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Speaker 1: Welcome to Becker's Healthcare podcast. I'm Chris Sosa, your host, and I'm thrilled to be joined today by doctor Nathaniel Beers. He's the CEO of Blytheale Children's Hospital in New York. Nathaniel, thank you for joining us today.

Speaker 2: My pleasure. Thanks for having me.

Speaker 1: Nathaniel, you just took over officially as CEO of Ideal Children's about four weeks ago. But for those in our audience who may not be too familiar with you and and your journey as a health care leader, can you please introduce yourself and tell us a little bit about your background?

Speaker 2: Sure. So by training, I'm a general and developmental behavioral pediatrician, and have been, providing pediatric care for close to thirty years now. And I have really focused my pediatric career on the interface between health and education services for kids with disabilities. And so unlike many pediatricians, I haven't had sort of a straight trajectory of, you know, just working in clinics. I actually, did my fellowship up at Boston Children's, in child advocacy after doing my residency at Children's National.

When I came back to DC, I, was able to, join the faculty at Children's National, and I saw patients there for the last twenty four years. But I left Children's, from a work perspective, and, went and worked for the DC government for a number of years, including, as the Deputy Director for Policy and Programs for the Community Health Administration for the DC Department of Health. And then from there went on, to work for DC Public Schools, where I was hired to overhaul their early childhood evaluation process and think about how could we identify more kids, with special education needs since we were under identifying children. And then was promoted to be the head of special education for DC public schools and ran special education for DC public schools, helped DC get out of three class action lawsuits, and then, decided it was time to go back to healthcare. And so I, took another year being the chief operating officer at DC public schools, which is again, another strange twist, where I learned about construction and all kinds of things that help me now in this type of job, to be more informed in the conversations.

And then went back to healthcare and worked for the, health services, or HSC health care system, which is, again, similar to Blythe Dale in that it's focused on kids with disabilities in DC. And in 2019, HSC health care system and Children's National merged. And so I was back in the Children's National family where I spent the last, six years, serving, as the executive vice president of community and population health, and working together with the team there prior to joining the team here at Blythedale.

Speaker 1: As I said, it's anything but a straight line that got you from

Speaker 2: Very circuitous.

Speaker 1: Over the last thirty years or so. What led you to Blythe Dale in particular?

Speaker 2: Yeah. I mean, I think the unique thing about Blythe Delta is the only, children's hospital in the country and probably in the world where, there is also a co located special education school district, on the same campus. And so for my interest in working with kids with disabilities and kids who've been discharged from the, you know, neonatal or pediatric intensive care units, and being able to partner together with the school system, to think about how are we supporting kids when they go home, is really a unique opportunity that doesn't exist anywhere else in the world. And so, I really couldn't pass up the opportunity to think about this as an opportunity. I'm thrilled that I'm here to lead the team.

Speaker 1: They are glad you mentioned what makes Blaiddell unique. I'm curious what else excites you about taking over this job.

Speaker 2: Yeah. I mean, I think it is again a a really unique opportunity in health care right now. That is a hospital that, is, doing well financially, and is really positioned to think about how can it be, at the forefront of the field. And so because of, where it is financially, we're able to think about what is, where's the innovation to happen? How do we make sure that we can impact the lives of more patients and families?

And think about what the future of health care is gonna look like and how can we be prepared, to be a leader in that space.

Speaker 1: Gotcha. Well, that dovetails nicely into my next question, which simply is, what do you consider Blythe Dale Children's best strengths, and how can it best go about using them?

Speaker 2: Yeah. I mean, like many children's hospitals, I will say its people are its best strength. Right? We have lucky to have an, a workforce that is truly committed to the mission that we have around serving, patients and families of children with medical complexity. And so, that passion that people bring to work every day makes it a lot easier, to do the work, and, and to work together.

In addition, Blytheville has been fortunate

Speaker 1: to

Speaker 2: have been led by a leader, for the last twenty six years who really was an incredible advocate for children, and an incredible advocate for those children who had medical complexity. And so he's been able to pass a local legislation to make sure that children with disabilities are being better supported and that there's appropriate, financial resourcing for the services that they need. But also, has led a team that is, really leaders, in the space of making sure that we are sort of stepping forward, and not just continuing to do things the same way we've done them for the last twenty years. And so the culture of innovation, the culture of a willingness to embrace change, all of those, I'm stepping into, as opposed to having to build those pieces out, so that the organization can can be ready for the changes that are gonna come to all health care organizations, particularly with legislative and Medicaid changes that are coming, in the coming years.

Speaker 1: Nathaniel, to say that there's a plethora of changes coming would be maybe the biggest understatement ever. So without no need to elaborate on the avalanche or changes. I mean, I think it they're they're fairly well documented in the health care community. But I am curious, given that change and the innovation and the mindset that you mentioned that Blytheville has, what exactly do you think you and your team will be focused on over the next eighteen months, two years, whatever timeline you think, best fits from for for you at this moment?

Speaker 2: Yeah. I mean, I think, again, like many children's hospitals, but even even more so here, right, about eighty percent of our patients are Medicaid patients because of the long term care needs that they have. Right? So even families who may not qualify on their own income are patients qualified just given the long length of stays that they have and incredible medical expenses that they have. So we are highly dependent on medical, on Medicaid as an adequate payer.

And so, certainly, as we think about sort of our payer mix and thinking about those components, continuing to make sure that we are partnering with our state and local, legislators and making sure that we're thinking about how we are navigating the changes of Medicaid is going to be a big piece of this. But I also think that it is an opportunity for us to make sure that we're thinking about where is healthcare going as well. Right? And as we think about pediatric healthcare, we've seen a lot of progress in the adult healthcare market around micro hospitals or hospital at home programs, about making sure that people can be in the community they're in and thinking about those components, about how we improve the quality of life of patients as they're navigating through the systems. I think we have an opportunity here at Blythedale that we have an incredible knowledge base about how to take care of kids and make sure they can go home.

Over eighty five percent of our kids actually go home, not to another facility. And so, for those kids with medical complexity, that's not always the case. And so how do we take that knowledge and think about where we fit into a care that's being provided at home, in the community? How do we think about, the possibility of smaller satellite spaces? All of those pieces are things that over the next five to ten years, we can expect to start to happen more regularly in pediatrics as we get there.

And then the last piece is really about being a good partner for our referring providers. Right? So our referring hospitals are gonna get a ton more pressure to make sure that they're discharging kids sooner. And to be able to safely do that, they have to have an organization like ours that can take kids who are getting discharged from the neonatal or pediatric intensive care units and are ready to be supported in a lower level of acuity, but are not ready to go home. And so all of those are pieces that we will have to think about.

How do we raise the bar on what we can take and how we can be a good partner in that space? And how do we also think about how we're building those supports in the community so the patients can continue to go home safely.

Speaker 1: Got it. I mean, those are all worthwhile goals, and they're gonna take a lot more than just eighteen months. I'm sure. But, you know, that that's you work out a little bit at a time, of course. Lastly, Nathaniel, I my question is, what aspect of children's health care deserves a sprite a brighter spotlight in your mind?

Speaker 2: Yeah. I mean, I think that it is the care that we provide at Blytheville and other hospitals like ours around the country. Right? They are the piece that people forget about as a really critical linchpin, to the success for kids with medical complexity. Right?

The reality is if you're a patient who spends, you know, three months in the neonatal intensive care unit and is going home with, you know, tubing and alarms and maybe a gastrointestinal tube and maybe a tracheostomy and maybe other equipment needs, going straight from the neonatal intensive care unit to home sets you up for failure. And really it is about sort of making sure that we can continue to stabilize kids, think about how they can be ready to go home, how patients and families can have the time to learn what they need to learn to be able to safely monitor their children at home. Our home healthcare system in The United States is so broken, and has so many gaps in services that for many families who are going home with a child, they can experience around 25% of the, prescribed home care hours is being uncovered. And so that means someone in that household has to be ready to care for that child if there's not a nurse coming into that space. And so our job is to really prepare the family for all of those realities and make sure that they can be ready to go home, and that that child can experience life.

And so, in a way that like allows them to really be a child, and so the family to sort of embrace them in that space. And everyone knows where to go to the emergency room, where to go if you need sort of that high, you know, intense, you know, cancer treatment or surgery, you know, you're going to, you know, the big children's hospitals around the country. But the hospitals like Blytheville Children's are really about making sure you can go home afterwards. And so need to be part of how people are thinking about how they think about their care.

Speaker 1: Daniel, thank you so much for sharing your time, your insights, everything that's going on at Lisdale. We love to hear it, and we can't wait to share it with our audience. And we I hope our paths cross sooner rather than later.

Speaker 2: Me too. Thanks for having me.