Milwaukee Talks: Children's Hospital CEO Peggy Troy
Peggy Troy's 40 years in health care began as a bedside nurse and have progressed through a variety of leadership roles. Today, she is president and CEO of Children's Hospital Wisconsin and chair of the Children's Hospital Association Board of Trustees.
Troy has witnessed the trends and changes in health care, and the impact it has had on how children's hospitals everywhere address the health care needs of their patients.
Like the hospital she leads, Troy impacts the community daily as she is a member of the Greater Milwaukee Committee and serves as a director on the boards of Marquette University, the Metropolitan Milwaukee Association of Commerce, Blood Center of Wisconsin, Wisconsin Hospital Association and Teach for America.
In this latest edition of "Milwaukee Talks," Troy discusses the mission, vision, challenges and opportunities at Children's.
OnMilwaukee.com: Could you please outline the core mission and the core missions of Children's Hospital?
Peggy Troy: When I arrived here six-and-a-half years ago, I took the time to get to know what's happening, what we are and what we're not. A few things dawned on me as I've been in Children's Hospitals for my entire c career. You may know but my first job out of college, after I worked as a nurse intern, I was a staff nurse.
I've always kept my eye on Children's Hospital of Wisconsin, and I'm from this area. First of all, we are an extraordinary Children's Hospital. We're top ranked in all the national rankings. But the thing I didn't understand is how diverse we are. We have a Medicaid-only health plan, so we insure 130,000 Medicaid lives. We are a full-risk insurance contractor with the State of Wisconsin. It's adults and kids. The second thing that was different than a lot of other Children's Hospitals is that we have a pretty big primary care footprint. We have about 15 locations. At the time, with more than 60 doctors we're growing that like crazy. Then we have a footprint across the state with more than 40 locations.
We also have a hospital within a hospital at Theda (Appleton Medical Center). Which is a fabulous partner. But then we also have a lot of communities that contract with us for child abuse prevention, intervention treatment and other types of social service activities out in those communities. The other thing that we have going for us is that we have CSSW, Community Services – Children's Hospital of Wisconsin. It was founded in 1892 by a minister who had a horse and buggy who went around the City of Milwaukee and literally picked up orphans. That emerged into an organization that does foster care case management for kids. We have about 3,000 that we foster care case manage in southeast Wisconsin. We also do private adoptions. We do close to 300 per year.
You always think of Children's as a hospital, but when you start to look at the other
pieces and parts and you start to think about pulling the threads through of what the
power of what that means.
OMC: What's the future look like at Children's?
PT: We sat down with the board of trustees and said, "Okay. Let's look at some data, let's look at some information. Let's look at the pathway forward." We had some consultants come in too and help us with 'What do we really want to be?' What's the north star? Started the conversation by saying, 'What hole would we leave if we weren't here?'
That's where we started really spelling out all that we are. The hole would be pretty darn big. Then we said, "Okay. What's our north star?" Our north star that we vetted back then is still the north star today. We want the kids of Wisconsin to be the healthiest in the nation. Why did we pick that? Well, if you look at "Healthy People 2010," We stack up, for the state, in the middle. If you look at health outcomes, we looked at about 52 different health outcomes. We stack up about the middle.
The shock to me personally, having just moved here from Memphis on the Mississippi border, was that when you look at the central city of Milwaukee we dropped to the fourth worst in the country. What's the big driver? Poverty. You start to get back to what is happening to kids and why would their health outcomes be so bad? It's access to care. Which means access to insurance, good food, safety and education. It really drove us towards, 'Yeah, we could be the best healthcare institution and deliver the best healthcare.'
The other thing we looked at is (the fact that) only about 12-13 percent of a person's outcome is driven by healthcare delivery. Most of it is either your genetic make-up or your socio-economic environment. There's literature all over the place on the impact of that and what it means to health outcomes. So we said, 'We want to be the very best Children's Hospital in the world. We want to do transplants and ICU and great emergency department.' All those things that would have to be true. But we also have this infrastructure of other parts of our organization that if you put this together in a longitudinal looking-at-kids-over-time way, we can affect health outcomes.
OMC: What was next?
PT: We then developed a strategic plan that basically is driven by the thought what does it mean to have the best health? To have the healthiest kids? Which sort of goes against the financial model today of what makes hospitals thrive. It's people in beds in ICUs. Because that's been the traditional revenue stream.
When you really start to think about this and push this in the other direction, you start to think about a kid, for example, in the central city with asthma. I'll tell you how I think about this. We have school nurses in nine schools now, that are totally funded by Children's Hospital. In the Central City of Milwaukee we have four clinics, purposely put where we had some of the worst health outcomes and a total lack of good pediatric medical care. We have one at Mount Sinai Aurora. That's where our child abuse program is currently located. Along with a dental clinic and a medical clinic. But we said, "We've got to do better at that."
So, we looked at, like I said, crime statistics, poverty and picked some of the most blighted communities in the city. We also said, "We are going to find partners. Because we can't do this alone." If you go back to the social determinants of health, you realize it's education and food and jobs and all those other things.
OMC: How do you work wit the community to accomplish these goals?
PT: We can influence it (kid's health) through partnerships. So we picked the Children's Outing Association. We picked the Next Door Foundation, where we had a clinic. We picked the Northside YMCA, in the Lindsay Heights area. Then we said, "We think we know what people need and want. But too often health institutions think they know better than everyone else." So we brought in the Consilience Group, who led focus groups in those neighborhoods. They talked to neighbors about what does health mean to you? What do you need? What do you want? And, what we heard we this: "We want great children's health. But you've got to give care to the caregivers, too. Because if the caregivers aren't healthy, we're not going to be able to give the very best care."
OMC: What's the impact of your Community Navigators. It's kind of like a block watch for health, right?
PT: Yes, we have Community Navigators, which is a unique concept. But it's coming into vogue. If a school nurse notices that a kid is missing school for a couple of days, and the child has asthma and the Community Navigator, who is from that community, actually goes and knocks on the door and determines what's happening – it makes a difference. If the kid has three different locations during the day and only one inhaler, they could be missing their treatment. They're probably insured by our health plan.
So we get to decide, instead of fighting with another health plan, that while traditionally you only give one inhaler, in this kid's case we need to give three. Because they go from school to neighbor to home. A young child, seven or eight years old, probably isn't as responsible about taking the inhaler with him/her.
OMC: What about immunizations and community health?
PT: One thing we did take on that I thought was pretty tangible, because you could actually measure it, is immunizations. And the immunization rates when we got started on this in Milwaukee were pretty grim.
We've seen a marked improvement because we've taken this on seriously, even in the sites of service we have, to really raise those immunization rates. It's not the only thing, but if you start to do those kinds of things, there's other things that happen as a result of that. We're starting to show some nice improvements. We've actually got some funding from outside funders who are really intrigued with the pathway we've forged and wanting to help us. Because we're on to something.
OMC: What's the biggest challenge in healthcare in Greater Milwaukee for Children's moving forward?
PT: That's a great question. If you look at what's happening in Milwaukee and southeast Wisconsin or even across the state, we're seeing a lot of collaborative work coming together among health systems and they're forming pretty substantial partnerships. The term that everybody is working with right now is "clinical integration."
First of all, like I said, we're a nationally recognized institution for care, for our education, for our research and for our advocacy. We believe that the way that we thrive is that we are here for all kids. Our board of trustees has absolutely committed that we will be a self-governed, free-standing Children's Hospital. That said, we do have an academic relationship with the Medical College of Wisconsin. It's a very important relationship. Actually for our education research and for our clinical care mission. It's great because they employ three, close to four hundred specialists. But they work exclusively at Children's Hospital.
Now, as there are these systems that are emerging, one of the things that we want to be available to all kids in Wisconsin. So as they are developing these products that are called Neural Networks that they're offering to companies, we want to be part of that. So that no parent finds that they sign an insurance deal only to find out that Children's is not a Tier One so they might have to pay more or be transferred away from here to receive care.
That, to me, is the challenge. Where do we fit in to all this? A lot of it we can influence but we're not the final decider on how some of this is going to evolve. The next three to five years is going to be a very critical time. Because nobody wants to pay more for healthcare. I talk to all the large employers, many are on our board of trustees, and they're very worried about the cost of healthcare and what it means to their companies. Everyone wants adequate insurance for their employees. That's a very powerful offering. And the cost is burdensome. The cost for us is burdensome. We're dealing with that every day. That's why we have a suite of offerings that give people the right healthcare at the right time for the right reasons. But do it in a way that is cost effective and we can afford.
OMC: And, Children's is relatively small in size, correct?
PT: There are about five million people in the state of Wisconsin. So there's about 1.5 million kids. We were just ranked three stars with the Society for Thoracic Surgery in our cardiac outcomes. When you look at kids that have really serious heart problems and you look at your outcomes compared to the world, because this is the world, the STS is the world, we are one 5 percent of the institutions in the world that have three stars. That's the highest ranking you can get.
The STS has determined that you have to do about 500 cases per year to even be in that. It's interesting because kids born with cardiac problems, that number doesn't ever change. It hasn't changed in years. Nobody knows why. But it's a static number. There are about 630 pediatric cardiac procedures done in the state of Wisconsin. We do about 550 of those.
There's a community conversation that I'm emerging right now to say, "What do we really want?" As these competitive things are happening, I think preserving the best interest of the Children's Hospital – not so I can make a lot of money, so I can continue to serve in the right way. Because frankly, our goal for an operating margin is two percent. That's just enough to fund back into capital and the things that we need to keep this place at that top level.
OMC: There are so many doctor and treatment options now, everywhere. How is a parent best to know, as a new parent, where to turn first? There is so much information, so much access, that it's overwhelming?
PT: What I'm encouraging parents to do is do the research. But to think of Children's first. Because we do have the primary care network. We do have so many pieces and parts and attributes. We've been known as the sick place. But, when you come into Children's family with a pediatrician that's in Delafield or Pewaukee or New Berlin, wherever it happens to be, you can gateway in. So if there's ever a problem with your child, no matter what it is, you've got a full service institution that can take everything from bronchiolitis to a heart transplant. And everything in between in a coordinated way. That's what I want parents to know.
I have a lot of employers tell me, quite frankly, Jeff, that young families want to know what the healthcare opportunities are for their children and talk about the value proposition of having the Children's Hospital here that's full service.
You also have to pay attention to what's happening because their bodies are just different. They're in an evolution stage that we're not in anymore. That's where I think is sometimes the almost behind-the-scenes piece of it that you get better appreciation for when you're here.
OMC: How so?
PT: A great example is an orthopedic injury. If a kid is seven or eight years old, one of the things our pediatric orthopedists understand is growth plates. I'm not going to say that we're the only ones that can fix a broken arm because you can. But the way in which you fix it has to take into consideration the growth plates. Because you can have consequences down the road if that's not taken into consideration. I'm biased, but even on the easy stuff, there are other considerations that have to be taken into account that when that's all you do everyday, 24/7, and then you have the incredible network of specialists and psychologists and all the other things that we offer. Your kid is ... It's a holistic approach to how we are able to ... A lot of what we do is parent advice and counseling. Because we do kids. That's all we do. We love them.
OMC: Two of the biggest lessons that you've learned as a parent that you've been able to incorporate here?
PT: Two of the most, hmmm. For me it's the whole family dynamic and the importance of family. I knew that before, but when you have your own children you really understand that first of all people come with a whole host of other things in their lives (that you don't know about). But you need to know. Because the circumstances and all the things that led up to the reasons that they're there are important. And you need to have that understanding.
The importance of the family. And the family unit. And being there for the family. I have parents stop me, write me letters and the thing they say about Children's is that, "You took extraordinarily good care of my kid but you also took care of me." I think that's the thing that ... First of all, we've got to deliver the best. Because I know that when my kids have had ear tubes and all that other stuff, you want the best. And nothing short of the best is sufficient.
You're going to have that kid for a period of time. Doing whatever you do. They're going home. You've got to be able to allow the family to be successful in whatever it is, post-op visit from the ED or whatever, to be able to just keep doing it. That gives me great appreciation for how we need to set ourselves up for success and the different services that we have to offer to keep that family whole and intact.
OMC: Define success.
PT: I think success is we're here, we're relevant, we can do all that we've over the many years, over a hundred years now, have pathwayed to become and just making sure we are giving outstanding care. That we're financially sound.
There are seventy million voters, no one under 18. So we need to make sure that as policies and laws emerge, that children aren't forgotten in that space and that they're considered to be relevant, important and people think about impact on that. That to me is success. And, of course, having the healthiest kids in the nation.
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