Jamie Snow, MBA, CCLS Assistant Director of Child Life and Social Work

Mary E. Tietjens, BS, CCLS Manager of Child Life

Texas Children’s Hospital, Houston TX

Texas Children’s Hospital Child Life Conference

October 5, 2013

Identify key components of the Patient Protection and the Affordable Care Act of 2010 (ACA)

Review how the changing healthcare environment impacts health care consumers

Gain an understanding of common healthcare terminology and how to translate child life’s value into healthcare concepts

Examine why measuring and reporting the quality and outcomes of child life interventions adds value to your program

By the end of today’s workshop, participants will walk away with a high level overview of the changing healthcare market and an understanding of how to reframe the work of child life into healthcare concepts

Throughout today’s workshop, participants will begin the creation of a “Child Life Portfolio of Value” that can be utilized to demonstrate how child life services add value to their organization

Discuss current changes in the healthcare system, breaking down specific components and how they relate to the world of child life

Breakout Session: Link child life value to health care concepts

Report Out: Create your Child Life Value Portfolio

Discuss the importance of measuring quality and outcomes

Breakout Session: Identify ways to measure and report child life outcomes

Report Out: Enhance Child Life Value Portfolio with measurement and reporting strategies

Questions and answer session

Patient Protection and the Affordable Care Act of 2010 (ACA) - Fully implemented 2014

• Quality, Affordable Heath Care for All Americans

• Systematic insurance market reform – eliminate discriminatory practices

• Tax credits to support affordability • Penalties if not insured • More coverage for preventative services

• The Role of Public Programs • Expands eligibility for Medicaid • Enhanced federal support for Children’s Health Insurance

Program (CHIP)

• Improving Quality and Efficiency of Health Care • Investments to improve quality and delivery of care and inform

consumers about patient outcomes • Financial support linked to quality performance

Prevention of Chronic Disease and Improving Public Health • Create infrastructure for health promotion and disease prevention

• Healthcare Workforce • Encourage health workforce training and retention (Loan programs

for schools)

• Transparency and Program Integrity • Combat fraud in public and private programs

• Improving Access to Innovative Medical Therapies • More affordable medications for children and underserved

communities

• Community Living and Assistance Services and Supports • Long term insurance program for community living assistance

and support

• Revenue Provisions

• Excise tax on high cost employee sponsored health coverage

Value Based Purchasing

Bundle Payments Diagnosis Related Groups

Access to Care

Health care reform success is contingent on consumer savviness

Health care costs are moving toward consumers: creating more consumer driven care

Healthcare transparency Compare providers based on quality, safety and patient

satisfaction

Compare insurance plans: Insurance Marketplace

Consumer sites are become prevalent: HeathGrades

Access to information on smart devices is increasing

Pros Create more efficient processes in hopes to reduce cost New Model of Care – Good patient outcomes equal more

federal support More insured, could help the bottom line More preventative care

Cons Influx of new patients taxing the system as whole, creating

more paperwork, more need for access in a system that is already stretched for patient access

Complex and hard to fully understand Tracking quality metrics takes time and resources

Understand your individual health care institution’s change and evolution What quality metrics does my hospital report, or plan to

report, and how are they collecting and reporting that data?

What change is taking place to embrace health care reform?

Know your hospital’s priorities and goals

Track hospital/unit statistics

Who are your consumers

Embrace and market consumer driven healthcare Create an environment that embraces patient

engagement

Create value driven ideas and statements using marketing techniques Target audience

Tell the stories that targets key components Product, Pricing, Placement and Promotion

Provide examples

Create supply and demand

Convenience and Accessibility Strategies to enhance way finding

Community based hospitals, health centers

Medical Homes: High quality medical care for underserved communities

Child Life’s Role in Supporting Convenience and Accessibility Share expertise: wellness programs, orientation

On-site in-services

Identify Distinct Local Market Needs Child Life Teams: Meet unique needs of hospitalized

children

Marketing/Media

Child Life’s Role in Identifying Local Market Needs “What do our patients need?” vs. “What services do we

want to provide?”

Proactive Patient Outreach ACA: Health promotion/disease prevention:

Prevention and Public Health Investment Fund

“Sick care” vs. “Health care”

Supporting preventive care health initiatives

Child Life’s Role in Supporting Patient Outreach Health and wellness fairs

Programming around wellness: cooking classes

Healthily lifestyle choices: exercise incentives

Customer Service Focus Customer satisfaction linked to reimbursement

Child life traditionally linked to satisfaction

Child Life’s Role in Customer Service Competency driven

Highlight programs to your leadership

Performance tool objective

Patient Loyalty Consumer options focus on market differentiation

Insurance carrier

Hospital provider

Specialists

Don’t make assumptions

Child Life’s Role in Creating Patient Loyalty Develop relationships

Demonstrate strong competencies Clinical, work ethic and attitude

I.V.

“Put to sleep”, gas, anesthesia

Dye

Urine – “you’re in”

Stool

Medicine through a small, tiny tube; I.V. = into the vein

Medicine to help you go to sleep, different than sleep at night

Medicine to help us see your picture

Pee – use child’s familiar term

Pooh, Poop – use child’s familiar term

Accountable Care Organizations (ACO) Network of hospitals and physicians

Goal to limit unnecessary spending

Primary care physician driven

Savings incentives for keeping costs down

Fee for Service Payment model (past or current)

Quantity vs. quality

Bundled Payments Payment model (future)

Set expected cost of clinically-defined episodes of care

Marketplace/Exchange State/federal insurance website

Comparisons/financial assistance

Opened Oct. 1 for Jan. 1, 2014 coverage

Utilization Management/Review Assess interventions

Appropriateness, medical need, efficiency

Alignment with health benefit plan

Proactive vs. retroactive Terms are used interchangeably

Diagnosis Related Groups (DRGs) System to classify cases into groups

Intent to identify services needed

Set reimbursement and timeframes

Encourages examination of processes and discharge barriers

Potentially Preventable Readmissions (PPR) Analyze administrative data to identify readmissions

Factors that impact PPR Severity of illness, age, mental health diagnosis

Assess if related to a prior admission

Market Share

DRG s

Preventable Readmissions

Animal assisted therapy is a unique program within our market that enhances the emotional well-being of our patients and families.

Positive coping promotes the patient /families ability to achieve patient care goals and meet discharge criteria .

Enhanced understanding and compliance can be met through developmentally appropriate diagnosis teaching, aiding in the reduction of preventable readmissions.

Patient Satisfaction

Preventive Care

The Child Life Zone is offering additional play programming, enhancing the opportunity to normalize the healthcare environment and create customer satisfaction.

As a part of our department’s wellness initiative, child life is teaming up with nutrition support to offer cooking classes for patients and families coping with a diagnosis of type 1 diabetes

Break into your groups

Choose a member to scribe

Review the health care terms listed on your large Post It Note paper

Share and brainstorm your current programming components that bring value to your organization

Match programming components to a health care concept that demonstrates how child life brings value to that specific concept

The desired

outcome of this

exercise is to begin

reframing your

thought process and

link the value of

your child life

programming to

your hospital’s

overall health care

concepts.

Break Out Session

Choose someone to speak for your group

Share specific child life programming ideas that demonstrate value and identify the link to a health care concept.

Challenge yourself to utilize the heath care language when reporting out to the group!

The desired outcome

of this exercise is to

enhance your tool kit

of programming

ideas that

demonstrate the link

between child life’s

value and health care

concepts.

Use your Start Doing

and Keep Doing cards

to begin the creation

of your Child Life

Value Portfolio

Group Report Out

What determines quality Patient Satisfaction: Hospital Consumer Assessment of

Healthcare Providers and Systems (HCAHPS) Hospital Policies & Procedures Child Life Council EPB statements Accrediting Agencies Hospital Trends/Priorities (marketing priorities) Community Needs Assessment

Establish goals/objectives

How do you track and measure Use validated tool or develop tools and techniques to capture

quality

Determine your target audience

Include all stakeholders

Determine tools Scorecards/Dashboards

Meetings (presentations)

Marketing

Hospital Wide Implementation of Care Progression Rounds Better daily communication on patient care

Timely discharge (increase access)

Child life’s role in a hospital wide initiative Active and present members daily

Identify and report child life’s scope of services and barriers to discharge Coping/Diagnosis Education/Compliance

Project Scope: To build a child life specific Participant Classification System to support appropriate child life staffing for Texas Children’s Hospital (TCH).

Long Term Goal: Understand and track current staffing and plan towards a formal staffing model that would reflect child life priorities within a participant classification system. This classification system would eventually correlate with unit specific demand and child life quality measurements.

What Makes a Quality Intervention and How do you Measure the Outcomes of That Intervention Indentify tools and resources needed

Time for pre-assessment

PIES

Individualized intervention

Environment

Comfort Measures

Measure Outcomes “Active coping response” vs. “inactive coping

response”

Demonstrating behaviors “non-interfering”

“potentially interfering”

“interfering”

Measuring Quality

Reporting Outcomes

The child life department utilized a parent survey to assess the patient’s dietary habits pre and post implementation of the type 1 diabetes cooking class to measure changes in food choices and insulin levels.

Survey results were presented in a teaching aid summery which outlined specific learning objectives, evidence based practice references and methodology; demonstrating the link between developmentally appropriate teaching and behavior modification.

Break into your groups

Choose a member to scribe

Review the child life programming concepts listed on your large Post It Note paper

Share and/or brainstorm ideas for measuring and reporting the quality and outcomes of child life programming

Match child life programming components to a health care concept that demonstrate a measurable link between child life programming and quality health care outcomes.

The desired

outcome of this

exercise is to

generate ideas for

measuring and

reporting the

quality outcomes of

child life

programming

concepts.

Break Out Session

Choose someone to speak for your group

Share specific strategies that can be utilized to measure the quality of child life programming and the outcomes that can be linked to a health care concept.

Challenge yourself to utilize the heath care language when reporting out to the group!

The desired outcome of

this exercise is to enhance

your tool kit of quality and

outcome measurement

and reporting strategies

that demonstrate the link

between child life’s value

and health care concepts.

Use your Start Doing and

Keep Doing cards to add

reporting ideas to your

Child Life Value Portfolio

Group Report Out

Thank you for your thoughts and participation!

Center for Medicaid and Medicare (2013). Bundled Payments for Care Improvement (BPCI) Initiative: General Information. Retrieved from http://innovation.cms.gov/initiatives/bundled-payments/#collapse-majorjointupperDetails

Consumer Reports (2013) Health Reform: Seven Things You Need to Know Now. Retrieved from http://www.consumerreports.org/health/resources/pdf/ncqa/The_Affordable_Care_Act-You_and_Your_Family.pdf

Ellis, J & Razavi, A (2012, 6, 15). Pros and Cons of Healthcare Reform for Hospitals. Retrieved from www.heathcarefinancenews.com/pringt/57901

Gamble, M. (Composer). (2013, 04 03). 5 Retail Principles for a More Effective Hospital Market Share Strategy [Web Graphic]. Retrieved from http://www.beckershospitalreview.com/hospital-physician-relationships/5-retail-principles-for-a-more-effective-hospital-market-share-strategy.html

Herman, B. (Composer). (2011, 11 29). 10 Ways for Hospitals and Health Systems to Increase Profitability in 2012 [Web Graphic]. Retrieved from http://www.beckershospitalreview.com/racs-/-icd-9-/-icd-10/10-ways-for-hospitals-and-health-systems-to-increase-profitability-in-2012.html

Responsible reform for the middle class. Retrieved from http://www.dpc.senate.gov/healthreformbill/healthbill04.pdf

Skinner, J. (Composer). (2013, 4 11) How to Reform your Healthcare Marketing in 2013. Retrieved from http://wwwtruenothrecustom.com.blog/how-to-reform-your-healthcare-marketing-in-2013

Spoeri, B. (Composer). (2012, 6 6). 6 Trends in an Era of Consumer –Driven Healthcare. Retrieved from www.beckershospitalreview.com/strategic-planning/6-trends-in-an-era-f-consermer-dreiven-healthcare