In an interview with Chief Healthcare Executive, Lawrence Moss discusses helping kids get and stay healthy, investing in the right areas, and strengthening children’s hospitals.
Lawrence Moss politely wanted to revise the question.
In an interview with Chief Healthcare Executive®, Moss, the president and CEO of Nemours Children’s Health was asked what should be done to improve care for children.
Gently, Moss said he wanted to look at it from a different perspective.
“The question I want us all talking about is what should be done to improve the health of our children,” Moss said.
“At the root of that is the reality that medical care is an important but a relatively small part of health for all of us, especially for children,” he continued. “There's a wealth of data that would say that medical care accounts for about 20% of the health of our population, and 80% happens outside the hospital.”
Moss has been working to spread the message of improving the health of children and going beyond treating kids. During a program at the HLTH Conference in Las Vegas last month, Moss and other healthcare leaders talked about the need to focus on improving the health of kids to avoid problems later in life.
In a wide-ranging interview with Chief Healthcare Executive, Moss discussed ways to help children lead healthier lives and the impact that will have on society as a whole. He also talks about tackling the social drivers that affect the health of children, and the need to strengthen children’s hospitals.
“Nemours is in the business of creating health, not only in the business of delivering medical care,” Moss said.
‘Starting with children’
Moss says it’s important to invest more in efforts to help kids have a better chance for living a healthy life. While social drivers such as safe housing and freedom from violence can have a big impact, Moss views the biggest determinants as food security and education.
“It’s unequivocally proven by fact, a child that gets three healthy meals a day will perform better in school, be more likely to graduate from high school, be more likely to graduate from college and generate way more economic productivity for a lifetime than a child who doesn't,” he says.
Some lawmakers have pushed to expand free lunch and breakfasts for kids in school. Moss says he doesn’t want to get into political debates, but he says it’s critical to ensure kids aren’t missing meals.
“However we get there, we need to get the healthy food in front of the kids,” Moss says.
Many kids rely on schools for their meals, and may go hungry when they aren’t in school. Nemours has partnered with a Florida nonprofit organization, Blessings in a Backpack, to help give kids healthy food over the weekend and holiday breaks.
“It doesn't cost that much and has a huge impact,” he says. “And it just underscores, however we do it, we've got to get healthy food in front of kids who need it to ensure their future.”
He says programs and efforts focused on kids will have the greatest long-term return on investment.
“When we do the right things with kids, even if they're little things, they have pervasive and long-term effects on health,” Moss said. “If we want to impact cancer, diabetes and heart disease in adults, we can spend a massive amount of money and make a little bit of difference. So I really want to get the message out that starting with children is the way to address the health of our society.”
As a pediatric surgeon, Moss has spent many years taking care of children and working in academic medical centers. He says he’s “worn out” trying to make the argument that taking care of kids is the right thing to do.
“That carries the day with maybe 30% of society,” Moss said.
Now, he said he’s come to see that the more successful path lies in focusing on helping kids as a step to helping everyone.
“If you really want to carry the day with the majority and be able to change policy and move the needle on what we do in American health care, the argument I think that resonates with a much broader swath of the population is that anything we do in kids is the next generation,” Moss said.
“It's the health of our society,” he added. “It's healthcare costs in the next adult generation. Its workforce, economic productivity in the next generation. It's our GDP in the next generation. And that's the argument I think that can carry the day, and those of us who care about children and make those arguments need to do a better job of articulating that, myself included.”
‘Real challenges ahead’
While Moss is focused on improving the health outside the hospital, he says children with complex health conditions and those with disabilities need to be able to count on children’s hospitals.
“They need our specialty care children's hospitals and all the wraparound services that go with that,” Moss says, and he adds, “They need a healthy children's hospital industry.”
Children’s hospitals are hurt by inadequate reimbursements from the federal government, particularly for Medicaid, Moss said. At Nemours Children’s Hospital in Orlando, Florida, the organization has received less than half of the costs for kids on Medicaid.
Moss said it’s critical to get better reimbursements for children with special needs or complex health issues.
“They need everything a big complex specialty children's hospital offers and they will for the rest of their lives,” he said.
Nationwide, children’s hospitals have continued to face financial pressures. Like other hospitals, children’s hospitals are experiencing higher costs and staffing shortages.
“There are some real challenges ahead and there is not yet on the acute horizon a sustainable solution for our country's children's hospitals,” Moss said.
But he added that he sees room for optimism.
“The definition of health, the way we pay for health, the financial incentives that are built into our health systems, all of that is on the table for change for the first time in my career,” Moss said. “So we haven't found the way yet but we are starting to have the right conversations.”
Moss said he sees growing recognition from Republicans and Democrats that funding is a problem. He added that he is encouraged by the increasing creativity and openness that he’s seen from the Centers for Medicare & Medicaid Services.
“That is very reassuring to me, which gives me hope that we can come together around children's health and around health in general,” Moss said.
Moss sees shifting to value-based care, and moving away from the fee-for-service model, as a key to keeping children healthy.
“We're going to be willing to change the way we get paid and will be willing to go at risk and be paid for health instead of being paid for the volume of medical care we provide,” Moss said.
Looking at the healthcare industry, Moss said paying by volume isn’t making people healthier.
“So we need to change that and in my view, that change is best started with children and interventions, and with our nation's children's hospitals being more than the place sick kids go, being the stewards of health in our communities,” Moss said.
The U.S. spends more than $4 trillion on healthcare, but only 7% is being directed toward children’s health, Moss notes.
“We can make a pretty big and pretty aggressive bet with the 7% and do things radically differently, and not upset the aircraft carrier of the $4 trillion,” Moss said.
And Moss said that’s the smarter bet.
“Anything we do with kids is 100% of the population if you just wait around long enough,” Moss said.