Industry Voices—Nemours Children's CEO calls for CMS to push smarter strategies for children's health

As a pediatric surgeon who has cared for thousands of children, I marvel at the wonders of modern medicine. Everyday miracles now save the lives of children with rare and complex medical conditions who previously would never have had a chance.

Yet, at the same time, it is difficult to comprehend how our country continues to allow chronic, preventable conditions to plague our children.

Our healthcare system is excellent at treating advanced and complex disease. But too often we fail to address the root causes of illness. We are missing the opportunity to provide lifelong health to our children that could ultimately save billions of healthcare dollars and transform the health of the next generation of adults.

Research has established that at least 80% of health is the result of things that happen outside the doctor’s office, many of these are described as “social determinants of health,” such as nutrition, housing, education, transportation and living conditions.

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These factors are particularly crucial for the 46 million children in the United States who were enrolled in Medicaid or the Children Health Insurance Program as of 2017— more than 60% of all our nation’s children.

The Centers for Medicare and Medicaid Services (CMS), which manages these vital state-federal partnerships, has taken preliminary, encouraging steps that could greatly benefit America’s children and make our system both more effective and more cost-efficient.

With over 15% of children experiencing entirely preventable health conditions, CMS should do everything possible to ensure that states have the flexibility to implement innovations that will better meet the needs of their local populations, particularly children.

In a promising development, the Department of Health and Human Services (HHS) Secretary Alex Azar, whose department oversees CMS, recently voiced support for testing innovative models to address the complex challenges of the underlying social determinants of health.

Through its Innovation Center, CMS has already announced demonstration projects that enable state agencies to improve health by screening for the social needs of enrollees and linking them to community-based services. Another new model will support efforts at early identification of children’s mental and behavioral needs, along with improvement in care coordination and case management so that care is delivered more efficiently and addresses needs that go beyond health care.

Just last week, a new CMS rule took effect that will allow more flexibility for health plans that serve seniors to cover home-delivered meals as well as transportation to see their care providers as part of the Medicare Advantage program. 

While these are important first steps, we encourage CMS to continue to remove the barriers and complexity in providing these services through their existing authority. Together this is how we improve outcomes for patients.

Medicaid does cover medically necessary transportation services for children’s health care. This is a great first step, but there are significant administrative hurdles to the administration of these benefits and benefits that address other social determinants of health. We encourage CMS to build on Secretary Azar’s first steps and allow states more flexibility to act in the best interest of children on Medicaid.

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According to a National Academies Press study, one million children miss their medical appointments because they can’t arrange transportation. In addition, many children cannot be discharged from the hospital just because they don’t have a ride home. Something as simple as coordinated, reliable, and reimbursed transportation can ensure that kids get the best care possible while their health conditions are still manageable.

At Nemours Children’s Health System, we started a transportation subsidy for children in need, sharing the cost of Uber and Lyft rides with their families to make sure our children can access the care they need in a timely fashion. Since 2016, we’ve provided transportation for nearly 1,400 children covering 27,000 miles to and from their medical appointments. This was not covered by Medicaid. It’s unthinkable that we as a society could allow children’s health to be jeopardized because their families don’t have the resources to get them to the doctor.

This is just one example of common sense solving a common problem.

America has the power to improve our healthcare system, and much of that will happen through innovations that begin at the state and local level because doctors, patients, families, community stakeholders, and health officials will continuously seek to improve care.

CMS has the power to unleash that innovation by issuing specific guidance to clarify the strategies that state Medicaid agencies can implement under current law, and through waivers, like a recently approved North Carolina waiver, to address social determinants for pediatric populations.

This should include a compendium of examples to lift up what states are already doing. Such guidance would help to disseminate existing bright spots and encourage further innovation to help address underlying social issues in order to improve delivery of quality care and positively impact health.

We must give our kids the healthiest possible start for lifelong health, and the federal government through important CMS programs has the power to help us unlock this potential.

R. Lawrence Moss, MD, FACS, FAAP was appointed president and CEO of Nemours Children’s Health System in October, 2018. He previously held positions with Nationwide Children’s Hospital and Yale University.