ViVE 2023: Tripledemic, mental health crisis highlight unequal investment in children's health

NASHVILLE, Tennessee—The fall and winter’s so-called tripledemic overwhelmed pediatric wards and—for those elbow-deep in the world of adolescent care—underscored the inequity of resources the U.S. allocates to its children as compared to unhealthy adults.

In a ViVE 2023 panel on the current state of pediatric care, children’s health leaders bemoaned the relative lack of financial support they receive from federal programs and health tech investors alike.

Combining that with recent spikes in infectious disease presentations and a steady increase in mental health burden over the course of the pandemic yields a national health system that’s failing its most vulnerable patients, they said.

“It’s really a problem of inadequate supply,” Ali Alhassani, M.D., chief clinical officer of pediatrician telehealth platform Summer Health, said in Nashville. “Pediatric inpatient units, in the decade prior to the pandemic, decreased by 20%—and it’s only accelerated in our city of Boston [where] two pediatric units closed just last year. When it comes to the workforce, … nearly half of pediatricians plan to leave clinical practice in the next five years, and if you look at nurse practitioners and physician’s assistants only a tiny sliver enter pediatrics.

“All of this really stems from the poor reimbursement, especially compared to adult medicine, and the underfunding of Medicaid and CHIP. What that leads to is overcrowded clinics with just a couple of minutes per visit. It leads to, like, obscenely long wait times in emergency rooms, and the tripledemic was just sort of the fever pitch of that inadequate supply,” he said.

Session moderator Brenda Schmidt, the head of enterprise growth at health tech startup builder Redesign Health, noted that about a fifth of the U.S. population is made up of children; however, children’s health and related investments claim just 1% of all investments across digital health.

Part of the explanation for that “niche” mindset among investors is that kids are generally more healthy than adults and “the majority of the cost of our health systems in pediatrics are a very small number of kids,” Boston Children’s Hospital Chief Innovation Officer John Brownstein said. While that presents “a very challenging business case” in the short term, there’s a clear opportunity for organizations that adopt a longitudinal mindset.

“By intervening early on some of these larger issues in our pediatric populations, behavioral health being one of them, they can have massive downstream impacts and save a huge amount of costs for a health system,” Brownstein said during the panel. “But these are things that can take years to show, so the challenge is, of course, proving out these models. These are large-scale studies that need to take place [though] I think finally we’re seeing those learnings."

Nemours Children’s Health Vice President and Chief Value Officer Karen Wilding agreed that the cases for broader pediatric health investment should be self-evident for risk-bearing organizations.

“Most people will say ‘Well, why value-based care and pediatrics?’ There’s not much cost to it and there actually is a tremendous opportunity, not only with the medically complex children and certainly around preventative services,” she said. “There’s an opportunity to invest in pediatric health and well-being, to look at the ability to curb obesity [and] hypertension. We know the impacts those two diseases in particular have on adults, so imagine if you were able to delay those or work with children to stabilize that. Those are huge impacts.”

The panel’s speakers had no shortage of asks for potential areas of investment and improvement. Brownstein, whose personal work often veers into biomedical informatics and epidemiology, outlined pediatric care’s relative inability to integrate various internal or external data sources and create more robust modeling data units that organizations can use to manage capacity.

Wilding agreed and, again, noted the difficulty in obtaining data-sharing consent from parents and no nationwide, uniform data sets for analysis.

“In the adult world there is robust Medicare data that is shared in a standardized way, but in pediatrics, we don’t have that,” she said. “We work with Medicaid [managed care organizations], we work with commercial players, and there are 31 flavors of different payer claims that are out there. So our ability to standardize and aggregate that information is very challenging … there is an incredible opportunity for us as we start to look at how we elevate pediatrics and look at the investments that can be made around data and tech."

Other potential projects involving data analysis, screening or telehealth don’t necessarily need to differ much from their adult-serving counterparts, panelists said.

Laurie Strongin, CEO of the Hope for Henry Foundation, described a behavioral economics-based patient adherence program her group had put together for adults that found additional success among adolescents.

“We said ‘No one’s doing that with kids,’ it was a wide open space that we stepped into and now we’ve developed this leading program that helps kids adhere to medical procedures,” she said. “Based on the data that we collect off the thousands of patients, there’s a 95% improvement in the patient experience, and I think that’s connected to, hopefully, a lifelong appetite for healthcare, which you need on the preventive side to keep people healthy.”

Alongside serving an unmet need, dipping a toe into pediatrics could be a strong tactical approach for entrepreneurs and innovators looking to establish themselves within digital health, panelists said.

“It’s just a much less crowded space, it’s much easier to sort of develop a beachhead. If you want to start an adult mental health digital solution, there are countless ones,” Alhassani said. “There aren’t a lot of pediatric solutions, and so I think it’s a really good place to not get out-competed and really develop a strong product that you could then apply to larger markets.”

“With all of the attention on pediatric health, I told someone that the other day, 'You could build 30 pediatric mental health startups, and you wouldn’t saturate this market'," Schmidt noted.