As a pediatric surgeon for 25 years, Larry Moss, M.D., has worked in one of the most lucrative lines of business a hospital can have.
And that has bothered him—a lot.
"It's driven me crazy that the incentives of our system are so misaligned," said Moss, the newly minted CEO of Nemours Children's Health System. He previously served for seven years as surgeon-in-chief at Nationwide Children's Hospital in Columbus for seven years, as well as a professor of surgery at The Ohio State University College of Medicine.
"When a child has multiple complications and needs repeat surgery and needs to spend a long time in the hospital, the system benefits financially," Moss said.
|More about Dr. Lawrence Moss|
RELATED: Nemours Children's Health System positions itself, pediatric hospitals for leadership role in shift to value
"I see Nemours taking the lead nationally in demonstrating how that can be done and demonstrating how a healthy child means a happy child, a happy family and a financially successful and viable health system," he said.
Here's more from our conversation:
FierceHealthcare: What is your biggest focus as you take on this role at Nemours?
Larry Moss: Health for kids is much more than medical care. There's been a lot of good work that suggests that medical care is about 20% of health in kids and the other 80% are education and safety and freedom from poverty and freedom from food insecurity and all of those things.
FierceHealthcare: All those social determinants?
Moss: Sometimes I don't use the term social determinants because I think it carries different connotations to different people. I like to keep the focus on health. It's my belief that in the children's world that healthcare institutions like Nemours should be the stewards for children's health in all areas and we should be the beacon of what American society thinks about children's health. Nemours already has a history of having that outlook but it’s my intention that we double-down and accelerate that and we would become visible and impactful to what is going on in this country and health policy.
FierceHealthcare: This conversation happens a lot: the need to shift to value-based care. But how do you actually make that happen?
Moss: When incentives are misaligned, it drives culture, it drives behavior. It drives a lot of things. Another way to look at it is who is running the system and providing the care. I think there’s a lot of things we can do in the way we train and educate providers—physicians, nurses, therapists, all the providers of healthcare—and Nemours has a major educational program. We are already being thoughtful of how do we train the next generation of providers for what the next generation of medicine is going to look like which is radically different from what it looks like today.
FierceHealthcare: What is it going to look like?
Moss: The risk will be shifted to healthcare organizations as opposed to external payers. So healthcare organizations will be deeply incentivized to keep people healthy.
FierceHealthcare: It does seem like health organizations have been talking about this for a while, but there hasn't really been as much actually changing. How do we actually get movement?
Moss: I would counter that to say they are changing. CMS is a large government agency and is doing a lot of innovative things to change payment models. You take something as large as CMS—you're not going to turn that aircraft carrier in a year.
FierceHealthcare: What makes Nemours' approach different?
Moss: We're not on the payer side. We provide healthcare and all healthcare organizations see it coming and want to get there. I think we are optimally positioned to lead that effort. We are a multistate, multihospital, multisite system. That's rare in pediatrics. That exists to some extent in the adult world, but in pediatrics, we're pretty special. And for decades, we've been focused on the broader view of health beyond medical care. We operate a large variety of prevention programs and are involved in early childhood education. We're involved in nutrition. We're involved already in areas healthcare institutions, in general, will need to get involved with.
FierceHealthcare: What makes pediatrics so different?
Moss: In any large healthcare system, children are about 7% of the total and so traditionally, they’ve gotten about 7% of the attention and 7% of the dollars if we’re lucky. The other 93% carries a lot of votes and a lot of influence. But healthcare is not a zero-sum game. It’s incumbent upon people in roles like mine to have the public understand that 7% is going to become all fo the 93%. Every adult in this country was a kid once. So our opportunity to influence healthcare in an enduring way forever is through kids.
FierceHealthcare: No pressure ...
Moss: So many of the things we've talked about—which you called social determinants—by the time people reach adulthood, they're set. It's pretty hard to impact the patterns in their life that are already set. If we are successful and we can create the first generation of truly comprehensively healthy kids, they're going to grow up, they'll raise healthy kids and that's what ultimately changes the world. That's what Nemours intends to do.
FierceHealthcare: That makes sense. But this stuff isn't reimbursed yet. So how big of an investment does that mean you have to make?
Moss: Right now, if we support nutrition programs and we have programs that work on poverty and are focused on education, that's expensive. We're willing to spend those dollars—I mean, we are—because it's the best thing for kids but once you flip the incentives and align them, all of those things ultimately are going to keep kids out of the hospital. So then the question is, no longer 'How do you pay for it?' It's 'What does America want to do with all this extra money we're not spending on healthcare?'
FierceHealthcare: Can you tell us about any specific moves Nemours is taking to become a leader on this, whether it be tangible, such as increased investments or new infrastructure?
Moss: It could be. I don't want to get specific now. We're going to figure it out together. It's very clear to me that the associates in our organization are ready for this journey and they're ready to do something special.