A children's hospital chief executive becomes the first leader of New Jersey health system's pediatrics service line.
RWJBarnabas Health has named the president and CEO of one of the health systems three children's hospitals to lead the organization's newly created pediatrics service line.
Warren Moore, MA, FACHE, will serve as senior vice president of pediatric services at the West Orange, New Jersey–based health system. Moore, who has worked in the organization for two decades, will continue serving as president and CEO of Children's Specialized Hospital.
HealthLeaders recently spoke with Moore to get his perspectives on managing the systemwide pediatric service line. Following is a lightly edited transcript of that conversation.
HealthLeaders: Why did you pick pediatrics as your main field of interest?
Moore: In some ways, pediatrics picked me. In 1998, I was about eight years into my healthcare career, which had all been on the adult side, and I was asked to work at Children's Specialized Hospital. I was a relatively new father—I had a 1-year-old and a 4-year-old. Once I toured Children's Specialized and watched the wonderful care that was given to kids, there was an immediate emotional connection for me as a new dad.
HL: For a health system or a hospital, what are the benefits of establishing a pediatrics service line?
Moore: From the perspective at RWJBarnabas Health, we have many places throughout the system where we are providing excellent care for children. For example, there's the Children's Hospital of New Jersey, Children's Specialized Hospital, and NICUs throughout the system. We have incredible services for kids, and what we have now is an opportunity to bring these great but disparate services into one system of care. We want to focus on our overall population and how we can get to the point where we can effectively care for more than a half million children in our service area.
HL: Limiting clinical care variation is a primary objective in prominent services lines such as cardiology. Is limiting variation a primary objective in pediatric service lines?
Moore: Absolutely. One of the challenges in pediatrics is it involves a large group of services—there are multiple service lines within pediatrics. We have cancer care, we have cardiac care, and we have care for medically complex children. From that standpoint, we have an opportunity with a pediatrics service line to look at best practices and how we can bring those best practices to children across our health system.
HL: Conversations about care variation can be difficult—particularly in pediatrics given the intense emotional connection that many clinicians have with their patients and their patients' families. How do you have that conversation?
Moore: In my 21 years in pediatrics, I have found that when you bring the conversation down to what is best for the kids, everyone pays attention. When we have sound data, and when we can show that we can treat patients better, very few clinicians push back. You must focus the conversation on the child and what is best for the child. You need the hard data that shows the best care for particular situations.
HL: What are your goals for the pediatrics service line at RWJBarnabas?
Moore: For us, it's similar to what we look at for adult care. Our goal is to promote health in the communities that we serve. There are about a million children in our health system's geographic area. In the next five years, we are focused on how we can provide coordinated, safe, high-quality, compassionate, and family-centered care. That means we need to develop a network of primary care, subspecialty care, and ambulatory care for approximately half of the market—about 500,000 kids.
HL: How do you think pediatric care at RWJBarnabas will look different five years from now?
Moore: The big thing that will look different is we will have a large ambulatory and primary care network. Right now, we work with informal relationships in pediatrics across New Jersey. I believe formalized networks of care are important in our future as we move away from fee-for-service to value-based care, which involves generating the best outcomes for children.
HL: What is one of the most significant challenges in pediatric care?
Moore: It's the funding. Traditionally, pediatrics has not been fully funded across the spectrum of healthcare compared to the adult side.
Typically, our reimbursement for care is less than you see on the adult side. And when you are dealing with kids, 50% or more of your patients are going to be on Medicaid as the insurance. So, Medicaid funding is always at the forefront of what we are thinking about financially. In graduate medical education, typically per slot on the pediatric side we get about 50% of what Medicare pays for graduate medical education. The same is true for cancer research—pediatrics is negatively proportionate to the adult side.
For the past 20 years, a big focus for me has been how do we keep moving the dial toward adequate funding to make sure we ensure the future for kids and make sure they all reach their full potential.
HL: How is operating a children's hospital different from operating a general acute care hospital?
Moore: To have a good outcome for a child, we need to engage the family and treat the entire family. Obviously, a child is dependent on parents or other caregivers or siblings. Without a healthy home environment, a child does not have a good chance of a positive outcome.
I realized early in my career at Children's Specialized the need to completely and holistically engage a family in the care of a child. We must make sure that the caregivers are in the right mindset and have the supports they need to take on the challenges of caring for their child. One of the most gratifying things for me working in pediatric care is watching our team wrap its arms around a family and truly make sure that we have them set up for success with their child.
HL: How do you fully engage family members and other caregivers?
Moore: We have focused on getting the voice of families into everything we do. So, we have "family faculty." We hire parents and caregivers of current or former patients, and we engage them in two broad categories.
One category is to give them an actual job function to help bridge the communication between families and our clinical team—they broker the space and help build the trust we need to build. The other category is to utilize them from a policy and operations standpoint. We have a member of either our family faculty or our voluntary family advisory council on every committee in our organization—from the board of trustees, to the patient safety committee, to our operating committees, to our performance improvement committee. So, the voice of families is literally in everything that we do.
Christopher Cheney is the senior clinical care editor at HealthLeaders.
The new pediatrics service line at RWJBarnabas is being designed to serve half of the children in the health system's market.
One of the top goals of the pediatrics service line is limiting care variation.
A key element of creating the new service line includes establishing formal primary care and ambulatory care networks.