- Prepare to dive into the forefront
of healthcare innovation at our 14th annual meeting coming
up on April 8th
through 11th at the Hyatt Regency in Chicago, with thousands
of industry leaders converging over four dynamic days
of discussions on crucial topics from health IT
to executive leadership.
It's where the future of healthcare takes shape.
We can't wait to connect with you in person
and engage in these important conversations.
- This is Chris. So with the Becker's Healthcare Podcast,
I'm thrilled to be joined by Dr.
Arturo Brito, president
and Chief Executive Officer of the Children's Health Fund.
Arturo, thank you for joining us today.
- Thank you for having me, Chris. Pleasure to be here.
- Arturo, would you please introduce yourself
and tell us a bit more about your background?
- Yeah, so I'm, I'm a community pediatrician
with a population health focus.
I received my medical degree from the University
of South Florida College of Medicine.
Uh, completed my pediatric residency, um,
at Emory University
and affiliated hospitals in Atlanta, Georgia,
including at Grady Memorial Hospital,
the Safety Net Hospital, uh, for Atlanta.
I then went on as I was working as a community pediatrician
to receive my master's
of public health degree from the University
of Miami Miller School of Medicine.
As you said, I'm president
and CEO of Children's Health Fund.
I rejoined the fund back in September of 2021,
a little over two and a half years ago, um,
having previously served of between 2006
and 2011 as Chief Medical Officer.
Uh, and those approximately 10 years in
between those two roles of the current one.
And the previous one, I served as deputy commissioner
and lead physician, uh,
for the New Jersey Department of Health.
Then went on to become the executive director
of the Nicholson Foundation,
a family foundation focused on early childhood
and healthcare in New Jersey.
Um, so my clinical
and leadership career has always been focused on underserved
populations and healthcare equity.
Um, immediately after residency,
I worked in southwestern Alaska
for the Indian Health Service, providing care to UIC people,
a native Alaskan population,
living in ro remote areas of the state.
Quite an experience I've learned a lot there about
what it means to be a marginalized population, what it means
to live in a remote part of the country, that access
to healthcare is a big challenge.
You know, after that, I spent the next 11 years
as the medical director
of the South Florida Children's Health Project.
This is one of the early partnering program
of Children's Health Fund,
and a continues to be one
of now 24 programs in 15 states, Puerto Rico
and Washington dc um, that form our national network.
Um, throughout our network, we provide care
to more than a hundred thousand, uh, individual children
every single year through nearly 500,000 clinical visits
on mobile clinics via telehealth.
And at more than 400 schools
and other community sites, four out of five kids served
by our national network are black
or brown, all live in low income households.
Um, so like many of our other partners,
when I was in South Florida, we had a custom design,
38 foot long mobile medical clinic,
a doctor's office on wheels, if you will.
Um, this was my medical office.
I worked alongside mental health providers, social workers,
nurses, nutritionists
and others, uh, to provide comprehensive healthcare
for children growing up in under-resourced communities
throughout Miami-Dade County.
It was also a great opportunity to teach medical students
and residents who rotated on that, uh, uh, mobile clinic
and throughout our sites on a regular basis.
And this is University of Miami's, uh, teaching program
for community pediatrics.
Um, so my diverse leadership
and clinical experience, um, helped me in my current role
as president and CEO of CHF.
It's really about carrying forward a more than 36 year
history of chfs values about focus on
under-resourced communities and marginalized populations.
What's most important to us is that we believe
that every child in this country,
every child in the United States, deserves quality.
And I emphasize the word quality here, right?
Healthcare, you know,
our current strategy builds on the more than 36 year
history of innovation.
Um, the use of a mobile clinics as a pediatric medical home,
for example, was unique in 1987 when we began,
and when we established
and used the first one to serve children
and families living in squalor
and deplorable conditions in homeless
shelters throughout New York City.
We continue that work today throughout, um, uh,
New York City, uh, in those mobile clinics, uh,
through our flagship pro program,
the Bronx Health Collective,
who also have a state-of-the-Art, uh,
fixed site clinic in the South Bronx, uh, hunts Point, one
of the poorest congressional districts in the country.
We were also at the forefront
of developing electronic health records as early as 1989
to ensure that healthcare services were comprehensive
and included social drivers of health.
We didn't call it that back then,
but they were social drivers of health, such
as addressing food insecurity,
transportation needs, and housing.
We've also developed the award-winning education materials
such as our Asthma guide that make it easier for parents
and physicians alike to follow evidence-based
national guidelines to better control this chronic disease
and help children stay active
and out of emergency rooms and hospitals.
In short, because our focus has always been about working in
under-resourced communities, working
to serve underserved populations
and marginalized populations, we've been able
to really create this niche of really ensuring that
as many kids in this country as possible,
getting the quality healthcare they they need
and deserve to thrive and succeed.
Um, in 2000, uh, 14, to continue our innovations,
we developed and established healthy and Ready to learn.
This is a program that addresses health barriers
to learning within the school setting.
Um, I would give a little more detail about that later
because it's one of our goals this year to grow
that program, not only within New York City
where it currently exists, but
outside New York City and into other states.
Um, and just a few years ago,
we developed our community health equity
and engagement roundtables.
This is all about really listening to community members, uh,
including youth, not just necessarily patients,
but community members who really understand, have a pulse
of what's going on in their community
and to drive programs that serve their needs.
Um, and it's, everybody talks about, uh, equity
and everybody talks about creating a voice.
Uh, we're actually walking the walk here
with our Chairs program.
Uh, so I often get asked, you know,
what drives me to do this work?
Why have I, I spent my entire professional career focused
on children living in under-resourced communities.
Well, I'm an immigrant myself from Cuba VI Nicaragua,
initially Columbus, Ohio, if you can imagine that.
Back then, we were one of the first
Latino families in that part of the country.
Uh, when I was seven years old, you know, I saw firsthand
what it's like to be discriminated against
not having access to quality of healthcare.
And I watch how my parents had to work, as they say, twice
as hard to get half as far.
And I also want to make sure I build on that to make sure
that all children in this country have the
opportunity to thrive and succeed.
- Arturo, given the vast scope of your career already,
and who knows what's, what's ahead really,
and given the scope of what the Children's Health Run wants
to do, it certainly seems like they have the right person
in in that position.
Uh, you touched on some of the organization's goals.
Uh, would you mind right now getting into the top three
goals that you have for just this year?
- Yeah, yeah. So, first off, okay, uh, we want
to increase the number of children served
by our national network.
Um, eventually we wanna get to at least 150,000 children,
uh, annually.
Right now, this last year, we're at 118,000.
So over the next few years, we wanna increase that.
So our goal is to get more resources
so we can expand our network, both, uh, adding new partners,
but also giving more resources
to our current partners so they can see more children.
The need is definitely out there. Okay. So that's one goal.
The other one is we know there's a huge mental health crisis
with our youth and children.
There's no question about that.
There's a lot of evidence and, and, and data around that.
So, we wanna expand our integrative mental health services
through our mobile clinics, through telehealth
and at school-based centers that, uh,
our national network partners, uh, serve.
Um, and like I said, we wanna duplicate our Healthy
and Ready to Learn program to school
districts beyond New York City.
So, I wanna talk a little bit about that program.
If, if it's okay, Chris, um, you know, this unique program,
it, it, it, and I wanna talk about it
because it's being requested from our partners
and others from around the country about
how they can duplicate it.
Well, our Healthy
and Relearn program is built around addressing health
barriers to learning within the school setting.
What this means is if a child has asthma
that's uncontrolled,
we make sure they're getting their medication
and have the right provider
so they can focus more in school, stay outta the hospital
and not miss so many school days.
'cause we know, uh, that's a big reason
kids miss, uh, school.
Another reason kids miss school a lot is
because of dental issues.
Te uh, they, they have problems with, uh,
oral health issues like, uh, cavities that are causing a lot
of pain, abscesses, et cetera.
So we wanna make sure that kids have dental services,
and I don't mean just screening,
but actually taking care
of the dental problems in the school setting,
particularly in the poorer parts
of the country under-resourced communities.
Um, in this case, in New York City, right now,
we're in the Bronx, the South Bronx,
but we want to go elsewhere,
and we're looking at, uh, expanding it in New Jersey
and maybe other parts of the country.
But we believe this program has a big chance
of becoming something that could be a model program
to tie in to bridge, if you will, the health
and educational sectors
that are often live in their own silos.
And among the biggest issues is something I already
mentioned about the growing mental health crisis.
We need more mental health providers,
we need more mental health services, uh, whether
through telehealth or in school settings at the school sites
where healthy and ready to learn are,
this is the biggest request we get from the teachers,
the principal, and other school personnel,
because a lot of the kids that we see have a lot
of trauma in their lives that has been exacerbated
during the COVID-19 pandemic and surrounding social issues.
Um, and then the,
so those are the three goals, just to reiterate.
So we wanna increase the number
of children served by our national network.
We wanna expand our integrative mental health services,
and we want to take our healthy and regular Learn program
and replicate it in school districts outside
of New York City and throughout the country.
Um, we're looking for the resources to do that.
So it all takes resources,
but in the end, those resources will pay dividends
because the kids will be healthier.
So the communities are healthier,
and our country as a whole is healthier.
- Thank you, Arturo. I'm sure anyone who has a child
or is simply interested in the mental health
of their community is behind the goals that you guys have.
Uh, you mentioned a little bit about the partnerships
that the Children's Health Fund has.
So at this time, um, I'd like you, if you don't mind, uh,
to get into the main benefits of these partnerships as far
as your organization is concerned.
And how can leaders of other organizations
see if they're a good fit and maybe work
with the Children's Health Fund?
- Yeah, so I,
I learned a lot about this when I was at the Nicholas
Foundation, and we, we worked hard, um,
in partnering with the government sector,
New Jersey State Government in that case, you know,
government has a broader reach than the private sector.
So that's the advantage of working with government.
You may have a great idea, you may have a great program,
but you can reach a lot more people by partnering
with the right government agency at the right time.
The private sector can bring innovation and more depth
because government often doesn't have the
personnel be able to do that.
Um, so they have the broader reach.
Private sector can bring the innovative ideas and depth.
Um, so when design right,
they can compliment each other, right?
Having worked in both sectors, I understand
that it takes a certain patience
and strategic thinking to make it work.
Um, so when I was the Nicholas Foundation, uh,
we worked not only with the government sector,
but we also work with other private, um, not-for-profits
to unite our resources to do
demonstration models that would lead to, uh,
changes in systems.
In fact, that the Nicholson Foundation are, tagline wise,
change in systems, changing lives.
We wanted to change systems,
so our investments would have long-term
and sustainable impact.
I can give you a couple of examples.
One of the things we did, we did a demonstration model on
the value Okay.
Of community health workers for the state of New Jersey.
Um, and what that led to was eventually
after a two year, uh,
demonstration model alongside other foundations, was that
like we have seen around the country, uh,
there was an improvement in healthcare outcomes.
There was a decreasing of disparities
and lowering of healthcare costs by the,
with the use of community health workers.
And eventually, uh, New Jersey, like a lot
of other states have done, moved to, uh, reimbursing
through Medicaid for community health workers forming
and establishing a community health worker training
institute, um, that would really follow
what we did together there.
So that's one example.
So again, the potential impact of that institute
is, you know, population
of New Jersey, about 9 million people.
It could potentially reach, you know, millions
of those people, particularly those
that are on the lower income level
and that need those services.
Um, so what I would say
to somebody about other organizations,
and we actually put together, um, a, a, a guide on this,
if you will, at the Nicholson Foundation, glad to share
with anybody if they want to contact us about how
to know if you're ready to do this
and how you can assess it,
and how do you know if the government entity is ready?
Well, I think you have
to have both partners interested in making
that long-term impact
and ready to let go of, of a lot
of their preconceived notions about each other
and figure out what strengths each has in that case.
But again, generally speaking, government has
a broader reach that can reach more people,
and the private sector can bring the innovation, uh, to them
and working together, they can really, uh,
have substantial impact.
What I would also say in Encourage is
for not-for-profits out there that are writing the checks
for organizations, um, to do the work is to work
with other not-for-profits,
because that makes it easier for government too.
If they have one body of people working together as opposed
to five different entities coming to them at different times
with similar ideas or even the same idea.
It's a lot easier just to work with one,
because people in government are generally very, very busy
and o overworked and understaffed.
So I would just suggest that, so to know if you're ready,
if you're ready to make those changes and understand,
and these things take time, they take a few years,
you're not gonna get the same result.
But eventually that result will be longer lasting
and have more depth, uh, and a broader reach.
- That definitely makes sense. Arturo,
and I'm glad you mentioned the innovation elements of this.
That leads me to my next question,
and that is, in terms of technology, I mean,
everyone these days inundated with AI or virtual reality
or telehealth or anything else
that is just flooding the industry at the moment.
So what technology excites you most in terms of helping,
uh, assist communities and the organization's mission?
- Yeah, so there's a lot going on,
and I'm gonna say this about Children's Health Fund,
and we've had a long history of being at the forefront
of using technology for under-resourced communities
and underserved populations.
It's really important that this didn't
just start when I arrived.
In fact, when I was in South Florida Children's Health
Project, serving as a medical director working there, uh,
I recall that, uh, children's Health Fund,
think about this on a mobile clinic,
they had developed these third iteration, I believe,
of an electronic health record
that we could use on mobile clinics, even in areas
where access to wifi was limited.
Um, it was as effective as it could be,
but they were at the beginning, 1989,
as far back developing their first set
of electronic health records.
And the reason CHF has been at the forefront is
because of our focus on populations that frankly, a lot
of people have forgotten about or don't care about.
Um, and we needed those tools.
You can't carry around paper charts on mobile
clinics, you, there's a limit.
So that was one of the, um, reasons that that was developed,
but also because they, the type of people that come to work
for Children's Health Fund, like our current, uh,
vice president, uh, of our innovation lab,
something we developed last year, uh, Jen Pruitt, um,
you know, these are people that have it in their heart, uh,
to do the right thing for every child in this country
and also have, have the brain.
She's wicked smart and very creative about
how we approach things, uh, often
with limited resources in the communities we serve.
So, to answer your questions, I'll just give you some
of the potential, uh, projects of our innovation lab
or things we're working on
and looking for the resources to work on, um,
health education apps.
Like I mentioned before, we have award-winning education
materials that we've developed over the years,
and they're award-winning
because they are written at a level that anybody, anybody,
even me as a pediatrician who I've read all the, uh,
national guidelines, my goodness, you know,
I've used these materials forever since I worked on
that mobile clinic in South Florida.
It just makes it so much easier, less complicated,
and more direct to make sure
that kids are getting the asthma care they need and deserve.
We want to take, uh, those, these,
those education materials and turn 'em into apps.
Just about anybody now has access to smartphones
or a phone that they can easily look at an app so
that parents and their pediatrician,
their child's pediatricians alike,
can follow along together, uh,
and make sure that the children are receiving their, um,
you know, the medications they need to control their asthma,
keep 'em outta the hospital, keep 'em healthy,
and keep 'em in school, right?
Um, so that's one example.
There's other health education apps we'd like to develop.
What we're interested in morning thing is this digital
divide that I worry, worry, uh, you know, you talk about ai,
but who's gonna benefit from AI most
and who is gonna bear the burden?
I worry, like a lot of things have happened historically
that certain populations reap the benefits of advance
of technology and other populations actually don't read the
benefits, and even worse, they often bear the burden.
We wanna make sure that the digital divide, we have, um,
we do our part to make sure our, uh, service sites are
not, uh, excluded from any of the benefits that AI has
to offer or any other technological advances.
So one example is with our Healthy
and Ready to Learn, uh, program that I talked about
before, we've also created a resource
and training center to make, uh, quality materials, uh,
available to educators, health staff,
and school health advocates, even in schools we're not, uh,
physically in, uh, so that we can support their work
and ensure students are healthy and ready to learn.
Um, we're gonna, we want to continue
to develop this resource center, um,
adding new target audiences topics and interactive tools.
Um, so we also wanna produce a national child health
resource and training center, um, along those same lines
that this will provide a platform for materials
and information sharing, uh,
across disciplinary collaboration
and other interactive tools, um, directed though
to physicians and residents serving
under-resourced communities.
So, um, those are the main things we're
focused on for this year.
But I believe this innovation lab, you know,
the sky's the limit on it, uh, with the right resources
and with our leadership that we have here and, um,
and the dedication that we have
for the populations we serve.
- Uh, thank you, Arturo. It just seems
so simple the way you put it in terms of, Hey,
here's this healthy and ready to learn program
so we can keep kids, give them the very basics, right?
Let's keep them in the classroom.
And sometimes it's more difficult than it might seem,
certainly in these communities
that you're trying to help the most.
Les you did mention mental health,
and certainly that is on everyone's mind.
Don't real pun intended in that way.
Um, but yeah, if you don't mind getting into a little bit
about, about
how Children's Health Fund can go about
addressing that in communities.
- Yeah. So we know we have a huge mental health
crisis, okay?
We also know that, um,
even if you have all the money in the world,
there aren't enough right now enough, uh,
mental health providers for every community in this country.
Um, the problem is even more staggering for, uh,
marginalized communities,
marginalized populations like the L-G-B-T-Q, uh, children
and youth in our country, uh, that we have a number
of programs that are serving them.
Um, so there's, there's a couple things I wanna say about
how improving communities mental health, um,
you know, what we can do.
And I also wanna talk about advocacy
because I haven't talked about how we translate, uh,
lessons learned on the ground into, um, informed policy
and advocacy to make the right changes.
So, let, let, let's let, let me start first with what we do
through our national network
and through our healthy and learning program.
So we bring mental health
and other services directly into communities with the use
of mobile clinics, telehealth,
and through school-based clinics.
Okay? Um, we're also advocating for change at these clinics
and in schools in particular, uh, for
states around the country.
And some have moved in this direction to adopt, uh,
what is referred to as the, uh, CMS
or the Centers for Medicare
and Medicaid Services Administration,
the Federal Administration, uh, free care rule reversal.
What this refers to is back in 2014, CMS, um,
allowed now, uh, for the reimbursement
of services, clinical, medical,
mental health, and others in the school settings to expand
beyond just children on individualized education, uh,
programs or plans, right?
Um, in the past, before 2014, uh,
CMS would only allow you to get reimbursed
as a provider in a school setting to, um,
for children who were on those plans.
And that's about 18% very state to state,
but about one in five children, uh, that are on that plan.
So basically, you were excluding four outta five, uh,
kids from getting me needed services like mental health,
which is one of the biggest requests we get.
And since 2014, they said, oh,
now you can, uh, change that.
But it's up to each state.
We're working right now in New York to, uh,
have the Medicaid office adopt that change.
Uh, we're like to go to other states like New Jersey
that haven't adopted that change.
A little over 20, I believe at
to this date, have adopted that.
But there's a lot of states that haven't,
and we believe that's the starting point for widening.
Um, the access to mental health services
for kids they spend most of their day in school, why not,
uh, allow providers to go there to do that?
And it should be available both in person and telehealth.
Telehealth is a great way
to reach more kids when you have a diminished number
of mental health providers at the moment.
Um, and in youth in particular, they are teen, preteen,
teen and, and young adults.
It's been shown over
and over to be widely effective, just as effective in many,
most cases, as in-person.
Um, I also wanna say something else about the message
that we send communities
by bringing our mobile clinics into them.
Um, you know, one thing that's anecdotal
and something that I wish, uh, we could quantify,
uh, better, um, is that there's a subtlety
to the use of mobile clinics as a very intimate way
of providing healthcare in a community.
It forces you as a provider to really understand
and listen to those community needs, something
that we truly value here.
It also sends a message to the school
or other community sites you park at, that
you really do care about that community,
and it really helps build relationships, particularly with
teachers, um, and other staff at schools.
So, in a subtle way, it also helps
with the mental health aspect
of the needs of that community.
Now, having said that, we need to figure out as a country
how we're gonna have more providers of mental health.
And we, on our advocacy side, you know,
bringing services directly to community sites with the use
of mobile clinics, with telehealth or at schools
and advocating for more mental health, uh,
services in school settings, particularly,
is gonna go a long way to improving, uh, the health
of children in the under-resourced communities.
So we also need to look beyond traditional model, where I,
as a pediatrician, see a child with a behavioral problem
or a mental health issue,
and then refer them out to a mental health provider.
That model has a lot of challenges,
even though it's gotten better over the years,
there's still a lot of stigma
around mental health providers, transportation issues,
getting to mental health providers, scheduling issues,
and so on so forth that we all know about, right?
A better model is to have mental health providers
that are part of a healthcare team,
just like we did in South Florida,
just like our national network partners, um, continue to do.
For instance, I worked alongside,
uh, I can still remember Dr.
Christina, we called her a psychologist, and she
and I would just see patients sometimes together.
And there was a part where people would say,
wait, who's the pediatrician?
Who's the psychologist? Who's the best compliment?
Because I learned a lot about mental health
and behavioral issues in children,
and she learned a lot on the medical side.
And to work as a team in an integrative model like
that is gonna, uh, be a lot more effective.
It doesn't mean that every patient
needs a mental health provider.
It doesn't mean that every patient
that needs a mental health provider is gonna see
that psychologist, but she can make a better determination
and advise parents and,
and through this process also reduce any stigma
that is still out there about mental health,
particularly in a lot of the populations we see,
even though, uh, again, things have gotten better,
there's still populations out there that, uh,
they don't want people to know
they're seeing a mental health provider.
So that's integrative models like that.
And then the use of telehealth, like I said earlier,
increasing that because you can see a lot more kids,
particularly our youth, um, uh, through that model,
that it can be very effective.
And there's also, um,
developmental models like Healthy Steps
where a developmental specialist is integrated into, um,
the healthcare team
and where they can identify developmental issues in babies
and toddlers at a much earlier age, uh, than most
of us would in the traditional healthcare setting,
and refer them to the right places.
And then guide the parents about
what they can be doing at home
to stimulate their child's, uh, development.
Um, so we have to look at different models,
but then there's also what we refer to as community health.
You know, we need to work together
with the communities we're in,
and we're doing that in places like Baton Rouge
where they're working with the local police department,
for instance, um, to really, uh, build safer areas
and address safety issues that really add
to the trauma a lot
of kids are under right now, and families.
Um, and we need to be talking about that
and working with, um, you know, local police departments,
working with educators to destigmatize mental health issues,
lessen the trauma by creating safer spaces for children, uh,
and families, uh, to live, work, learn, play, uh,
and just, you know, be themselves.
- Ur thank you for being so generous with your time
and insights today.
We absolutely cannot wait to share them with the audience,
and we look forward to connecting with you soon.
- Well, uh, thank you Chris.
And you know, I, I don't know if you have,
if you can do this, but if you, if, if those listening want
to know more and have more information about us, I,
we're all on social media follow Children's Health Fund.
You can find us just by Googling, uh, children's Health Fund
and we're on LinkedIn, Facebook X,
formerly Twitter and Instagram.
Um, and you can also visit our website,
children's Health Fund, no,
apostrophe children's health fund.org,
and you can learn more about us.
And, uh, I, I appreciate the time with you
and, uh, it's really my pleasure to have been here.
Thank you.