September 4, 2019

Have you ever been asked to do something, but not given the tools to do it?
Have you ever wanted to do something, but lacked resources to get it done?

Not having what you need is one of life’s great frustrations. And unfortunately, this is the case for many students each and every day. They may not have a pen, pencil, notebook or other necessary supplies to do well in class.

Texas Children’s Health Plan addressed this issue head on with three successful back to school fairs. Together, the events provided nearly 3,000 students with day-one ready backpacks.

  • The August 10 event in Tyler had the highest attendance with 1,800 families present and 1,300 backpacks distributed.
  • The August 3 Pasadena event resulted in the distribution of 1,100 backpacks.
  • Port Arthur was host to the July 26 event where 492 students received backpacks.

In addition to the backpack giveaway, the events also included an opportunity for vaccines, health screenings and application assistance for any family wanting to apply for insurance through Texas Children’s Health Plan.

August 26, 2019

There is a lot of talk these days about immigration into our country and requirements around the process. Recently, new rules went into effect regarding the Public Charge Inadmissibility Law – commonly known as public charge.

So what do the rules mean for Texas Children’s and for us as employees?

First, they mean that many of our patients 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. Patients with the following situations 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?
Several states have filed lawsuits to stop the law from taking effect. However, the new regulations are scheduled to start October 15, 2019. The new rule will only cover applications filed after mid-October.

What do I tell patients who are in the process of trying to obtain a green card?
Tell them that it is important to speak to a lawyer about their individual case before making any decisions.

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

Hundreds of Texas Children’s employees walk into potentially dangerous situations every day.

Not only in the aftermath of a natural or man-made disaster, but on any given weekday. A routine Tuesday or Wednesday holds possible harm for these staff members.

So who are they?

They are our remote work force, which largely consists of a subgroup of Services Coordinators. They are the men and women who provide direct care and support inside of patients’ homes and out in the community.

They sit on the health plan side of the organization and spend the majority of their time in face-to-face interactions with families.

“Since the heart of our mission is to enhance the health and well-being of every child, our team is dedicated to the members we serve, and they live in every kind of neighborhood you can think of, including some that aren’t very safe,” said Ashley Simms, director of Care Coordination at Texas Children’s Health Plan. “When these employees are hired, they undergo the basic safety training, but we are now rolling out an entire suite of services to ensure that they are even safer on the job.”

What type of situations are they facing?

Katara Butler, assistant director of Care Coordination at The Health Plan, said the potential threats are varied.

“Unfortunately, we’ve had service coordinators physically attacked and threatened. There is also the potential for accidents or falls inside of a family home,” Butler said. “And, of course, by spending so much time on the road there is always the chance that there will be car trouble in an unsafe area.”

How are we ramping up safety for these employees?

Six different services will be available starting in October.

Workplace violence training

  • Live and online courses that teach employees how to stay aware of their surroundings, identify dangerous situations, predict when interactions may escalate and more.

Crisis prevention training

  • Coaching on self-defense and verbal de-escalation.

Risk management training

  • A course on how to avoid risky situations, evaluate risks in the moment and report any risk following a visit or interaction.

Disaster bag

  • An emergency car kit will be placed in each vehicle.
  • The kit will include a first aid kit, a thermal blanket, a raincoat, jumper cables, a flashlight and basic tools.

AAA coverage

  • Each remote employee will receive a membership to AAA, which will include options for towing, a locksmith, tire changes and battery care.

My EOP (Emergency Operations Plan) app

  • An app that employees can download on their mobile devices, which offers information on how to handle a variety of situations like a fire, a bomb threat, severe weather, a cardiac arrest and much more.

Want more information?

Managers and supervisors will provide more information in the coming weeks.

August 20, 2019

There’s no greater responsibility than raising a child. Who should do that alone?

If you asked Adrian McKinney, manager of Texas Children’s Nurse Family Partnership (NFP), she’d say no one. Thanks to McKinney and her team, more than 625 first-time mothers and 487 children have benefited from personalized nursing support since 2009.

That’s 10 years of taking pre-natal and post-partum care directly into the home of Texas Children’s Health Plan members. Certainly something worth celebrating.

“We couldn’t be more pleased about the success we’ve had as a team,” McKinney said. “Our mothers are all entering one of the most challenging times in life and if we can help make preventative health care a priority before their children are born then we’ve already won.”

And that is ultimately the focus of the program. Much like a strong pre-school experience is important to the educational life of a child, so is a good prenatal experience. If the seeds for success are planted early there is time to yield an incredible result.

Rachael Mumbach knows this personally. Mumbach is currently enrolled in the NFP program and calls it an answered prayer. She is mom to little Alaina, who will be two-years-old in December.

“As a first-time mom you get so much inconsistent information about how to handle your pregnancy and raise your children. Your mom and grandmother will tell you one thing. Your boss and your friends will tell you something different,” she said. “They all mean well, but you don’t really know what’s right and what’s wrong.”

Mumbach’s nursing partner, Savanah Ryan, has been an NFP nurse for six years and thoroughly enjoys her work. “Every day looks completely different,” she said. “We are on the road, in homes and providing that hands-on support that our moms need. It’s a joy.”

More than mom
Although moms are the primary focus of the program’s coaching model, McKinney says other family members can also be involved in the sessions. “Dads, grandparents, friends and others who will be part of the child’s support system can absolutely take part in the sessions. We want to make sure that as many people as possible are informed and prepared for the baby’s arrival.”

Who teaches what?
McKinney’s team of nurses conduct weekly and semi-monthly sessions. They teach on topics such as maternal health, sexual health, depression, anxiety, drug use, general child development, parenting and more. Nurses on the team are:

  • Savannah Ryan
  • Galynn Jackson
  • Natalie Nichols
  • Jeanette De Leon
  • Erika Dunn

A big congratulations to the entire team on their 10-year anniversary and successful outcomes for moms.

*****

The Bottom Line
  • Any first-time mother who is a member of Texas Children’s Health Plan and no more than 25 weeks pregnant may be eligible for NFP Services.
  • Anyone who is interested and thinks they may be eligible can contact Mary Perez at 832-828-1274, mmperez1@texaschildrens.org
  • Want more information about NFP? Visit nursefamilypartnership.org
August 12, 2019

Tricia Foster and Charles Summerhill are the most delightful people providing the most helpful data. They are the geographic mapping experts at Texas Children’s Health Plan.

When you step into their office you feel invited, intrigued and ultimately in awe of the work they do each day to care for our members.

So what exactly do they do?

To the untrained eye the world of GeoMapping seems complicated, but essentially Foster and Summerhill – along with the Business Intelligence Analytics team – build and analyze maps. These maps are then used to meet member, clinical, financial, and operational business needs.

“We use technology that allows us to see where our members are, the resources that are nearby and how to get those resources to them as quickly as possible,” said Foster, senior business intel analyst. “Many times when you work with data and technology you aren’t really sure how your work translates to patient care, but in this job we know we are making a big difference.”

How big?
Big is probably not a big enough word. In recent years the team has had a chance to help patients in the aftermath of some major situations like Hurricane Harvey and the plant explosion in Crosby, Texas.

“On day one of the Crosby explosion we were able to tell the Care Coordination team which members were within a one mile radius of the event and which ones had asthma or breathing related health issues,” said Summerhill, senior business intel analyst.

Foster chimed in with an obvious question – “How many times do you get a call from your insurance company asking how they can help you? People just don’t expect it and it’s wonderful when we can go in and be helpful in times like that.”

The Health Plan’s Mission Control project is another example of how their work has been used to help meet organizational goals.

What can the maps tell us?

The capabilities for the map data are unlimited and always evolving. In addition to knowing where our members are located, we can also tell them the locations of nearby:

  • Provider offices (Doctors, Therapists, etc.)
  • Emergency rooms and Urgent Care Clinics
  • Transportation services (bus stops, rail stops, etc.)
  • Pharmacies
  • Labs

But wait, there’s more.
The GeoMapping technology also helps prove that we are meeting state requirements such as having enough providers within a certain proximity to our members. Texas Health and Human Services Commission – the state agency that funds The Health Plan – wants to know that we are making care convenient for our families.

“In addition we can tell if our members are in a food desert,” Summerhill said. “If access to healthy and nutritious food is tough for the family, that is something our member service and care coordination teams should know. There are a variety of factors that impact member care.”

Want to know more about GeoMapping at The Health Plan? Contact Kim Battenfield, manager of Clinical and Business Analytics at kabatten@texaschildrens.org.

What You Need to Know

GeoMapping – When clinical and business data is used to build a map.

Members – Children and women who have insurance through Texas Children’s Health Plan. While Texas Children’s Hospital has patients, Texas Children’s Health Plan has members.

Member Services – The department at Texas Children’s Health Plan that speaks one on one with members to answer questions and provide assistance. You’ll often hear this group referred to as “the call center staff.” Our member services representatives work in our call center on the 10th floor of the 6330 West Loop South building in Bellaire.

Care Coordination – Staff who work directly with families to ensure that their care is managed. Care coordinators work in a case manager or social worker capacity. A great deal of care coordinator work remotely and are often called the “road warriors.”

Food Desert – an urban area in which it is difficult to buy affordable or good-quality fresh food.

Let’s say you had a business and every three months it was guaranteed to lose 100 customers.
(Whoa!)
You operated this way because you couldn’t figure out how to prevent this from happening.
(Oh.)
And then one day someone showed you how to predict which of your customers might leave in the next three months – so that you can keep them.
(Yay!)

The happy ending in the above scenario is now happening at Texas Children’s Health Plan. The solution is a cloud-based software platform called Predictive Analytics.
Three Health Plan departments – Finance, Business Analysis and Member Engagement – are working together to meet members’ needs through this new capability.

How does it work?

Di Miao, senior decision support analyst, explains that hundreds of data points are fed to a machine learning model to determine the likelihood of a member leaving the plan. These might include location of residence, number of missed appointments, number of providers, etc.

All of those variables are entered into a system that produces a likelihood of which members may leave. That list of members is then given to the Member Engagement team.

“When we know a member has a high likelihood of leaving, we work hard to prevent that by providing them VIP status at member events or taking extra steps to meet their needs,” said Alejandra Lima, marketing event planner. “It isn’t a perfect science but at the very least we have an idea of who might not be as satisfied with our services as we would want them to be.”

Time will tell

As is the case with most new efforts, time will tell how well the project works. However, the potential is very promising.

“I’m so excited about this project,” said Miao. “It really does have so much potential to help us care for members better. Often times when you work in positions like ours and you build the model or pull the data, you never fully understand the impact.”

But in this particular case the impact is clearer.

Miao worked alongside Kyle Stringer, senior decision support analyst, and Sadhana Sharma Luetel, data architect, to create the model.

“The old way of doing things is that you have a theory or an idea and then you use data to prove it. But when there is more data, more computing power, and more mature machine learning techniques you can take that data and then use it to discover interesting patterns or new ideas,” Miao said. “That is a better way of working and a better way of taking care of our families.”

The Next Step

The team agrees that adding more manpower to the process is the next step. “It takes time and attention to cull through the names each month and choose who to focus on. Then – maybe most importantly – it takes time to keep up with those families, follow them and determine if they actually left or not.

Adding at least a part-time staff member to the efforts is the next steps to seeing the potential of the project all the way through.

Want to know more about the predictive analytics program or think your department can help? Contact Di Miao at dxmiao@texaschildrens.org or Alejandra Lima at axlima@texaschildrens.org.

July 29, 2019

Just when you thought life couldn’t get any better, The Center for Children and Women is on Instagram.

Log on and double tap if this made your day – https://www.instagram.com/thecenterforcw/.

“We are always looking for new ways to engage our members on social media and what better way than Instagram?,” said Rosa Pruneda, social media specialist for Texas Children’s Health Plan. “Everyone is on Instagram and we’re so excited to bring information to where members are.”

Pruneda, who will be managing the site by posting photos and information, will also answer member questions in English and Spanish. “The page won’t just be informational, it will also be interactive,” Pruneda said.

The Center for Children and Women is owned by Texas Children’s Health Plan. The two Center locations are full-service clinics for Health Plan members only, with a few exceptions for members of other government-sponsored programs.

All employees are encouraged to follow the new page at https://www.instagram.com/thecenterforcw/. Double tap, tag and tell everyone you know.

Want more information about The Centers? Visit https://www.jointhecenter.org/