Phone Calls, Home Visits, and Virtual Hearts

What does it look like to meet a child where they are, not just physically, but technologically, emotionally, and clinically? In this episode, three innovators share how they are redesigning pediatric care delivery around the child rather than around the hospital.

Dr. Caitlin Sayegh, clinical psychologist and researcher at CHLA and USC Keck School of Medicine, describes her work using cell phone coaching to help teenagers with chronic illness take their medications. The insight that drives it: a small dose of human accountability (a phone call or text from a coach who sees a teen as a whole person) can produce meaningful improvements in medication adherence across a wide range of conditions, from HIV to sickle cell disease to organ transplants.

Taylor Beery, co-founder of Imagine Pediatrics, shares how his company is delivering integrated medical, behavioral, and social support to children with complex special healthcare needs (at home, virtually, and at no cost to families) through value-based contracts with Medicaid health plans. His personal story of losing his son Walker to pediatric brain cancer, and founding Imagine Pediatrics a week after his funeral, is one of the most powerful origin stories in this podcast's history.

Dr. Sassan Hashemi, Assistant Professor at Cincinnati Children's Hospital Heart Institute, explains how virtual surgical planning (using 3D models derived from imaging data, viewed in virtual and augmented reality) is changing how surgeons prepare for complex congenital heart procedures, enabling interventions that once seemed impossible, and building toward an AI-enabled future of pediatric cardiac care.

Episode Resources:

▶️Randomized pilot trial of cell phone support to improve medication adherence among adolescents and young adults with chronic health conditions

▶️Adolescent and Young Adult Medicine CHLA

▶️Kids Join The Fight: Nonprofit

▶️Heart Institute | Cincinnati Children's

Connect with Dr. Caitlin Sayegh:

Dr. Caitlin Sayegh LinkedIn

Dr. Caitlin Sayegh CHLA

Keck School of Medicine of the University of Southern California Website

Keck School of Medicine of the University of Southern California LinkedIn

Keck School of Medicine of the University of Southern California Instagram

Connect with Taylor Beery:

Taylor Beery LinkedIn

Imagine Pediatrics Website

Imagine Pediatrics LinkedIn

Imagine Pediatrics Instagram

Connect with Dr. Sassan Hashemi:

Dr. Sassan Hashemi LinkedIn

Cincinnati Children's Hospital Website

Cincinnati Children's Hospital LinkedIn

Cincinnati Children's Hospital Instagram

Connect with us:

KidsX Website

KidsX LinkedIn

Children's Hospital L.A. Website

Children's Hospital L.A. Instagram

Children's Hospital L.A. LinkedIn

Transcript

SPEAKER_04 0:01

Welcome to the Dose of Optimism, where I talk to the optimists in healthcare. My name is Omkar Kulkarni, and I work at one of the world's best children's hospitals where I lead innovation. I started Kids X, which is a premier international startup accelerator for pediatric innovation, and over the years I've met thousands of startups, investors, and innovators. Every one of them has a story, and every one of them is optimistic about the problems they're solving. On this podcast, you'll meet amazing people who will share their stories and what makes them optimistic about the future of healthcare. A little note before we get into this episode: this podcast is for informational purposes only. We are not offering medical advice and we're not endorsing any products. Please talk to your own physician about your health or the health of your children. All right, let's get started. Dr. Caitlin Sayeg is a clinical psychologist based at Children's Hospital, Los Angeles. She leads the DASH lab, which stands for Design with Adolescents and Young Adults for Self-Management and Health, where she partners with teens managing chronic conditions to co-create digital health tools. Her work blends evidence-based therapy and technology, including automated text coaching and social media health literacy initiatives. She's both a practicing clinician and an investigator, which means that she mentors students and she pilots interventions aimed at improving medication adherence, readiness to transition from pediatric to adult health care. Really innovative person. I've worked with her for many years and seen her work, a really great blend of digital health and working with teens and adolescents to improve clinical outcomes. I hope you'll enjoy this conversation with Dr. Caitlin Sayek.

unknown 1:48

Dr.

SPEAKER_04 1:49

Sayek, thank you so much for joining me.

SPEAKER_00 1:51

Of course. I'm happy to be here.

SPEAKER_04 1:53

So cell phones have been a point of discussion between parents and pediatricians for a long time. You're innovating in finding ways that cell phones can be really beneficial for kids, and particularly teenagers.

SPEAKER_00 2:06

Yeah, absolutely. I think a lot of what the society is grappling with right now is this idea that cell phones are too invasive in teenagers' lives with phone bands at schools and bands on social media. But in my lab, what we look at is if these cell phones are in the hands of teenagers, how can we use them to help activate teens to take control of their health?

SPEAKER_04 2:35

And you've been doing this for 20 or so years, right? This is a long set of studies you've been putting together.

SPEAKER_00 2:40

Well, the studies that birthed to the cell phone support interventions started before I came to Children's Hospital LA. Marvin Belzer, who's a physician scientist in the division of adolescent and young adult medicine, and his colleagues were just struggling with how to help youth living with HIV take their medication on a more regular basis. So they developed an intervention that was very simple, where coaches would reach out for a few minutes a day, calling teenagers on their cell phones and young adults to help keep them accountable for taking their medication. So that has been really the first insight that we discovered here at the dam. The D-A-Y-A-M is division of adolescent and young adult medicine at CHLA. But just figuring out that this really small dosage of human accountability could be really powerful for teenagers and young adults.

SPEAKER_04 3:40

Now, does it have to be a phone call or could it also be a text message or a push notification? I mean, I imagine with the technology evolving over time, we can try different ways of engaging patients or these teenagers with cell phones.

SPEAKER_00 3:53

Absolutely. So that was when I came to join the team, cell phone support had established efficacy for this phone call version. But what we noticed was the behavioral science behind it, we had that pretty well understood that these human coaches could help motivate young people to take control of their health, but that the way that we were communicating and delivering the intervention needed to adapt with the times. Back when I joined the team, it was about 10 years ago, and we were hearing teens don't want to talk on the phone. They only want to text. So we decided to look at expanding the flexibility of this intervention, cell phone support, so that people who sign up to use it could talk on the phone in the old school way. But if they weren't interested in that, they could communicate by text. And we found similar outcomes between the two modalities in terms of how well youth were able to improve taking their medications. Although we've also been understanding the pros and cons and kind of what is lost when you take away the more rich communication you can get when you're talking on the phone.

SPEAKER_04 5:11

So tell me more about that.

SPEAKER_00 5:12

Our pilot studies have been smaller. So we don't see a significant difference between the phone call version and the text message version, but we have seen patterns where the biggest improvements we found among the adolescents doing the phone calls. The qualitative data, we've been doing interviews and focus groups with participants who go through our studies. We hear that phone calls are annoying and they don't really like them, but that they make a bigger impact because they interrupt and they are something you just can't ignore. Whereas a text, you can just swipe it away or even just answer really short responses and move on. But being there in one place in time with their coach on a phone call seems to help them grow the connection they have and they feel more supported, even though they feel more annoyed. So now we're at this stage in our science of trying to figure out what's the optimum amount of annoyance so that you actually grasp someone's attention without irritating them so much that they decline to participate or just drop out of the intervention because it's too annoying.

SPEAKER_04 6:33

How do you think they show us that they're annoyed?

SPEAKER_00 6:36

I think that for the youth talking about how it helped them, I mean, they're already annoyed at the behavior that they have to engage in to take care of their health. The one we're focused on is taking their pills, taking their oral medication every day. So that in itself, it's already an emotionally laden experience that at the least might just be frustrating. But sometimes is even more emotional. Like people could really be feeling despair, anger, alienation from that. And sometimes they just get into a routine, which is what we're trying to do of help embrace the task and just let it be part of your day. But it's really normal for it to be an annoying part of your day. And so for our intervention, it's getting paired with that behavior that's already irritating. And it seems like we have to we can't smooth the experience to a point where it's so easy that it's just forgettable. So it has to be like a little bit hard, but not escalating the annoyance to a point where we're just making it an even less pleasurable experience.

SPEAKER_04 7:52

This reminds me a lot of this whole concept of taking something that is annoying yet still finding ways to get people to be motivated to do it, right? This reminds me a lot of the nudge theory and all the nudges that the whole concept around nudges and how it's important to nudge people to do the things they need to do. Are you familiar with that methodology? And do you incorporate that in some sort of way with your research?

SPEAKER_00 8:16

We are thinking about nudge theory and persuasive design elements and thinking about lifestyle redesign about how the technology can ease the labor involved in taking care of your health. But more, I think what we add to the experience is that connecting with a human being makes the annoyance more tolerable. And it's the carrot. It's worth it to have somebody who's caring, listening there for you, sees you as the whole person, enjoys the good things going on in your life with you. So that that little blip where you interrupt your day and the things that you're doing to take care of your health, it becomes less annoying because you have a cheerleader or a confidant or somebody who's to be accountability buddy to you. So I think it's trying to deepen the experience instead of just solve the problem. It's trying to make the problem something you're not working on all by yourself.

SPEAKER_04 9:28

That makes a ton of sense. So tell me more about the outcomes you've seen. How does your intervention texting, calling patients impact their ability to take or their demonstrated behavior of being able to take their medication? Does it help?

SPEAKER_00 9:44

Yeah. So far we're seeing very promising results. The most clear results have been with young adults and teenagers living with HIV, seeing improvements in self-reported adherence, but also in terms of biologically verified adherence in a lot of different conditions. There are labs that you get drawn regularly that are to monitor your health, and they can also monitor how well you're taking your medications. So we've seen youth living with HIV make remarkable improvements in their adherence after receiving cell phone support. And now we're finding more support that this same intervention works with a wide range of chronic conditions. So we've seen promising pilot data to show improvements in medication adherence for youth living with solid organ transplants, type 2 type diabetes, sickle cell disease. And my current study is taking away the condition-specific inclusion criteria and just looking at the behavior of taking a pill for any purpose. If you have a prescribed daily oral medication and you're in our age range, you can sign up for our current study at CHLA. And our hope is that we can understand how well this coaching intervention works across a very wide range, including people who have multiple chronic conditions or have to take really complex regimens, like multiple medications throughout the day or with specific instructions. And I also think the qualitative data is giving us a lot of insight into what the needs are for youth with chronic illness. We hear a lot about how our intervention helps people think about why they're not taking their medication for the first time. And it's in a way like a guided self-reflection or a guided journal, but with the benefit of a caring adult who can help walk through the steps of reflecting on what really were the barriers that were getting in the way of taking medication. And then what are the specific personal solutions that work for that one young person? And with technology, it offers us an amazing tool for increasing personalization so that we can take into account for that end of one, that one young person, what's going on specifically in their context with their illness, with their regimen, with their life and motivation that's leading to poor medication adherence, and then help them personally develop their game plan to take their medication on a regular basis. And it can look different for every single person in the study.

unknown 12:41

Dr.

SPEAKER_04 12:41

Sag, that's incredibly powerful. Thank you for joining me today and sharing about how your really novel solutions and interventions are helping kids do what they need to do, even if it's annoying, to live healthier lives. Thank you. Dr. Susan Hashemi is an assistant professor in the UC Department of Surgery, and he's a faculty member at Cincinnati Children's in pediatric cardiothoracic surgery. His passion lies in transforming the way complex congenital heart disease is visualized. He harnesses 3D modeling, visual surgical planning, and he's quite a pioneer in digital twin technology in pediatrics. He's motivated by the challenges that he's seen clinicians face in interpreting 2D images of intricate heart anatomy, and he's using that to dedicate his career towards more actionable visualizations. I think you'll appreciate this conversation that we have with Dr. Hishemi and his work as he thinks about advanced imaging, 3D printing, the use of AI to automate image segmentation and analysis, and the use of mixed reality, augmented virtual reality tools to help improve outcomes and the experience for kids with heart disease.

unknown 13:59

Dr.

SPEAKER_04 14:00

Hoshemi, thank you so much for joining us today. Thank you for having me. Excited to be here. You have been recently posting about virtual interventional planning as it relates to the work you do at Cincinnati Children's. It's a concept that has been around for a while, but I'm excited to hear about how you're applying it in pediatrics. Tell our audience first, what do you mean by virtual interventional planning? How would you define it?

SPEAKER_03 14:24

So basically, taking the raw images and visualizing it in a way that the surgeon can see what he's gonna expect in the OR and basically practice a couple of different surgical strategies for these complex cases. So when he goes in the OR, he goes in with a plan. He doesn't get surprised and potentially comes out with better results and hopefully faster surgery and things like that. So we do it a couple of different ways as this technology has evolved so much over the years. A few years ago, people were probably mostly excited about 3D printing. There were a lot of push for 3D printing, which is still in use and we use it here extensively as well. But the turnaround time is slower, and there's extra costs associated with it and complications. So to really take advantage of virtual planning in clinical scenarios, you need to be faster and be able to iterate faster. So there has been a shift to doing things virtually that means sometimes taking it into virtual reality, argument reality, and things like that. That's what we're heavily invested in in the Hart Institute, especially at Cincinnati Children's.

SPEAKER_04 15:39

So let's unpack that a little bit. So maybe a decade ago, standard of care was a two-dimensional image that was produced and was then used, or maybe a handful of images were used to prepare for the surgery. And then the next step, or one of the big next steps, was around 3D printing, as you pointed out, where you could create a three-dimensional image which could then be printed to help with planning for the procedure. But there's costs associated, and there's there was it takes time. And for early on, it took a long time and it got faster and it's gotten much faster. But this is this using the same type of technology to basically render a three-dimensional image, but instead of it being printed, it's now being put into a virtual interactive world.

SPEAKER_03 16:27

Correct. So when we go from the raw images, that com images basically to a 3D space, that transition, like we take the raw images, do the segmentation, basically, we paint the raw images to define where different structures are. And then when you're done with that, then you have the flexibility to do whatever you want with that. That's the labor-intensive part, the artistic part, the scientific part. That's the part that we focus the most. And that's what basically defines what we can do with that 3D model. That 3D model then can be taken and get printed, or can be taken into a virtual reality environment and be looked at. It can be taken to very specific 3D or surgical planning softwares and be worked on, or it can even be tweaked a little bit and be taken to computational fluid dynamic workflows for basically visualizing the simulated flow and stuff like that. So the most important part is going from the raw images from the grayscale basically to the binary space, which is a segmented anatomy. When you do that part nicely and you have a reliable and anatomically accurate model, then again, the you have different avenues to use it however you want. It can be virtually looked at and analyzed and also printed for surgical planning or just patient education. Sometimes we print a model just to show it to the patients and the family to onboard them with the surgery. It's very complex. Having that piece of physical model in their hands sometimes helps. Some people are more comfortably looking at or enjoy looking at the anatomy in VR, whether they're surgeons or just family or the patients. So these are all different items. Like we have all of that available as options for the surgeon, for the imager, for the team. The goal is to create like a shared mindset and shared plan for everybody. So the surgeon and the patient and the care team, they're all on the same page. And we think having a reliable 3D model, whether it's physical or virtual, is the perfect tool to do that, to create that communication. So when the kid goes to the OR, everybody knows what to expect and what the challenges are, what the complications are, and things like that.

SPEAKER_04 18:55

Are there examples of where if you think of the old two-dimensional DICOM world versus the three-dimensional world now that you're looking at for surgical prep, where decisions have been made that are different than perhaps they would have been if you were just looking at two-dimensional? Is it actually improving clinical care decision making as it relates to surgical prep?

SPEAKER_03 19:14

Absolutely. Yes. I don't want to say I see that daily, but I see that at least once or twice a week. That 3D modeling and ritual planning is changing decision making. And it actually has enabled a lot of our talented surgeons to try very new things that, like a few years ago, nobody even dared to even discuss it. Now, instead of putting patients on a single ventricular pathway, which has a lot of complications and morbidity and mortality associated to it, now there's a lot of push to be able to fix these very complex intracariac anatomies and given like a normal biventricular physiology. So that's like the new big thing in pediatric congelom heart surgery to be able to some of these complex hearts that are borderline between single ventricle physiology and biventricular physiology to push them towards normal physiologic biventricular circulation. So for these ones, 2D really doesn't do justice because the surgeon needs to see all the relationships between the whole holes in the heart, the valves, the actual tracks, and honestly, a detailed anatomical model really puts everything in perspective for the surgeon. And again, they can go even create the patch and the baffles and things like that inside our software and virtual planning software. And we can even export those things and print it for them as like an stencil. So they can in the OR just quickly trace the outline of their patch and use it on the patient. Like instead of guessing how the patch will look like, you know exactly how the size of it, the shape of it, and you go into the OR, it did all of that available to you.

SPEAKER_04 21:02

Wow. And I imagine this is it creating an impact, a positive impact on complications, less complications, less perhaps less length of stay, perhaps better outcomes clinically. So you could imagine a world where this is a net positive for care delivery. Are the payers starting to pay for or help reimburse better for these types of things? Is there a payment model where these models are printed in a way that it's aligned with how much clinical improvement exists with it?

SPEAKER_03 21:31

I want to touch on the point you said about the improved outcome based on doing virtual modeling and things like that. The problem is these things are very hard to quantify. Mostly because 3D modeling and virtual planning is reserved for most complex cases. So these are the cases that otherwise wouldn't even get offered certain surgeries. But by the means of 3D printing and 3D modeling and virtual planning, now that Surgeons are thinking about taking those very complex cases to the OR. So there is a huge selection bias that kind of makes studying the impact of 3D modeling and virtual planning challenging. But there are a lot of work that is being done. But if somebody systematically looks in the literature for improved outcome, it might be hard to find. Again, because there is the selection bias when it comes to the patients that actually get offered these services.

SPEAKER_04 22:27

That's a fair point. And thank you for pointing that out. Hopefully at some point we can look maybe macro at the national level to see, you know, different centers are using 3D modeling, whether print or virtual, what kind of impact it's having. Because I imagine to your point about the selection bias, but also the sample size is probably still fairly small to be able to show the kinds of impacts as you look across similar cases and things along those lines. So hopefully that research will come out with multi-site studies over time.

SPEAKER_03 22:54

Boston Children's probably was the pioneer to start the billing process for some of these efforts and be followed suit based on their model. And we've been seeing some success with billing. Obviously, this is reserved for selective cases. This is not a workflow to generate models. This is a clinician driven, question-driven workflow to find answers for very complex cases. So again, it is not like a process that if the moment the imaging comes out, some people start working on a virtual model or plan for that patient. It only comes to us usually or almost always after we discuss these patients, after like in our patient management conference. And the group decides that by the means of 3D print 3D modeling and virtual planning, we might be able to offer something to these family and the patient that we couldn't otherwise. So again, we use very selectively. And then following Boston's model, we build for the efforts based on the complexity of the model and the amount of work that went into it. And again, we've seen some success in that front, as a few other centers, I think Boston, Chop, Cook Children's in Texas, and I'm sure some other centers have started doing that. And I think there's some T-codes that are supposed to come out this July, but I don't know the details of that. But there's been some work being done on that front.

SPEAKER_04 24:24

And I imagine this really positions you well for the next phase, which is layering in artificial intelligence because you've got these 3D models and whether physical or virtual, and that creates this really interesting rich amount of data, which you could then use for clinical decision support as you think about different ways that AI can help better through and look at all that data. So I feel like it positions you well. It's like a great stepping stone. Not only does it do all this amazing work in terms of prep, but it also creates an amazing rich data set that allows you to start learning and evaluating the information.

SPEAKER_03 24:59

Yes, that is very true. I think as someone who works in the pediatrical space and congenital Hoggins, especially, our patient populations are much smaller and very diverse. So the anatomy is very different. So when we talk about artificial intelligence, we obviously need very good training data sets for the AI. So if Cincinnati Children's or Boston or Stanford or LA, they they do their own thing and try to develop something based on their own data, it might be a little challenging. It's very good if we can come together as we have. We have forced database that we share a lot of CTs and MRIs between institutions. If we have more efforts like that, we can be faster in the AI front to be able to train data sets and support decision making in a more systematic way, I think.

SPEAKER_04 25:50

That has to be our future. We have to figure out ways to come together considering the relatively small sample sizes we have and the need for richer training data sets for these models to ping off of. But I do think that the 3D rendering is an enabler. I think it helps for those hospitals that are early adopters of that of that methodology. I think it's great. Well, Dr. Hashemi, thank you so much for joining us and appreciate all the pioneering work you're doing at Cincinnati Children's to bring 3D modeling and the virtual preparation of for surgeons and for patients and families in your specific Heart Institute. Thank you. Taylor Beery is a co-founder of Imagine Pediatrics. Drawing on his experience as a parent of a child with medical complexity, he directs the delivery of a care model focused on high-quality, personalized, empathetic care. He keeps kids safe at home and in their communities. In 2021, he co-launched a nonprofit called Kids Join the Fight with his son Walker to support pediatric brain cancer research. You can see in everything that we talk about how the memory of his son and the experience his son went through play such a big role in how he's built Imagine Pediatrics. He served as the policy director in the White House Gulf Coast Rebuilding Office. He's held executive roles in healthcare and in private industry. He deeply cares about this work, and I think you'll see that in the conversation we have. Enjoy my conversation with Taylor Beery. Tell us more about Imagine.

SPEAKER_02 27:24

Yeah, sure. Imagine Pediatrics. We are a pediatrician-led medical group. We provide integrated medical, behavioral, and social support to children with special health care needs. We provide support 24-7 and we provide in-home services as well. All of this is at no cost to the families that we are honored to serve. We operate on value-based contracts with health plans to provide the service. We don't disintermediate or disaggregate any of their current care in any way. We work alongside their existing provider networks in sort of what's thought of as an extensivist type model, where our objective is to augment and extend the care that they receive virtually and in the home to these children who have such complicated lives as do their caregivers, navigating their disease, as well as tons of other social determinants of health and challenges that they face. So we're really here in hopes to be a problem solver and someone that can take what is a very fragmented and uncoordinated in many respects for these families, all these different pockets of things they have to manage at the same time and try and take some of that off their plate while, you know, also leaning in and trying to figure out what's the next thing that could go wrong, working with their care teams to keep kids on their care plans and keep them safe and home as much as we can. At the turn of the year, we'll be pretty close to 100,000 children that we're honored to serve in eight geographies and are seeing just incredible things, including my favorite statistic, uh, which is an 86 plus NPS uh net promoter score with the families that we that we serve. I came to the work as a caregiver myself, and that's my proudest statistic. Uh, but we also have reduced costs because children are uh really focusing those visits to the ED when they really need to and not when they don't. And so you see this combined impact of more safe days at home, of happier families. When you benchmark against existing adult value-based care models, particularly, you know, it's a lot of the folks who came together to help us initially synthesize the value-based care model for Imagine Pediatrics came from the world of MA-based seniors with medical complexity, value-based care world. And when you think about that relative to what we do, there's five particular conditions that contribute up, you know, 95% of medical complexity in a in a senior and a child that is incredibly heterogeneous. Uh, and as I mentioned, we integrate medical, behavioral, and social support. So you're thinking about medical diagnoses that range across an extremely broad number of categories: children with cystic fibrosis, cerebral palsy, cardiac and respiratory disorders, uh, on the mental health side, and that's just a few. They're uh 40 some odd diagnoses on the behavioral side, severe mental illness, bipolar schizophrenia, suicidal ideation, severe ADHD, ASD, things of that nature. Uh so about three-quarters of our kids have a BH diagnosis. For about a quarter of our kids, that's their primary diagnosis. About a third of our kids are tech dependent. So these are children with tracheostomy. Um, they have central line, G tube, massive polypharmacy and DME needs. If you kind of look at it across a broad spectrum, our kids have about three plus comorbidities. So these are children that are incredibly heterogeneous, which is very different than sort of many of the different value-based care models that have been incumbent over the last dozen plus years. I think that probably intimidated a lot of people away from the pediatric space when it came to value-based care. You know, one of the things that we've seen, uh, and there are many different elements that I think contribute to our success thus far, but one of them being the underestimating of the capability and incentive of these incredible hero caregivers who are in the home, who are tech savvy, who are looking for support at 2 a.m. in a rural area, or they're a few blocks away from a complex care clinic in some cases, or you know, they need a bridge script over a weekend, or they need DME support, or they need social support, or they need a crisis line, or they need a follow-up after discharge. These things really do all dramatically improve the reduction in preventable admission. In that sense, you start to see a common thread that allows you to get into the value-based care headspace of, you know, a durable, impactable spend that is side by side with better outcomes, happier patients, better access, uh, effective provider network integration. And so that's kind of the approach that we had when we started. And I think we have only been really astounded by the results in terms of some of the stats I gave, all the different ways we look at value-based care, uh, both in terms of quality performance, in terms of patient satisfaction, provider network satisfaction, uh, and ultimately reducing total cost of care because these children have more safe days at home.

SPEAKER_01 33:06

One of the things that you mentioned was quality outcomes that you're tracking. I think it's really important from value-based care. Uh, the quality aspect of it would really be interested in understanding what are what are those? What do those entail? I know you mentioned NPS, but even from a clinical perspective, what do those entail in the population that you're serving?

SPEAKER_02 33:25

Yeah, so we have quality performance baked into all of the agreements that we execute with our plan partners. They can look a little bit different from plan to plan and state to state, but there are definitely some consistencies. There is, for instance, an extraordinary opportunity to better execute on social determinative health screeners with families. This is uh a roadblock in many different places, but our big time focus of both being children first and building trusted relationships with our families enables a comfort to the conversation of completing the SEOH screeners and not just completing them, but identifying where there are opportunities for us to support these families better, acknowledging, as we all do, the direct impact of these social determinants on the ultimate health outcomes of the children and the ability of the of the caregivers to partner, you know, with not just us, but the entirety of the ecosystem that supports their child's health. Things like potentially preventable uh visits and readmission, you know, some of these things you see pretty consistently in the quality tracking of the plans that we work with, but there are bits and pieces everywhere. We've so far exceeded all target benchmarks that we have set with our plan partners to support the closing of quality measures. And I think it, you know, is a large part has to do both with the trusted relationship we're building, but also the partnerships that we build with the networks that already support these children. For instance, Well Child Visits is a big one. And we do not take PCP attribution. We are not the child's PCP. We work alongside that PCP. And so we can really, again, augment and extend their ability to get the children in for these visits by helping coordinate and support those visits, working alongside uh their team. And we've had a lot of success doing that as well.

SPEAKER_04 35:32

So you guys are Texas and Florida, right?

SPEAKER_02 35:34

We are currently Texas, Florida, and the District of Columbia. Uh, we have just signed contracts to enter several additional states. Uh so we kind of came into the year with about 40,000 children across Texas, Florida, and the District of Columbia who are honored to serve. At the turn of the year, we're going to be closer to, but less than about 100,000 children. Um, and that expands us from about the three geographies to about eight by entering some new states. I am not a clinician of any description. So take this from the layman version of these things. My our clinical, incredible clinical team could do this much more effectively. But I immediately think of a child who was diagnosed with a broad variety of behavioral health conditions. And if I had the, I could pull up the specific ones. I'm doing this from top of mind, so forgive me. But there's a long list of behavioral health conditions that had led the caregiver to the conclusion that a skilled nursing facility was the only true option going forward. They had been on a wait list for a number of months trying to get into a facility with no success. We connected with that family after a discharge from a behavioral health diagnosis admission, and engaged the family in our services, walked them through all of our programming and support opportunities. Ended up supporting the family through uh several different both behavioral, I think there were a number of calls into our crisis line. There was then a few different medical comorbidities that we supported the family through and developed a trusting relationship such that at I can't remember exactly if it was a six-month or an eight-month mark after we had engaged with the family. And this is long after they had started their process to try and uh move the child to the nursing facility. They had been contacted, that they were off the wait list, and the caregiver actually declined to go to that facility or or ship the child to that facility based on the fact that they had gotten as comfortable as they had with the support that they now had access to through through our services. I come to this work as a caregiver. So my oldest son was diagnosed with a pediatric brain cancer. You're all very steeped in all these things. So it's called medulloblastoma at the age of seven. His name was Walker. And when we first started conceptualizing this, I went back to a variety of different experiences. But one of them was a particular night where uh Walker, when we were tucking him into bed, there was some shifting around and his G tube came out. And at the point this happened, it was two o'clock in the morning. We did not have a backup G tube, and we ran to the emergency department. It was actually fairly far away. We were traveling from our home hospital. And he ended up in the ED. And then the it went too long. So they had to bring in the surgery team because the hole had started to close. We ended up being admitted. And I hear that anecdote somewhat often within our current patient population, where we truly have an opportunity both on the DME side to make sure the families are prepared. When the call comes in at two o'clock, they'll be on the line with the provider in under a minute. There are a variety of other options you can take to make sure that the hole doesn't close, uh, that the child is very safe, the hole doesn't close, and you can manage all this in a very either direct fashion from the parent themselves or in an outpatient environment. And, you know, we get to hear our incredible, empathetic experts on the front line at point of care deliver this type of support to families, and we didn't have it. And I get to sit around them every now and then and listen to them do it. It's I tell people this will be the best job I ever have. We unfortunately lost Walker September 4th, 2021. He was amazing and fought like hell and uh inspired a lot of great things, including his end foundation. But it was actually a week after his funeral that I came together with some complex care experts who had built a similar program at the hospital in St. Louis and founded Imagine Pediatrics.

SPEAKER_04 40:22

All right, thank you for joining us for your dose of optimism. Make sure to check out our show notes to get more information about our guests and the work they're doing. Visit our podcast page on the Kids X website to join our podcast community and to learn more about pediatric innovation. Thank you to our sponsors and to our presenting partner, Kids X. Please subscribe wherever you get your podcasts. And remember, it takes a village to make sure our kids grow into healthy adults. So volunteer at your local library, help out at the community center, and if you're so inspired, donate to your local children's hospital. Alright, see you next time. The content, views, opinions, and information presented on this podcast do not reflect the views of Children's Hospital Los Angeles or of the sponsors of the podcast.