'It's Simple:' Nemours CEO Shares 3 Ways to Fix Healthcare

R. Lawrence Moss, MD, FACS, FAAP, shares steps that healthcare execs can take to create a better and less complicated healthcare system.

Editor’s note: This article appears in the July-September 2023 edition of HealthLeaders magazine.

The country's healthcare system is almost always defined as "complicated"—but changing it doesn't have to be, according to one healthcare executive.

R. Lawrence Moss, MD, FACS, FAAP, who serves as president and CEO of Nemours Children's Health in Florida, recently published 'Finding Health by Looking in the Right Place: How Understanding What Actually Creates Health Can Fix U.S. Healthcare.' In the ebook, Moss shares thought leadership on shifting the healthcare system with three "simple" steps.

Moss recently spoke with HealthLeaders about these steps that healthcare executives and others can take to start taking the complication out of healthcare and to create a better system.

HealthLeaders: What inspired you to release your book with information about fixing the healthcare system?

R. Lawrence Moss: What inspired me more than anything else is the refrain I keep hearing: Healthcare is so complicated; we'll never figure it out. My viewpoint is: fixing healthcare is not complicated at all. The complicated part is summoning the collective will to do it and overcoming all the perverse incentives that have existed in our country for decades that stand in the way of us doing the right thing. My inspiration for not only the content of the book but the layout and the images and the whole ambiance it portrays, is that solutions are simple. The book is my effort not to simplify something that's complicated, but rather to articulate to people that it is simple, that we actually all do understand it, and we all can participate in fixing it. We just need to have the will to do so.

R. Lawrence Moss, President and CEO, Nemours Children's Health. Photo courtesy of Nemours Children's Health.

HL: What are the steps in which leaders, patients, consumers, and the general public, alike, can take to help the current healthcare system?

Moss: It's really simple. We've got to do three things:

1. Understand what health is.

Good medical care is really important to health. It accounts for about 20% of health. However, 80% of health is not medical care. It's outside the hospital and outside the physicians' office. It's safe housing, food security, freedom from violence, good education, all of those many things that create health. A fundamental problem with our approach to healthcare in this country is we equate it with medical care. We think if we just spend more and more on medical care, then we'll get better and better healthcare. But what we're doing is spending an excessive amount on the 20% and not nearly enough on the 80%.

2. Pay for health.

Our country's health system is a $4.1 trillion annual enterprise and essentially every penny of that goes to the opposite of health. We incentivize volume of medical care and complexity of medical care, so that's why we have the highest volume, most complex care delivered in our country. We don't incentivize health and we don't get health in this country. By every measure of health you want to look at, we're far behind our peer countries because we don't pay for health.

3. Start with children.

People tend to think of children's healthcare as being about kids, and it is partly about kids, but it's also the key to overall health of the country.  Children become the next generation of adults. Understanding health, paying for health, and starting with kids is the key to a vibrant, productive economy with good workforce productivity and national security.

Childhood is the time when a small investment can make a big difference. We talk about diabetes, heart disease, and cancer, as the major health problems that plague our society, and we think of those as adult diseases. They are, but if we start to address the roots in kids, we can throw a bit of resources at those things and change that trajectory through adulthood. I don't want people to think of investing in children as only returning benefits to children, it actually returns benefits to all of society.

Healthcare isn't [just] a problem for doctors, for healthcare CEOs like me, for people involved in the delivery system; it's an opportunity for everybody in this country and we should all care more and be involved more. We all have a seat at the table, and we all have a voice.

HL: What steps can children's hospitals take to further help with health equity efforts in the communities that they serve?

Moss: I'm pleased and gratified to see the increasing focus our country has had on health equity in the last few years. I don't believe it's possible to have a healthy population without health equity and I do believe that children's hospitals have a major role to play.

I'm very proud that we recently received a $25 million gift from the Alan Ginsburg Family Foundation to start [the Ginsburg Institute for Health Equity at Nemours Children's Health]. And we've just hired an [inaugural] executive director.

The lens of health equity is yet another opportunity for looking at health as something much more than medical care. There are inequities in medical care, and Nemours is committed to playing a major leadership role in addressing that. But the inequities in the other components of the other 80% that determines health … are enormous and make the inequities in medical care pale in comparison.

The first step is to rigorously measure and track and then ultimately report our outcomes stratified by race, gender, and other categories related to health equity.

You can't fix a problem if you don't know it exists, and we're in this process at Nemours. It's a learning curve for us, just like our peer organizations, but we're committed to the journey, and we're committed to following through. I foresee the day in the not-too-distant future where we publicly report our outcomes stratified by equity measures. Where we're not doing well, we need to know about it, and we'll hold ourselves accountable to fix it.

HL: What advice do you have for healthcare executives about this work?
Moss: I believe very strongly that our country's children's hospitals should be the stewards of the health of our children, not just the institutions that deliver medical care. When kids get sick, we should deliver medical care, that's part of being the overall stewards of child health. But there's so much more than that. At Nemours, we're in the business of creating health, not just in the business of treating disease.

I would like to see my peers and my colleagues join me in thinking of our job as health, not just treating disease. I realized that that's more complicated and more expensive and more nuanced in the adult world than it is in the children's world, but I still think it's possible.