1 00:00:00,620 --> 00:00:02,420 - Welcome to Healthcare Upside Down, a podcast 2 00:00:02,565 --> 00:00:05,185 by Becker's Healthcare and ECG management consultants in 3 00:00:05,185 --> 00:00:07,745 which we'll explore the upsides and downsides of healthcare 4 00:00:07,805 --> 00:00:09,345 and the industry's most current trends. 5 00:00:10,125 --> 00:00:12,145 I'm Molly Gamble, and today I'm joined by three guests, 6 00:00:12,235 --> 00:00:14,905 Peggy Troy, president, and CEO of Children's, Wisconsin. 7 00:00:15,445 --> 00:00:17,905 Dr. Jeff Speering, CEO of Seattle Children's Hospital, 8 00:00:18,365 --> 00:00:19,905 and Evan Lynch, throne principal 9 00:00:19,905 --> 00:00:21,545 of ECG Management consultants. 10 00:00:22,075 --> 00:00:24,305 Peggy, Jeff and Evan, welcome to the podcast. 11 00:00:24,555 --> 00:00:26,025 Thank you so much for joining us. 12 00:00:27,725 --> 00:00:28,805 - Absolutely. Thank you. - Thank you. 13 00:00:30,245 --> 00:00:31,295 - Well, to get us started, 14 00:00:31,475 --> 00:00:33,095 can you please introduce yourselves 15 00:00:33,115 --> 00:00:35,815 and share a bit more about your roles and organization? 16 00:00:36,305 --> 00:00:37,775 Peggy, can I turn to you first? 17 00:00:38,965 --> 00:00:40,215 - Sure. Hi. 18 00:00:40,355 --> 00:00:42,495 As I said, I'm Peggy Troy, uh, president 19 00:00:42,495 --> 00:00:45,455 and CEO of Children's Wisconsin in the Milwaukee area. 20 00:00:45,635 --> 00:00:47,295 And I have been at Children's, Wisconsin 21 00:00:47,395 --> 00:00:48,455 for the last 15 years. 22 00:00:49,795 --> 00:00:52,095 So, um, a little bit about children's. 23 00:00:52,555 --> 00:00:54,495 Uh, we have nearly 60 locations 24 00:00:54,495 --> 00:00:55,655 across the state of Wisconsin. 25 00:00:56,435 --> 00:00:58,575 So we have a hospital in Milwaukee. 26 00:00:59,035 --> 00:01:01,775 And then we have a hospital within a hospital up in the Fox 27 00:01:01,775 --> 00:01:05,375 Valley, which is a couple hours north of our organization. 28 00:01:05,755 --> 00:01:08,015 Our primary site, we have a surgery center. 29 00:01:08,475 --> 00:01:12,175 We have 22 primary care clinics, five urgent care clinics, 30 00:01:12,235 --> 00:01:13,775 and then several specialty clinics. 31 00:01:14,595 --> 00:01:17,295 Uh, we also have a robust community-based program 32 00:01:17,405 --> 00:01:18,935 that support and strengthen family. 33 00:01:18,995 --> 00:01:21,735 So we have child advocacy centers, school nurses, 34 00:01:21,835 --> 00:01:24,375 and community health navigators, safety 35 00:01:24,515 --> 00:01:25,655 and injury prevention. 36 00:01:25,715 --> 00:01:28,375 And then we also have the largest foster care 37 00:01:28,375 --> 00:01:30,935 and adoption, uh, program in the state of Wisconsin. 38 00:01:31,475 --> 00:01:33,775 We foster care case manage about 3000 kids. 39 00:01:34,675 --> 00:01:35,895 We also have a health plan, 40 00:01:35,995 --> 00:01:38,975 and we, uh, it's a Medicaid health plan plus a marketplace. 41 00:01:39,115 --> 00:01:41,535 And we insure about 150,000 members. 42 00:01:42,045 --> 00:01:45,295 It's a at full at risk program, uh, first dollar. 43 00:01:45,755 --> 00:01:48,175 We have more than 6.5 million connections 44 00:01:48,175 --> 00:01:49,175 with kids across the year. 45 00:01:49,835 --> 00:01:54,655 And, uh, so we have a big responsibility in terms of, uh, 46 00:01:54,655 --> 00:01:56,455 serving the kids of the state of Wisconsin. 47 00:01:56,735 --> 00:01:58,295 'cause we are the only independent freestanding 48 00:01:58,535 --> 00:01:59,775 children's hospital in the state. 49 00:02:01,235 --> 00:02:03,055 - Mm-Hmm. an important note. 50 00:02:03,055 --> 00:02:04,415 You ended on there, Peggy. Thank you 51 00:02:04,415 --> 00:02:05,775 for the introduction and overview. 52 00:02:06,235 --> 00:02:07,695 Dr. Speering, can we hear from you next? 53 00:02:08,405 --> 00:02:09,855 - Sure, absolutely. So, um, 54 00:02:10,195 --> 00:02:13,015 I'm Jeff sparing the CEO at Seattle Children's, 55 00:02:13,205 --> 00:02:15,215 have been here for, uh, eight years now. 56 00:02:15,215 --> 00:02:16,975 And so Seattle Children's, again, 57 00:02:16,975 --> 00:02:19,335 also an independent freestanding children's hospital with, 58 00:02:19,395 --> 00:02:21,255 uh, main hospital campus in Seattle. 59 00:02:21,755 --> 00:02:24,175 Um, but we have the incredible privilege of taking care 60 00:02:24,175 --> 00:02:27,215 of kids, uh, every day from four states, Montana, Idaho, 61 00:02:27,215 --> 00:02:28,535 Washington State, and Alaska. 62 00:02:29,195 --> 00:02:32,015 Our main hospital campus is, is obviously in Seattle. 63 00:02:32,395 --> 00:02:35,175 Um, but we have 43 different outreach sites throughout those 64 00:02:35,175 --> 00:02:38,135 other four states, bringing specialty care, hopefully closer 65 00:02:38,235 --> 00:02:40,815 to home and patients and families and, and where they live. 66 00:02:41,265 --> 00:02:44,175 We're also one of the five largest pediatric, 67 00:02:44,195 --> 00:02:45,535 uh, research institutes in the country. 68 00:02:45,635 --> 00:02:47,575 So every day, our team, um, 69 00:02:47,635 --> 00:02:49,335 not only thinking about cares today, 70 00:02:49,555 --> 00:02:51,295 but obviously looking for cures for tomorrow 71 00:02:51,395 --> 00:02:52,895 and how we continue to bring the best 72 00:02:53,155 --> 00:02:55,615 and most innovative treatments to kids in clinical trials. 73 00:02:55,675 --> 00:02:58,135 So we make sure that, uh, we're finding more cures 74 00:02:58,395 --> 00:02:59,405 for kids in doing that. 75 00:02:59,465 --> 00:03:01,645 And then an incredible foundation, uh, 76 00:03:01,645 --> 00:03:04,045 that really helps support our mission through philanthropy. 77 00:03:04,065 --> 00:03:06,405 And so like Peggy, all the way from primary care 78 00:03:06,425 --> 00:03:07,845 to the highest level of specialty care. 79 00:03:07,945 --> 00:03:09,045 But thinking about this 80 00:03:09,465 --> 00:03:11,885 and how we really center our work in our communities 81 00:03:11,885 --> 00:03:13,045 and improve children's health broadly. 82 00:03:14,145 --> 00:03:15,885 - All. - Thanks, Dr. Speering. 83 00:03:15,885 --> 00:03:17,405 And, and Evan, let's, let's hear from you. 84 00:03:18,725 --> 00:03:21,545 - Thanks. I'm Evan Lynch, throne of principal of ECG, 85 00:03:21,545 --> 00:03:24,425 which is a full service healthcare only consulting firm. 86 00:03:24,695 --> 00:03:26,305 It's been around for over 50 years. 87 00:03:26,725 --> 00:03:28,745 I'm part of our academic healthcare division, 88 00:03:28,925 --> 00:03:31,785 and I lead our firm's, uh, children's service line, 89 00:03:31,785 --> 00:03:35,385 which is a multidisciplinary group of consultants, uh, 90 00:03:35,385 --> 00:03:37,585 with focused experience working on the issues 91 00:03:37,615 --> 00:03:39,705 that pediatric organizations face. 92 00:03:39,845 --> 00:03:41,905 So I spend a lot of my time working 93 00:03:41,905 --> 00:03:43,905 with children's health systems on clinical 94 00:03:43,905 --> 00:03:46,105 and academic partnerships and affiliations 95 00:03:46,845 --> 00:03:49,425 and redesigning organizational structures 96 00:03:49,425 --> 00:03:52,185 to enhance the relationship between the children's hospital 97 00:03:52,205 --> 00:03:53,345 and the faculty practice. 98 00:03:55,025 --> 00:03:56,685 - Thanks Evan. Well, on, on the note 99 00:03:56,685 --> 00:03:59,325 of organizational structures, you know, let, 100 00:03:59,325 --> 00:04:01,285 let's talk about m and a and consolidation. 101 00:04:01,375 --> 00:04:04,005 We've seen hospital and health system consolidation. 102 00:04:04,115 --> 00:04:06,285 It's expected to continue its upward 103 00:04:06,285 --> 00:04:07,685 trajectory this coming year. 104 00:04:08,185 --> 00:04:09,925 And I'm curious, when we talk to leaders 105 00:04:09,945 --> 00:04:11,445 of independent freestanding children's 106 00:04:11,645 --> 00:04:12,845 hospitals like you, Peggy, and Dr. 107 00:04:12,845 --> 00:04:16,005 Spearing, how do you anticipate this trend will affect 108 00:04:16,165 --> 00:04:18,325 children's health systems, including your own? 109 00:04:18,735 --> 00:04:20,685 Peggy, can I turn to you first for your thoughts? 110 00:04:21,355 --> 00:04:22,885 - Well, that's a great question, Molly, 111 00:04:22,945 --> 00:04:25,645 and something that we ponder frequently within our own 112 00:04:25,645 --> 00:04:28,805 organization because we are watching, uh, carefully these 113 00:04:29,315 --> 00:04:32,645 mergers and consolidations of healthcare systems. 114 00:04:33,945 --> 00:04:36,925 We strongly believe as an organization, along with our board 115 00:04:36,925 --> 00:04:40,165 of trustees, that the best way to do the work that Jeff 116 00:04:40,185 --> 00:04:44,005 and myself do, both in not only the clinical care 117 00:04:44,025 --> 00:04:45,405 but the academics, the research, 118 00:04:45,585 --> 00:04:46,885 et cetera, is to stay independent. 119 00:04:47,275 --> 00:04:50,245 Because when you become absorbed within a large adult 120 00:04:50,245 --> 00:04:51,765 system, which Jeff 121 00:04:51,765 --> 00:04:53,445 and I have both been in that situation, 122 00:04:53,445 --> 00:04:54,525 you become a service line. 123 00:04:55,105 --> 00:04:58,165 So the allocation of resources is very competitive, 124 00:04:58,465 --> 00:05:01,605 and there are many ways in which we need 125 00:05:01,605 --> 00:05:04,845 to fund our missions, uh, in order to do it correctly. 126 00:05:04,985 --> 00:05:06,925 And so that independence allows you to do that. 127 00:05:07,585 --> 00:05:09,045 You know, and when we think about it, 128 00:05:09,045 --> 00:05:11,165 you've gotta have a very strong leadership team. 129 00:05:11,785 --> 00:05:13,685 You have to have a board of trustees 130 00:05:13,715 --> 00:05:15,165 that believes that as well. 131 00:05:16,065 --> 00:05:19,845 Uh, a strong strategic plan looking forward, knowing 132 00:05:19,875 --> 00:05:23,205 that independence is the goal, most importantly, 133 00:05:24,085 --> 00:05:25,965 a solid balance sheet in today's world. 134 00:05:25,985 --> 00:05:29,765 And the economy of healthcare is becoming very challenged, 135 00:05:30,115 --> 00:05:32,485 very differently than I think we've experienced in the past. 136 00:05:32,945 --> 00:05:34,565 So keeping a strong balance sheet 137 00:05:34,625 --> 00:05:37,685 and a positive margin is a way for us to, 138 00:05:37,745 --> 00:05:41,165 to remain independent, a strong academic partner 139 00:05:41,275 --> 00:05:42,365 with true integration. 140 00:05:43,065 --> 00:05:44,605 So you're operationally, financially 141 00:05:44,605 --> 00:05:48,325 and strategically integrated is another very important way. 142 00:05:49,105 --> 00:05:51,405 And then I think also having 143 00:05:51,405 --> 00:05:52,805 partnerships with adult systems. 144 00:05:53,695 --> 00:05:55,525 Pediatrics is becoming more 145 00:05:55,525 --> 00:05:57,260 and more constrained within adult systems. 146 00:05:57,525 --> 00:06:00,445 I think it's an opportunity for us to look for partners 147 00:06:00,665 --> 00:06:02,965 to help manage their pediatric service lines 148 00:06:03,505 --> 00:06:05,165 and provide some of the expertise 149 00:06:05,165 --> 00:06:08,005 that we experience in our institution so 150 00:06:08,005 --> 00:06:09,205 that we can serve more kids. 151 00:06:10,705 --> 00:06:12,285 - So Peggy, what I, what I'm hearing is it's really 152 00:06:12,285 --> 00:06:13,565 important that agility is important. 153 00:06:13,565 --> 00:06:15,405 You can move closer to the adult systems 154 00:06:15,505 --> 00:06:16,685 and to other systems systems, 155 00:06:16,685 --> 00:06:19,245 but being a free stand independent organization is 156 00:06:19,245 --> 00:06:21,245 so important when it comes to allocation 157 00:06:21,245 --> 00:06:22,445 of resources, like you said, 158 00:06:23,825 --> 00:06:25,205 - And talent - And talent. 159 00:06:26,045 --> 00:06:27,975 Jeff, what would you add? Do you see things any differently 160 00:06:27,975 --> 00:06:30,295 from Peggy or, or would you add a a different 161 00:06:30,295 --> 00:06:31,335 perspective to the conversation? 162 00:06:31,845 --> 00:06:33,295 - Yeah, no, completely agree with 163 00:06:33,295 --> 00:06:34,695 how you were certainly seeing, you know, 164 00:06:35,095 --> 00:06:37,455 continue obviously consolidation broadly across healthcare. 165 00:06:37,455 --> 00:06:39,295 And I think, you know, with that, the reality 166 00:06:39,295 --> 00:06:41,135 that doing pediatric care is actually is, 167 00:06:41,195 --> 00:06:42,535 is getting harder all the time. 168 00:06:42,955 --> 00:06:45,135 Um, and you know, everything from the complexity 169 00:06:45,135 --> 00:06:47,135 and acuity of, of pediatric patients 170 00:06:47,435 --> 00:06:48,735 to the financial constraints 171 00:06:48,735 --> 00:06:51,135 and pressures to, as Peggy mentioned, really, you know, 172 00:06:51,205 --> 00:06:53,215 some significant shortages in workforce. 173 00:06:53,355 --> 00:06:55,815 And so what's interesting to all of us is watching 174 00:06:56,115 --> 00:06:57,815 as adult systems consolidate, 175 00:06:57,815 --> 00:06:59,575 making the choices on their priorities 176 00:06:59,595 --> 00:07:01,735 and, you know, understanding that pediatrics and, 177 00:07:01,735 --> 00:07:04,135 and we're obviously also seeing this in, in women's health 178 00:07:04,135 --> 00:07:06,615 and obstetrics may not be one of those priorities. 179 00:07:06,615 --> 00:07:09,055 And so, you know, seeing community-based hospitals 180 00:07:09,055 --> 00:07:11,175 as they're coming into systems, dropping some 181 00:07:11,175 --> 00:07:12,455 of their pediatric services 182 00:07:12,515 --> 00:07:13,775 or some of their women's services, 183 00:07:14,195 --> 00:07:16,935 and as Peggy said, that's our, that's all we do. 184 00:07:16,935 --> 00:07:18,095 That is our priority. 185 00:07:18,095 --> 00:07:21,055 And so I think for us then looking at how can we help kind 186 00:07:21,055 --> 00:07:24,055 of fill that gap, or as Peggy said, I completely agree. 187 00:07:24,055 --> 00:07:25,495 How can we be the best partner to some 188 00:07:25,495 --> 00:07:28,175 of these adult systems, if, you know, for them pediatrics, 189 00:07:28,175 --> 00:07:29,535 you know, isn't something that they want 190 00:07:29,535 --> 00:07:30,615 to try to continue to do. 191 00:07:30,995 --> 00:07:32,935 How can we be that best partner to fill 192 00:07:32,935 --> 00:07:34,495 that need, you know, within the community? 193 00:07:34,795 --> 00:07:37,555 - Mm-Hmm. , - Well, Evan Perspectives out 194 00:07:37,555 --> 00:07:40,635 of the Milwaukee metro area and then Washington 195 00:07:40,775 --> 00:07:42,035 and its four state area. 196 00:07:42,185 --> 00:07:44,235 What, what, what are you seeing Evan, uh, in terms 197 00:07:44,235 --> 00:07:45,995 of what's unfolding across the industry when it comes 198 00:07:45,995 --> 00:07:47,955 to consolidation in children's hospitals? 199 00:07:49,865 --> 00:07:50,875 - Well, I think what Peggy 200 00:07:50,975 --> 00:07:53,075 and Jeff described is really 201 00:07:53,075 --> 00:07:54,915 what we're seeing across the country right now. 202 00:07:54,975 --> 00:07:58,235 And, uh, a lot of these smaller community-based pediatric 203 00:07:58,235 --> 00:08:01,725 programs are just facing tremendous challenges, 204 00:08:01,995 --> 00:08:04,685 remaining viable, but operationally and financially 205 00:08:04,995 --> 00:08:07,645 because it takes a certain level of volume 206 00:08:08,105 --> 00:08:11,245 and the access to pediatric specialists to really be able 207 00:08:11,245 --> 00:08:12,245 to deliver that care. 208 00:08:12,585 --> 00:08:16,325 And many are considering, whether they close altogether 209 00:08:16,585 --> 00:08:19,845 or, um, what we've seen more of, which is, you know, 210 00:08:19,845 --> 00:08:21,645 discussions on creative partnerships 211 00:08:21,645 --> 00:08:24,165 with children's hospitals, uh, to figure out ways 212 00:08:24,185 --> 00:08:26,685 to continue to provide those services in the community. 213 00:08:27,385 --> 00:08:30,285 And then I think even, uh, recently in the last few weeks, 214 00:08:30,335 --> 00:08:33,565 we've seen a pretty notable announcement of a, a merger 215 00:08:33,595 --> 00:08:36,045 between two freestanding children's 216 00:08:36,205 --> 00:08:37,405 hospitals, which is pretty uncommon. 217 00:08:38,555 --> 00:08:41,175 - Mm-Hmm, . - Well, when we talk, I think Dr. 218 00:08:41,175 --> 00:08:42,815 Spearing, you said, doing pediatric care is 219 00:08:42,815 --> 00:08:43,935 getting harder all the time. 220 00:08:44,635 --> 00:08:47,695 And one big headline under that umbrella 221 00:08:47,715 --> 00:08:49,975 of a statement is the mental health needs of children 222 00:08:50,075 --> 00:08:52,215 and how they've just been surging in recent years. 223 00:08:52,855 --> 00:08:54,575 I know your hospitals have been responding, 224 00:08:54,575 --> 00:08:56,005 both Seattle Children's 225 00:08:56,005 --> 00:08:59,045 and Children's Wisconsin have made some major investments 226 00:08:59,045 --> 00:09:00,605 to address the pediatric mental 227 00:09:00,745 --> 00:09:02,085 and behavioral health crisis. 228 00:09:02,855 --> 00:09:04,485 Peggy, can, can you describe for us 229 00:09:04,485 --> 00:09:06,285 what strategies you've put to use 230 00:09:06,465 --> 00:09:09,725 to deliver highly specialized in these needed services 231 00:09:10,065 --> 00:09:11,645 and what you've learned from the past couple 232 00:09:11,645 --> 00:09:13,405 of years in those investments? 233 00:09:14,915 --> 00:09:17,045 - Well, first and foremost, the need is 234 00:09:18,275 --> 00:09:19,925 just growing every single day. 235 00:09:20,145 --> 00:09:22,085 So a couple things we did, we have, uh, 236 00:09:22,155 --> 00:09:25,645 pediatricians 120 pediatricians in 22 locations. 237 00:09:26,545 --> 00:09:28,285 And at the time we did this evaluation, 238 00:09:28,285 --> 00:09:30,725 there were enough psych beds in our community for the kids. 239 00:09:31,465 --> 00:09:33,805 So we really felt we should take advantage 240 00:09:33,865 --> 00:09:37,405 of the touch points we have with, uh, primary care 241 00:09:38,065 --> 00:09:40,525 and really start way back with the kids 242 00:09:40,525 --> 00:09:42,005 because you can diagnose anxiety 243 00:09:42,005 --> 00:09:44,725 and depression in kids as early as two or younger. 244 00:09:45,425 --> 00:09:47,645 And so what if we had mental health workers working 245 00:09:47,645 --> 00:09:49,445 alongside of our pediatrician so 246 00:09:49,445 --> 00:09:53,805 that parents had immediate access to a resource so 247 00:09:53,805 --> 00:09:56,645 that they could begin the journey towards how 248 00:09:56,645 --> 00:10:00,565 to prevent catastrophic things from happening down the road. 249 00:10:01,145 --> 00:10:04,565 Uh, many complexities came into that, uh, in terms 250 00:10:04,565 --> 00:10:07,725 of the workforce and just, uh, in the state of Wisconsin, 251 00:10:07,745 --> 00:10:09,485 you have to sign a separate consent 252 00:10:09,485 --> 00:10:11,045 for mental health services, et cetera. 253 00:10:11,345 --> 00:10:12,685 But we've overcome a lot of that, 254 00:10:13,225 --> 00:10:16,285 and we're starting to see a real change in 255 00:10:17,305 --> 00:10:20,205 how parents perceive the need for mental health services 256 00:10:20,225 --> 00:10:21,885 and are willing to access it right there 257 00:10:21,885 --> 00:10:22,925 at the pediatric visit. 258 00:10:23,425 --> 00:10:25,765 The other thing we've opened up is five, uh, a couple 259 00:10:25,765 --> 00:10:29,765 of urgent care centers, uh, just for mental health so 260 00:10:29,765 --> 00:10:33,965 that the kids, the families can access that care immediately 261 00:10:34,345 --> 00:10:37,365 and not have to wait six months to get an appointment 262 00:10:37,365 --> 00:10:38,805 with a psychologist or psychiatrist. 263 00:10:39,065 --> 00:10:41,405 So we really believe that backing that up 264 00:10:41,985 --> 00:10:44,645 is really important in terms of changing the trajectory 265 00:10:45,705 --> 00:10:49,005 and making sure that we're helping kids grow up 266 00:10:49,005 --> 00:10:51,205 to be resilient, productive, and fulfill in their lives. 267 00:10:53,075 --> 00:10:54,255 - Thanks, Peggy. And, and Dr. 268 00:10:54,255 --> 00:10:56,535 spearing, can you describe Seattle Children's approach? 269 00:10:57,015 --> 00:10:59,935 I, I'm curious too, how you see Children's Health systems 270 00:10:59,935 --> 00:11:01,135 responding effectively 271 00:11:01,135 --> 00:11:04,095 and sustainably to the overwhelming community 272 00:11:04,095 --> 00:11:05,295 needs that have unfolded. 273 00:11:05,885 --> 00:11:07,415 - Yeah, no, it's a great question, ma. 274 00:11:07,475 --> 00:11:09,135 And to your point, the sustainability piece 275 00:11:09,135 --> 00:11:10,295 is such a key part of that. 276 00:11:10,315 --> 00:11:11,495 And obviously, you know, as members 277 00:11:11,495 --> 00:11:13,655 of Children's Hospital Association, you know, 278 00:11:13,655 --> 00:11:15,495 it is the number one thing that we're hearing from all 279 00:11:15,495 --> 00:11:17,695 of our Children's Hospital colleagues around the country. 280 00:11:17,795 --> 00:11:19,815 So this is not unique to any one of us. 281 00:11:20,315 --> 00:11:22,895 Um, and as you know, as, as Peggy said exactly right, 282 00:11:22,975 --> 00:11:24,655 I mean, the, the numbers are staggering. 283 00:11:24,955 --> 00:11:27,455 We were seeing the trend obviously developing even 284 00:11:27,455 --> 00:11:28,455 before the pandemic. 285 00:11:28,635 --> 00:11:30,215 Um, you know, we had doubled the number 286 00:11:30,215 --> 00:11:32,975 of inpatient psychiatry beds, you know, even before that. 287 00:11:33,075 --> 00:11:35,055 And in 2018, I kind of called 288 00:11:35,075 --> 00:11:36,855 for a moonshot in Seattle Children's 289 00:11:36,855 --> 00:11:38,055 around mental behavioral health. 290 00:11:38,075 --> 00:11:40,135 And I, I don't think any of us were even then prepared for 291 00:11:40,135 --> 00:11:41,375 what happened during the pandemic 292 00:11:41,875 --> 00:11:45,695 and kind of the, uh, kind of, you know, just amazing, uh, 293 00:11:46,055 --> 00:11:47,735 increase in not only just the volume, 294 00:11:47,875 --> 00:11:50,655 but the acuity of kids coming in, in crisis. 295 00:11:50,835 --> 00:11:52,935 And so I think the challenge that we've had 296 00:11:53,005 --> 00:11:54,925 as children's hospitals, as Peggy said, is we, 297 00:11:55,145 --> 00:11:57,045 we are always kind of that place of, you know, 298 00:11:57,045 --> 00:11:58,485 the highest level of care and crisis, 299 00:11:58,585 --> 00:12:00,365 and we're seen as kind of, you know, 300 00:12:00,365 --> 00:12:01,605 people that find solutions. 301 00:12:01,605 --> 00:12:02,925 And so we're seeing more and more kids 302 00:12:02,925 --> 00:12:05,845 and families coming to us kind of in that level of crisis, 303 00:12:05,985 --> 00:12:07,605 and we wanna be able to be there and, 304 00:12:07,625 --> 00:12:09,405 and have a level of access for that. 305 00:12:09,745 --> 00:12:12,125 But as Peggy described, what we'd all really love 306 00:12:12,125 --> 00:12:13,685 to do is move further upstream. 307 00:12:13,705 --> 00:12:16,885 And so we find ourselves kind of in this dual reality 308 00:12:16,985 --> 00:12:18,805 of having to navigate, you know, 309 00:12:18,805 --> 00:12:21,285 crisis care right now at levels that we've never seen. 310 00:12:21,705 --> 00:12:24,405 But then trying to think about how do we move resources, 311 00:12:24,625 --> 00:12:26,485 you know, to where we can intervene in schools, 312 00:12:26,545 --> 00:12:29,685 in primary care, find other things so that we can get 313 00:12:29,685 --> 00:12:31,805 to kids before they get to that level of crisis. 314 00:12:31,985 --> 00:12:33,445 And so for us, you know, 315 00:12:33,505 --> 00:12:36,325 we are expanding our intensive outpatient programs, 316 00:12:36,325 --> 00:12:38,045 partial hospitalization programs, 317 00:12:38,475 --> 00:12:40,765 embedding mental health in our specialty clinics, 318 00:12:40,765 --> 00:12:42,045 embedding them in primary care, 319 00:12:42,465 --> 00:12:44,285 and then really thinking about school-based clinics 320 00:12:44,285 --> 00:12:47,045 and how can we again, kind of move further upstream. 321 00:12:47,545 --> 00:12:50,165 So even while we're dealing with crisis now, trying to kind 322 00:12:50,165 --> 00:12:51,765 of, in some ways hopefully prevent kind 323 00:12:51,765 --> 00:12:53,565 of the next wave from coming. 324 00:12:53,665 --> 00:12:55,965 And obviously the, the long-term implications for that. 325 00:12:56,625 --> 00:12:59,165 - Couple other things, um, that, that are important 326 00:12:59,165 --> 00:13:02,285 to also recognize is we need more research. 327 00:13:02,585 --> 00:13:04,685 We need to understand if the interventions 328 00:13:04,685 --> 00:13:08,405 that we're all working towards is really developing 329 00:13:08,485 --> 00:13:09,725 a positive outcome for the kids. 330 00:13:10,185 --> 00:13:12,525 The other thing is, is we can't solve this by ourselves, 331 00:13:12,745 --> 00:13:14,965 as Jeff said, by the time the kids are coming 332 00:13:14,965 --> 00:13:18,445 to our urgent care or our emergency departments, you know, 333 00:13:18,445 --> 00:13:19,725 they're already in crisis. 334 00:13:20,185 --> 00:13:22,365 So how do we work with schools and communities 335 00:13:22,365 --> 00:13:24,285 and all these other resources that are available 336 00:13:24,705 --> 00:13:28,205 and try to knit together a comprehensive system of care 337 00:13:28,625 --> 00:13:31,125 so there's no wrong door, whether it's in the schools, 338 00:13:31,265 --> 00:13:33,525 in the boys and girls clubs, wherever it happened to be. 339 00:13:33,945 --> 00:13:35,005 And then I think the other thing 340 00:13:35,005 --> 00:13:36,325 to consider is the financial picture. 341 00:13:36,605 --> 00:13:38,565 'cause right now the reimbursement 342 00:13:38,565 --> 00:13:42,005 for mental health services is not, does not have parody 343 00:13:42,005 --> 00:13:45,165 with other types of things we treat kids for. 344 00:13:45,585 --> 00:13:48,125 So we need to make sure that our insurance companies, 345 00:13:48,365 --> 00:13:50,045 Medicaid and others understand 346 00:13:50,045 --> 00:13:53,845 because unresolved mental health issues lead to cancer 347 00:13:53,985 --> 00:13:55,765 and heart disease and some of these other things 348 00:13:55,765 --> 00:13:57,765 that are catastrophic for our kids. 349 00:13:58,305 --> 00:14:01,245 Uh, and again, if we can back it up and get to it 350 00:14:01,245 --> 00:14:04,365 before it becomes a crisis, I think we'll have a better 351 00:14:05,305 --> 00:14:07,245 stable of kids growing up 352 00:14:07,345 --> 00:14:08,645 and doing all the things 353 00:14:08,645 --> 00:14:11,285 that we hope they can accomplish. Mm-Hmm, , 354 00:14:11,865 --> 00:14:12,865 - Thanks Peggy. 355 00:14:12,865 --> 00:14:14,845 And I think underpinning your remarks 356 00:14:15,065 --> 00:14:16,285 is the point of access. 357 00:14:16,385 --> 00:14:18,645 And I, I understand care access is such a 358 00:14:18,795 --> 00:14:20,285 cornerstone of health equity. 359 00:14:20,675 --> 00:14:23,005 Many leaders like yourselves are working hard 360 00:14:23,145 --> 00:14:25,405 to expand access with renewed 361 00:14:25,405 --> 00:14:27,885 and heightened focus on health equity strategies 362 00:14:27,885 --> 00:14:30,445 for historically underserved populations. 363 00:14:30,985 --> 00:14:33,165 Uh, Dr. Spear, if I can go to you first here, 364 00:14:33,305 --> 00:14:35,925 how is Seattle Children's meeting the evolving needs 365 00:14:35,925 --> 00:14:39,285 of patients, families and providers within its facilities? 366 00:14:39,625 --> 00:14:41,365 And then what strategies do you use 367 00:14:41,425 --> 00:14:45,045 to deliver specialized care across a, a really significant 368 00:14:45,105 --> 00:14:47,405 and and large geographic region, like you highlighted 369 00:14:47,405 --> 00:14:48,605 for us in your opening remarks? 370 00:14:49,435 --> 00:14:51,445 - Yeah, it's, it's one of the great challenges and, 371 00:14:51,445 --> 00:14:53,685 and really cool opportunities that we have to, 372 00:14:53,705 --> 00:14:56,685 to think about how do we change kind of our delivery models 373 00:14:56,705 --> 00:14:58,445 and, and kind of break down traditional systems 374 00:14:58,555 --> 00:15:01,645 that we know have led to kind of disparities in access 375 00:15:01,705 --> 00:15:04,165 or not being able to actually move our care 376 00:15:04,165 --> 00:15:05,245 where we really want it to do. 377 00:15:05,305 --> 00:15:07,485 So. Ma to your point, I mean, we're spending a lot 378 00:15:07,485 --> 00:15:09,205 of focus thinking, again, you know, 379 00:15:09,285 --> 00:15:11,245 we're historically children's hospitals where a lot 380 00:15:11,245 --> 00:15:13,685 of like have everybody come to us, you know, 381 00:15:13,705 --> 00:15:16,965 how can we actually move our care closer to families 382 00:15:17,265 --> 00:15:18,485 and patients where they're at? 383 00:15:18,505 --> 00:15:20,485 How do we center our communities in that care? 384 00:15:20,545 --> 00:15:23,085 And I think that comes with everything from, you know, 385 00:15:23,085 --> 00:15:25,845 where are we putting our specialty clinics, you know, 386 00:15:25,845 --> 00:15:27,485 where are we putting our primary care offices? 387 00:15:27,705 --> 00:15:29,525 Are we thinking about our brick 388 00:15:29,525 --> 00:15:30,925 and mortar strategy in a way 389 00:15:30,925 --> 00:15:32,765 that really has an equity lens to it? 390 00:15:32,785 --> 00:15:34,205 And we're thinking about making sure 391 00:15:34,205 --> 00:15:35,965 that we we're addressing where those, some 392 00:15:35,965 --> 00:15:37,365 of those access deserts have been. 393 00:15:37,665 --> 00:15:39,205 And I know like Peggy has done, you know, 394 00:15:39,205 --> 00:15:42,005 we've opened up our community health clinics in areas where, 395 00:15:42,005 --> 00:15:44,165 again, historically they might not have had that same access 396 00:15:44,305 --> 00:15:47,405 and actually moved specialty care into those in a way that, 397 00:15:47,405 --> 00:15:50,085 again, they don't have to come to the main hospital, uh, 398 00:15:50,085 --> 00:15:51,405 to Seattle to be able to do. 399 00:15:51,825 --> 00:15:52,845 And then to your point, 400 00:15:52,845 --> 00:15:54,925 because of the, the large geography in some 401 00:15:54,925 --> 00:15:56,885 of those distances, how do we use digital and 402 00:15:56,885 --> 00:15:59,725 and technology to make sure that we're bringing access again 403 00:15:59,725 --> 00:16:02,005 to communities that historically would've had to do, 404 00:16:02,265 --> 00:16:04,765 you know, multiple hours drives to be able to get to 405 00:16:04,925 --> 00:16:06,605 that our, our patients and families in Alaska 406 00:16:06,985 --> 00:16:08,605 who are incredibly resilient 407 00:16:08,605 --> 00:16:10,885 and creative around how they can access care. 408 00:16:10,945 --> 00:16:13,405 So not only, you know, our clinics in Anchorage, 409 00:16:13,405 --> 00:16:16,165 but how do we do more travel and outreach or use digital 410 00:16:16,185 --> 00:16:17,685 and technology to be able 411 00:16:17,685 --> 00:16:19,085 to move care closer to where they are? 412 00:16:19,085 --> 00:16:21,285 And so we really to exactly to your point, it's, 413 00:16:21,285 --> 00:16:24,165 it's really making sure that there is an equitable access 414 00:16:24,185 --> 00:16:26,445 for kids and families, you know, where they need it. 415 00:16:26,505 --> 00:16:29,925 And a lot of kind of getting out of our centric around 416 00:16:29,925 --> 00:16:31,325 where our hospital is based 417 00:16:31,385 --> 00:16:34,085 and how do we actually think about it more like an ecosystem 418 00:16:34,105 --> 00:16:36,445 of care that's really out in our communities. 419 00:16:36,785 --> 00:16:39,805 - Mm-Hmm. , - Peggy, different market for you, 420 00:16:39,825 --> 00:16:42,245 but I imagine some similar challenges and goals. 421 00:16:42,425 --> 00:16:43,845 Can you, can you talk to us a little bit about 422 00:16:43,845 --> 00:16:45,685 what Children's Wisconsin is doing, 423 00:16:45,685 --> 00:16:47,405 and then too, you mentioned research before. 424 00:16:47,865 --> 00:16:49,005 Um, can you talk too about 425 00:16:49,265 --> 00:16:52,205 how you see leaders better meeting not only care delivery, 426 00:16:52,585 --> 00:16:54,485 but also training and research needs? 427 00:16:55,865 --> 00:16:58,725 - So, a couple of things. First of all, I agree 100% 428 00:16:58,795 --> 00:17:00,405 with Jeff is that we've got 429 00:17:00,405 --> 00:17:03,285 to get ourselves out in those communities to understand. 430 00:17:04,045 --> 00:17:05,725 I think one really important aspect 431 00:17:05,725 --> 00:17:07,485 of this is also understanding 432 00:17:07,485 --> 00:17:09,005 what the community needs and values. 433 00:17:09,105 --> 00:17:10,645 And I'll give you a couple examples of that. 434 00:17:11,465 --> 00:17:14,245 But when we think about what drives overall health, we know 435 00:17:14,315 --> 00:17:17,125 that healthcare delivery is only a small part of it, 436 00:17:17,185 --> 00:17:19,885 but it's, you know, that your genetics, the choices you make 437 00:17:19,885 --> 00:17:21,605 and where you live, and when you start 438 00:17:21,605 --> 00:17:25,085 to think about those aspects of overall health, you know, we 439 00:17:25,635 --> 00:17:27,925 term it in whole child health, uh, 440 00:17:27,925 --> 00:17:31,405 because we think about physical, mental, dental, social, 441 00:17:32,345 --> 00:17:35,045 and you know, for instance, kids need food, 442 00:17:35,475 --> 00:17:38,485 they need housing, they need transportation. 443 00:17:39,425 --> 00:17:41,925 Uh, all these things play into how you can, 444 00:17:41,975 --> 00:17:43,205 again, have healthy kids. 445 00:17:43,625 --> 00:17:47,165 So we've gotta think more broadly about how we can, not 446 00:17:47,265 --> 00:17:49,085 by ourselves, but solve for some of these issues 447 00:17:49,185 --> 00:17:51,005 and partnering organizations. 448 00:17:51,625 --> 00:17:55,245 We, uh, do food stability evaluation on all kids that come 449 00:17:55,245 --> 00:17:57,325 through our specialty clinics and emergency room. 450 00:17:57,865 --> 00:17:58,925 And we, it's amazing 451 00:17:58,985 --> 00:18:01,805 how many families we find are actually hungry today. 452 00:18:02,195 --> 00:18:04,285 Well, we can't be the food bank for all kids, 453 00:18:04,425 --> 00:18:07,125 but we sure can find those resources in our community 454 00:18:07,665 --> 00:18:10,445 and connect families, transportation, housing, 455 00:18:10,705 --> 00:18:11,725 all these other aspects. 456 00:18:11,825 --> 00:18:13,005 So really important 457 00:18:13,005 --> 00:18:15,165 to think about it a little differently than how Jeff 458 00:18:15,165 --> 00:18:17,325 and I were raised to think about pediatric healthcare. 459 00:18:17,985 --> 00:18:20,565 Um, because we, we know 460 00:18:20,565 --> 00:18:23,045 that we can only affect a very certain part of it. 461 00:18:23,785 --> 00:18:28,525 Um, so I think that, you know, hospitals systems, I think 462 00:18:28,525 --> 00:18:29,685 that insurance companies 463 00:18:29,685 --> 00:18:32,125 and others are starting to take a more holistic view. 464 00:18:32,865 --> 00:18:35,285 And I do think research is a very important part of it. 465 00:18:35,305 --> 00:18:38,485 We know that we've got major gaps in health equity 466 00:18:38,905 --> 00:18:40,925 and we know that what we do in one community 467 00:18:40,935 --> 00:18:42,045 isn't gonna work in the other. 468 00:18:42,465 --> 00:18:44,845 But the only way we could substantiate that is 469 00:18:44,845 --> 00:18:47,725 by doing careful evaluation, understanding 470 00:18:47,725 --> 00:18:48,805 what the community values, 471 00:18:49,345 --> 00:18:53,645 and then doing the research to see did this work. 472 00:18:53,905 --> 00:18:56,565 And it doesn't have to be basic science research, 473 00:18:56,625 --> 00:18:59,485 it can be just research by gathering some data, 474 00:18:59,485 --> 00:19:00,485 looking at outcomes 475 00:19:00,625 --> 00:19:04,965 and doing A-P-D-S-A-P-D-S-A cycle so that you can change 476 00:19:05,505 --> 00:19:06,525 the way you're doing things. 477 00:19:09,105 --> 00:19:10,285 - Uh, let me turn to you here. 478 00:19:10,305 --> 00:19:12,365 We just heard from Peggy and Dr. 479 00:19:12,365 --> 00:19:14,245 Spearing a number of innovations tools 480 00:19:14,265 --> 00:19:16,285 and how they're really thinking about this work when it 481 00:19:16,285 --> 00:19:17,405 comes to access and equity. 482 00:19:17,675 --> 00:19:18,845 What else would you add in terms 483 00:19:18,845 --> 00:19:20,965 of things you're seeing other health systems leverage? 484 00:19:22,495 --> 00:19:25,985 - Well, I think, um, just as a framing too, you know, 485 00:19:26,185 --> 00:19:29,305 children's hospitals, the last two years probably have been 486 00:19:29,305 --> 00:19:30,985 some of the hardest financial 487 00:19:30,985 --> 00:19:34,905 and operational years for even the strongest organizations 488 00:19:35,015 --> 00:19:36,505 with the healthiest balance sheets. 489 00:19:36,685 --> 00:19:40,905 And I think that has led to a willingness maybe 490 00:19:41,045 --> 00:19:44,065 to reconsider traditional approaches and, 491 00:19:44,165 --> 00:19:47,105 and an openness to, we really do have to think about 492 00:19:47,105 --> 00:19:50,305 how we restructure everything we do to meet the needs 493 00:19:50,445 --> 00:19:51,905 of the community and our patients. 494 00:19:52,375 --> 00:19:54,025 There's not one solution on this. 495 00:19:54,345 --> 00:19:56,545 I, I think you have to do a lot of everything to try 496 00:19:56,545 --> 00:19:58,065 and meet this because there's fewer 497 00:19:58,165 --> 00:19:59,705 and fewer providers all the time. 498 00:19:59,765 --> 00:20:02,545 And so much of this falls back on the freestanding 499 00:20:02,785 --> 00:20:06,345 children's hospitals to, to be the safety net for, you know, 500 00:20:06,345 --> 00:20:07,985 sometimes whole states or regions. 501 00:20:08,565 --> 00:20:10,745 But I think, um, new bricks 502 00:20:10,745 --> 00:20:14,185 and mortar access, um, so that to Jeff's point, 503 00:20:14,205 --> 00:20:15,665 you don't have to drive downtown 504 00:20:16,245 --> 00:20:17,705 for everything that has to happen. 505 00:20:18,125 --> 00:20:21,825 Um, more virtual, uh, wherever it can be done, 506 00:20:22,745 --> 00:20:25,745 a closer working relationship between the hospital 507 00:20:25,765 --> 00:20:28,185 and the physicians, um, in their organization 508 00:20:28,325 --> 00:20:31,585 and out in with community pediatricians to say, 509 00:20:31,585 --> 00:20:32,945 how do we create more access? 510 00:20:33,525 --> 00:20:35,705 How do we make it easier for patients 511 00:20:35,965 --> 00:20:39,025 and families to get in to schedule their own appointments, 512 00:20:39,685 --> 00:20:42,465 um, to make sure that we're, we're freeing up the time. 513 00:20:42,805 --> 00:20:46,625 And, and then also how do we work across our specialists 514 00:20:46,885 --> 00:20:49,885 to really deliver effective multidisciplinary care too? 515 00:20:50,025 --> 00:20:53,565 So it's, um, you know, we can combine visits and, and, 516 00:20:53,585 --> 00:20:56,845 and make sure that you're getting holistic care if patients 517 00:20:56,845 --> 00:20:59,365 do have to travel, because we know, you know, in a lot 518 00:20:59,365 --> 00:21:01,565 of markets and in a lot of rural areas, sometimes 519 00:21:02,465 --> 00:21:05,005 if it's you have to get in the car and drive three 520 00:21:05,005 --> 00:21:06,405 or four hours to go get care, 521 00:21:06,555 --> 00:21:09,325 sometimes those kids just don't ever get seen to begin with. 522 00:21:10,355 --> 00:21:11,885 - Well, Evan, Peggy, Dr. 523 00:21:11,885 --> 00:21:13,325 Spearing, I wanna thank each of you. 524 00:21:13,405 --> 00:21:15,245 I mean, this has been a real great opportunity 525 00:21:15,245 --> 00:21:16,765 to get some high level thoughts 526 00:21:16,765 --> 00:21:18,845 and observations from you about m 527 00:21:18,845 --> 00:21:21,405 and a behavioral health access from the vantage point 528 00:21:21,405 --> 00:21:24,245 of independent freestanding children's hospitals like yours. 529 00:21:25,065 --> 00:21:27,285 Is there anything else that you weren't able to share yet 530 00:21:27,285 --> 00:21:29,085 that you wanna make sure our listeners hear from you? 531 00:21:32,015 --> 00:21:34,105 - Well, just a couple of things to reiterate. 532 00:21:34,165 --> 00:21:36,545 You know, healthcare has changed tremendously over the last 533 00:21:36,735 --> 00:21:38,865 several years, and especially since Covid. 534 00:21:39,265 --> 00:21:40,545 I think that we've learned a lot to that. 535 00:21:41,305 --> 00:21:44,105 I think our scope in children's hospitals is 536 00:21:44,105 --> 00:21:46,985 so much larger than what the traditional concept 537 00:21:47,085 --> 00:21:48,505 of a hospital was, uh, 538 00:21:48,505 --> 00:21:50,705 because we have to move beyond our own walls 539 00:21:51,125 --> 00:21:52,985 to really address kids' needs and, 540 00:21:53,205 --> 00:21:55,865 and how we need to think about providing those services. 541 00:21:57,095 --> 00:21:58,975 I think you have to diversify your portfolio 542 00:21:58,975 --> 00:22:01,095 because we're seeing competition in new places. 543 00:22:01,995 --> 00:22:05,015 You know, there's others entrance into healthcare that think 544 00:22:05,015 --> 00:22:06,455 that they can do it better than we can. 545 00:22:06,795 --> 00:22:09,015 And so making sure that we're staying on top of those, 546 00:22:09,355 --> 00:22:11,415 but not overreacting to some 547 00:22:11,415 --> 00:22:12,495 of the things that are out there. 548 00:22:13,195 --> 00:22:16,135 Um, again, I can't emphasize enough of having a, 549 00:22:16,215 --> 00:22:18,895 a strong balance sheet and making sure that you're able 550 00:22:18,895 --> 00:22:20,375 to face the financial headwinds. 551 00:22:20,755 --> 00:22:22,495 You know, when you think about the population 552 00:22:22,495 --> 00:22:25,575 of kids we serve most of the children's hospitals, over half 553 00:22:25,575 --> 00:22:28,975 of our patient base is on Medicaid and Medicaid. 554 00:22:29,245 --> 00:22:32,175 Well, it's a, a great program to cover kids. 555 00:22:32,235 --> 00:22:34,215 It only pays you a certain percentage of your cost. 556 00:22:34,275 --> 00:22:36,375 So you've gotta be able to accommodate that 557 00:22:36,795 --> 00:22:39,815 and then think about how else you're gonna balance out 558 00:22:39,815 --> 00:22:42,095 that portfolio to make sure that you don't have to be 559 00:22:42,655 --> 00:22:44,055 absorbed by a adult system. 560 00:22:44,715 --> 00:22:46,495 And, you know, being very active in public 561 00:22:46,495 --> 00:22:47,775 policy, kids don't vote. 562 00:22:48,625 --> 00:22:51,725 And so we need to be that really strong voice to make sure 563 00:22:51,725 --> 00:22:55,005 that our policy makers understand the needs and of kids 564 00:22:55,065 --> 00:22:58,285 and how we can better work with them together to ensure 565 00:22:58,285 --> 00:23:00,365 that these kids have everything they need from us. 566 00:23:01,565 --> 00:23:03,695 - Yeah, and I mean, I would just add to what Peggy said. 567 00:23:03,695 --> 00:23:05,055 I mean, we're always gonna take the opportunity 568 00:23:05,055 --> 00:23:07,215 to be shameless advocates for kids and kids' health. 569 00:23:07,315 --> 00:23:08,695 And to her point, you know, 570 00:23:08,855 --> 00:23:11,175 children's hospitals have historically always been there 571 00:23:11,475 --> 00:23:12,975 to take care of kids with the highest level 572 00:23:12,975 --> 00:23:14,255 of acuity needs and most severe things. 573 00:23:14,255 --> 00:23:16,295 But we really do wanna make sure that we're addressing 574 00:23:16,935 --> 00:23:17,935 children's health broadly. 575 00:23:18,515 --> 00:23:19,935 And it's, we care about it 576 00:23:19,935 --> 00:23:21,815 because it's obviously something that we see every day. 577 00:23:21,815 --> 00:23:22,815 But obviously as society, 578 00:23:22,915 --> 00:23:24,735 we just always wanna remind everyone in healthcare 579 00:23:24,755 --> 00:23:25,895 to not forget about the kids 580 00:23:26,005 --> 00:23:27,535 because obviously, you know, 581 00:23:27,815 --> 00:23:30,375 children's health issues today become adult health issues, 582 00:23:30,755 --> 00:23:33,335 um, later and are much more expensive if we're not kind 583 00:23:33,335 --> 00:23:34,935 of moving upstream in, in dealing with that. 584 00:23:34,955 --> 00:23:37,975 And so, again, for all of us really trying to, to advocate 585 00:23:37,975 --> 00:23:39,455 and make sure that we're thinking about 586 00:23:39,715 --> 00:23:41,935 how do we put resources into improving the health 587 00:23:41,935 --> 00:23:44,575 of our kids so that we all kind of have a healthier future 588 00:23:44,575 --> 00:23:46,325 and a healthier tomorrow because of 589 00:23:46,325 --> 00:23:47,645 that investment that we're making today. 590 00:23:49,505 --> 00:23:51,825 - I just wanted to add that, um, I, I think these, 591 00:23:51,955 --> 00:23:54,785 these children's hospitals are, um, tremendous assets 592 00:23:55,045 --> 00:23:59,345 for the community and no one is as committed 593 00:23:59,365 --> 00:24:01,625 to the mission like these organizations are. 594 00:24:01,765 --> 00:24:04,025 So I think everything that Peggy 595 00:24:04,205 --> 00:24:06,585 and Jeff highlighted about how you continue 596 00:24:06,585 --> 00:24:07,825 to do this sustainably 597 00:24:07,885 --> 00:24:11,065 and ensure that they, uh, continue to remain, um, 598 00:24:11,255 --> 00:24:12,425 independent and vibrant, 599 00:24:12,745 --> 00:24:14,785 I think is in the everybody's best interest. 600 00:24:16,425 --> 00:24:17,815 - Thank you so much, Peggy, Dr. 601 00:24:17,815 --> 00:24:19,095 spearing, Evan, for your time 602 00:24:19,115 --> 00:24:20,415 and for this great discussion today. 603 00:24:20,835 --> 00:24:23,615 We also wanna thank our podcast sponsor for this episode, 604 00:24:23,815 --> 00:24:25,335 e EEC g Management consultants. 605 00:24:25,675 --> 00:24:28,175 You can tune into more podcasts from Becker's Healthcare 606 00:24:28,235 --> 00:24:31,255 by visiting our podcast page at becker's podcast.com. 607 00:24:31,465 --> 00:24:31,895 Thank you.