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

31.  Measure Outcomes
 “Active coping response” vs. “inactive coping
response”
 Demonstrating behaviors
 “non-interfering”
 “potentially interfering”
 “interfering”

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

35. Thank you for your thoughts and participation!

36. 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