Investing in children’s health

The future of pediatric healthcare forum in collaboration with Phoenix Children’s

This contributed column is the first in a content series as a lead-in to Becker’s 9th Annual CEO+CFO Roundtable: Nov. 9-11, 2020. During this premier gathering of the country’s most distinguished and accomplished healthcare executives, Becker’s, will present the inaugural Future of Pediatric Healthcare Forum in collaboration with Phoenix Children’s, along with other terrific pediatric leaders.

Phoenix Children’s is honored to work with Becker’s in elevating the conversation of pediatrics as a substantive component of the overall healthcare value chain. Over the next several months, we are excited to bring you a robust offering of informative and insightful pediatric content. We encourage healthcare leaders to engage in the dialogue and participate in The Future of Pediatric Healthcare Forum by RSVP'ing your spot here.

A common question I field in my role as CEO of Phoenix Children’s concerns investments in pediatric health, especially as it relates to financial outlay, efficacy, areas of need and rationale for spend.

According to the most recent data from the Centers for Medicare and Medicaid, children represent roughly 25% of the population. Interestingly, expenditures for children’s health account for only 11% of overall healthcare spending.

Each population segment, from pediatric patients to working adults and the elderly, requires differing funding levels to meet their medical needs. While market forces, regulatory environment and demographics drive aggregate healthcare spending, our charge as healthcare leaders is to develop cost and quality synergies that improve health outcomes – no matter which population we serve.

Pediatric systems face a unique set of challenges because children are not simply small adults. They need specialized care that only highly trained and specialized pediatric practitioners can deliver. In short, we must stretch our dollars to ensure our patients – particularly those with complex and chronic conditions – receive the highly specialized, pediatric-specific care they need.

Importance of Pediatric Spend

Research increasingly shows the economic benefit of investing in children’s health early – for their own benefit and for the benefit of the country.

When looking at Medicaid as an example, a new study by the non-partisan National Bureau of Economic Research reports that the government recoups much of its investment over time in the form of higher future tax contributions. Moreover, children make up 50% of enrollment but account for less than 20% of costs of the whole program.

A majority of the spending in pediatrics funds treatments for medically fragile children – kids with chronic and life-threating conditions like cancer and congenital heart disease. Other funds provide preventive care for otherwise healthy kids. In all cases, investing in children’s health is an absolute necessity.

It is our responsibility to patients and families to optimize spending in the pediatric space to spur innovation, accelerate productivity, increase competencies and capabilities, and improve the cost/quality value proposition for stakeholders.

In order to fulfill our mission to provide hope, healing and the best healthcare for children and their families, we’ve identified five critical pillars of pediatric spend: human talent, technology, care access, R&D and strategic partnerships.

Pillar 1: Human Talent

Without question, our team members are the energy and lifeblood of Phoenix Children’s. They are the foundation for our care quality, patient safety and clinical excellence. Attracting and retaining premier talent is one of the most important directives of all major pediatric and adult health systems. Indeed, it’s especially important right now amid concerns over medical professional scarcity. The Association of American Medical Colleges reports that by 2032, the U.S. will face a shortage of between 47,000 to 122,000 physicians. The issue is similar in nursing where by 2025, the industry will face a 260,000 shortage according to information provided by Arizona State University.

These numbers are alarming whether in child or adult populations. However, from a pediatric perspective, there is a heightened level of urgency. Children require specialized care across many areas of clinical expertise. Scaling adult treatments is not a solution; pediatric providers must address physiological differences, an array of childhood-specific illnesses, and psychosocial and behavioral differences in children. Whether treating a premature infant or a 17-year-old linebacker, pediatric patients required tailored therapies, from preventive care and vaccines to radiation dose, prescription dosing and patient experience. We’re also treating a host of congenital issues that persist into adulthood.

Moreover, recruiting the right talent is rife with challenges, as physicians generally are boarded for adult care first and must pursue additional training to treat children. Pediatric provider in general earn less money, yet their education burden is higher. In other words, children’s health systems are competing against adult systems as well as peer pediatric systems for qualified providers.

An additional consideration is transitional or adult care for patients with congenital conditions. For example, some 1.3 million adults in the U.S. have congenital heart disease and require care from a physician who specializes in treating adults with congenital vs. acquired heart disease. These clinicians are few and far between. In heart care and across numerous other specialties, pediatric systems must recruit and retain the finest practitioner talent with the right expertise.

That is why Phoenix Children’s continues to invest in educating the next generation of medical talent. This commitment has pushed our health system to become the nation’s 11th largest residency program – and this program continues to grow. In addition, Phoenix Children’s now offers fellowships in 21 pediatric subspecialties and plans to build out this program over the next several years. We have also partnered with Arizona State University on a program that gives undergraduate and post-graduate nurses pediatric-specific training and bedside experience. These efforts fill the pipeline with workforce ready providers who possess the right knowledge and real-world know-how to address the wide-ranging needs of infants, children and young adults.

A key directive for the nation’s pediatric and adult health systems over the coming years is the encouragement and promotion of more professionals to enter the physician and nursing community. Only by expanding the pool of well-trained medical experts will health systems have the capabilities to deliver quality and cost-effective care to patients.

Pillar 2: Technology

Investing in technology is a vital component of successful pediatric systems. Certainly, information technology and data analytics are staples. These tools assist in creating a robust enterprise-wide architecture of innovation, which allows team members to operate effectively, productively and in a pro-active manner. As one example, our health system is now utilizing a real-time telehealth logistics dashboard to coordinate, integrate and streamline telemedicine delivery for patients, families and physicians.

And while advancements in cloud technologies and the Internet of Things are extremely important, physicians and nurses rely heavily on diagnostic, surgical and recuperative instruments to bring healing to patients.

From next generation imaging like advanced fetal MRI and 3-D tumor tracking, our custom-built acute kidney injury monitoring system and dose-range checking programs, to the recent introduction of the FDA-approved Medtronic Stealth Autoguide Robot for use in neurosurgery, cutting-edge technologies at Phoenix Children’s and all pediatric health systems are pushing forward the frontiers and giving children new hope for the future.

Our health system is deploying resources into technology investments, which are leading to substantive reductions in medical error rates and pushing ever closer in the journey to zero harm.

And this is just the beginning of the advances in technological innovation. Emerging breakthroughs in augmented and virtual reality, blockchain and machine and deep learning software are providing exciting opportunities across the healthcare landscape.

Pillar 3: Care Access

The COVID-19 pandemic has radically shifted the way healthcare is delivered to patients. Today, telehealth has taken center stage as a platform for care around the globe. Phoenix Children’s and many other health providers worldwide have made a considerable investment in telehealth to ensure we deliver care in the way patients and families need it.

In coordination with the state’s Medicaid program, the Arizona Health Care Cost Containment System (AHCCCS), Phoenix Children’s ramped up telehealth offerings at an unprecedented scale, speed and with remarkable success to provide patients with uninterrupted access to the care they need. Between March 18 and May 1, our 31 division teams completed 18,040 telemedicine visits, representing 60% of all ambulatory clinic visits.

Virtual care is an important modality for all health systems right now, but improving access to care is not a one-size-fits-all model; geography, population and delivery models all play an important role. In sprawling regions like greater Phoenix, physical expansion is a critical solution for improving access to care.

To that end, Phoenix Children’s is working with committed purpose to expand our presence across Arizona with brick-and-mortar locations to serve patients where they live, work and play. Investing in physical infrastructure is a massive undertaking, as in the case of our state-of-the-art Women’s and Children’s Pavilion at Phoenix Children’s Hospital – East Valley, a collaborative venture between Dignity Health and Phoenix Children’s.

But for many pediatric health systems, improving access to care is a much larger and more complex issue when it comes to vulnerable patient populations, including children exposed to childhood trauma. There’s a direct and negative link between adverse childhood experiences – or ACEs – and long-term health status and high costs of care. This is especially evident in Arizona, where children experience more ACEs than in any other part of the country.

To address the issue for children in our community, Phoenix Children’s created the Center for Resiliency and Wellbeing to screen patients for ACEs and toxic stress. Providers intervene early on with children and families exposed to trauma, providing behavioral healthcare and other services and resources to help them break the cycle and grow up to become strong, resilient, and healthy adults who contribute to their communities. We also work directly with Arizona schools, training educators in high-risk communities on trauma-informed teaching methods, mindfulness and resilience.

In addition to our ACEs program, we are launching a new approach to expand access to behavioral health services with a model built around licensed clinical social workers. These providers are capable of providing much-needed care in communities where pediatricians tell us it is most required. The model is also economically viable and builds in the broader support of Phoenix Children's when kids need additional care.

Investments in access are incredibly valuable to the communities we serve and in metros from coast-to-coast. Pediatric healthcare executives must deploy capital to improve their physical operations, virtual platforms, and to customize care delivery for vulnerable populations.

Pillar 4: R&D

Whether it’s the next lifesaving cancer treatment, a cure for diabetes or a revolutionary surgical procedure for congenital heart disease, R&D in areas of genomics, medical devices, life sciences and biomedicine offer the potential to transform the healthcare sphere.

Research funding remains critical in ensuring pediatric outcomes across a variety of conditions continue to improve. Phoenix Children’s is currently involved in more than 500 studies backed by the Institutional Review Board in areas as diverse as neuroscience, cardiovascular care and neurology. As a specific example, our health system is at the forefront of investment in cancer research, one of just a handful of hospitals nationwide approved to offer CAR-T therapy and involved in more than 25 local and international research studies. With so many research areas, the demand for funds will continue to accelerate, requiring ongoing and dedicated investment into R&D and innovation.

The National Institute of Health invests ~$41.7B annually in medical research for the American people. Pediatric healthcare executives must be proactive in securing more of these funds for pediatric research. However, the work cannot end there. Leaders must also engage with the business community and philanthropic organizations to secure funding.

Pillar 5: Strategic Partnerships

A final area of pediatric investment is the development of collaborative partnerships among a broad range of diverse groups including business, non-profit, government, academic and health entities.

The Women’s and Children’s Pavilion is a striking example of strategic engagement that benefits patients. The partnership of Dignity Health, one of the nation’s largest health systems, and Phoenix Children’s, Arizona’s only U.S. News & World Report’s Best Children’s Hospital, brings expert providers together under one roof to care for mothers and their babies. Working in tandem, institutions can provide patients and families with unparalleled care that may not be possible without a joint effort.

But health system collaboration is just one aspect. Strategic investment partnerships with academic research facilities, insurers, community advocacy groups and economic development organizations must also be considered. As an example, Phoenix Children’s works closely with the Greater Phoenix Economic Council to advance our region as a hub of innovation, academic excellence, healthcare dynamism and entrepreneurship.

And returning to talent, Phoenix Children’s and Arizona State University have formed a collaborative endeavor with two educational tracks: a dedicated education unit for BSN students and an acute care pediatric nurse practitioner doctor of nursing practice. This first-of-its-kind offering brings together academic and clinical expertise in a setting designed to foster collaboration and the preparation of world-class pediatric nurses. Partnerships such as these elevate care while also addressing looming shortages of pediatric-trained providers.

Investing in forward-looking relationships with dedicated partners can improve health outcomes and benefit patients and entire communities.

For pediatric healthcare executives, it is critical that we advocate the importance of pediatric healthcare to political and business leaders. Extraordinary innovations and discoveries in pediatrics provide critical insights and best practices to the adult healthcare community. Investing in children’s health – and our nation’s future – is more important now than it has ever been.

Phoenix Children’s is committed to the health and well-being of all children. We look forward to collaborating and sharing information, insights and best practices with the Becker’s community and patrons of Becker's 2020 CEO/CFO Roundtable: The Future of Pediatric Healthcare Forum.

Please reach out and join the conversation on Investing in Children’s Health, as well as upcoming topics including the next discussion: Workforce Challenges (Nursing and Physicians.) We look forward to seeing you in November!

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