Innovation Opportunities to Improve Children’s Health — Full Transcript

In this episode of StartUp Health NOW, pediatric experts discuss the lack of funding for children’s health, and how academic children’s hospitals, nonprofits, and industry insiders are tackling this problem.

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Key takeaways from this episode of StartUp Health NOW can be found here.

[00:03] Wendy Sue Swanson, MD: You know, we’re here as those who are invested in pediatric solutions. And, what I hope you get out of this is a strong feeling and a strong compulsion, ultimately, to think of whatever it is that you love and care about, incorporating solutions that take care of, and incorporate children and their families who raise them. It’s unique to take care of children, because you’re taking care of those who they are dependent upon in those decisions. That cuts anything, from prenatal care, to the transition at birth, to even getting your vaccines when you’re a child. And I think we’ve all heard the statistic, but we can keep reminding ourselves that only 20% of health outcomes are ultimately influenced by healthcare. And it’s the rest. It’s the social determinants. It’s, ultimately, the built environment. And it’s the places and spaces where children learn to think, and talk, rewire, and trim their brains, in the first three years of their life, knowing that the first thousand days will change up their life trajectory in just how many words they’ve heard. So, we come to you, I think, as those who are giving their time and their energy to help, specifically, solutions that help children and their families. And we come about them from, I think, very diverse perspectives. So, I’m a pediatrician. I’m a mom of two. I have nine and eleven year old boys who teach me a lot. My son was just bit by a dog and I had to figure out when a puppy bites your dog, do you do rabies prophylaxis or not? Turns out you, maybe, don’t. I build solutions at the hospital at Seattle Children’s that are, ultimately, in kind of working in patient and family engagement, and I came to that, really, from being a early adopter of the silly social media tools and starting the first pediatric blog for hospital in this country. I’m also the Chief Medical Officer of a company called Before Brands, working for, really, ultimately, guiding the prevention of food allergies in children with an MD/PhD founder and PhD co-founder. And I do a lot of media and television translation for pediatric issues across the country. I’ll let these guys introduce themselves and then we’ll get started.

[02:01] Kip Webb, MD, MPH: Great. So, I’m the person who didn’t get named there, but I’ve decided I want to be Esther Dyson. So, I’m Kip Webb, I’m a pediatrician as well. For the last 11 years I’ve led up Accenture’s provider healthcare practice here in North America. I’m very passionate about the social determinants of health, as well as the kinds of work that we’re doing in hospitals all over the country, mostly around the digitization of health care, whether it’s the implementation and maintenance of electronic medical records, or subsequent use of that data for, towards good ends. Esther?

[02:38] Esther Dyson: Thank you. So, if you had told me a couple of years ago that I was going to be on a children’s health panel I would have said, mmm, but I’ve changed my mind. So, for the last three or four years I’ve been working as part of a nonprofit project called Way to Wellville and our mission is to help five small communities that applied. It’s not a nice white lady coming to help people, but communities that want to be healthier, seeking guidance, coaching, whatever. And it’s a ten-year project. So, what I’ve learned is it all starts with the children. You know, if early childhood trauma correlates with smoking, drugs, going to jail, not graduating from high school, having children early, addiction, obesity, mental health problems. And so, I would say, probably the greatest social determinant of health is your parents. And it’s, it’s great to come to that conclusion, that challenge is, what do you do about it? How can, how can you help babies be born healthy and then create the resilience that’s going to help them through the rest of their lives? That’s, in essence, our mission at Way to Wellville and I’ll talk more about it later. [04:01] John Brownstein, PhD: Great. Hello everyone, my name is John Brownstein. I’m the Chief Innovation Officer at Boston Children’s Hospital. I am also a professor at Harvard Medical School where I run a team in digital health, specifically, around new sources of data and understanding health of populations. Also co-founder of a company called Circulation. I’m fortunate at the hospital in that the hospitals really doubled down in digital health to really think about how digital is going to impact the full patient journey, which I, hopefully, will get to talk about a little bit today. But in the context of social determinants, we’re thinking about that patient journey very broadly, not just when that patient enters the door of the hospital and then leaves, It, really, is all about the end-to-end experience and the tools that they connect with to empower themselves and their children and thinking about their healthcare journey. So, hopefully, we’ll get to talk a little bit about some of the applications in those spaces.

[04:50] Dr. Swanson: And, ultimately, I’ll just mention we have other folks and partners in the group from Impact Pediatric Health, which is a consortium of about eight academic children’s hospitals, and the reason I mention it is, in part, we sponsored the panel. And it’s a group of Boston Children’s, Cincinnati Children’s, Seattle Children’s, Stanford Children’s Hospital Los Angeles, Georgia. You know, we’re, what we’re trying to do, pediatricians are really nice. It’s a nice place to work, but in even a competitive landscape of academic children’s hospitals we’ve partnered up into a consortium to try to make sure that we’re swapping the spit of what our solutions are and getting, kind of, outside and inside solutions out to the pediatric population, kind of, faster. So, I want to start the panel. When we had a call getting ready, we were talking a little bit about, kind of, funding pediatric solutions. So, all of you out there know, I think pediatricians or, excuse me, pediatric recipient, those families are often, kind of, thought of as a use case, a small portion of the population, and thought of as a secondary use for most solutions out there. So, why don’t we talk a little bit about, kind of, what you’re doing in the space where we, kind of, in pediatrics, always feel like we have to do a lot more with less. And I think more than ever in the hospital environment, in the CHIP non funding, at government levels and at state levels, you know, we are defunding solutions that take care of children and prevent the long-standing effects that later cost our system and our population their lives. So, I’d love for you guys to talk about, specifically, what do we do about the challenge of the, kind of, noose around the money that goes in to take care of the beginning of life, as opposed to the end?

[06:22] Dr. Webb: Here, why don’t, why don’t I kick that off with a little bit of context here, is the work that Accenture does, is most typically with large hospitals and large hospital systems, both in the United States and around the world. And if you think about the United States as, you know, a three and a half or three point seven trillion dollar health care industry, pediatrics is relatively small. We only spend about a quarter of a trillion dollars, about two hundred and fifty billion dollars on pediatric care each year, so it’s a small slice of the pie. Second thing is I think that, you know, even if it’s a small slice of the pie, what we’re learning to do with hospitals all over the country right now is doing more with less. You know, that we know reimbursement is going to get cut back and how do we come up with innovative solutions to care delivery that are going to help to ameliorate that sort of stuff? So, then let’s dive a step further and we said if it’s 250 billion dollars spent on pediatric care, how is it being spent? Well, about twenty percent of it is spent on well baby, well child, and well dentistry care. So, about 20 percent is that. Another 30 percent or so is on self-limited disease. Things like colds, acute diarrhea, ear infections, things like that. And then it’s the remainder, that last remaining one hundred and twenty five billion dollars, that’s really devoted to illnesses, with prematurity being the biggest of those. And there are a lot of companies out there that are trying to solve for the prematurity problem. But the second biggest is attention deficit disorder. And so, thinking about how can we find alternatives to what is about to be a ten billion dollar a year drug industry is going to be very important and how can we use other technology tools in order to address that?

[08:08] Esther: So, in a sense we’re starting in a world where a lot of what we’re helping the communities to do is not reimbursed in the first place, so we’re not losing reimbursement as much as trying to justify doing the right things. There’s, there’s stuff like Nurse-Family Partnership, prenatal and postnatal care, that actually does have a pretty short ROI, if you can just persuade people to send out the forces, Visiting Nurses, that kind of thing. But the, the overall mission of Way to Wellville is to invest in health and to show the value of doing that. Unfortunately, not in the next year or two, but over the course of ten years. And the challenge is, it’s not just, it’s a long-term return. It’s also, the return may go to a different silo. So, one thing we’re doing in Way to Wellville, is we’re working in five small communities, where, in Muskegon, the head of the YMCA’s the brother of the head of the hospital. People know one another and the community will see the benefit, even though the fire department is not funded by the other parts. But it’s, it’s, it’s a challenge, because it’s really slow. I don’t know of any other, maybe the Millennium Development Goals or something, but there aren’t a lot of ten-year projects out there and our goal, genuinely, is to show the value of spending money now to help children grow up healthy and see what the returns are, which we predict will be huge in ten years and use that to inform policy.

[09:50] Dr. Brownstein: Right. Yeah, I mean, I, this, this discussion around trying to retrofit solutions that come in adult populations to kids comes up over and over again, and of course we’re in constant discussions with startups and efforts that are trying to repackage. At the other end of it, I think there is a huge opportunity in pediatric hospitals. They really are hotbeds of innovation led by this Impact Pediatrics example, where there’s a lot of effort and collaboration and a lot of data sharing that doesn’t exist in other environments that is actually furthering a number of research areas. And so, we’re involved in a whole range of projects through our accelerator and collaborates with many hospitals like Seattle, in thinking about how to improve patients, but also extend to the adult populations as well. So, a few examples. One is in the gaming area. So, you mentioned ADHD. You know, we’re thinking about digital therapeutics much cheaper, much more extensible to a broader set of the population. We launched a company called Mightier that’s now funded and really thinking about biofeedback and tools to, essentially, modulate behavior just through a reaction of the game itself. We also think about areas around literacy, and so, opportunities to intervene in populations way earlier, of course, means real impact for, for patients and it, just, individuals over the course of their lives. So, we’re thinking about digital tools that allow for assessment of failure to read and, potentially, dyslexia way earlier than what’s normally identified, because we know with that early identification comes potentially earlier intervention and opportunities to really course correct. We’re also thinking about ways in which we can change the patient journey. So, for instance, if we look at our data we see hundreds of thousands of missed appointments and there’s a, there’s a social basis for many of those missed appointments. One of those is lack of transportation, and so in seeing that opportunity and seeing the issues around transportation, we actually built a logistics platform called Circulation which was trying to address this situation of lack and barrier of access to care on a very simple thing, just not having access to a ride. So now, we work with Uber and Lyft and essentially integrate into a platform that was done specifically for a pediatric environment, but now it’s actually extended to over sixty healthcare systems representing over a thousand healthcare facilities around the country. So, some really critical use cases actually can come out of pediatric populations that have broader impact. So, still advocate for it. Start with the pediatric and go bigger from there, so.

[12:14] Dr. Swanson: Yeah. I mean, I think, we don’t think of this as an outlier thing, we think of it as the beginning. I mean, to the point of talking about the first thousand days of life and what are called ACEs, or adverse childhood events. I mean, children are resilient and we give them a lot of credit for that, in that, they are making themselves. And when caught in a bad environment, right? They can be righted. But to Esther’s point about, you know, the lottery of life and where you’re born matters. And of course, your zip code matters more than almost anything else when you’ve been reared in this country. So, you know, we’re looking at different different solutions in that space. But I’ll tell you, you know, at Children’s I’ve kind of come about this knowing that as a pediatrician, and as a mom, and as a patient myself, right? The relationships in healthcare, for me, are still the most precious things that exists. As much as we bring in protocolization, as much as we bring in AI, as much precision as we bring, diagnostically, and forward-leaning. When we are sick, and when we hurt ,and when we go in for care, we care deeply about who helps us translate that and understand that. We’ve built two solutions in the last year. One from donated services from an amazing design firm called Artifact, which is in the Seattle area, which, actually, because of Impact Peds Health, I got to know, because of John. A firm that came in and took a cancer oncologist taking care of children who are terminally ill with cancer and taking care of chronic kids with diabetes, and looking at the quality of their life. Looking at self-reported resiliency scores, and we digitized a bedside curriculum that we’re using in the hospital where kids and their families were learning how to do goal-setting, mindfulness, catching negative thoughts, deep breathing, and using an app that we’ve now built. We’re just about to deploy that across the organization. So, a cancer group of kids who are at the end of their life or in chronic disease, I think, can now help us understand how, even going into a hospital setting, the degree of suffering and the relationships that you’re having, how to actually guide patients and family. And we’ve also just recently built an app, really looking, not just at the opioid epidemic, but the challenges of how we communicate. We can talk all about artificial intelligence, but if your kid gets their tonsils out and you go home and they have a lot of pain and you don’t know how to manage that pain, and they’re suffering or you’re worried about their bleeding, that is what matters the most, is who you connect with and how you get the information. So we’ve recently, in-house, built an app that teaches patients and families on, kind of, taking virtual care, pushing it out to them every day, giving them pain maps, having them log in their med administration of acetaminophen and ibuprofen on a schedule that we know can effectively take care of a child’s pain, and then guiding them with a digitized checklist on when and how to use an opioid. And our goal for the very first time, is our ear, nose, and throat Doc’s are gonna get feedback of how many doses these patients actually get. Across the country tonsillectomy is the number one surgery in Pediatrics and yet most people go home with about 30 doses of an opioid. Most clinician offices in hospitals don’t even know how many doses kids have. So you’re populating in an environment with an opioid something that we know causes extreme amounts of suffering, challenge, and health outcome. And our goal in just the beginning inside the hospital, and we will take any of your help if you want to help us, is just send people home with a guide, that on their smartphone, helps them use the over-the-counter meds, right? And then tell us how many doses of the opiate they actually use, so instead of knee-jerk giving 30 doses down the line, maybe we’ll only send kids home with 10, right? Or maybe we’ll know which segment of how a three-year-old responds in a different way that a 13 year old versus even a third year old having that kind of procedure. So, you know, I think, you know, pediatricians and those who take care of children that lends themselves to great cooperation and I think the call here and what I want to leave you with, is that working in a population that takes care of children and those who are invested, people will volunteer, they will work in the morning, they will work deep into the night, because they will fight for children more than they will fight for almost anything. And pediatricians and the ROI and pediatrics will never be held by pediatric hospital systems, because the good work of creating a population that’s less likely to get a food allergy, the good work of creating a population that’s less likely to be overweight and lead to secondary conditions like diabetes. Those outcomes will ultimately bear the cost, kind of, in the adult space. So, if you can come in and start capturing these solutions early as we become more like accountable care organizations. As we take care of populations and reimburse in that structure, I think we’ll see a lot more benefit, so.

[16:30] Dr. Webb: If I could echo that appeal. You know that, right now, we have about 40 million elderly people who get Medicare. And that program is funded to, about, the tune of 500 billion dollars a year. As you know from news stories recently, we’ve been unable to reach funding agreement for CHIP, which is the child insurance program. And, the funding for that is 20 billion dollars, you know, and we have 80 million children in the United States. So, twice the population, right? With a one, one twentieth of the funding request. 1.4 percent of the funding request. And we still can’t get it passed. So, there’s a question of advocacy that comes across here, you know, that says how do we convince our government the children are important? You know, this is not only the next generation of our workers, but two generations from now, our next leaders. And what the data shows is that in the United States only about 55 percent of children are really thriving through that genetic and social lottery, you know, that they were born into. So we need your help on this.

[17:39] Dr. Swanson: Well, one thing, one quick introduction, and then, Esther, take it. But, but, the ultimate opportunity there too is that it’s, again, 20, it’s only 20 percent of health outcomes are determined by health care, right? So those of you who want solutions that reach the parents and families who are caring for kids, I mean, raise your hand if you’ve got kids and you don’t care about your kids most and in priority over anything else in your life? Like, we will do and we will consume for our kids in ways that are unmatched in anything else that we do. So the profound opportunity here is, we’re defunding pediatric solutions inside health systems. You can create great solutions in the peer to peer, mom to mom, dad to dad space, that if it makes a child’s health better, helps a parent or family feel more in control of their child’s disease or condition, they will buy your solution and they will make sacrifices for it.

[18:24] Esther: Yeah. So, what we’re doing in Wellville, very, more specifically, is focusing, one on the kids. And we’re launching trauma-informed care training, and programs, and so forth. And, you know, clearly this is important, but we’ve had sex harassment training for years and, you know, the challenge is not just doing it, but doing it effectively. So that’s, that’s one thing we’re focusing on. The other is working with the parents. We’re not, neither we, Way to Wellville, which is five people, nor the partners we have in the communities, we’re not walking in and telling parents you’re inadequate, we’re gonna give you training. Somehow, I don’t think that would really work. But we’re hoping, primarily, to reach a lot of parents through both marital counseling and diabetes prevention programs. The, the, the number of parents who need diabetes prevention programs is huge all around the country. It’s under screened, under recognized, under treated, everything. But the the programs of choice actually work in group settings where parents not only learn about nutrition and exercise and stuff like that, but they learn about self-discipline, communication, thinking ahead, planning, and they work in groups where they’re going to get peer support. And so, it’s, it’s that kind of social support that is often so lacking in the lives, especially people who are short of money, short of time, short of access to good food, short of transportation. One thing we’re doing is trying to scale the YMCA diabetes prevention program which operates in some of our communities, but is honestly a vector for doing it countrywide.

[20:20] Dr. Brownstein: Yeah, I mean, completely agree. I mean, from the clinical context, you know, we’re starting to take risk on patient populations in the Medicaid space and we have a limited set of tools that are that are designed to really think about how to holistically take care of patients. I mean, if you think about the the drivers of disease and admission, they’re really, those risk factors are not found in the electronic medical records. You don’t have a lot of good data on these populations. And so, when you start to drill in there’s a lot of local context that could be, you know, drive from census data and other files, but they’re not integrated within the electronic medical record whatsoever. So we really, you know, we’re building those algorithms now. We’re thinking about how to do a better job of targeting interventions to the right populations. But we’re so early on site. I mean, highly advocate people that are thinking about data integration, to think about the broader sets of data that are out there, and even pretty publicly available, to actually make predictions about health outcomes for patients. So, you know, we spend a lot of time thinking about how to open up the EMR. We spend a lot of time building apps, and visualization, and decision support tools, but we’re only as good as the data that flows into these systems. And so, we’re, kind of, at this point a little bit handicapped. I mean, I think there’s a lot of resources being pulled in to figure this out, but we still need those tools. So very, you know, we’d be excited to talk to people in this room, especially if you do have tools that are, especially, trying to integrate and, unfortunately, integrate into these EMR systems that were never designed to have something as simple as, what does local contexts mean for the risk of this patient? You know, what is, what is this individuals connection to, you know, food, environments, and other types of variable, that just doesn’t exist right now in a clinical setting.

[22:02] Dr. Swanson: Yeah, and I think we’re all looking for a lot of help, in that, we still live and function in academic hospitals or in hospitals at large, right? In the clinical environment where I do primary care, right, we’re living in the electronic health record. And to your point, what we care about, essentially in a child’s life, is typically not captured there. And I’m not, not certain that it will. Now, I think one of the incredible opportunities have, kind of, open access and allowing a parent, in the ped space, is that, you typically have advocates who are either empowered with data or not. And moms and dads want their children’s data and they want each other. And, you know, I think as we allow them more and more of that and we can see great success. I mean, I think one of the Impact Peds partners at Stanford was even talking about, one of their successful companies was a home asthma monitoring company. The CEO was a pediatric cardiologist on the panel last year here. Is now actually getting data to parents and families while their children sleep when the air quality, and when their child symptoms are actually triggering an event before it leads to, to you know, trouble. Or, another company that Stanford Children’s has pushed out is called Lully. A sleep, a sleep company. A device that goes under a mattress and helps with, what are called sleep terrors. You know, the best thing you can do is wake a child right before those start, but now they actually have a smart device to do that. So I think we’re, or again, continuing to say, let’s get every, let’s get parents and families all the data that they can. Let’s get a population’s view on what’s happening in a family. But then, let’s also get the kind of solutions that you’re all thinking about into these homes and allow an opportunity, even, for those community members or health organizations for low-income families to purchase those solutions at large. But, you know, we talked backstage, you know, one of the things we’re really bad at is some of these, kind of, wonderful solutions, is making sure that we prove that they do a really good job at a population level. And that’s when you want to tie into large healthcare, you know, state-level systems, to hospital systems, like John and I are fortunate enough to work in, as well.

[23:55] Dr. Webb: Which, I think, begs a question, sort of, where are the innovation opportunities in this particular space? You know, the first thing is care model innovation, right? You know, how do we move the locus of care away from the most expensive resources in the most expensive setting to something that’s much closer to home? Children want that, parents want that, you know, frankly, the healthcare system needs that. And so, thinking about that’s the first one. Second one is to say, how do we identify those children at risk using, sort of, a big data approach that says, how do we ingest a lot of data to understand things about air quality, water quality, violence in the home, allergens, you know, a variety of different things that are going on there, to supplement the data that we already have in the electronic medical records? And then the third part, and this is the part that people are actually starting to, sort of, aggregate right now, is what do you do with it? You know, that in the context of a busy pediatric visit the doctor’s worst nightmare is to ask the question, “How are you doing at home?” or, “Are you able to pay your bills each month?” Because not only does the doctor not have the time to ask those kinds of questions, but they don’t know what to do with those questions. So, if we can give doctors, and nurses, and social workers, the tools that help them to understand the services that are available in their community in order to support those patients who we’ve now identified at particular risk, I think then we’re on to something that will really improve children’s health.

[25:20] Esther: Yeah. though, I’m on the board of 23andme, I love precision medicine, but at the same time in our communities or, and in parts of all communities, there are a lot of kids you don’t need a lot of data to know they’re at risk. You just walk outside and look. You walk down the streets here and you see people sleeping. We’re complaining because our coat got wet, but people are sleeping outside. And it’s, community health really does depend, not just on you, but what your neighbors are doing and, and the, the context around you. So, you can do a lot of good without too much of the specific data, even though that helps. And the second thing I think is really important, is most of this stuff that all of you who are startups are selling works. If somebody takes it, does it, uses it, adheres, follows the protocol, whatever, things will get better. But often the challenge is getting people to the point where they want to change. Whether they want to use your app, whether where they have the ability to, and it’s, it’s ironically the same problem you have if you go to a hospital. You don’t just need to have software that works you need to retrain, not necessarily the doctor, but the staff. You need to hook your wonderful new system that does X, Y, & Z, up to the old system that does A, B, and C. And it’s, it’s just not that easy and what a lot of people don’t understand, whether it’s vendors, or government officials, or anybody else, it’s, stuff needs to work in context. And the context is probably not one that you’re familiar with.

[27: 17] Dr. Brownstein: You brought up precision medicine, so I just figured I’ll just riff off that, even though that wasn’t exactly the point of what you’re saying. So yes, we’re talking about basic interventions and basic data, but of the same scale, I think the pediatric environment is a great use case for precision medicine, despite being a, you know, a real buzzword. You know, we spend a lot of time at our institution, I know in Seattle as well, thinking about the rarest and most complex conditions that are genetically based, so of course, environment is definitely a thought around risk. But genetic diseases, of course, are identified very early on, often in the care of children. And so, the opportunities there around doing a better job of collecting phenotyping information from patients. Right now we don’t have great tools to collect deep phenotyping of patients within the EMR, so we’re focused on really thinking about how to do that, but more importantly, connecting that information to genomic information. There is, not necessarily, a great pipeline for precision medicine that exists, pretty much, anywhere at the moment and we’re trying to do a better job of bringing all these piece parts together to create this clinical service that, essentially, allows any patient, any pediatric patient, out there in the wild with rare symptoms that is potentially on a social network, potentially on a Google search, identifying that patient that in trying to cut down that diagnostic odyssey to the point where we can bring them in, and whether they need a genomic interpretation or a reinterpretation we can do that at speed and, potentially, connect that data to phenotype to the point where we can do end of one therapeutic identification. So, that’s, that’s one of our Holy Grails and moonshots that we’re thinking about. Of course, this doesn’t apply to the broad set of pediatric populations that we think about as well, but to us that also represents a great opportunity for the skill sets that exist within our institution.

[29:12] Dr. Swanson: Well, this is our chance to, I think, open it up for questions and comments. We’d love, you know, there are other members of Impact Ped’s Health as well here, representing multiple different hospitals. We have a table upstairs, number six and seven, so you can mill around up there and check us out, but we’d love to take some of your questions. I don’t know how the rotating mic situation works, actually, sorry. Do you want to, oh, you guys have it? So, I guess over here? Okay.

[29:34] Audience: Could you talk a little bit about how Children’s hospitals are at risk?

[29:47] Dr. Swanson: John, do you want to do that or you want me to?

[29:48] Dr. Brownstein: Go ahead, I mean, I mean we’re now just in the, in the, in the starting point of an ACO. So that’s what we’re doing now, I mean, it’s, it’s very early days and that’s why we’re in this data collection period and really thinking about the tools that will enable us to be effective. But yeah, it’s an ACO.

[30:04] Dr. Swanson: Yeah, same thing. So, of course, you know, we’ve started creating an ACO at Seattle Children’s and multiple different ped, were organizing all the pediatric practices. We take care of a large five state landmass there. So, we’re incented to be very efficient, right? So, part of the secondary strategies for me is a, kind of, blogger and translator and generalist. I care deeply about how much time we spend educating in person and how much time we can do that digitizing that. So, we’re laying on some technology. Virtual care and telemedicine care, ultimately, to accomplish the opportunity of saying we’ve got this mass of children. Only a certain, very hopefully, small segment of them will actually need care in a large children’s and we can, kind of, you know, stratify that risk. So, they’re, the incentives are just being efficient. And I think communication is an exceedingly wasteful part of health care, so we’re certainly working on the strategies with my group in that space, but serving the needs of understanding how do we predict and understand, in a precise way too, what is the population of which we’re caring for, how do we intervene early and reduce cost that way? From simple things of coordinating the electronic health records, the immunization schedules, and flu vaccine, which is recommended for every child over the age of six months of age and a huge significant financial burden to hospital systems at this time, when we actually have to reroute and move patients aside. Many hospitals across the country this week are at capacity because of circulating influenza. So, simple solutions, like getting every child a flu shot can have dramatic impact on the cost of serving and taking care of a whole population, and a child is dependent on their family being immunized as well. So, it’s, it’s a big approach that way. I don’t know if you guys want to talk about that, but.

[31:36] Audience: I, I’m Terrence Hibbert from the University of Mississippi Medical Center. We are the only Children’s Hospital in the state and, and I think, Esther, the way you’re talking I can, kind of, tell you feel the experience that we have in our, in our community, where that, you know, the children are coming in, by the time they get to our hospital there are so many things that could have happened before that to prevent things from happening, and obesity, our state is 70 percent obese, so it’s, it’s, you know, it’s prevalent. It’s, it’s in a neighborhood where, if you’re of a healthy weight people are calling you too skinny and want to get you fatter. But, all that to say that I’m, kind of, curious to know. It seems to me that the part of the solution that we need to enact is getting in better touch with the community organizations that are out there doing stuff and I was wondering if anyone had any examples of anyone who’s doing really interesting work in that, sort of, community engagement area. But to, especially, in particular, in between the hospital and community organizations, but if there are any general community movements I’d be interested in hearing that as well.

[32:51] Esther: I can talk about a couple that are happening in the various Wellvilles. In both, in Muskegon and also in Scranton, which is, kind of, a sixth Wellville partner, the hospitals are doing food as prescriptions and working with local growers, farmers, things like that, and there’s, there’s both the benefit of the food, but there’s also the Community Connections that just make everybody feel more connected. In Muskegon also, we’re just starting to work with Meijer and with Walmart. Meijer’s the local grocery chain, Walmart you’ve probably heard of. They do wellness days and they used to test people for a bunch of things. They would give flu shots and they would tell you you’re pre-diabetic. Go talk to a doctor. And now, when they tell you you’re pre-diabetic, they send you to the YMCA, which has a program. So, there’s, it’s, it’s those kinds of things, and there are people in the community that actually are really interested in helping, but it’s, it’s hard to find them. And, you know, if you’re a doctor you have eight or ten minutes and there’s a whole lot of stuff you have to get through first. So, the challenge is how you, how you add to that. In Spartanburg, and this is the last example, but come see me for more. There’s the 15 minute doctor’s appointment and then there’s the other 45. Which is when you, the patient, or the parent with the kid, or whatever, you sit down with the resident who says, “Did you understand what the doctor said? Does it make sense to you? Can you actually afford the pills? Can you do what the doctor told you to do? And if not, let’s see if we can figure out how to make it work for you.” And it’s, that’s, that’s that connection that makes the medical part actually be able to be useful.

[34:51] Dr. Webb: Yeah, and if I could comment that one of the unexpected, or at least unexpected to me, benefits after the passage of the Affordable Care Act, was most of the hospitals in the United States are nonprofit hospitals. When people got health insurance that meant that they were being compensated for that care so that there was less bad debt, which meant that these nonprofit hospitals had extra money that they could use for community benefit. And so, we saw a big uptick in community relations and addressing some of the SDOH, that we’ve been talking about today, and that’s been great. That, of course, is very much in jeopardy right now with the uncertainty around the future of Obamacare. Right now, what we’re starting to see though, is that the SDOH wave has really picked up and hospitals are saying I need to lose less money on patients who are uninsured, frequent flyers, etc. And there was a wonderful article I recommend in Politico a couple of weeks ago, looking at Parkland Hospital, It’s the county hospital in Dallas, Texas. And some of the incredibly innovative work that they’re doing in order to help people and prevent some of these really over-the-top medical costs that they were seeing before.

[36:03] Dr. Swanson: Well, and one thing I’ll just add on. I mean, I think the defunding of CHIP and the defunding of government support of pediatric solutions, I mean I think, talking about community partnerships. When I think about how we make relationships from Seattle Children’s, it’s deeply tied into the Department of Health. Our public health clinics, our nurses, our WIC program, our free dental care, the walk-in clinics, the kind of catchment areas. And I think that’s, in part, why we have to keep being really pressured to government officials to continue to fund governmental organizations investment in health.[inaudible] a ton of that coordination, right? That allows, actually, a whole community to come together and take care of those who are most vulnerable and who lack access to education, or diet, or live in a food desert, or all those other things. You know we’ve recently been, we’ve had, like everywhere else in the United States, we’ve had multiple mass shootings in our area and in the last couple of years we’ve started a gun coalition where we’re just giving away trigger locks and we’re giving away lock boxes when people come through the emergency department, when they come through with a mental health problem, because we know the risk of suicide for a child, particularly the teenage years, is 9 fold if there’s a firearm in the home. And, you know, but how do we, we’re really dependent on the Cabelas actually opening us up for a Saturday, where we can give lock boxes away. So, the last thing you think of as a retail organization, being a house of safety and, kind of, changing the norms of how do we actually create better protections for an end injury like that? But. Now, we have a minute and a half left, so if there’s another question we would love to have it . Well, would you guys like to close with the final thought of why these amazing people should be working for children and their families?

[37:35] Dr. Brownstein: Yeah. I mean, I you know, from the Boston Children’s perspective, but I think also Impact Pediatrics. I mean, there is a real thirst to be

[37:43] Guest: Is this supposed to be sticking to your cheek? Is that how it’s supposed to be?

[37:49] Dr. Swanson: Probably picking up someone’s mic somewhere. Hello. Thanks for joining us, carry on, John.

[37:53] Dr. Brownstein: Yeah. I mean, I think, I think it’s representative of all the pediatric hospitals that are part of our network that, really, there is an opening up of our ability to collaborate our data, our interest in working with startup companies. So, many of the companies that are here, you know, that is new, probably, from the last few years, that, really, there’s this interest in, in collaboration. So, whether, you know, I think we brought up a huge number of use cases today, so if they’re organizations, groups that want to work together and partner and pilot, you know, I think that’s, we’re excited about that. So.

[38:28] Esther: So, for parting words, I would just say that the biggest challenge in everything is to think long term instead of short term. Whether it’s kids who take the first marshmallow without the grit and self determination to wait a little longer and get two or three marshmallows, to governments and companies who are not willing to invest in the long term and want to be reelected right now, or have a high profit this year, or, frankly, communities who keep doing pilot after pilot, rather than sitting down and saying, “We’re going to scale something and grow it so that we can reach all the pre-diabetics in our community.” It’s that thinking long term that, ultimately, leads to success. Short-term thinking is addiction. Long-term thinking is purpose.

[39:29] Dr. Webb: Yeah, and if I could just wind up, I’d, sort of, echo Esther’s thought there, which is that we know that the children who are most vulnerable and at risk today will be the most vulnerable and at-risk as adults and that is a there is a huge social cost related to that. And, and that population as it ages will be, you know, extraordinarily detrimental, if you will, to our economy, but also, you know, a tremendous burden on their own personal and health at a population level. And so, the time to act is now.

[40:04] Dr. Swanson: Yeah. I mean, I’m a pediatrician here, but I’m saying why don’t you think about it with a little bit of greed and think about it that, you know, we know, typically, that moms are the head of household when it comes to health care consumption in this country. And they care more about their children than just about anything else. And if you create something that takes their attention, holds their attention, and helps them feel like they’re doing a better job raising their children, they will create a bond with you and you can have a lasting sense of loyalty. So, don’t start down the line. Start at the beginning. And I think you’ll keep them around. If you help people care for children in their midst. Thank you so much. We’ll be around today and thanks for letting us talk about pediatric innovation. [Applause]

Resources:

• [01:26] Seattle Children’s
• [01:40] Before Brands
• [02:10] Accenture
• [02:53] Way to Wellville
• [04:03] Boston Children’s Hospital
• [04:07] Harvard Medical School
• [04:16] Circulation
• [04:54] Impact Pediatric Health
• [05:02] Cincinnati Children’s
• [05:02] Stanford Children’s Hospital Los Angeles
• [05:06] Georgia (Children’s Healthcare of Atlanta)