How much are healthy children really worth?
If it seems like a provocative question, it's because it's supposed to be. It's the latest question Larry Moss, M.D.—the CEO of Nemours Children's Health System—has sought to answer in a recently published white paper.
He said he's sought to make the case for value-based care for kids any number of ways through his career.
"I believe in the welfare of kids and I believe for any society that is the right thing to do," Moss said. "But you know, we can make the 'right thing to do' argument all day and to really change policy, we need to show benefit. We need to show impact."
So Moss, who has led the integrated pediatric health system since 2018, said he flipped the script as part of a series of white papers to make the economic case instead.
According to a newly released paper on the subject, Moss argues not adequately caring for kids has already led to reduced workforce productivity in the U.S. For instance, he said in the report, work losses connected to health are believed to cause U.S. employers more than $225.8 billion per year due to conditions such as cancer, bronchitis, depression, and heart disease resulting in higher average lost productivity costs.
American children ranked 39th for child well-being out of 180 countries, according to a national report published in The Lancet and the 2017 Youth Risk Behavior Survey found more than 30% U.S. high school students were overweight or obese.
"Health is the primary limiting factor of human capital in the United States," Moss said. "When we invest in the health of children and we create healthier children, we get a better educated population, we get a population that doesn’t miss work due to health problems. We get an overall more productive population and we get a population that lives a longer and more healthy life and has many more productive years of life they can contribute to the economy and will allow our country to grow and prosper."
This idea of the costs of poor adult health contributing to economic damage has gained recent traction. In June, a white paper published in the American Journal of Clinical Nutrition argued diet-related illnesses—obesity, diabetes, heart disease and cancer—are a growing burden on the United States economy and should be considered a national security threat.
Citing the Centers for Disease Control and Prevention, Moss pointed out conditions like heart disease and diabetes cost U.S. employers $36.4 billion a year in lost productivity due to absenteeism.
"We tend as a society, to contextualize those as adult disease because that’s when they see them. But preventing those diseases lives squarely in child health and if we can create the kind of healthy children who will grow into a different generation of adults, all of those diseases can be significantly impacted," Moss said. "All of those estimates—I think it was roughly $230 billion a year—that’s pretty conservative. And to imagine with a relatively modest investment into the health of children, we could get that kind of a return on a yearly basis. It’s really impressive."
Never has this been more apparent than during the pandemic, he said.
"The COVID crisis has shined a very bright light on the tremendous burden of chronic disease we have in this country," Moss said. "And we've seen a health crisis like COVID that very disproportionately effects those with chronic disease play out in a very tragic way in this country. If our burden of chronic disease was a half or a third of what it is, which are attainable goals, COVID would have been an entirely different circumstance and would have been way less tragic and way less impactful on society."
It has also shown just how much a role racial and economic inequities in the U.S. are playing in health outcomes. "The place to start is with children and if we can improve the health of all children, we create a uniformly healthier society."
All of this goes back to arguments Moss has previously made in support of a faster shift to changing how health care is paid for through value-based care models.
"Our healthcare in the U.S. is about a $3.5 trillion a year economic engine and almost every penny of that $3.5 trillion goes to pay for the opposite of what we're trying to get, which is health. All of that money is paid for volume and complexity of medical service. The more the healthcare system does, the most money the system makes."
Medical care makes up about 10% to 15% of the factors that contribute to an individual's healthcare while factors like education, food security, freedom from poverty and safety have a 60% o 80% impact.
"In our current pay for volume system, there is no incentive for health systems or society to invest in those things because the health system gets paid for delivering medical care and only that," Moss said.
But, even with few arguing against value based care, movement toward capitation models have historically been slow.
"A lot of it is fear and inertia. [Healthcare] is about 18% to 20% of our overall economy so there's a lot of fear in disrupting and there's a lot of economic winners in that game ... There's an awful lot of companies and large organizations that are benefitting significantly financially from the current system. There's a lot of resistance to doing things differently."
But the quick ramp up of telehealth sparked by the pandemic demonstrated healthcare can change—and change quickly, Moss said.
"COVID showed us our healthcare system in the United States actually can pivot on a dime," Moss said. "One huge win is the argument that we can't rapidly change payment, that we can't rapidly move to investing in social determinants of health, has fallen away."