Championing Children's Health with Mark Del Monte, CEO of the American Academy of Pediatrics (AAP)

[00:00:07] Hello everyone and welcome to the Health Beat Executive Speaker Series. I'm delighted to be here today with Mark Del Monte, the CEO of the American Academy of Pediatrics. Welcome, Mark. Great, I'm glad to be here. Thanks for having me. Thank you. Well, I'd love to start with asking you about what are the types of policies that pediatricians champion and also how do you decide which ones rise to the top of your agenda?

[00:00:29] What a great question. Well, the American Academy of Pediatrics is the biggest organization of pediatricians in the world. So 67,000 pediatricians, pediatric medical subspecialists and pediatric surgeons. And so we cover all health topics for all children. And so all of our members come up with priorities that they want the AAP to focus on. And of course, our board of directors comes up with priorities as well based on evidence, based on data.

[00:00:53] And so right now, if you look at our website, we're talking about school expulsion and what the policies should be around that or early literacy for newborns and reading to babies right at birth. And then the board sets priorities. And so for us as an organization, we've been thinking about mental health for a couple of years and the mental health crisis that we've seen in children or equity, diversity and inclusion or climate change and environmental health.

[00:01:18] We're thinking about the adequacy of the pediatric workforce going forward. Big topics of priorities like that. So our priorities come from the board in that way and also from the membership from the bottom up in that way. We produce about 60 or 70 policy statements a year across all topics of child health. And those are found in our journal pediatrics that you see. And then we have our family facing work.

[00:01:41] And so oftentimes it's, you know, morning drive time, the AAP says, you know, so we make a lot of news in the things that we say for families and children. That's so interesting. So it's not just your traditional health issues that are covered, but it's also you focus on social determinants of health and the other aspects of a child's life. And so the education, as you said. And of course, so much of what determines the life and health of a child happens outside the exam room. And I think pediatricians really have recognized this.

[00:02:11] And we can say that in a way that other medical societies are starting to adopt as well. What goes on in the life and health of people happens outside the exam room. But pediatricians have known that for a long time. And so whether it's car seats or trampoline safety or whatever that is, pediatricians have been on the forefront of that. And I think we continue to do that. And that actually gets us into some pretty deep topics and thinking about the environment.

[00:02:35] We're thinking about the lived environment that children, that whether it's enough parks and playgrounds or climate change. You know, we've got to get into all of these topics if we want to have children thrive in the world. Well, one of your key agenda items over the years has been preserving Medicaid and CHIP Children's Health Insurance Program. So what steps should be taken to make sure that kids do not lose their essential health care coverage? Medicaid and CHIP are essential coverage for children now.

[00:03:04] At the height of COVID, 56% of children were covered by Medicaid and CHIP. That's more than half, which means that Medicaid and CHIP is the primary source of coverage for children in the United States. That also means that half of children in the United States are poor enough to be covered by Medicaid and CHIP. So we really got to think about the child population in that way. Now that the pandemic is over, five and a half million children have lost their coverage.

[00:03:32] And so we've got to worry about those kids. Did they get something else? Are they uninsured? What has happened to them? And so we've been very worried about that over the last couple of years to make sure that if they're no longer on Medicaid and CHIP, what are they on? And who's taking care of them? What we've seen most of all is that those children have been removed from the Medicaid program for procedural reasons, which means that they didn't get found ineligible. They just didn't respond to a phone call or an email.

[00:04:00] And so they showed up at a pharmacy to get a prescription refilled or they showed up at a doctor and it was their doctor or pharmacist that determined that they didn't have coverage anymore. So we're really working on that as a priority. That's an urgent issue that's in front of us right now. We've got to make sure that everybody who's eligible for coverage gets it. And while we're doing that, in the meantime, we have to think about the system. And so we are really thinking big about the Medicaid program and what should it be, especially if half of kids in the United States are going to be covered by Medicaid and CHIP.

[00:04:30] And that number is just going to grow over time. Yeah, I can really picture this. It's the child who's having asthma exacerbation and who needs their albuterol or whatever other medication spilled. And then finding that they cannot get medical care or can't get their prescription. And so it's a really good thing that you're focused on this aspect. Yeah, it's not just an administrative issue. It's a health issue. If you can't get that medication, that's a crisis for your family.

[00:04:53] Absolutely. Well, you've also, speaking of the broader health issues, you've supported a strategy to combine Medicaid and CHIP into a broader national program that provides family-centered care and comprehensive care. So I wonder if you could describe what would this ideal health care system look like that supports family-centered care and also provides individualized and equitable care for children and their families? Oh, I think you said it just right. That would be the goal for us. So imagine what my grandparents get.

[00:05:22] They have Medicare, right, which is just one big federal program. If my grandparents live in one state, they get one thing. If they move to a different state, they get the same thing. For children, it's really dependent on what state they live in. Medicaid is different in every state. CHIP is different in every state. And so our idea in a policy statement that we released about a year ago says, look, we have to really think about Medicaid and CHIP as a national idea.

[00:05:48] What a child gets in terms of their health insurance shouldn't differ depending on where they live. You know, a child is a child and they need the health insurance that they need. And so even if the program remains roughly the same, that it's a national program, but it has a state-federal partnership that's really robust, how do we make changes to that program to really eliminate as much as we can this huge state-by-state variation that we see?

[00:06:11] So really to build a floor under that program as much as we can, even while keeping the basic structure that states administrate in partnership with the federal government. The first thing we think that needs to happen is that the structure that there's a CHIP program and a Medicaid program, the two programs next to each other, we can combine those into one kid's program that makes sense so that families are applying once. And if their jobs change or their eligibility, that the income doesn't really matter as long as they're in the range, they get one program once, they're not shifting back and forth. That's an administrative burden for the state.

[00:06:42] And it's certainly administrative hassle for a family that doesn't really change much in terms of the coverage. So we have some ideas about how to make the program simpler and make the program more even for children across the country. Well, that's fantastic. You had referenced the pandemic earlier. And as you know, one of the unfortunate legacies from COVID is this rising mistrust in vaccines. And I know that's something that the American Academy of Pediatrics is very much focused on.

[00:07:07] So tell me more about how AAP is countering vaccine misinformation and promoting routine childhood immunizations. Yes, this is a very important topic. Thank you for bringing it up. And I think we can think about this in two very important ways. One is it is still very true that the relationship between a family and a pediatrician is very strong. That that clinical healing relationship between a doctor and a family talking about a child's health is a wonderful thing.

[00:07:37] People bring their child to their doctor and want to know how to make them healthy and they get good advice. And they listen to that advice and they believe that advice. They should ask questions about every medical treatment that a pediatrician or anybody else is asking about their child about. And that's a good thing. What we worry about a lot, Don, is there are so many sources of misinformation that are flowing at families, whether it's social media or the Internet.

[00:08:05] It's very difficult for families to make sense out of all of the things that they're hearing in the world. And there are individuals out there who are putting this information out on purpose. So it's not just people wondering things to hate. Have you heard this thing? Is that true? That's normal. But we worry a lot about groups who are putting out information, misinformation on purpose. We call that disinformation. That's misinformation you're spreading on purpose. I think we have to worry about that a lot.

[00:08:35] And we have to really confront that. It is wrong to tell people the wrong thing about vaccines or anything else in medicine on purpose. And so we're trying to do that first by putting out really good information. So we have a website, healthychildren.org, where all of that information is right out there for families to look at. We're giving tools to our members, the pediatricians to use in practice to give good information to families one at a time. And then we have to put out videos and all the good stuff so the families have reliable information.

[00:09:03] But I think all of us, whether you're a pediatrician or a physician or just an American, we have a responsibility to say, like, you know, we have to push back against this notion of putting out all this bad stuff that scares families and makes kids sick.

[00:09:18] Yeah, absolutely. And I think that you are underscoring the privacy of the clinician-patient relationship and why it's so important that pediatricians are also at the forefront of promoting healthy behavior and communicating to families, but also underscoring the role that each of us has in promoting the accurate information as well. So, Mark, I really thank you for joining us today. And thank you for your work and also the work of pediatricians across the country. Thank you so much. This was fun. Thank you so much. Thank you very much.