Latest / Becker’s Healthcare -- Pediatric Leadership Podcast / Dr. Lawrence Moss, President and CEO of Nemours Children's Health

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Dr. Lawrence Moss, President and CEO of Nemours Children's Health · Becker’s Healthcare -- Pediatric Leadership Podcast

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  This is Laura Dedo with the Becker's Healthcare Podcast.
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  I'm thrilled today to be joined by Dr. Lawrence Moss,
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  president and c e o of Nomura's Children's Health. Dr. Moss,
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  it's a pleasure to have you on the podcast today.
• 0:11
  Thank you, Laura. Pleasure to be here.
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  Now,
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  I know you've recently released a new ebook called Finding Health by Looking in
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  the Right Place. Could you tell us a little bit more about it?
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  Uh, happy to. I maybe should start with the,
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  the underlying reason that I wrote this and that's that my continued
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  observation that in this country we tend to equate health with
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  medical care and we try to fix problems related to
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  help by throwing more and more medical care dollars at the problem.
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  And this book is a response to that and provides my, my point of view,
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  in fact, not just my point of view,
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  my observation and statement of the fact that health is mostly
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  not medical care.
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  We know from decades of research that health is about 80%
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  other factors such as food security, safe housing, freedom from violence,
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  good education, and about 20% medical care.
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  Nemours is an organization that provides medical care to children.
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  However,
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  we're an organization that sees ourselves in the business of creating health,
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  not just delivering medical care.
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  And that means getting involved in all of those other things.
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  Absolutely. That's fascinating and certainly such an important, uh,
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  area to be focused on right now.
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  I can imagine that there are so many different health issues that your patient
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  population is going through, especially coming out of the pandemic.
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  I know that the book subtitle is how understanding what actually Creates Health
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  Can Fix U US healthcare.
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  Could you tell us a little bit more about what that means in what really, uh,
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  you're getting at with some of the, these big themes and topics of the book?
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  Uh, of course.
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  Let me start with a bit of a personal perspective or a personal
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  story. Um, by training, before I became CEO of Nemours,
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  I'm an academic pediatric surgeon and I spent my career for 25
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  or 30 years prior to this role,
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  taking care of kids with extraordinarily complex problems including
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  complex congenital anomalies, advanced cancer, things like that.
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  So call that the 1% of the 1% in that
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  aspect of healthcare, or I should say medical care,
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  this country does extraordinarily well.
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  And if you're unfortunate enough to have a child with those kind of problems,
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  this is hands down the place on the planet you wanna be. However,
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  if you're the other 99.9% looking for health that
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  doesn't need complex, tertiary quaternary care,
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  this is arguably the worst place on the planet to be.
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  Or at least in the developed world,
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  the United States spends a massive amount on medical care, however,
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  we have among the worst health illnesses of any developed country.
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  And we tend to say, oh, that's because healthcare is so complicated.
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  This book is an effort to demonstrate that health and the pathway
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  to health is not that complicated.
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  It actually includes things that all of us are familiar with and all of us
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  experience in our lives every day.
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  And that is really the core message I wanted to send to people.
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  That's such an important message and so interesting to hear, um,
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  about just really being able to dig deep into these challenges and really
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  understand and, um, decompress some of the, the big issues in healthcare today.
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  And I'm wondering,
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  is this just a healthcare industry problem or are there roles for other sectors
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  to really pitch in and be part of the solution?
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  Could you talk through that a bit more?
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  Well, great question. No,
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  it's not just a healthcare industry problem and frankly it's not a healthcare
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  industry problem. It's a more global problem than that. Now,
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  I like to say that fixing healthcare in the United States is not complicated at
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  all. It's actually quite simple and we just need to do three things. Number one,
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  understand what health is.
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  And that's about realizing that health is 80% not medical care and realizing
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  that we need to get involved in those things. Number two, pay for health.
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  In the United States,
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  our healthcare enterprise is a roughly 4.1 trillion per year entity.
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  And almost every penny of that goes to the opposite of what we
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  want, which is health. We don't pay for health in this country.
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  We pay for volume of medical care delivered and complexity of medical care
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  delivered. Therefore we get what we pay for.
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  We deliver more than any other nation on earth.
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  We charge more than any other nation on earth, and we get,
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  and that's exactly what we get is an awful lot of medical care delivered and not
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  health. And finally, bullet number three is start with children.
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  And I think it's important for society to realize that children's health care
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  is not only about children's health,
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  it's about the health of our entire society and the roots of all
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  of the problems that we deal with in our adult population. Cancer,
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  heart disease, diabetes, poor workforce, productivity,
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  all of those start in childhood and can be addressed far more effectively
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  in childhood than they can after the horse is out of the barn.
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  That's such a great point and so important to keep in mind as we're thinking
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  about the global healthcare crisis and especially the healthcare system in the
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  United States. I know the pediatric population certainly gets overlooked, um,
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  quite often, but as you mentioned, it's, you know, those, uh,
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  health issues and habits and, and all sorts of other things, um,
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  really can make a big difference if you're starting as a child. And you know,
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  I know too that you have a chapter on health and transportation within the book.
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  What's the connection there and how can transportation issues, uh,
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  bring about changes in health?
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  So transportation might sound like kind of an esoteric issue that's
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  somewhat distant from health, but actually it's directly related to health.
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  Um, in a most obvious way,
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  nobody can get medical care unless they can get to the appointment in the first
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  place. And that is an enormous burden for a huge proportion of our population.
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  Children in the United States have their medical care funded by
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  Medicaid in 54% of cases,
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  which means the majority of children in the United States come from
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  economically limited circumstances. And in that population,
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  transportation can be a huge issue,
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  but the issue of of less than optimal access to transportation
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  goes far beyond simply being able to get to medical appointments.
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  It relates to being able to get to school,
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  being able to get to a supermarket where there's fresh and healthy food,
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  being able to get to daycare,
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  a parent being able to get back and forth to work and maintain employment.
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  So transportation runs pretty deep when we talk
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  about health, not just medical care.
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  Got it.
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  That's such an important point and definitely makes sense when you talk through
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  it that way. I, I really appreciate your expertise in, in such a,
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  a great perspective to have. Now I know another chapter,
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  you talk about nutrition having supernatural effects.
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  In what way does that occur?
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  Nutrition in many, many ways is really the root of health.
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  And when there are nutritional problems in early childhood
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  that subsequently leads to obesity,
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  to diabetes, to heart disease, to a higher risk for cancer, frankly,
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  to almost every adult disease that we see in the population.
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  And when I talk about children being a lever of impact,
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  tiny and very inexpensive changes in nutrition and other
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  areas that happen in early childhood can have profound influences
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  later in life in health trajectories. You know,
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  when we look at the profound health problems in our adult population, we can,
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  and we do spend massively trying to change those health trajectories
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  and we spend a massive amount for a little bit of effect
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  in early childhood.
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  We can spend a tiny amount for a huge effect
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  as a society. We'll,
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  we will readily spend a million bucks trying to change the trajectory of a
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  group of people with diabetes when a hundred bucks in early childhood could be
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  far, far more effective.
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  That's fascinating to hear and definitely such an interesting point by you and,
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  and certainly I, I love that narrative and analysis in looking at how,
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  especially for kids with diabetes, it makes a really big difference in,
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  in I'm sure many other, um, health issues as well.
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  I know many of the areas that you described are areas in which adult and
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  children can protect their health. Is that true?
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  Are there differences in how things can impact children as compared to adults?
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  Well, sure there are differences and children have some, uh,
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  susceptibilities that are, that are not relevant to the adult population,
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  although, you know,
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  I would put those issues as far down the list and relatively minor.
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  The overarching issue is doing the simple thing
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  that ensure good health and a good health trajectory in children
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  pays dividends. You know, I've,
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  I've never met an adult who didn't used to be a child.
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  So even though children are 15% of the population and even though they
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  represent only 7% of the nation's healthcare expenditures,
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  they ultimately are the key to making changes,
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  profound changes across society. When we make changes in childhood,
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  trajectories are changed and all we have to do is wait until those
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  kids grow up and that becomes the adult population. And even more,
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  there's the added benefit and we've seen this with experimental evidence that
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  when we change health behaviors and health beliefs early in childhood,
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  those kids grow up,
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  become adults and pass those behaviors onto their children
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  without any further intervention from us.
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  So it's an enduring and pervasive impact.
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  I see your point. That um, definitely makes a lot of sense. And you know,
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  I can imagine being able to reach children effectively takes a,
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  a real group effort, a village if you will, um,
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  from the parents to the caregivers to the community and then the health system.
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  Um, for the hospital and health system leaders who are listening to this podcast
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  today, what is most effective for them? How can they really influence, um,
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  and impact the children within their community most effectively?
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  Well, I'll speak to my peers in the children's hospital industry cuz I think the
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  issues may be a little bit different for adult hospitals,
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  but I believe very strongly that children's hospitals need to
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  become the stewards of children's health in this country.
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  Not just the place sick children go for medical care will always be the place
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  where sick children go for medical care.
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  But our obligation and our opportunity is so much greater than that now.
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  We are experts at delivering medical care. We're not experts in housing,
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  food, security,
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  education and all those other factors that predominantly determine health.
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  However,
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  we can be the conveners of experts in those areas that bring everybody
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  together to do what you say takes a village,
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  which is create a healthy trajectory for all children in this country.
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  Thank you so much for, for describing that for us.
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  I think that's so helpful and definitely, um, is important for all, uh,
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  children's hospitals in particular, but in others to just keep in mind. Finally,
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  before we wrap up,
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  what is the main thing you want readers to take away from this book?
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  Let's keep it simple, Laura. I want people to take away three things.
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  The prescription to fix healthcare, understand what health is,
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  pay for health, start with children, and that's it.
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  Simple, straightforward. I love it. Thank you so much Dr.
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  Moss for being here today. This has been such a fun conversation.
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  I'm really excited that you're able to launch this ebook and I know anyone can
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  download the book for free of charge at http slash slash
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  nemours.org/ Larry Moss leadership.
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  Thank you so much, Laura.
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  It was a privilege to talk with you and I appreciate Becker's interest in the
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  work that we're doing and we look forward to continuing to contribute to the
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  health of children.