A bold response to a call for help

2k13-0225-AK4_4351  Rehab Center for The Journal Magazine Issue 2 2013   Photo by A Kramer

As we move about the day, working alongside our colleagues, we might be surprised at the journeys some of them have traveled.

Take Kathy Green and her husband, Kurt. Both are Texas Children’s employees. In fact, Kathy has been at Texas Children’s about as long as I have. She met her husband here, and they have two children, ages 6 and 8. Kathy and Kurt are not only employees, they are also one of our patient families. Their children have used the services in about 60 percent of the departments at Texas Children’s.

Most of the family’s visits are for the Greens’ son who has major medical complexities, including immunodeficiency. For six years, Kathy has been his advocate and care manager, and she’s endured the challenges of coordinating care for a child who requires multiple specialists.

Because she’s a nurse and she’s immersed in the Texas Children’s system, Kathy’s an experienced, informed advocate for her son. But she has said that she often wonders how others do it. How do families who can’t afford the critical care and treatments needed for children with major medical complexities get the support they need? How do they even begin to understand the medical issues or navigate the complex, patchwork health care system for their children? Who’s looking out for them to make sure they receive the right care when and where they need it?

We are, Kathy. Yesterday, the Health and Human Services Commission of Texas announced a new contract with Texas Children’s Health Plan that will help close the gap for children who have major medical complexities.

This is a milestone several years in the making. Five years ago, I received a letter from Texas State Representative John Zerwas with a call to action. In response to the Affordable Care Act, Rep Zerwas asked for Texas Children’s help in developing an innovative approach to the way we serve children. He is a physician as well as a legislative leader, so he knows that the basic and most fundamental tenet of the Affordable Care Act is being able to provide access to the right care, at the right time and the right place — a fundamental tenet of Texas Children’s model of care.

Right away, I met with Texas Children’s Health Plan President Chris Born to discuss how we could create a better model for care, decreasing costs for the state while increasing efficiency for our patient families. Since then, Chris has worked diligently to re-configure the way we support families of medically complex children.

Currently, the system lacks proper coordination of care for children with medical complexities. Often, their physicians don’t communicate, which leads to a gap in what happens to these children once they leave the hospital or clinic setting. And their parents are left in charge of navigating the extraordinarily complicated health care system.

For the past few years, Chris worked intensely with the state to advocate for and develop a different approach to care for this population, which means moving these kids out of a fee-for-service model into a managed care model, where case managers can help take the burden off parents. Ultimately, the state supported the idea of a more comprehensive, coordinated approach to care for medically complex children and created the STAR Kids Program. And yesterday, almost five years to the day after that call-to-action letter from Rep Zerwas, Texas Children’s Health Plan was awarded STAR Kids designation to provide Medicaid Managed Care for children with medical complexities.

Through Texas Children’s Health Plan and a handful of other designated plans throughout the state, the STAR Kids Program will provide health coverage to children and teens with special health care needs, including benefits such as prescription drugs, hospital care, primary and specialty care, preventive care, personal care services, private duty nursing, and durable medical equipment and supplies.

The STAR Kids contract will allow the Health Plan to increase its reach to about 40,000 new children and teens in 54 counties. These children see multiple specialists and therapists, and many receive home care services. They typically see at least one physician every week. We will hire nearly 400 new case managers to help these patients coordinate care between their multiple providers and assist them in navigating the complicated facets of health care. Coordination and management of care helps prevent children with significant intellectual development disabilities or complex medical problems from falling through the gaps and provides a structure where their progress can be followed throughout the system.

This new care model is a huge step in supporting the unique needs of these patients and their families, and improving their access to health care services, while also reducing preventable events or unnecessary visits to the hospital or care provider.

This milestone and Texas Children’s involvement is the result of Chris’ passion and hard work over the years. He has spent countless hours pursuing better options for these children and encouraging the state to adopt a more robust, coordinated model of care. Now, it is a reality with Texas Children’s Health Plan leading the way.

We’ve responded boldly to Kathy’s question of “who?” From Day One, Texas Children’s has always answered the call, and because of the passion and vision of so many here, we will continue to do so for decades to come. It’s our mission.

Mark H. Wallace

Category: Advocacy/Awareness, Innovation, Optimization, Partnership

About Mark A. Wallace

Mark A. Wallace was appointed President and Chief Executive Officer of Texas Children’s Hospital in 1989 at the age of 36. Under his leadership, Texas Children’s has grown into one of the nation’s largest and most comprehensive pediatric and women’s health care organizations, garnering more than 4.3 million patient encounters annually and achieving international recognition as a referral center.

28 thoughts on “A bold response to a call for help

  1. Kristen Cover says:

    This is such an exciting time for the Health Plan and we are so happy to support the families through the STAR Kids product. Very proud that Texas Children’s answered the call and is providing much needed support.

  2. Christina Brennan says:

    I am excited to be with the Health Plan as we transition to serve our STAR Kids families. This is a huge milestone for Texas Children’s and I am honored to be part of it.

  3. BJ Strew says:

    It’s a real privilege to serve these families with an abundance of efficiency, expertise, and compassion—and to work at a health plan that goes the extra mile to close these challenging gaps in care.

  4. Jeanie Winebarger says:

    So happy to be a part of a group who has a vision to serve people with great care! Bring them on!

  5. Martha Lopez says:

    Texas Childrens Hospital is where we cure and are able to make dreams come true. Children are greatly taken care of by every staff member on board.

  6. Lisa Hollier says:

    It is such a wonderful opportunity to be a part of the Health Plan and part of a visionary solution for achieving the best health care for children with medical complexities. Thank you to Texas Children’s for answering this call!

  7. Christy Paschall says:

    I am excited and proud that Texas Children’s Health Plan will be supporting our Star Kids families, providing them with nothing but “The Best!”

  8. Alene Whitesides says:

    Such as exciting time! I got here just in time to be part of the expansion of TCHP! Texas Children’s Hospital is a great place to work supporting our community and beyond! Can’t wait to see where we go from here!

  9. Simone Simon Gardner says:

    It is an honor to be a part of the Health Plan during these exciting times as we prepare to welcome our Star Kids families. The care and services that these families will receive from our world class organization will be life changing and it is my privilege to be a part of it all!

  10. Anna Mateja says:

    It is awesome to be a part of Texas Children’s Health Plan and to have the opportunity to make a meaningful difference in the lives of children! Thank you Mark Wallace and Chris Born for leading the way!!

  11. Gail Parazynski says:

    This is so good for the special needs children and teenagers that will now be served by the TCH Health Plan. Meeting the needs of a very vulnerable patient population. Congratulations to Chris and his team in making this a reality.

  12. Jackie Ward says:

    This is an amazing accomplishment! TCHP will make a remarkable difference in the lives of families who today have difficulty navigating the healthcare arena for their children. I look forward to seeing it all come together!

  13. Stephanie Osborne says:

    So excited to be part of this amazing ride–Texas Children’s Health Plan is making history with the StarKids program! So glad we will be able to help the children & families that TCH has been caring for & provide the full spectrum of care that they need!

  14. Julie Wolf says:

    This is an exciting time for TCHP. These children will benefit greatly from having Case management assistance. This is a significant accomplishment for the the health plan.

  15. Jenni Aguilar says:

    Thank you to Mark Wallace, Chris Born and all the other exceptional leaders that were part of making this a reality for the Health Plan. It’s a very exciting time!! It’s one more reason I’m extremely proud to serve in this organization!

  16. Lauren Fincher says:

    This is such an amazing accomplishment! I’m so fortunate to be a part of the great work at Texas Children’s Health Plan. I’m excited to expand our network and extend our world-class services to help these families.

  17. Doug Pharms says:

    All children are precious gifts and deserving of the best care possible by professional’s who truly care. It is a privilege to be part of the Texas Children’s Health Plan family under the leadership of individuals who are defined by actions as well as words. Thank you Mr. Wallace and Mr. Born and many others for the opportunity to be part of something great now and on into the future.

  18. Sherry Vetter says:

    Congratulations to all! It will be an honor to serve children with medical complexities and their families. Thank you to Mark Wallace and Chris Born for their visionary leadership!

  19. Glenn Rogerson says:

    I’ve worked for a number of health insurers, most were good at something, Qualmed in Colorado was particularly good at managed care, because they were focused on the “care”, not the “cost savings”, which resulted in both great care and great cost savings. I’ve only been with the Health Plan for a year now, but I see that same dedication to care here. This will be a big win for those kids, and us.

  20. Tina Dewey says:

    What a testiment to the passion and dedication of Mark Wallace and Chris Born to lead TCH IDS and TCHP in to the next generation of providing care for this underserved population. Working with the IDS and local community physicians to ensure these families have everything they need and access to the specialists and services available will be a daunting task but one that the health plan is up to.

  21. Ashley McLean says:

    What a wonderful program to provide health coverage to children and teens with special health care needs. It’s a privilege to work for Texas Children’s Health Plan and witness this great accomplishment!

  22. Lystra McCoy says:

    To be a part of such an amazing opportunity to serve the STAR Kids population is monumental! Thank you to our leaders Mark Wallace and Chris Born for taking on the challenge.

  23. Ravi Mudaliar says:

    I feel great and proud to be part of an organization with great responsibility to care for and serve the future citizens thanks to Mark Wallace and Chris Born and their leadership.

  24. Scott Redding says:

    I am so grateful for being part of an organization that puts such importance and dedication to supporting children with special needs. I commend Chris Born for his diligence in achieving this goal of serving these families. And as always, thanks to Mark and Chris for their wonderful leadership. As much as we will help support these individuals, I believe that children with medical complexities actually do more for us than we do for them.

  25. Sarah Maytum says:

    In my conversations with families, I often hear about their struggles to achieve true coordination of care for their children. Thank you to Chris and the entire TCHP team for pursuing a better solution for this vulnerable population. I am confident that we will make huge strides forward in addressing their very unique needs. I am so proud to be part of Texas Children’s, an organization that consistently answers the call. We are ready to partner with you to make this new care model a reality!

  26. Crystal Nehs says:

    I am so excited to be apart of an organization where the primary goal is to support and care for children. Taking on StarKids says alot about us as a team and as a family. It is an honor to serve and be apart of Texas Children’s Healthplan. Looking forward to awesome things ahead!!!!!!

  27. Crystal Nehs says:

    I am honored to serve and work for an organization where the goal is to heal and care for children of all populations and complexities. Taking on StarKids says a lot about us as a team and a family.

  28. homepage says:

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