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