- Welcome to Healthcare Upside Down, a podcast
by Becker's Healthcare and ECG management consultants in
which we'll explore the upsides and downsides of healthcare
and the industry's most current trends.
I'm Molly Gamble, and today I'm joined by three guests,
Peggy Troy, president, and CEO of Children's, Wisconsin.
Dr. Jeff Speering, CEO of Seattle Children's Hospital,
and Evan Lynch, throne principal
of ECG Management consultants.
Peggy, Jeff and Evan, welcome to the podcast.
Thank you so much for joining us.
- Absolutely. Thank you. - Thank you.
- Well, to get us started,
can you please introduce yourselves
and share a bit more about your roles and organization?
Peggy, can I turn to you first?
- Sure. Hi.
As I said, I'm Peggy Troy, uh, president
and CEO of Children's Wisconsin in the Milwaukee area.
And I have been at Children's, Wisconsin
for the last 15 years.
So, um, a little bit about children's.
Uh, we have nearly 60 locations
across the state of Wisconsin.
So we have a hospital in Milwaukee.
And then we have a hospital within a hospital up in the Fox
Valley, which is a couple hours north of our organization.
Our primary site, we have a surgery center.
We have 22 primary care clinics, five urgent care clinics,
and then several specialty clinics.
Uh, we also have a robust community-based program
that support and strengthen family.
So we have child advocacy centers, school nurses,
and community health navigators, safety
and injury prevention.
And then we also have the largest foster care
and adoption, uh, program in the state of Wisconsin.
We foster care case manage about 3000 kids.
We also have a health plan,
and we, uh, it's a Medicaid health plan plus a marketplace.
And we insure about 150,000 members.
It's a at full at risk program, uh, first dollar.
We have more than 6.5 million connections
with kids across the year.
And, uh, so we have a big responsibility in terms of, uh,
serving the kids of the state of Wisconsin.
'cause we are the only independent freestanding
children's hospital in the state.
- Mm-Hmm. an important note.
You ended on there, Peggy. Thank you
for the introduction and overview.
Dr. Speering, can we hear from you next?
- Sure, absolutely. So, um,
I'm Jeff sparing the CEO at Seattle Children's,
have been here for, uh, eight years now.
And so Seattle Children's, again,
also an independent freestanding children's hospital with,
uh, main hospital campus in Seattle.
Um, but we have the incredible privilege of taking care
of kids, uh, every day from four states, Montana, Idaho,
Washington State, and Alaska.
Our main hospital campus is, is obviously in Seattle.
Um, but we have 43 different outreach sites throughout those
other four states, bringing specialty care, hopefully closer
to home and patients and families and, and where they live.
We're also one of the five largest pediatric,
uh, research institutes in the country.
So every day, our team, um,
not only thinking about cares today,
but obviously looking for cures for tomorrow
and how we continue to bring the best
and most innovative treatments to kids in clinical trials.
So we make sure that, uh, we're finding more cures
for kids in doing that.
And then an incredible foundation, uh,
that really helps support our mission through philanthropy.
And so like Peggy, all the way from primary care
to the highest level of specialty care.
But thinking about this
and how we really center our work in our communities
and improve children's health broadly.
- All. - Thanks, Dr. Speering.
And, and Evan, let's, let's hear from you.
- Thanks. I'm Evan Lynch, throne of principal of ECG,
which is a full service healthcare only consulting firm.
It's been around for over 50 years.
I'm part of our academic healthcare division,
and I lead our firm's, uh, children's service line,
which is a multidisciplinary group of consultants, uh,
with focused experience working on the issues
that pediatric organizations face.
So I spend a lot of my time working
with children's health systems on clinical
and academic partnerships and affiliations
and redesigning organizational structures
to enhance the relationship between the children's hospital
and the faculty practice.
- Thanks Evan. Well, on, on the note
of organizational structures, you know, let,
let's talk about m and a and consolidation.
We've seen hospital and health system consolidation.
It's expected to continue its upward
trajectory this coming year.
And I'm curious, when we talk to leaders
of independent freestanding children's
hospitals like you, Peggy, and Dr.
Spearing, how do you anticipate this trend will affect
children's health systems, including your own?
Peggy, can I turn to you first for your thoughts?
- Well, that's a great question, Molly,
and something that we ponder frequently within our own
organization because we are watching, uh, carefully these
mergers and consolidations of healthcare systems.
We strongly believe as an organization, along with our board
of trustees, that the best way to do the work that Jeff
and myself do, both in not only the clinical care
but the academics, the research,
et cetera, is to stay independent.
Because when you become absorbed within a large adult
system, which Jeff
and I have both been in that situation,
you become a service line.
So the allocation of resources is very competitive,
and there are many ways in which we need
to fund our missions, uh, in order to do it correctly.
And so that independence allows you to do that.
You know, and when we think about it,
you've gotta have a very strong leadership team.
You have to have a board of trustees
that believes that as well.
Uh, a strong strategic plan looking forward, knowing
that independence is the goal, most importantly,
a solid balance sheet in today's world.
And the economy of healthcare is becoming very challenged,
very differently than I think we've experienced in the past.
So keeping a strong balance sheet
and a positive margin is a way for us to,
to remain independent, a strong academic partner
with true integration.
So you're operationally, financially
and strategically integrated is another very important way.
And then I think also having
partnerships with adult systems.
Pediatrics is becoming more
and more constrained within adult systems.
I think it's an opportunity for us to look for partners
to help manage their pediatric service lines
and provide some of the expertise
that we experience in our institution so
that we can serve more kids.
- So Peggy, what I, what I'm hearing is it's really
important that agility is important.
You can move closer to the adult systems
and to other systems systems,
but being a free stand independent organization is
so important when it comes to allocation
of resources, like you said,
- And talent - And talent.
Jeff, what would you add? Do you see things any differently
from Peggy or, or would you add a a different
perspective to the conversation?
- Yeah, no, completely agree with
how you were certainly seeing, you know,
continue obviously consolidation broadly across healthcare.
And I think, you know, with that, the reality
that doing pediatric care is actually is,
is getting harder all the time.
Um, and you know, everything from the complexity
and acuity of, of pediatric patients
to the financial constraints
and pressures to, as Peggy mentioned, really, you know,
some significant shortages in workforce.
And so what's interesting to all of us is watching
as adult systems consolidate,
making the choices on their priorities
and, you know, understanding that pediatrics and,
and we're obviously also seeing this in, in women's health
and obstetrics may not be one of those priorities.
And so, you know, seeing community-based hospitals
as they're coming into systems, dropping some
of their pediatric services
or some of their women's services,
and as Peggy said, that's our, that's all we do.
That is our priority.
And so I think for us then looking at how can we help kind
of fill that gap, or as Peggy said, I completely agree.
How can we be the best partner to some
of these adult systems, if, you know, for them pediatrics,
you know, isn't something that they want
to try to continue to do.
How can we be that best partner to fill
that need, you know, within the community?
- Mm-Hmm. , - Well, Evan Perspectives out
of the Milwaukee metro area and then Washington
and its four state area.
What, what, what are you seeing Evan, uh, in terms
of what's unfolding across the industry when it comes
to consolidation in children's hospitals?
- Well, I think what Peggy
and Jeff described is really
what we're seeing across the country right now.
And, uh, a lot of these smaller community-based pediatric
programs are just facing tremendous challenges,
remaining viable, but operationally and financially
because it takes a certain level of volume
and the access to pediatric specialists to really be able
to deliver that care.
And many are considering, whether they close altogether
or, um, what we've seen more of, which is, you know,
discussions on creative partnerships
with children's hospitals, uh, to figure out ways
to continue to provide those services in the community.
And then I think even, uh, recently in the last few weeks,
we've seen a pretty notable announcement of a, a merger
between two freestanding children's
hospitals, which is pretty uncommon.
- Mm-Hmm, . - Well, when we talk, I think Dr.
Spearing, you said, doing pediatric care is
getting harder all the time.
And one big headline under that umbrella
of a statement is the mental health needs of children
and how they've just been surging in recent years.
I know your hospitals have been responding,
both Seattle Children's
and Children's Wisconsin have made some major investments
to address the pediatric mental
and behavioral health crisis.
Peggy, can, can you describe for us
what strategies you've put to use
to deliver highly specialized in these needed services
and what you've learned from the past couple
of years in those investments?
- Well, first and foremost, the need is
just growing every single day.
So a couple things we did, we have, uh,
pediatricians 120 pediatricians in 22 locations.
And at the time we did this evaluation,
there were enough psych beds in our community for the kids.
So we really felt we should take advantage
of the touch points we have with, uh, primary care
and really start way back with the kids
because you can diagnose anxiety
and depression in kids as early as two or younger.
And so what if we had mental health workers working
alongside of our pediatrician so
that parents had immediate access to a resource so
that they could begin the journey towards how
to prevent catastrophic things from happening down the road.
Uh, many complexities came into that, uh, in terms
of the workforce and just, uh, in the state of Wisconsin,
you have to sign a separate consent
for mental health services, et cetera.
But we've overcome a lot of that,
and we're starting to see a real change in
how parents perceive the need for mental health services
and are willing to access it right there
at the pediatric visit.
The other thing we've opened up is five, uh, a couple
of urgent care centers, uh, just for mental health so
that the kids, the families can access that care immediately
and not have to wait six months to get an appointment
with a psychologist or psychiatrist.
So we really believe that backing that up
is really important in terms of changing the trajectory
and making sure that we're helping kids grow up
to be resilient, productive, and fulfill in their lives.
- Thanks, Peggy. And, and Dr.
spearing, can you describe Seattle Children's approach?
I, I'm curious too, how you see Children's Health systems
responding effectively
and sustainably to the overwhelming community
needs that have unfolded.
- Yeah, no, it's a great question, ma.
And to your point, the sustainability piece
is such a key part of that.
And obviously, you know, as members
of Children's Hospital Association, you know,
it is the number one thing that we're hearing from all
of our Children's Hospital colleagues around the country.
So this is not unique to any one of us.
Um, and as you know, as, as Peggy said exactly right,
I mean, the, the numbers are staggering.
We were seeing the trend obviously developing even
before the pandemic.
Um, you know, we had doubled the number
of inpatient psychiatry beds, you know, even before that.
And in 2018, I kind of called
for a moonshot in Seattle Children's
around mental behavioral health.
And I, I don't think any of us were even then prepared for
what happened during the pandemic
and kind of the, uh, kind of, you know, just amazing, uh,
increase in not only just the volume,
but the acuity of kids coming in, in crisis.
And so I think the challenge that we've had
as children's hospitals, as Peggy said, is we,
we are always kind of that place of, you know,
the highest level of care and crisis,
and we're seen as kind of, you know,
people that find solutions.
And so we're seeing more and more kids
and families coming to us kind of in that level of crisis,
and we wanna be able to be there and,
and have a level of access for that.
But as Peggy described, what we'd all really love
to do is move further upstream.
And so we find ourselves kind of in this dual reality
of having to navigate, you know,
crisis care right now at levels that we've never seen.
But then trying to think about how do we move resources,
you know, to where we can intervene in schools,
in primary care, find other things so that we can get
to kids before they get to that level of crisis.
And so for us, you know,
we are expanding our intensive outpatient programs,
partial hospitalization programs,
embedding mental health in our specialty clinics,
embedding them in primary care,
and then really thinking about school-based clinics
and how can we again, kind of move further upstream.
So even while we're dealing with crisis now, trying to kind
of, in some ways hopefully prevent kind
of the next wave from coming.
And obviously the, the long-term implications for that.
- Couple other things, um, that, that are important
to also recognize is we need more research.
We need to understand if the interventions
that we're all working towards is really developing
a positive outcome for the kids.
The other thing is, is we can't solve this by ourselves,
as Jeff said, by the time the kids are coming
to our urgent care or our emergency departments, you know,
they're already in crisis.
So how do we work with schools and communities
and all these other resources that are available
and try to knit together a comprehensive system of care
so there's no wrong door, whether it's in the schools,
in the boys and girls clubs, wherever it happened to be.
And then I think the other thing
to consider is the financial picture.
'cause right now the reimbursement
for mental health services is not, does not have parody
with other types of things we treat kids for.
So we need to make sure that our insurance companies,
Medicaid and others understand
because unresolved mental health issues lead to cancer
and heart disease and some of these other things
that are catastrophic for our kids.
Uh, and again, if we can back it up and get to it
before it becomes a crisis, I think we'll have a better
stable of kids growing up
and doing all the things
that we hope they can accomplish. Mm-Hmm, ,
- Thanks Peggy.
And I think underpinning your remarks
is the point of access.
And I, I understand care access is such a
cornerstone of health equity.
Many leaders like yourselves are working hard
to expand access with renewed
and heightened focus on health equity strategies
for historically underserved populations.
Uh, Dr. Spear, if I can go to you first here,
how is Seattle Children's meeting the evolving needs
of patients, families and providers within its facilities?
And then what strategies do you use
to deliver specialized care across a, a really significant
and and large geographic region, like you highlighted
for us in your opening remarks?
- Yeah, it's, it's one of the great challenges and,
and really cool opportunities that we have to,
to think about how do we change kind of our delivery models
and, and kind of break down traditional systems
that we know have led to kind of disparities in access
or not being able to actually move our care
where we really want it to do.
So. Ma to your point, I mean, we're spending a lot
of focus thinking, again, you know,
we're historically children's hospitals where a lot
of like have everybody come to us, you know,
how can we actually move our care closer to families
and patients where they're at?
How do we center our communities in that care?
And I think that comes with everything from, you know,
where are we putting our specialty clinics, you know,
where are we putting our primary care offices?
Are we thinking about our brick
and mortar strategy in a way
that really has an equity lens to it?
And we're thinking about making sure
that we we're addressing where those, some
of those access deserts have been.
And I know like Peggy has done, you know,
we've opened up our community health clinics in areas where,
again, historically they might not have had that same access
and actually moved specialty care into those in a way that,
again, they don't have to come to the main hospital, uh,
to Seattle to be able to do.
And then to your point,
because of the, the large geography in some
of those distances, how do we use digital and
and technology to make sure that we're bringing access again
to communities that historically would've had to do,
you know, multiple hours drives to be able to get to
that our, our patients and families in Alaska
who are incredibly resilient
and creative around how they can access care.
So not only, you know, our clinics in Anchorage,
but how do we do more travel and outreach or use digital
and technology to be able
to move care closer to where they are?
And so we really to exactly to your point, it's,
it's really making sure that there is an equitable access
for kids and families, you know, where they need it.
And a lot of kind of getting out of our centric around
where our hospital is based
and how do we actually think about it more like an ecosystem
of care that's really out in our communities.
- Mm-Hmm. , - Peggy, different market for you,
but I imagine some similar challenges and goals.
Can you, can you talk to us a little bit about
what Children's Wisconsin is doing,
and then too, you mentioned research before.
Um, can you talk too about
how you see leaders better meeting not only care delivery,
but also training and research needs?
- So, a couple of things. First of all, I agree 100%
with Jeff is that we've got
to get ourselves out in those communities to understand.
I think one really important aspect
of this is also understanding
what the community needs and values.
And I'll give you a couple examples of that.
But when we think about what drives overall health, we know
that healthcare delivery is only a small part of it,
but it's, you know, that your genetics, the choices you make
and where you live, and when you start
to think about those aspects of overall health, you know, we
term it in whole child health, uh,
because we think about physical, mental, dental, social,
and you know, for instance, kids need food,
they need housing, they need transportation.
Uh, all these things play into how you can,
again, have healthy kids.
So we've gotta think more broadly about how we can, not
by ourselves, but solve for some of these issues
and partnering organizations.
We, uh, do food stability evaluation on all kids that come
through our specialty clinics and emergency room.
And we, it's amazing
how many families we find are actually hungry today.
Well, we can't be the food bank for all kids,
but we sure can find those resources in our community
and connect families, transportation, housing,
all these other aspects.
So really important
to think about it a little differently than how Jeff
and I were raised to think about pediatric healthcare.
Um, because we, we know
that we can only affect a very certain part of it.
Um, so I think that, you know, hospitals systems, I think
that insurance companies
and others are starting to take a more holistic view.
And I do think research is a very important part of it.
We know that we've got major gaps in health equity
and we know that what we do in one community
isn't gonna work in the other.
But the only way we could substantiate that is
by doing careful evaluation, understanding
what the community values,
and then doing the research to see did this work.
And it doesn't have to be basic science research,
it can be just research by gathering some data,
looking at outcomes
and doing A-P-D-S-A-P-D-S-A cycle so that you can change
the way you're doing things.
- Uh, let me turn to you here.
We just heard from Peggy and Dr.
Spearing a number of innovations tools
and how they're really thinking about this work when it
comes to access and equity.
What else would you add in terms
of things you're seeing other health systems leverage?
- Well, I think, um, just as a framing too, you know,
children's hospitals, the last two years probably have been
some of the hardest financial
and operational years for even the strongest organizations
with the healthiest balance sheets.
And I think that has led to a willingness maybe
to reconsider traditional approaches and,
and an openness to, we really do have to think about
how we restructure everything we do to meet the needs
of the community and our patients.
There's not one solution on this.
I, I think you have to do a lot of everything to try
and meet this because there's fewer
and fewer providers all the time.
And so much of this falls back on the freestanding
children's hospitals to, to be the safety net for, you know,
sometimes whole states or regions.
But I think, um, new bricks
and mortar access, um, so that to Jeff's point,
you don't have to drive downtown
for everything that has to happen.
Um, more virtual, uh, wherever it can be done,
a closer working relationship between the hospital
and the physicians, um, in their organization
and out in with community pediatricians to say,
how do we create more access?
How do we make it easier for patients
and families to get in to schedule their own appointments,
um, to make sure that we're, we're freeing up the time.
And, and then also how do we work across our specialists
to really deliver effective multidisciplinary care too?
So it's, um, you know, we can combine visits and, and,
and make sure that you're getting holistic care if patients
do have to travel, because we know, you know, in a lot
of markets and in a lot of rural areas, sometimes
if it's you have to get in the car and drive three
or four hours to go get care,
sometimes those kids just don't ever get seen to begin with.
- Well, Evan, Peggy, Dr.
Spearing, I wanna thank each of you.
I mean, this has been a real great opportunity
to get some high level thoughts
and observations from you about m
and a behavioral health access from the vantage point
of independent freestanding children's hospitals like yours.
Is there anything else that you weren't able to share yet
that you wanna make sure our listeners hear from you?
- Well, just a couple of things to reiterate.
You know, healthcare has changed tremendously over the last
several years, and especially since Covid.
I think that we've learned a lot to that.
I think our scope in children's hospitals is
so much larger than what the traditional concept
of a hospital was, uh,
because we have to move beyond our own walls
to really address kids' needs and,
and how we need to think about providing those services.
I think you have to diversify your portfolio
because we're seeing competition in new places.
You know, there's others entrance into healthcare that think
that they can do it better than we can.
And so making sure that we're staying on top of those,
but not overreacting to some
of the things that are out there.
Um, again, I can't emphasize enough of having a,
a strong balance sheet and making sure that you're able
to face the financial headwinds.
You know, when you think about the population
of kids we serve most of the children's hospitals, over half
of our patient base is on Medicaid and Medicaid.
Well, it's a, a great program to cover kids.
It only pays you a certain percentage of your cost.
So you've gotta be able to accommodate that
and then think about how else you're gonna balance out
that portfolio to make sure that you don't have to be
absorbed by a adult system.
And, you know, being very active in public
policy, kids don't vote.
And so we need to be that really strong voice to make sure
that our policy makers understand the needs and of kids
and how we can better work with them together to ensure
that these kids have everything they need from us.
- Yeah, and I mean, I would just add to what Peggy said.
I mean, we're always gonna take the opportunity
to be shameless advocates for kids and kids' health.
And to her point, you know,
children's hospitals have historically always been there
to take care of kids with the highest level
of acuity needs and most severe things.
But we really do wanna make sure that we're addressing
children's health broadly.
And it's, we care about it
because it's obviously something that we see every day.
But obviously as society,
we just always wanna remind everyone in healthcare
to not forget about the kids
because obviously, you know,
children's health issues today become adult health issues,
um, later and are much more expensive if we're not kind
of moving upstream in, in dealing with that.
And so, again, for all of us really trying to, to advocate
and make sure that we're thinking about
how do we put resources into improving the health
of our kids so that we all kind of have a healthier future
and a healthier tomorrow because of
that investment that we're making today.
- I just wanted to add that, um, I, I think these,
these children's hospitals are, um, tremendous assets
for the community and no one is as committed
to the mission like these organizations are.
So I think everything that Peggy
and Jeff highlighted about how you continue
to do this sustainably
and ensure that they, uh, continue to remain, um,
independent and vibrant,
I think is in the everybody's best interest.
- Thank you so much, Peggy, Dr.
spearing, Evan, for your time
and for this great discussion today.
We also wanna thank our podcast sponsor for this episode,
e EEC g Management consultants.
You can tune into more podcasts from Becker's Healthcare
by visiting our podcast page at becker's podcast.com.
Thank you.