There are more than 4 million children in Florida and Dr. Jeffrey Brosco just became responsible for them.
Brosco is a pediatrician at the University of Miami and a bioethicist with Jackson Memorial Hospital. And as Florida’s new deputy secretary for Children’s Medical Services, he now oversees everything from Florida’s poison control hotline to a state-run insurance program for extremely sick children.
Brosco sat down with Health News Florida’s Sammy Mack to talk about his new job. Below is an edited excerpt of their conversation:
Health News Florida: How has your work as a pediatrician prepared you for this role?
Brosco: A person's health, and especially child's health, is not just about their medical conditions. It's also about their school, and their neighborhood, and their family, and violence in the community, and if there are playgrounds. And so we also have to think about the public health issues that inform child health.
Events that children live through, their environment, how they grow up—actually gets written into their biology, gets written into their bodies. If you look at the most important health issues in the United States, things like stroke and cardiac disease and cancer, almost all that starts as a child.
What are some of the things you would like to see happen now that you're in this leadership position?
I think the biggest thing is this move—that’s really nationwide—towards what's called, “value-based care.”
For a long time, the way medicine worked, we were rewarded for everything we did. So if I saw a child with asthma and I did a lousy job and I had to see him again the next week, every time I saw him I would get paid. And not that pediatricians would ever do that on purpose. But the incentives were wrong.
So it would be much better if on that very first visit I was able to spend enough time with the child and the family to say, “OK, here's our asthma action plan.” And then maybe talk to the school nurse. Then maybe even did a home visit so we knew that there was no problem with allergies and mold and so on.
And you can see how if you start thinking about, “we want to prevent hospitalization,” it suddenly becomes an incentive for the whole health care system to try to improve health.
What else would you like to see happen at Children's Medical Services?
There are a variety of programs at Children's Medical Services. There’s our Early Steps early intervention program, there’s a newborn screening program, our child protection team—which helps identify children who have medical neglect or abuse.
And I think for all of these programs, what we're really hoping to look at is what are our outcomes. Are we really making a difference for children or families? And are these various systems working together?
What are some of the challenges to doing that?
The challenges are many.
One of the issues is that children, although we recognize them as being very important to the future, are a really tiny portion of the budget. If you look at how medical spending happens, the vast majority of it is on adults, a very small amount is for children, and a tiny amount for the children who have the greatest needs.
So often it's hard—just in the debate about how we reduce costs—to get children on the agenda.
How are you going to try to meet that challenge to get the resources that you need?
Children are a wonderful source of stories.
That is, when families come and tell their stories and talk to us about what it is they need, I think pretty much everyone feels like we should be doing our best to try and meet those needs.
So I hope to do both by using data that suggests what are the best things to do, and family stories — to really improve policy.
Children's Medical Services has had controversy in the past two years. Two years ago there was a change in the screening tool that gets used to determine whether or not a child is eligible for a health program for medically needy kids. And 13,000 children were removed from that health plan. How were you thinking about that legacy when you decided to take this job?
So this is a problem across the country, and that is: How do you decide what population of children you want to focus on and how do you figure out which group of children are the most important?
There are about 4 million children in the state of Florida, and about 800,000 meet the criteria for special health care needs, and probably about 80,000 have medical complexity.
And my response is we should probably be looking at all those children and having sort of a different approach for each different group.
How will you know if you've been successful at your job?
I think that what I'm hoping for is to move us in the right direction.
I think that if we can get our policy to be driven primarily by data and by our values, then I'll be the happiest guy around.