Becker's Hospital Review

26 THOUGHT LEADERSHIP 'We take our direction from our community': Texas health system battles to preserve its Medicaid plan By Jakob Emerson F orth Worth-based Cook Children's Health Care System, one of Texas's largest pediatric Medicaid managed care providers, is in a battle to retain its Medicaid contract with the state after being left out of the latest awards. "We take our direction from our community," Karen Love, president of Cook Children's Health Plan, told Becker's. "Provider-affiliated plans like ours, where you have the hospital and the doctors and the payer all working together for the benefit of these children, is a different model of care and a different model of coverage than the large national for profit companies." In March 2024, Texas awarded a majority of its Medicaid STAR and CHIP contracts to Blue Cross Blue Shield of Texas, Molina Healthcare, Aetna and UnitedHealthcare, which are collectively worth $116 billion. If the new contracts are implemented, nearly 1.8 million Medicaid beneficiaries in the state will have to move to new insurers. Cook Children's Health Plan, Houston-based Texas Children's Health Plan and Corpus Christi-based Driscoll Children's Health Plan were all denied contracts in the tentative award process. Collectively, the three plans serve more than 700,000 people. In June, Cook Children's took the Texas Health and Human Services agency to court, arguing that the procurement process violated state law. The court agreed and issued a temporary injunction in October that prevented the state from finalizing the Medicaid contract awards. While the state has appealed the ruling since then, the case has been put on pause to allow the Texas Legislature to weigh in. "We've abated the legal proceedings while the legislature is in session, and we're asking them to make it clear that the past performance of plans should be considered," Ms. Love said. "This shouldn't be just an essay contest about what plans might do in the future but should also include a 25-year track record of quality outcomes, high member satisfaction, high provider satisfaction, and strong financial performance." The Texas Legislature is in session until June 2. If lawmakers don't act in Cook Children's favor, Ms. Love said they'll continue the fight in court. "We're advocating for a system that continues to offer an array of plans, including locally embedded nonprofit plans," Ms. Love said. "It's not just about the contract. It's about continuing to provide the care that these families rely on." n DB: We've seen innovation take off in two interesting places. One is we're getting ready to do — all the way across our full company — smart rooms inside of our hospitals that will bring a whole new set of technologies into the patient room that we think will fundamentally change our staff 's experience, our physician providers' experience, as well as the experience of our patients and their families. It allows for a much more robust exchange of information, telecare and other clinical supportive elements, and we're very excited about that. at'll go live for us in 2026. We've also done a lot with ambient listening for our physicians in terms of their transcription. It's probably been the single most uniformly satisfying thing we've done for our doctors. It's cut their documentation time down by one to two hours a day, and it's had some pretty dramatic impacts on their quality of life — their ability to get home at a reasonable time aer a full workday. We have about 80 projects in the queue that really leverage next- gen tech or AI. ose would be two, though — that one very well established — and our smart rooms that will roll out in 2026. In some way, hospital rooms have kind of been the same for a long time. And the ability to change what happens inside the room — from a safety, engagement, clinical monitoring and telecare perspective — it'll be really interesting to see how that improves all those elements: from experience, safety, quality care, as well as family member engagement. And we're excited to see that. Q: Anything you'd like to expand on or add? DB: I've been a part of AdventHealth for 31 years, and so I came up through the clinical side. I started my career as a psychiatric social worker, ended up running behavioral health units, and then freestanding psych hospitals and acute care hospitals. And it's such a blessing to grow up inside of an organization, and I'm very committed to the Vision 2030 process. We have specifically focused around preeminence in faith-based, consumer-focused clinical care. And I'm motivated by the challenge to help every patient we serve to feel whole. at's a tough brand promise to hit, because wholeness is something that's defined by the patient or the end user. We don't always know what that thing will be, but our teams are committed to not only delivering safe, quality care, but doing it in a way that allows the person to be seen and not have healthcare feel like a transaction. Healthcare consumers, first and foremost, want their clinical problem solved. And they're willing, oentimes, to overlook inconvenience or other sorts of things that can happen in a typical healthcare experience. Our goal is to get it right first clinically, but we also never want a patient to feel like they had to make a trade-off: "Well, you saved my life, but nothing else was great." We want them to feel great about the entire experience — mind, body and spirit. I'm really motivated by that "feel whole promise." n

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