Latest / Becker’s Healthcare - Clinical Leadership Podcast / Driving Efficiency, Culture, and Regional Growth at Connecticut Children's with James E. Moore

Transcript

Driving Efficiency, Culture, and Regional Growth at Connecticut Children's with James E. Moore · Becker’s Healthcare - Clinical Leadership Podcast

0:00
Welcome to Becker's Healthcare podcast. I'm Chris Sosa,
0:02
your host, and I'm thrilled to be joined
0:04
today by doctor James Moore. He is president
0:06
of the Connecticut Children's Specialty Group and the
0:08
system chief medical officer and chief clinical network
0:11
development officer for Connecticut Children's.
0:13
Jim, thank you for joining us today. Hi,
0:15
Chris. I appreciate the opportunity.
0:18
As as you mentioned,
0:20
I'm doctor Jim Moore.
0:22
I also, in addition to the system chief
0:25
medical officer,
0:27
and president of our Connecticut Children's Specialty Group.
0:30
I'm also a practicing
0:32
newborn intensive care doctor or neonatologist
0:35
here at our level four,
0:37
NICU here in Hartford at Connecticut Children's.
0:40
Perfect, Tim. Thanks you for giving us a
0:42
little bit of overview of what your career
0:44
entails.
0:45
Today, we've got you on the podcast to
0:47
discuss any number of things going on at
0:49
Connecticut Children's. Clearly, things have been busy over
0:51
there, which is great.
0:53
So let's start with this. Let's look back
0:54
at 2025,
0:56
and that is simply what would you say
0:57
is the most important initiative or initiatives
1:00
that you led in the last year? Just
1:02
take us through how they evolved and the
1:03
results of them.
1:05
Sure. If you don't mind, I might like
1:07
to even back up just because I'm sure
1:10
some of the listeners might not know what
1:12
Connecticut Children's is, and if I could just
1:14
take a moment to just maybe
1:17
give a highlighted,
1:19
view of that.
1:20
We are,
1:22
the only
1:23
independent,
1:24
nonprofit
1:26
health system in Connecticut and only one of
1:29
two in New England
1:30
that's actually a 100%
1:32
dedicated to
1:34
pediatric care. We are a freestanding
1:38
children's hospital located here in Hartford, but we're
1:40
also
1:42
a health system,
1:43
that actually
1:45
has,
1:46
facilities and services in three different states in
1:49
Connecticut,
1:51
Massachusetts,
1:52
and New York.
1:54
As,
1:55
Chris,
1:56
mentioned to you earlier, we actually just opened
1:58
up a brand new
2:00
190,000
2:01
square foot tower this past December.
2:05
We now have about 215
2:07
beds in our primary facility.
2:10
And in addition to that, we partner with
2:13
three adult hospital systems,
2:15
across
2:16
the two states, in Connecticut and New York,
2:20
and provide care to 15 different hospitals other
2:23
than that.
2:24
Our 30 specialty and primary care centers are
2:26
located
2:28
in Connecticut, Massachusetts,
2:30
and New York,
2:31
and we have about 570
2:33
specialists. We're an academic training center for Yukon.
2:38
We have students, residents, and fellows. We're also
2:40
involved in research
2:42
and innovation initiatives. So,
2:45
a lot of times, I think people just
2:46
assume we're,
2:48
freestanding children's hospital in Downtown Hartford, but we're
2:51
actually much more regionalized.
2:54
Wonderful. Jim, thank you for clarifying all of
2:56
that. I'm glad you got a chance to
2:57
let us know
2:58
more about what Connecticut's
3:00
Connecticut Children's is all about and all the
3:02
affiliations
3:03
and all the work that you and your
3:05
compatriots do over there. So, yes,
3:09
thank you for taking us through that. Let's
3:11
look at at 2025.
3:13
So you have a lot going on.
3:16
What would you say is the most important
3:17
initiative that you led?
3:19
Just take us through everything about it, you
3:21
know, whether it's how it started,
3:23
what the results were, and anything else you
3:25
find important in this moment.
3:27
I appreciate that. And I think, you know,
3:29
as we look at,
3:31
health care in general, the economics are
3:34
more challenging than ever and our margins are
3:37
thinner. So it really puts pressure on us
3:40
to perform
3:41
at the highest level.
3:43
I'd like to actually maybe touch on two
3:45
different initiatives.
3:47
I'll I'll try to keep them not,
3:51
not going on for too long but Hey.
3:53
Don't worry about it. One of the the
3:54
first challenges we we were facing
3:58
was,
3:59
capacity and
4:00
you know, we definitely had an unmet need
4:04
in the market.
4:05
We had more patients that needed to come
4:07
in.
4:09
But I think like a lot of organizations,
4:11
we didn't have a ton of capital to
4:13
just add bricks and mortar.
4:16
So then we had to turn around and
4:18
say, alright. How do we accomplish this? And
4:20
a lot of this kinda fell on efficiency.
4:22
So we've
4:23
really needed to be able to track our
4:26
space utilization especially around managing
4:29
capacity,
4:31
in our busiest locations especially.
4:34
You know, we
4:36
really kinda tackle that in multiple different ways.
4:39
We needed to be precise and rigorous in
4:42
the management of that utilization. I think the
4:45
old school
4:46
approach is is that, well, these rooms are
4:50
ENT rooms, and these rooms
4:52
are general care rooms. We had to take
4:54
the approach that they're all kind of touchdown
4:57
rooms and multiple different areas can utilize them.
5:02
To accomplish that, we actually created dashboards to
5:05
look at room utilizations
5:07
by each of the divisions that occupied those
5:09
clinics
5:10
and then rearrange space and utilization to proactively
5:14
look at
5:15
issues we knew were coming up. I think
5:17
a lot of times we all know clinicians
5:20
have to spend time in the hospital and
5:22
when they're in the hospital they're not in
5:24
clinic.
5:25
And
5:26
as much as I think many of us
5:28
don't feel we get enough vacation, we do
5:30
take vacation and they're not in the clinic
5:33
at that time.
5:34
We wanted to be able to proactively
5:36
use that space. And a lot of those
5:38
instances were known
5:40
far enough ahead that we could actually repurpose
5:43
the space
5:44
and get more patients in in other areas.
5:48
That actually was highly successful. We actually increased
5:51
volume
5:52
by about 14%
5:54
in five of our key specialties.
5:56
We've also been developing plans for extended hours,
6:01
but that's been challenging in its own right
6:04
because
6:05
getting enough staff even for current operations, let
6:08
alone expanding
6:09
hours,
6:11
has been a bit of a challenge.
6:13
The second one, which I won't go into
6:15
great detail, which is
6:18
essentially the same approach, but, you know, now
6:20
turning our sites onto the OR and especially
6:23
ambulatory
6:24
surgery center
6:25
was
6:26
ways to get OR case volumes that were
6:29
actually backing up in several specialties because they
6:31
needed more time
6:33
to look at a efficiency and maybe being
6:35
able to leverage
6:37
the staff in a way that could extend
6:39
the sessions without
6:41
needing a lot of extra FTEs,
6:45
to really address some of those backlogs. In
6:47
our instance, that was in urology and NT,
6:51
and,
6:52
we also saw similar gains, especially in urology,
6:56
that we saw on the outpatient side.
6:59
Tim, thank you for taking us through everything
7:01
that's
7:02
Connected Children's is working on. Clearly, it's all
7:05
worthwhile, and I'm glad to hear that you've
7:08
been able to improve your your use volume,
7:11
get more cases
7:13
addressed.
7:14
Let's look ahead now at 2026.
7:17
So
7:18
we're a little bit into 2026, but only
7:20
a little bit. So
7:22
in addition to everything that Connected Children's has
7:25
accomplished, you mentioned, the new tower,
7:28
Huge things going on there. So when you
7:30
look at the next year and maybe a
7:32
little bit farther than that, what'd you say
7:35
are your biggest priorities and any headwinds you've
7:37
got going on? And and on the same
7:40
plane, any tailwinds that you're looking at?
7:43
Well, I mean, I think that's a a
7:45
great question. I think we're all really kinda
7:47
focusing on that right now.
7:50
We also have a new CEO and a
7:52
new chair of pediatrics, and we're we're also
7:55
in the midst of of, I think, really
7:58
trying to address
8:00
a lot of things that are changing
8:01
rapidly.
8:02
And I think many of us can really,
8:07
understand the pain point
8:09
of, you know, the issues around,
8:12
Medicaid rate
8:14
reforms and policy changes that have been going
8:17
into
8:18
effect.
8:19
You know, we we need to pay attention
8:22
to that because
8:23
that actually is a large driver for for
8:27
pediatric hospitals. We have a very high proportion
8:30
of
8:31
Medicaid reimbursement
8:32
and that ends up leaving our margins very
8:36
thin,
8:37
with the kind of proposed federal and state
8:39
changes.
8:40
This is gonna make that even more
8:43
challenging. So, you know,
8:44
to me, I think we've
8:46
got issues in the immediate sense, maybe in
8:49
the next year, but probably looking long term
8:52
as well.
8:54
And so, I mean, we obviously need to
8:57
work on our efficiencies. We talked a little
8:59
bit about that already,
9:01
trying to reduce
9:03
cost by maybe putting some of the services
9:05
as outpatient rather than inpatient.
9:09
We also need to get reimbursed appropriately for
9:11
the work that we're doing. This means paying
9:13
attention to coding and billing, reducing denied claims,
9:18
especially for things that are in our control,
9:21
and appropriately capturing
9:23
revenue.
9:24
But I think, realistically,
9:27
if we only take the approach to that,
9:30
we're only going to maybe get a a
9:32
short term benefit. You know, that traditional approach
9:35
of of,
9:36
you know, getting more bed days, more hospital
9:39
volume,
9:40
especially in today's climate of, you know, accelerating
9:43
costs, decreasing reimbursements
9:46
is not gonna be financially sustained.
9:49
We actually have to broaden our revenue streams.
9:52
You know, I think if we
9:55
look to
9:56
what our services provided traditionally,
10:00
sick care alone actually touched maybe ten percent
10:03
of the total pediatric population. We need to
10:05
be thinking much more
10:07
broadly. And whether that is, you know, through
10:11
mechanisms of partnering with primary and preventative care,
10:15
partnering with other health systems to put care
10:18
closer to home,
10:19
maybe home care, getting kids out of the
10:21
hospital and and into
10:24
a lower cost type of situation.
10:27
These
10:28
are ways that where you've got to start
10:30
thinking about
10:32
both improving more lives,
10:35
but also doing it in a way that
10:37
is going to be sustainable and potentially new
10:40
revenue streams.
10:42
You know I think the that'll have the
10:45
greatest long term impact.
10:48
You know, I think one of the ways
10:49
that can be done, and that varies kind
10:52
of state to state is, you know, value
10:54
based care. You know, that in and of
10:57
itself
10:57
actually
10:58
really helps to align reimbursement with what you're
11:01
really trying to do long term,
11:04
but it also rewards
11:05
outcomes and promotes quality. So I think we've
11:08
gotta look at new ways to actually provide
11:11
the services,
11:13
that improve children's health.
11:15
We need to actually,
11:17
improve quality and outcomes.
11:20
We need to touch more lives.
11:22
But to be able to sustain ourselves, there
11:24
may need to be new
11:26
ways to get paid for whether we're doing
11:29
school based care or others.
11:31
And probably looking at ways for innovation and
11:34
development of new technologies because I think the
11:37
bed reimbursement in the hospital model is not
11:40
going to be the way of the future.
11:43
I think a lot of your colleagues in
11:45
health care leadership would absolutely agree with you,
11:47
Jim. And I'll give you the I do
11:48
wanna give you a chance to expand on,
11:51
some of those growth opportunities that Connected Children's
11:53
has in a minute.
11:55
In for the meantime, though, I do wanna
11:58
ask you, what do you think is the
11:59
hardest thing you're going to have to do
12:01
in this coming year? Doesn't mean you're not
12:03
looking forward to doing it. Just means you
12:05
might need a little bit different level of
12:07
focus or community focus to get that goal,
12:11
whatever that is, accomplished.
12:13
Chris, I think that is is going to
12:15
be critical, and I think the way I'll
12:18
answer that may be slightly,
12:21
different than many people might assume. I I
12:24
think
12:25
the problem we're all facing
12:27
is really
12:29
that if
12:30
you are looking at the landscape right now,
12:32
you've got workforce shortages, you got labor costs
12:36
that are all contributing to this.
12:39
We're all experiencing this whether it's pediatric specialists,
12:42
nurses,
12:44
allied health professionals.
12:46
This is all really
12:48
producing both challenges getting folks in to provide
12:52
the services, and it unfortunately is impacting
12:55
higher labor costs.
12:58
You know, if you try to just say,
13:00
well, we'll go out and get new ones
13:02
or or not address,
13:05
turnover,
13:06
recruiting and retaining specialized care is really actually
13:10
quite expensive.
13:12
And so we're focusing on kinda the the
13:16
other side, which is to once you've got
13:19
folks in the door,
13:21
you wanna make sure they wanna stay. And
13:23
I think that's really important.
13:26
We
13:27
are working, I would say, most diligently right
13:30
now
13:31
on our culture work.
13:33
We call our our work on culture our
13:36
one team and providing better health through a
13:40
one team approach.
13:42
You know, we've had a very strong mission
13:44
and I think
13:45
anytime you talk about taking care of sick
13:48
kids
13:49
and, you know, being able to
13:51
be involved with kids and families,
13:54
it's kinda easier for kid people to get
13:58
behind
13:58
that. And,
14:00
you know, I I think it is gives
14:02
us a bit of a head start.
14:05
But what we really wanna strive for
14:08
is for our our team members to feel
14:11
like they actually both belong here
14:14
and that they can succeed here.
14:17
And that hopefully, they feel they're supportive of
14:20
each other. You know, there was a great
14:23
description of kinda that mentality
14:25
that came from one of our floor team
14:28
members. And it was like, you know, the
14:31
way they described that was
14:33
we want folks to answer the call bell.
14:36
You know? When you you got that nurse
14:38
call button on
14:40
and and, you know, often I've been
14:43
even with some of my own family in
14:44
the adult hospital and the bell just rings
14:46
and rings.
14:48
And a lot of times, it's because people
14:50
are short staffed or they're taking care of
14:52
other families.
14:53
What we wanna encourage is is that, you
14:56
know, everybody feels empowered to be able to
14:59
answer that call bell and take care of
15:01
that child and take care of that family.
15:04
And
15:05
if you can
15:07
get that kind of feeling,
15:09
if
15:10
your team members can feel like they're heard,
15:13
more importantly that they're valued,
15:16
and that what they're coming to is not
15:18
just a job.
15:20
They're gonna be much more wanting to stay
15:23
in the organization. They feel they can grow
15:25
in the organization,
15:27
and they
15:28
hopefully will be easier to retain. And it's
15:31
a lot easier to to manage staffing when
15:35
you've retained employees than to constantly be looking
15:37
for new ones.
15:39
I think we've got that strong culture, but,
15:41
you know, I I think we can always
15:43
do more.
15:45
And then the other thing that we've gotta
15:47
do is develop new avenues to to help
15:50
broaden out the the number of potential
15:53
team members, not just for us, but for
15:55
everybody. And that probably looks at colleges and
15:59
even younger, let's say, high schools,
16:02
to enlarge,
16:04
the recognition and both understanding and interest in
16:07
these careers because
16:10
I think
16:11
there are folks out there wanting to go
16:13
into this, but we also need to support
16:15
the education
16:17
system because
16:18
often there are
16:20
two, five, 10 times more applicants than there
16:24
are spots available to train them. So we've
16:26
got multiple different issues,
16:28
but, you know, we know workforce is expensive.
16:32
Replacing workforce is even more expensive.
16:35
Keeping workforce is what we're all trying to
16:38
do, but we've gotta make the environment
16:41
where people feel that they've got a real
16:43
opportunity.
16:44
And then we've gotta be able to
16:46
both raise awareness and actually drive folks to
16:49
wanna be a part of this.
16:52
That's an excellent description of the landscape that
16:54
you're dealing with right now, Jim. I do
16:56
wanna ask just to follow-up.
16:58
Certainly,
17:00
every organization
17:01
like yours wants to build a culture, and
17:03
I think that a lot of them are
17:05
succeeding in some way, shape, or form.
17:07
How do you know, though,
17:09
beyond just what you're hearing in the hallways
17:12
of Connecticut Children's,
17:14
that this culture is succeeding in becoming,
17:18
more inviting and more
17:20
sustainable
17:21
for clinicians and and others who work there?
17:24
I think that is
17:26
looking at it through multiple lenses. I mean,
17:29
we obviously
17:31
do feedback, We do employee,
17:34
surveys,
17:35
during the year as well.
17:38
But we also get kinda direct, you know,
17:41
leadership rounding feedback and and things that,
17:46
our team members are saying are pain
17:48
points. We've developed,
17:50
you know, what we call the
17:52
the red tape,
17:54
work group. You know, we we have a
17:56
lot of things that people are like, these
17:58
are
17:59
pains in my my my feet that are
18:02
are I need to get the stone out
18:03
of my shoes, so to speak.
18:05
And we actually
18:07
empower and allow those teams to actually help
18:10
provide some of those solutions.
18:12
But we also need to develop
18:14
the the,
18:16
you know, our our entire workforce. And whether
18:19
that's kinda giving them that personal experience when
18:21
they're onboarded
18:23
to leadership development during the, you know, course
18:27
of their career,
18:29
We also have actually started a pilot
18:32
for some of our leaders
18:35
to actually, I think, kinda help model
18:38
the the culture that we're all trying to
18:40
achieve,
18:41
but also to help develop it. And,
18:44
you know, I hate to use this,
18:46
my colleagues in HR will probably hate me,
18:49
but what we're trying to do is avoid
18:51
HR speak and make it be much more
18:54
almost grassroots.
18:56
And, you know, they know what they need
18:58
best. They know what is most valuable to
19:01
them. We just need to help support it.
19:05
That makes total sense. Thank you, Jim.
19:07
Lastly, I simply wanna ask you, as I
19:09
alluded to before, what
19:11
opportunities for growth you think Connecticut Children's needs
19:14
to capitalize on in the coming year,
19:17
five years, whatever time period you think is
19:20
appropriate?
19:21
I
19:22
I think that I we're all kinda focusing
19:25
on this, and,
19:26
you know, I would almost put it into
19:28
a couple of buckets.
19:30
I would say maybe
19:31
both the primary medical center, the quaternary hospital,
19:35
and then kind of our more,
19:38
community and outpatient focus.
19:41
Internal,
19:42
you know,
19:43
we've got to be able to leverage
19:46
not just our own hospital, but our partner
19:49
hospitals as well
19:51
and really focus on being a regional center
19:54
of excellence and
19:56
maybe getting those various designations
19:58
and kind of the things that we do
20:01
best and that I think
20:03
are
20:04
things that will attract people from not just
20:07
the local area, but across regions and states.
20:11
I think one of the examples of that
20:13
is is work that's being done in the
20:16
new tower right now.
20:18
We're increasing the offerings of our oncology
20:21
services
20:23
and our fetal care center.
20:25
Within the new tower is,
20:27
state of the art
20:29
advanced cellular and gene therapy.
20:31
This includes,
20:33
things including bone marrow transplant and CAR T
20:37
but
20:38
also includes gene therapy for muscular dystrophy,
20:41
sickle cell and other types
20:43
of initiatives.
20:45
So that is much more than just straight
20:47
oncology.
20:49
It is actually a much broader program
20:53
and that is actually going to draw folks
20:55
from,
20:56
March larger region as well.
20:59
You know, if we
21:01
look at the other,
21:03
service that I mentioned inside that new tower,
21:06
which kinda goes along with our newborn intensive
21:09
care unit is
21:10
the fetal care center.
21:12
This center actually provides care even prior to
21:16
birth.
21:17
And because it is a full service,
21:21
fetal care center,
21:22
these babies with complex anomalies can actually even
21:25
begin treatment often surgically,
21:29
prior to birth.
21:31
And then obviously once,
21:33
a patient is born especially if they may
21:36
not need surgery prior to birth, we have
21:38
the full surgical suite and subspecialty
21:41
care
21:42
services that are available to that mom and
21:44
to that child,
21:46
immediately after birth.
21:49
I think
21:50
that helps kind of, you know, distinguish us
21:53
from,
21:54
you know, many others and,
21:57
you know, with centers of excellence in rare
21:59
bone,
22:00
hematology,
22:01
oncology, and others,
22:03
that's really where we're going to focus kind
22:05
of on the inpatient side.
22:08
On the outpatient side, we really need to
22:10
leverage that regional care and the care close
22:13
to home model.
22:15
You know, focusing on expanding
22:17
and maybe strengthening
22:19
our adult partner locations,
22:21
but really also on our ambulatory
22:24
services
22:25
and locations that are actually outside the main
22:28
campus.
22:29
Sometimes actually quite far away.
22:32
You know, while many of the financial
22:34
pressures we're up against are not easily
22:37
fixed,
22:38
you know, we can actually
22:41
do our part to provide care at the
22:44
right
22:44
location
22:46
with the right services at the right time
22:49
and actually hopefully do it in a more
22:51
cost effective manner. So whether that's providing urgent
22:54
care,
22:55
ambulatory surgery,
22:57
specialty care.
22:59
More and more care,
23:01
pediatric especially,
23:03
is moving more outpatient than inpatient, and we've
23:06
gotta be where the patients are,
23:09
but we've gotta do it in a manner
23:11
that is sustained. And having twenty, thirty different
23:15
people providing that care is not, you know,
23:18
financially good sense. We wanna be able to
23:22
partner with other organizations
23:24
to be their preferred per pediatric provider. Say
23:28
that three times fast.
23:29
And,
23:31
also be able to, you know, provide that
23:34
care to the families that we serve
23:37
now in three states across our region.
23:40
Jim, thank you so much for everything you've
23:42
been able to share with us today on
23:44
the podcast, and we look forward to seeing
23:46
you at our conferences coming up later this
23:48
year. And, yeah, we look forward to any
23:50
time,
23:51
paths cross.
23:53
Chris, I really appreciate the opportunity. Thanks so
23:55
much.