanueva is leading training efforts for Texas Children’s Hospital employees while Angie Ross, Epic Project Team Trainer, will lead training for Health Plan employees. Together with senior IT Project Manager Quintus Bratton, the three will ensure that nearly 1,000 employees across the system will be prepared on Go Live day.

An important point to remember is that employees will receive formal training, but they will also have access to a virtual “playground” where they can spend some time working within the modules at their own pace,” said Ross.

Training dates and locations will be released in October and training sessions will begin in December.

For more information about the overall project, visit https://texaschildrensnews.org/new-health-plan-system-will-provide-better-care-for-members/

March 2, 2020

Not so long ago the Claims department at Texas Children’s Health Plan faced significant challenges. Those challenges led to unhappy providers and millions of dollars in state penalties. But in the last year April Riggs, director of Claims Administration – and her newly restructured team – have overseen a remarkable turnaround. The team is more efficient, providers are happier and within the last eight months, the department has incurred $0 in state penalties.

Remarkable is perhaps an understatement.

In record time, the team has:

  • Ensured that 98 percent of all claims are paid within 30 days.
    • They reduced the average time from 22 days to five days.
  • Reduced the amount of claims in cue.
    • The team had 80,000 claims in cue at their lowest performance level.
    • The goal was to be at less than 30,000 claims in cue, which they have achieved and sustained for 14 months.
  • Eliminated liquidated damages, which are non-compliance penalties issued by the state.
      • The department previously incurred $2 million in damages over a 21- month period.
  • For the past eight months, they have incurred NO new liquidated damages.
How did they do it?

“We coined our mission Mission Possible and we set some very straight forward goals,” said Riggs. “We knew that to be successful we had to define our mission, review historical practices and in no way could we return to business as usual.”

Riggs immediately set her team on a course that consisted of:

  • Putting the right people in the right positions
  • Making data driven decisions
  • Implementing metrics that matter
  • Consistently monitoring productivity; and
  • Collaborating with key business partners

After all of these efforts were in place, she noticed a shift occurring within her team. “It was a pleasure to watch it happen. We became a team that could identify issues very early on and then move swiftly to identify solutions.”

And if that wasn’t enough, Riggs said her staff began daily briefings to review their work for the day, the week and even for the following week. “I believe Mr. Wallace calls that skating to where the puck is going to be,” she said.

Indeed it is.