February 24, 2020

On February 24, the Public Charge Inadmissibility Law – commonly known as Public Charge – went into effect after much debate and a January ruling by the Supreme Court.

So what does the new rule mean for Texas Children’s and for us as employees?

First, it means that many of our patients, health plan members, and their families may start asking more questions or may shy away from our services due to misinformation. Secondly, it means that all employees should understand exactly what public charge means and what to say to the families who may have questions.

What is a public charge?

“Public charge” or the “public charge test” is used by immigration officials to decide whether a person can enter the United States or get a lawful permanent resident status (green card). In this test, officials assess the likelihood of whether a person will lean heavily on the government for support.

What does the new rule mean?

The United States Department of Homeland Security issued a final rule (a new regulation) for legal immigrants in the United States wishing to enter or remain here.

Based on a number of factors – such as income, employment, personal health, education, skills and family situation – a person may or may not be allowed into the country or allowed to apply for lawful permanent status or a visa. The more public assistance a person has received in the past or the more assistance he or she is likely to receive, the less likely their chances of getting a green card.

Are there any exceptions to the rule?

Yes. Individuals listed below will not have to undergo the public charge test:

  • Pregnant women who need public assistance during pregnancy or for 60 days after giving birth
  • Pregnant women on Medicaid

The following forms of assistance do not count against anyone subjected to the public charge test:

  • Medicare Part D low-income subsidy
  • Benefits received by children until the age of 21, including Medicaid and CHIP
  • Emergency medical assistance
  • Food pantry assistance
  • School lunch program participation
  • Foster care or adoption

When does the new rule start?

Monday, February 24.

What do I tell patients who are in the process of trying to obtain a green card?

The public charge rule will only apply to individuals who apply for a green card on or after February 24. Tell them that it is important to speak to a lawyer about their individual case before making any decisions. They can seek low-cost or free counsel through Baker Ripley’s Citizenship and Immigration Services (https://www.bakerripley.org/citizenship-and-immigration-services).

What about our financial counselors that help families who are inpatient? Can the Health Plan help them?

Texas Children’s Health Plan is here to guide them and help answer their health coverage questions. If they have any questions about their CHIP or Medicaid coverage, they also can:

Visit the Texas Health and Human Services Commission website at yourtexasbenefits.org

Call 2-1-1 for information

Contact Texas Children’s Health Plan at 1-888-559-PLAN for further assistance or visit texaschildrenshealthplan.org/plan

Where do I go if I’d like to know more about this topic?

The United States Citizenship and Immigration Services has published a very helpful fact sheet.

Visit: https://www.uscis.gov/news/fact-sheets/public-charge-fact-sheet

February 10, 2020

We all know it when we see it.

The people who excel at everything they do. The organizations that achieve all parts of their mission. The companies that deliver great service without fail. But do we understand what it takes?

I’ve been alive long enough to know that “high quality” doesn’t just happen. But I was reminded of this recently when I sat down to talk with three members of the Quality Team at Texas Children’s Health Plan.

After a conversation with quality improvement specialists Rosendo Cardoso Gonzalez, Jeremiah Judkins and Joshua Fernelius, it all came back to me. High quality requires the right people, planning, oversight and accountability. Becoming the best is never an accident.

For this reason, improving quality is – literally – a full-time job for this team.

We started our talk with acknowledging the health plan’s upcoming accreditation survey from the National Committee for Quality Assurance (NCQA). They explained to me that although our survey takes place in mid-April, the results are the sum of what we do every single day.

Here is a look inside our conversation:

How would you describe your roles at Texas Children’s Health Plan?
All: We are the team that serves as a resource to the entire health plan. We support leaders and front-line staff in a shared responsibility to achieve national HEDIS (Healthcare Effectiveness Data and Information Set) goals.

What is the most challenging part of the work that you do?

Rosendo – “Ro”: It’s a lot of work, but that’s why we are here. It’s also challenging because most issues are complex and don’t just involve one department. Making sure that multiple departments are on the same page can be difficult.

Jeremiah – “JJ”: Encouraging employees to use us a resource. Our job is to come in and rethink processes, systems and methods. Just because we’ve been doing something one way doesn’t mean we will keep doing it that way. But like Ro said, that’s why we are here – as a resource to help facilitate the changes.

Joshua – “Josh”: Fostering change in the organization. Lasting and sustainable change is never easy, however it’s important that we evolve for the sake of our members. They deserve for us to operate effectively at the highest level of care.

What is the most rewarding part of the work that you do?

Rosendo: It’s extremely rewarding when everyone comes together and focuses on reaching for the same goals. It’s also rewarding when we can maximize each other’s strengths to solve problems.

Jeremiah: I love Texas Children’s. I have a personal connection because my six-year-old daughter has had a health condition since she was in-utero. Texas Children’s helped save her life. I want to be part of ensuring that this organization is always operating at the highest level it possibly can.

Joshua: I have been invested in public health for many years. It truly is my passion. I enjoy the opportunity to positively impact the lives of more 400,000 health plan members each and every day. Your work seems to focus on the big picture, but what do you do on a daily basis to improve quality?

All: We run the daily operations briefing, which is the glue that holds The Health Plan together. The “DOB” offers a way to uncover organizational issues and bring barriers to the forefront. If we have more visibility into our challenges, we can solve them effectively.

***

Rosendo, Jeremiah and Joshua report to Yahaira Colorado, manager for Quality & Outcomes Management. Colorado’s team, together with Natasha Pierce – manager of Credentialing – and her team, are preparing The Health Plan to gain its NCQA accreditation this summer. For more information on NCQA, visit https://texaschildrensnews.org/strive-for-five-strive-for-five/

To learn more about “Hayes on The Health Plan” and to learn basic information about Texas Children’s Health Plan visit https://texaschildrensnews.org/hayes-on-the-health-plan/.

January 26, 2020

A new system will soon allow Texas Children’s Health Plan to better integrate data for an improved member and provider experience.

Epic Tapestry, a module within Epic health care management, will help make this possible by first providing better information and improved work processes for employees who treat our more than 400,000 customers.

With the launch of Epic Tapestry – set for February 1, 2021 – employees who must now use up to ten systems to do their job, will be able to use just one or two. They will have access to more information, need to ask fewer questions and will be better prepared to offer comprehensive service.

“This is going to be very exciting for our workforce, allowing us to be much more efficient in our processes and therefore better able to meet the needs of our members,” said Justin Loudon, assistant vice president at Texas Children’s Health Plan. “The promise for Epic’s impact is enormous and we are enthusiastic about what this means for our future.”

The Benefits of Epic Tapestry

Epic Tapestry is an overarching application that will replace a variety of applications currently used. Its goal is to integrate the business of Texas Children’s Health Plan. It will:

  • Ensure a comprehensive, integrated enterprise solution with a common look and feel
  • Reduce manual work and provide a better data source for information
  • Incorporate evidence-based decision-support tools and better data entry at point of care
  • Optimize the patient/family experience across the enterprise
  • Challenge current practice—streamline and simplify

Reinforcing One Amazing Team

Project leaders also note that the current applications used at Texas Children’s Health Plan have no integration or communication with applications used at Texas Children’s Hospital.

“This is something that has to change,” said John Turner, assistant vice president at The Health Plan. “Thousands of Health Plan members are also Texas Children’s Hospital or Texas Children’s Pediatrics patients. Many of our providers also work within both worlds. Introducing Epic at The Health Plan will ensure that all systems can talk to one another.”

Texas Children’s Hospital implemented Epic in 2008 and now it’s The Health Plan’s turn.

Money Saved = Increased Member Care

Loudon added that this implementation is also a cost savings measure as The Health Plan spends over $7 million each year on maintenance and hosting for all of its many applications. This annual cost will be significantly less once those applications are replaced by Epic.

Applications to be replaced include QNXT, Vital, Impact Pro, Maccess, Formworks, Harmony/WellSky, Member Portal, Provider Portal, MicroDyn and Altegra. Once full implementation takes place, only Epic and Onbase will be in use.

Employees will be trained for the change

All essential groups will be trained beginning in October of this year. Watch Connect for a separate story on training details.

Want to know more?

All employees, providers and members who are affected will receive targeted communications from a variety of sources, including: managers, supervisors and corporate communications.

January 13, 2020

Texas Children’s Health Plan has long been focused on improving its operations in many ways. At the top of the list is establishing and maintaining good relationships with our providers.

“When providers are happy, members are happy,” said Anna Mateja, vice president at The Health Plan. “It’s an understatement to say that we value providers. They are absolutely essential to the care of our members and families.”

So to that end, meeting the needs of nearly 12,000 physicians and specialists, has become high priority. Among efforts to address this priority was the recent establishment of the Strike Team, a team of four employees solely focused on trouble shooting and customer service.

“Our team ensures that concerns are addressed in a timely way, underlying issues are resolved and overall quality service is delivered to our providers,” said Jennifer Sima, senior decision support analyst who project manages for the group. Strike Team members are Nekia Grays, senior provider relations representative; Christopher Sam, senior claims examiner; Imani Phillips Spears, operations systems analyst II, and DaShawn Wilson, senior provider relations representative. The formation of this special team has required that these employees temporarily step out of their every day roles and take on this special task.

When first commissioned, the group was faced with a backlog of more than 3,043 issues. The combined effort of the Strike Team and multiple departments helped to reduce the targeted backlog to 390 within just a few months. Their work is ongoing and their value to The Health Plan increases each day.

Sima adds that she is incredibly proud of the Strike Team’s progress. She emphasizes that their success has come largely at the hands of collaboration and cooperation with normal operations; including provider relations, claims processing and member services. “The Strike Team is definitely part of our One Amazing Team.”

An overarching theme at The Health Plan is customer obsession. In an effort to become more customer obsessed, there are several projects taking place.

Just a few of these are:

  • The implementation of Epic Tapestry, a core claims processing system for managed care organizations that will provide integration across the Texas Children’s system and eliminate the need for multiple databases and duplication of many processes.
  • Streamlining the onboarding process for new providers which will make it easier and faster to join the Health Plan network.
  • A brand new claims processing dashboard project that provides real-time information on how we are managing claims.
  • Customer service training from the Patient Experience department for our Member Services and Provider Services call center employees.

For more information about the Strike Team’s work, please contact Jennifer Sima at jxsima@texaschildrens.org.

December 16, 2019

Just a mention of The Center for Children and Women and you’ll get the type of reaction that many health care organizations envy. The all-inclusive health care model, beautiful clinical spaces and friendly faces make The Center a part of the Texas Children’s family that we can all be proud of.

Employees at the Southwest location recently celebrated five years in operation, a time in which they have consistently increased the number of members served and services offered.

“I’m extremely proud of the work put in by my team and the support that we receive from Texas Children’s as a whole,” said Frances Monroe, director of the Southwest facility. “We are absolutely obsessed with our members and how to take care of their needs. In the next five years, our efforts in this area will only grow.”

All about The Center

The Center for Children and Women is designed to ensure that all patients have access to proper care by providing extended hours to accommodate the families’ busy schedules. The Center’s health care model provides comprehensive care for the well-being of the whole patient. This is done with the help of many medical professionals on site every day such as pediatricians, advance nurse practitioners, OB/GYNs, certified nurse midwives, optometry, imaging, a laboratory and an onsite pharmacy, and behavioral health specialists. The medical home provides a means to address the shortage of primary medical care for families.

Awards earned

The Center has received several awards and recognitions since it opened such as; The National Committee for Quality Assurance (NCQA) Level III Recognition four years in a row. The Center is NCQA Patient Centered Medical Home (PCMH) and Patient Centered Specialty Practice (PCSP) recognized. The Center for Children and Women was the first OB/GYN practice in Texas to receive PCSP designation. In addition, the Center is COLA Certified for clinical laboratory compliance and received COLA’s Laboratory Excellence Award and acknowledged by Centering Healthcare Institute as an accredited Centering Pregnancy site, to name a few.

More information

For more information about Texas Children’s Health Plan The Center for Children and Women visit www.JoinTheCenter.org.

December 10, 2019

No one working in healthcare today would say that it is easy. And children’s hospitals are even more complex: we must wrap our arms around not only our patients, but their families (and teachers, school nurses, caregivers, and others). Overcoming these unique challenges yields extraordinary rewards – for kids, families, and communities – so it’s worth it. Building healthier futures is why we do what we do.

Delivering Texas Children’s-quality healthcare requires unparalleled care-coordination. As emphasized in Planning a Patient’s Care (one key element of Care Coordination), this means recognizing potential barriers to care and addressing them in advance.

“This particular element sets an expectation to look at each patient’s individual needs and take the time to understand the clinical and non-clinical resources that are required and available, “ said Dr. Katie Ostermaier, medical director at Texas Children’s Health Plan and a Care Coordination team lead. “It sounds simple, but what it really demands is that we build relationships with the right partners and deliver resources in way that is proactive and well thought-out.” Ostermaier compared care coordination to a village raising a child: “Someone in the village must be thinking in advance about everything that child will need in the future and the best way to deliver it.”

The same applies to Texas Children’s. Sterling care coordination requires:

  • Having a shared care plan that forces us to anticipate needs and potential problems.
  • Communicating with patients by explaining treatments, procedures, and follow-up care.
  • Facilitating communication between providers and caregivers by sharing complete patient stories during hand-offs.
  • Transitioning patients efficiently between areas within our system and stages of care.
  • Optimizing patient convenience by considering things like scheduling, transportation, supplies, and medications.
  • Using community resources effectively.

Both clinical and non-clinical employees are critical to this work. Care Coordination is a priority for each and every member of our One Amazing Team.

Tell us your story

Do you or someone you work with coordinate care well? Tell us how by sending a note to connect@texaschildrens.org. We want to hear from you!

Want to know more about Care Coordination? Reach out to Andrea Romay, senior project manager for Care Coordination at maromayd@texaschildrens.org or 832-824-7831.

November 26, 2019

 

An unprecedented future and unlimited possibilities were the talk of this year’s Health Plan Town Hall, hosted at the Bayou City Event Center on November 1.

The strong tone of optimism and opportunity was only made stronger by the event’s inclusion of Mark Wallace’s 30th anniversary celebration. Wallace, who is the president and chief executive officer of the Texas Children’s system, opened the event with an organizational overview and closed the event following a special film that documents his life and leadership.

Mark Mullarkey, president of Texas Children’s Health Plan, presented a “state of the health plan” to his nearly 900 employees who were enthusiastic and energized about the year ahead.

Fiscal Year 2019 accomplishments included …

  • People and Structure: The Health Plan opened over 100 incremental positions and better leveraged the subject matter expertise of 18 senior leaders.
  • Stronger Connection to the System: The Health Plan strengthened its connection to the Texas Children’s system and became an even more integral part of our One Amazing Team.
  • Focus: Health Plan leaders rallied around four key priorities to drive process improvement and operational excellence – Customer Obsession, Membership Growth, Effective and Efficient Operations, Highest Quality Care in a Cost Effective Manner.

In 2020, the focus will be on …

  • Continued intensity on the four key priorities listed above.
  • Assisting the Health and Human Services Commission (our state funding agency) as they attempt to reach the goals outlined in their new “Blueprint for a Healthy Texas.”

Links to visit:
The top10 things you should know about The Health Plan
HHSC’s Blueprint for a Healthy Texas
All about Mr. Wallace’s 30th anniversary and his legacy as the leader of our organization