Demonstrating the Value of Child Life Services in a Changing Health Care Environment
1. 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
2. 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
3. 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
4. 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
5. 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)
6. • 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
7. • 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
8. Value Based Purchasing
Bundle Payments
Diagnosis Related Groups
Access to Care
9. 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
10. 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
11. 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
12. 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
13. 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
14. 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?”
15. 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
16. 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
17. 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
18. 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
19. 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
20. 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
21. 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
22. 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.
23. 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
24. 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
25. 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
26. 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
27. Determine your target audience
Include all stakeholders
Determine tools
Scorecards/Dashboards
Meetings (presentations)
Marketing
28. 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
29. 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.
30. 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
32. 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.
33. 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
34. 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
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