When it comes to healthcare, children are not miniature adults. As growing, maturing human beings, they require regular well-child attention, care, and treatment that considers their size and their ongoing and seemingly ever-changing developmental needs as they make the trek into adulthood. Children’s hospitals, in particular, play a unique role in ensuring and elevating the health of our nation’s kids by providing opportunities for quality care and treatment and by addressing the non-medical factors that affect child health outcomes — the social determinants of health.
As CEO of the Children’s Hospital Association (CHA), Matthew Cook joins us to explain how CHA advocates for the advancement of child health in the areas of federal and state policy, research, quality care delivery, and workforce development.
Guest:
Matthew Cook, CEO, Children’s Hospital Association
Host/Producer: Carol Vassar
EPISODE 69 TRANSCRIPT
Carol Vassar, podcast host/producer:
Welcome to Well Beyond Medicine: The Nemours Children’s Health Podcast. Each week we’ll explore anything and everything related to the 80% of child health impacts that occur outside the doctor’s office. I’m your host, Carol Vassar. And now that you are here, let’s go.
MUSIC:
Well Beyond Medicine!
Carol Vassar, podcast host/producer:
You’ve probably heard the saying, “Children are not miniature adults.” This is especially true when it comes to their healthcare needs. As growing, maturing human beings, they require regular, well-child attention and care, and treatment that takes into consideration not just their sized treatment that take into consideration not just their size but their ongoing and seemingly ever-changing developmental needs as they make the trek into adulthood. Parents and guardians, of course, play a huge role in ensuring the health of their children, and so do pediatricians and pediatric specialists and children’s hospitals and children’s healthcare systems. Children’s hospitals not only treat the youngest members of our society but play a tremendously influential role in the communities they serve to address the nonmedical factors that affect child health outcomes, the social determinants of health.
Joining me to talk about the role of children’s hospitals in our kids’ lives and in our communities is Matthew Cook, Chief Executive Officer of the Children’s Hospital Association or CHA. CHA is the national voice of more than 220 children’s hospitals, including Nemours Children’s Health, advocating for the advancement of child health in the areas of federal and state policy, research, quality care delivery, and workforce development. Matt stepped into this role in October 2023, having served in leadership capacities at hospitals and hospital systems in Northern California, Indiana and Pennsylvania. We began our conversation by asking about CHA’s overall vision for advancing child health across the US. Here’s Matt Cook.
Matthew Cook, CEO, Children’s Hospital Association:
Well, first, Carol, thanks for having me today. I really appreciate the opportunity to get to talk about CHA and what we’re doing. To answer your question, I think, first and foremost, we have this belief that every child deserves timely access to high-quality, safe and effective care. And so what we do at CHA is really in support of that belief. So we do a number of things. One, probably first and foremost, you mentioned that we’re the national voice for over 200 hospitals. Advocacy is really central to what we do. Particularly on issues of financial sustainability for children’s hospitals, workforce adequacy, mental health, and the current state of mental health in children and what we can do to support that. So that would be one.
Second is we’re a convener. So, we bring together specialists and professionals from all around the country. I was at our Quality Conference in Chicago and we had presentations and discussions around a variety of topics, so how to recognize and treat sepsis more effectively? What’s the latest in school-based programs? What’s the latest in mental health programming? So we do that as well. And then finally, we have a variety of data and analytic services. And this is really geared towards supporting continuous improvement for hospitals, whether that is for health services research or for quality improvement. And so all three of those services come together to form really what the children’s hospitals do and the association does and that’s really in the spirit of advancing child health.
Carol Vassar, podcast host/producer:
And as we look at your membership, children’s hospitals, what role do they play in advancing the health of children?
Matthew Cook, CEO, Children’s Hospital Association:
Yeah, that’s a great question because they’re really central in their communities for what they do do. First and foremost, they’re providing care for children in that community. They’re often the only comprehensive children’s hospital in their area, or there might be one or two more. But it’s not like what you see in adult medicine, where in any given metropolitan area, you would see 20 hospitals or so. You see one or two children’s hospitals. And so they provide care. They also are the training ground for our workforce. So they train our physicians, they train our nurses, our respiratory therapists. So, they play a key role in supporting the workforce infrastructure for our entire country. And then third, they do a tremendous amount of research, whether it is translational, so bench to bedside, or health services research, the areas of policy and the areas of social determinants of health. So they’re really playing a critical role across multiple dimensions to support children’s healthcare.
Carol Vassar, podcast host/producer:
And as we look at that research and all of the work that’s done in children’s hospitals, it benefits not just that one community, but all of the children of the US and I would dare say the world. Let’s talk about healthcare and children’s hospitals’ place in the overall ecosystem of the healthcare system that we have here in the US. What is that place, and what’s unique about it?
Matthew Cook, CEO, Children’s Hospital Association:
Yeah. Well, I think what’s unique about the role that children’s hospitals play in the ecosystem is that it expands beyond the four walls of the hospital. So most of our children’s hospitals have deep relationships in the community. So they may have school-based programs, which may be for primary care, often it’s for behavioral health. They have mobile vans that go out into the community to provide care for children who cannot come into the hospital or cannot come into one of our ambulatory sites. But they’re also deeply tied into other community services and the communities in general. And that is really with the goal of addressing some of the other social needs that children have, whether that be housing insecurity, food insecurity. Our children’s hospitals play a critical role in the community in helping to address some of those issues. So normally, we think of a hospital, we think of you go there, you get your care, and you leave. But for children’s hospitals, that’s really not true. That’s just one step in the journey of what a child experiences when they access our services.
Carol Vassar, podcast host/producer:
Talk about that a little more. The social determinants of health are something that we talk about a lot on the podcast, and it’s talked about a lot in healthcare provider circles and health system circles. The importance, it sounds like, of children’s hospitals in examining and working towards health equity and social determinants of health, really examining those, is really important. Expand on that.
Matthew Cook, CEO, Children’s Hospital Association:
Yeah. An important part of what our children’s hospitals do, and it was part of what my hospitals did when I was running a hospital. So we, for example, had an Anchor Institute strategy. And that’s really about how do you take the economic power of the hospital itself, partner with the community using your own resources and intellectual resources and manpower, and raising the tide for everybody in that community? And it often revolves around some of these issues I talked about, which is food insecurity. It may be just basic access, it may be housing insecurity, it may be partnering with the schools and having clinics and trying to reduce absenteeism. So it can take a variety of different topics.
And each one of our children’s hospitals, what they do is they really focus on the key drivers of issues in their own communities. So what I did, for example, in Northern California, will look very different from what I did in Indianapolis by design. Because what we’re trying to do is partner with the community, understand where resources are already existing, and not recreating the wheel, but leveraging what they do so that we can act, again, as a convener or as a coordinator for those resources and not expect that we have build it all ourselves. We don’t want to recreate the wheel if there’s something in the community that can be leveraged to address the needs of kids.
Carol Vassar, podcast host/producer:
And it sounds like with every community, there are different needs, and there are different solutions to those needs. If I’m hearing you correctly?
Matthew Cook, CEO, Children’s Hospital Association:
Absolutely.
Carol Vassar, podcast host/producer:
Let me ask this. CHA does work—you talked about this—with policymakers at the federal, state, and probably local levels as well. In what ways do you work with these policymakers to prioritize children’s health in particular?
Matthew Cook, CEO, Children’s Hospital Association:
First and foremost, we try to insert child in everything that we discuss with, whether it’s administration or whether it’s with lawmakers on Capitol Hill. Oftentimes when policy is being developed or legislation is being developed, kids are not top of mind. And so we have this tendency to develop policy in this country and think about our adult population first. And if we even think about kids, that’s generally an afterthought. And so what we always try and do is insert kids into the language and say, how will this impact children’s hospitals or children in general? And we know from a policy perspective, let’s just take CMS, there’s a lot of policy that starts with Medicare. And so how are these policies going to impact our adult population? But we know from over time what happens in Medicare tends to trickle down to the commercial insurance market and then to Medicaid.
So we know that if early on we don’t start a conversation about how a policy might impact kids, we might inherit something that is not optimal for children. And so that’s where we start. We start with what’s really best for the children’s hospitals. But I would say the other way we work with them are on these issues of financial sustainability. As I’m sure you know, Carol, Medicaid is the single largest payer for children’s healthcare in this country. For most children’s hospitals, it’s 55% or more. I ran a hospital where 70% of our patients were covered under the Medicaid program. And if you’ve seen one Medicaid program, you’ve seen one Medicaid program. Because this is a federal-state partnership, this program varies tremendously from state to state. And so we talk about those issues, we talk about the issues that are going on in particular states and from a national level. And then also, with our federal partners, we talk about the issues of workforce.
Carol Vassar, podcast host/producer:
Let’s talk about workforce. We had Amy Knight, president of CHA, on last year to talk about the pediatric healthcare workforce. Give us an update on the status of the workforce today.
Matthew Cook, CEO, Children’s Hospital Association:
So, unfortunately, I don’t think much has changed since Amy Knight was with you discussing this a year or so ago. If you look at the physician workforce, we still have shortages across the board. We are still seeing long wait times, particularly in areas like pediatric neurology, developmental medicine, adolescent medicine, child and adolescent psychiatry, and pediatric endocrinology, Rheumatology would be another one. So these are all pediatric specialties where the workforce isn’t sufficient, and parents experience really long wait times to get an appointment for their child. But I wouldn’t want to just say it’s a physician-only issue because we certainly have issues on the nursing side with respiratory therapy, with some other areas like imaging and lab, where we really do have some fundamental shortages, and we’re struggling to fill those roles. And they really do impact our ability to provide cohesive care.
Carol Vassar, podcast host/producer:
And I’m guessing that CHA is advocating for the pediatric workforce. Why is it so important to do so from a policy and practical perspective?
Matthew Cook, CEO, Children’s Hospital Association:
Well, I think from a practical perspective, we don’t want to be sitting 10 years from now with a shortage that begins to ration care for children. And so it’s really important to invest today, where we’re already struggling by the way, and this is not new, this is not a result of the pandemic. We’ve been struggling for years and so we need to start investing in the workforce now because 10 years from now, it may be too late for some hospitals and some children. And I don’t think, as a country, we want to be in that position. And so we’re having those conversations today. I think depending upon where a children’s hospital is, their challenges may be less or they may be more. It just depends on the number of training programs in their state, not just for physicians but for some of these other roles that I mentioned.
Carol Vassar, podcast host/producer:
Are there policy changes that can be brought to bear? Anything that can happen on the state and federal level to get more people into the workforce training now so that we have that workforce in 10 to 15 years?
Matthew Cook, CEO, Children’s Hospital Association:
I do think one area, and this has certainly been in the news, is really loan forgiveness. And so we know, for example, that medical students entering their residency, et cetera, already have a lot of debt. And in some of these specialties, the compensation levels don’t really support paying off that debt in a timely way that matches their lifestyle desires. And so think there is something very much around loan forgiveness that we could be thinking through. And then I think there are some workforce programs that we could think about on a broader level. So, for example, when I was in Indiana, where we had some challenges around specific types of healthcare workers, like pharmacy techs and certain nursing positions, we had a very specific program designed to support people in going through those. And so I think we could potentially look at that from a policy perspective and say, is there something we can do on a more national level to address the supports that communities need to get enough people going through these programs to create the workforce supply that we need for children’s hospitals?
Carol Vassar, podcast host/producer:
Should parents be worried?
Matthew Cook, CEO, Children’s Hospital Association:
I would be worried. Depending upon where I lived, I certainly would be worried. As I said, this is a global issue around the country, but it does impact some geographies more than others. I would be worried that my child may not have timely access to care.
Carol Vassar, podcast host/producer:
I want to continue on the parent point of view. What does CHA know about the parent and caregiver point of view on the role children’s hospitals play in America’s healthcare system and in their communities as well?
Matthew Cook, CEO, Children’s Hospital Association:
We actually know a lot more now than we used to. This is an area of research that we’ve engaged in over the last few years. We have a program or a campaign called Made Possible by Your Children’s Hospital. And as part of that, we did a lot of research into the views of parents on the importance of children’s hospitals in their communities. And so here’s what we know from that work. We know that parents view the children’s hospitals as being an incredibly important part of the community, particularly for providing access to specialized care. We know that parents are willing to travel for care. So they’ll travel farther to go to a children’s hospital as opposed to bringing their child to a general adult hospital.
We know that parents feel like children’s hospitals ought to be funded adequately so that they can continue to provide the services that they do provide. And really, that’s across all three missions, whether we’re talking about clinical care, workforce, or research. And so we know that parents feel very strongly about children’s hospitals, which is really encouraging for me in my role. I know that I have an engaged and willing group of individuals in this country to help support our cause. And I think now it’s up to us to figure out how do we tap into all that goodwill that we do have.
Carol Vassar, podcast host/producer:
Talk about research that CHA is either doing or knows about that really excites you and that you’d like to share with our audience.
Matthew Cook, CEO, Children’s Hospital Association:
Yeah. So there’s a lot of cutting-edge research going on across the industry right now in a lot of different areas, particularly pediatric cancer. So, there’s been a lot of breakthrough treatments in pediatric cancer over the last few years with immunotherapy and gene therapy. But that also extends to other areas. So, we’ve seen tremendous advances in sickle cell treatment after decades of not having any advances. So now we’re seeing gene therapy approaches to treating and potentially curing sickle cell. There was nothing on the horizon 10 years ago.
But we’re also seeing this in some of the neurological areas as well. And so in treatments of relatively rare diseases, again, this approach of cell-based therapy to provide a curative treatment. And I think what’s important about understanding this is a lot of these treatments are curative. So what this does for the child, what this does for the family, is it gives them hope that they’re going to have a normal life, that they’re going to be able to stop thinking about going to the hospital every month or every quarter for treatment or for a checkup. And just think how transformative that is for that child’s development and what they can do with their friends or what they can do with their dreams that they couldn’t do 10 years ago.
Carol Vassar, podcast host/producer:
Artificial intelligence is another area that is big in healthcare and has really hit the mainstream in a lot of ways. What’s CHA’s take on AI in children’s healthcare?
Matthew Cook, CEO, Children’s Hospital Association:
Yeah. So AI is a hot topic, as you mentioned. I think we’re still waiting to see where AI gets employed. So there’re a couple of different areas that we’ve started to see. We’ve started to see AI assist physicians in their notes. There certainly are some back office-like approaches to employing AI to make operational processes more effective.
I think the question in my mind is where AI gets employed directly into the provision of care. And that’s where, as a country, we’re lacking a regulatory framework. And I think this is where the administration is potentially going to need to step in, whether it’s through the FDA or some other part, is to think through how do we validate AI approaches to providing care. And who’s going to do that? And are we just validating the fact that the algorithm more or less works or are we evaluating the efficacy of the algorithm? So that, to me, is a big unknown question. I think time will tell how that plays out. I certainly think AI will continue to make inroads in what we do across the board, but it really is making sure it’s safe and effective before rolling it out.
Carol Vassar, podcast host/producer:
And when you talk about that regulatory framework, are you concerned about privacy and equity issues?
Matthew Cook, CEO, Children’s Hospital Association:
So, I think it runs all dimensions. I mean, I think there’s a question about privacy, I think there’s a question about equity, I think there’s a question about, is it effective? And so I think we have to look at this from all these different angles and say, what really makes sense here in deploying AI? And how does that get regulated?
Carol Vassar, podcast host/producer:
80%, we know this, of what happens to a child in terms of their health happens outside of the hospital or healthcare setting. Do you have some examples of hospitals that are really doing that well, that are partnering with their communities, as we talked about earlier, to improve children’s health from the outside in?
Matthew Cook, CEO, Children’s Hospital Association:
Yeah. So I mentioned this week that we had the Quality Conference in Chicago, and at the end of that conference, there were some different tracks for specific groups of folks. And one of the topics that came up was the school-based program and providing care in the school. And this really revolves around a few different areas. One is, is there a way of providing basic care in the school that a child might not otherwise access? So we do know that in certain parts of the country, children don’t receive primary care. They don’t have an assigned primary care physician or an identified primary care physician, and they’re not receiving that care. So, I think one question is, can we do that in partnership with the school districts? And so the goal of that would be, one, to provide routine preventative care that we know is instrumental in keeping a child healthy, but also keeping that child in school so that there isn’t an issue of absenteeism and potentially not doing well from an academic standpoint that could possibly hold the child back.
So that’s just one example of what’s going on. I mentioned that many children’s hospitals have Anchor Institute strategies, but there are children’s hospitals that have invested heavily in housing. Knowing that if you have housing security, that you are much more likely to have a stable environment and also prevent certain clinical conditions that could develop, like asthma. So, if you’re living in a home that has significant issues as it relates to air quality, then you have a child that’s much more likely to suffer from the effects of asthma. So Nationwide Children’s Hospital, for example, in Ohio, is a hospital that has a really robust strategy along those lines. And so I think some of those are some of the examples that I’ve seen from around the country.
Carol Vassar, podcast host/producer:
It sounds like, especially with the school-based health centers, because there are schools in every community, you’re reaching communities that perhaps were not reachable, and I’m talking about the rural areas of our nation because sometimes healthcare is centered on a city and the rural areas lose out. Is that what I’m hearing, that we’re looking at an expansion of healthcare into schools for that purpose?
Matthew Cook, CEO, Children’s Hospital Association:
Well, I think the expansion into schools serves two purposes. One is it should be geographically agnostic. And so we don’t want this divide in the country where individuals in urban areas have better care than individuals in rural areas. A fundamental issue though, and this comes back to workforce, so we talked about the shortage of pediatricians, it tends to be more acute in a rural area. And so you may have a general pediatrician, you may not have enough, but what you often don’t have in those areas are pediatric specialists. So you might have cardiology, you might have endocrinology, but you might not. And so I think part of the school-based program is we know care starts with primary care. We know you have to receive good preventative healthcare and have routine monitoring of your development of your condition. So what the school-based program does, whether this is rural or whether this is urban, is it gives a baseline level of care for a child. And then if the child needs something different, then we have to figure out where’s the appropriate setting for a child to go after that.
Carol Vassar, podcast host/producer:
And that might be a hospital, it might be telehealth, it might be right there in the school?
Matthew Cook, CEO, Children’s Hospital Association:
Correct. Yeah. If you look at some of our members, they have multi-state markets. So if you look at some of our members in the west, so take Colorado Children’s for example, they pull patients from multiple states, all the surrounding states, because not every state has a children’s hospital. And I think we tend to forget that, as a country that there are states that do not have a children’s hospital. And so, by definition, when you have a sick child, that child will have to travel out of state.
Carol Vassar, podcast host/producer:
Matt, you’ve been in the role under six months. What’s your vision moving forward in leadership of CHA?
Matthew Cook, CEO, Children’s Hospital Association:
Well, first, it’s a great organization, and I feel honored and privileged to have been offered this role. As I look to the future, CHA is a relatively young organization. It was formed by the merger of two predecessor associations that were becoming more overlapping in their activities. And so they were brought together. So the association’s really 10, 11 years old, so that makes it fairly young. So what I’m looking forward to is, okay, what does the next 10 years look like? What are the things that we really need to do as an association to have a great impact? I think we talked about the national voice. I think that’s incredibly important right now that we provide for our members in Washington a place for the administration to come to, for Capitol Hill to come to and understand at a national level what the policies that they’re contemplating are going to do for children, either positively or negatively.
And so I think that’s an incredibly important role. And I think it’s then up to us to say, “And you should go talk to these children’s hospitals. This one’s in your district. And they can also share with you how it’s impacting them directly in your area.” So, I think that is an incredibly important piece. Data is another one. If we go back to the AI conversation that we just had, these algorithms will need to be validated. And so how’s that going to take place? And so I think that’s where we also maintain a data set from the children’s hospitals. It’s one potential opportunity to validate some types of algorithms as we move forward. Certainly the electronic medical record vendors can validate as well for clinically oriented types of algorithms. But I think the data piece is only getting more important as we continue on our journey, not less important. And so I think what we do with data to influence quality improvement, to influence research, is still a vital part of what we do and will only be more important as we move forward.
Carol Vassar, podcast host/producer:
Matt, anything I haven’t asked you that you wanted to share?
Matthew Cook, CEO, Children’s Hospital Association:
Well, we talked on mental health a little bit, but it’s probably an area that deserves more attention. It’s interesting when COVID started, and we were calling it an epidemic and then a pandemic, if you look back at mental health issues, particularly in children and adolescents, that was really our first epidemic. COVID is really the second epidemic. And so it was just a few years ago where we declared this national state of emergency for mental health in children and adolescents. And we’re making some progress, but this is probably the single biggest issue for children these days is mental health.
And so this deserves a lot of attention from not just our federal government but from state and local governments. And it’s an area where we struggle from a workforce perspective. We struggle with diagnosing and treating children. And really, by the time a child shows up in our AED, we’re already too late because that means we didn’t prevent something from happening. So we didn’t intervene soon enough. And that’s not always the role of the children’s hospital. That’s why these school-based programs are so important that have a behavioral health component so that there can be early identification of potential issues and early intervention as well.
Carol Vassar, podcast host/producer:
I know the idea of parity between mental health and physical health in the payment realm has been talked about a lot. Has it come to fruition as of yet?
Matthew Cook, CEO, Children’s Hospital Association:
No, we still struggle with this issue of reimbursement for mental health services. It certainly has been at the forefront of a lot of conversations, in some areas there’s been some progress that’s been made. But this is still a heavily under-reimbursed area and where the coverage is also highly variable as you go from commercial plans into even Medicaid. And so this is still a significant area of concern. I will say one of the benefits of the pandemic is we did move to a lot of telehealth services in the mental health area. And that’s been very helpful. We’ve been able to leverage the workforce in a way that we weren’t able to prior. But I do think that’s opened up access for a lot of kids that didn’t have it prior. So I don’t want to be all doom and gloom here, there are some very positive things that have happened over the last few years, but we still have a tremendous amount of work to do.
Carol Vassar, podcast host/producer:
Matthew Cook is the Chief Executive Officer of the Children’s Hospital Association.
MUSIC:
Well Beyond Medicine.
Carol Vassar, podcast host/producer:
Thanks to Matthew Cook for joining us on this episode – and thanks to you for listening. Children’s hospitals do so much in our communities across the U.S. What’s your local children’s hospital doing to address the social determinants of health? Our voicemail system stands ready to hear from you. Just visit nemourswellbeyond.org to leave us a voicemail shoutout to your favorite children’s hospital. That’s the same site where we house all of our podcast episodes. Feel free to go there to listen to any of our podcast episodes anytime. It’s also the place to leave a review and subscribe to the podcast. Again, that’s nemourswellbeyond.org.
Our podcast team this week includes Cheryl Munn, Susan Masucci, Che Parker, and Lauren Teta. Many thanks to each of them for their work! Join us next time as we explore the world of the hidden helper—the children, teens, and young adults who are caring for a veteran parent or other family member. I’m Carol Vassar. Until then, remember, we can change children’s health for good—well beyond medicine.
