Peter Grollman is the Senior Vice President of External Affairs at Children’s Hospital of Philadelphia. Acting as liaison between Children’s Hospital of Philadelphia (CHOP)

and key stakeholders in government and the community, he has been instrumental in ensuring that children with illness in Lakewood have access to the best pediatric care available in the United States. Chai Lifeline sat down with Mr. Grollman to discuss what exactly his role was in United HealthCare Community Plan of New Jersey’s decision to continue offering access to CHOP.

Can you give an overview of the matter with United Healthcare Community Plan (UHCCP) and CHOP? How did the situation affect New Jersey families with sick children?

UHCCP is the only New Jersey Medicaid Managed Care Organization that has a full participating agreement with CHOP. Any UHCCP member has access to the full continuum of services provided by CHOP, from primary to quaternary care to inpatient and outpatient care. Unfortunately, the other Medicaid Managed Care Organizations in New Jersey do not have a full participating agreement with CHOP. This means that CHOP is out-of-network and access to our care is only available on a limited basis. We think these arrangements are not ideal for patients and their families because they often require burdensome approvals from insurance companies on a case-by-case basis. When UHCCP announced its intentions to terminate its contract with CHOP, we were deeply concerned, because thousands of children would have lost access to our care, a disaster for sick children in New Jersey. Fortunately, UHCCP later decided against terminating its contract, preventing a real crisis.

What was your role in advocating for children, and how did that tie into your relationship with Rabbi Fried and Chai Lifeline?

As Senior VP of External Affairs in CHOP, I oversee four departments: Marketing and Public Relations, Government Affairs, Community Relations, and the Office of Diversity and Inclusion. Each of these teams has an awesome opportunity to communicate our mission in a way that inspires support from a number of different stakeholders, including patient families, policymakers, donors and more. At the epicenter of our mission is the child, and everything that goes into making that child healthy. This is core to who we are as one of the nation’s largest and best children’s hospitals.

In our advocacy for New Jersey’s children, a vast team within CHOP worked with patient families, doctors, government officials, and social service and advocacy organizations to help educate them around CHOP’s role in meeting the needs of New Jersey’s children. People are often surprised to know that CHOP has over 15 locations in New Jersey, where we offer a number of services, including primary care, specialty care, behavioral health services and outpatient surgery. And, for services we can’t provide in the community, our hospital in Philadelphia is nearby to provide the highest quality, specialized care with a number of programs that can’t be found anywhere else in the world. We spent considerable time reinforcing this message to help people appreciate that contract terminations can be harmful to vulnerable children.

We also spent considerable time proposing solutions to make sure all health plans offer access to the full continuum of pediatric care – everything from primary care to cancer treatments, fetal surgery and more.

Chai Lifeline wants the same for the children and families it serves. The organization has a simple, straightforward goal that we identify with: all children must have access to the highest level of pediatric care possible. That’s why we stood shoulder-to-shoulder, ensuring decision makers understood that uninterrupted, continued access to care must be the highest priority.

What was the result of your work with Chai Lifeline?

Together, we built a solid case for making sure children covered by UHCCP have access to CHOP. Ultimately, UHCCP leaders agreed to continue providing access to CHOP. They also committed to working with us and identifying solutions to a market failure that exists in New Jersey, where only one Medicaid Managed Care Organization chooses to contract with CHOP.

Can you give us an update? Where things are heading, and what are your goals for the future?

Our work is not done. We will need to advocate in Trenton and Washington for the necessary change to ensure all children have access to the care they need. No child should be turned away from CHOP because their insurance company is unwilling to contract with us. We are well positioned to help children get the treatment they need to live healthy lives, and the breakthroughs generated from our “bed to bedside” research are making a remarkable impact. We are innovating around approaches to cancer, blindness, spina bifida, congenital heart disease and so much more. That’s why making sure CHOP is accessible to all families is a priority moving forward.

In New Jersey, there is only one plan that makes CHOP fully accessible to children. That is unacceptable, and it needs improvement, attention and advocacy. All Medicaid health plans should ensure that children have access to all care, at all times, and as close to their homes as possible. That’s hard to do when only one plan has a contract with CHOP — a children’s hospital that cares for over 25 percent of New Jersey’s children.

This care can be quite costly for the sickest children. Spreading that cost in a way where families can choose from a number of plans that include CHOP and other pediatric providers “in network” makes for a better proposition for all health plans.

Very few hospitals provide all the services children need under one roof, so families should have every option they need offered to them by their health plan. Boundaries of a state should not determine which type of care any child is able to receive.

I was so impressed by the “all in” approach to advocacy from my colleagues at CHOP: our leaders, clinical staff and the teams who work on issues like this just about each and every day. Children are our highest priority, and we all wanted to bring solutions to the table. We look forward to working with Chai Lifeline and all those who make children a top priority so that no child should ever face a barrier to the care they need.