It’s not magic. The Children’s Institute just combines good mission-driven business sense with the ability to turn on a dime if management senses there’s an unmet need or something isn’t working.
President and CEO David Miles says in many ways the nonprofit children’s hospital, school and child welfare program sells itself, which makes his job easy.
“Even as far as the recruitment of board members, all we have to do is bring people — and even donors — into the building (and) have them take a walk around,” he says. “And what they see here is something that’s very mission driven.
“They see an organization where it’s a very happy kind of atmosphere, and the relationship between the staff and the children is very supportive — it’s nice to see,” Miles says. “And most people leave here feeling very upbeat.”
Miles himself has been with the organization for more than 35 years. He started as a teacher in the private school program, which provides educational services for children with neurological impairments. That can mean children with medical problems or learning and behavioral challenges.
The other two components are the acute care hospital that focuses on the rehabilitation of children with special needs, traumatic brain injury, spinal cord injury and chronic pain; and Project STAR, which provides adoption, foster placement and family preservation services.
As the head of The Children’s Institute for the past 11 years, Miles has gradually focused less on operations and more on strategy, and one of their new initiatives — a care coordination system — is being closely watched by others as it develops.
Heading into new territory
Like others in the health care industry, The Children’s Institute is trying to stay ahead of changes. So, the organization takes time to listen closely to what the community is telling them.
Based on that dialog, Miles says, they decided to start a care coordination system, a kind of population management.
The organization has nurse case managers, social workers and health coaches who work with families, the families’ physicians or different government agencies to help the family navigate the health care system.
Miles says they want to ensure everyone is talking to one another so the best decisions can be made.
The concept is similar to medical homes where the primary care doctor coordinates the child or adult’s care. But because The Children’s Institute recognized that care coordination is already an organizational strength, it wanted to find a way to expand that core competency to fill an unmet need.
“That is something that we’ve always done here as part of rehabilitation,” he says. “I believe we do it exceptionally well. And so we thought let’s create the care coordination, and then let’s go out and try to build the bridges with the primary care doctors offering this as a service.”
Developing the plan
Once the need is identified, Miles says a thorough business plan is needed with data, numbers and analytics to back it up before moving forward.
“You’ve got to do the background stuff on this,” he says. “Do your analytics, do your business development and make sure that there’s actually a need for it.
“And not only that, (you need to know) if you get the program up and running that you have enough demand for it that it’s going to remain sustainable.”
The Children’s Institute’s business development department, along with finance and operations, has the capability for in-depth statistical analysis.
Miles says they can determine within a particular geographic region how many possible children might need their coordinated care services and which health networks are already servicing them.
That diligence paid off when The Children’s Institute took their concept to get funding.
“We went out into the philanthropic community and the philanthropic community really loved it,” he says.
The Children’s Institute was able to obtain funds for a two- to three-year period to create a proof of concept program, where it doesn’t cost the primary care physicians anything to participate. Then, Miles says they added a research component to make it sustainable in future years.
The Children’s Institute is working with local insurance companies to demonstrate its services can lead to better outcomes and reduced costs.
The idea is that when the money runs out, the insurance companies will be willing to get into a rate sharing arrangement in order to share those savings.
More than 100 families are already participating in the program, with the goal of having 300 to 400 involved by the end of June.
Mission first
Another challenge has been navigating the turbulent relationship between two major competitors — the University of Pittsburgh Medical Center and Highmark Blue Cross Blue Shield.
When your company works with competitors, you want to stay independent and draw referrals while not offending anybody, so the mission needs to remain in the forefront.
This has become more challenging within the region where there’s a relatively small population of potential customers within any geographic area, Miles says. The Children’s Institute is one of the few pediatric specialty independent hospitals in the country.
“You spend a lot time trying to keep everybody happy and making sure that they understand that all you’re interested in is doing what’s in the best interest of the kids that you serve,” he says. “You’re not really trying to side with any one system or another.”
The important thing is to remember the mission.
“If you come into the organization you can really feel it — it’s all about the mission, it’s all about servicing the families and the children who need our services. They come first and foremost,” Miles says. “And I think if you stick to that; if you know what your mission is and you stick to your mission, I think you’ll be successful.”
