This is Chris Sosa with the Becker's Healthcare podcast. And today, we'll be joined by doctor Angelo Giardino, chair of the pediatrics department at the University of Utah and chief medical officer at Intermountain Primary Children's Hospital in Salt Lake City. Doctor Giardino, thank you for joining us today. Thanks, Chris. I'm looking forward to talking with you in the audience. Excellent. Yes. So great to have you on with us today. Doctor, for those of us who are not as familiar with you and your work, could you please introduce yourself and tell us a bit about your background? Sure. So, Chris, I'm a a pediatrician, and I've been, serving as the chair of pediatrics here in Salt Lake and the CMO at the Intermountain Primary Children's Hospital for about 6 years. Prior to that, I was in Houston at Baylor College of Medicine and, Texas Children's Hospital. And then prior to that, I had a long career in the Philadelphia area. Gotcha. Thank you for sharing those, details of your background with us today. Doctor, let's get into the questions. So let's start with what are your top priorities today? Well, you know, in pediatrics, Chris, one of the really big issues that has come to the forefront over the last few years is just the, the depth of mental health and behavioral health needs that children in our community have. So we've been spending a fair amount of time both in the department of pediatrics and at the children's hospital thinking about how to assess that mental health, behavioral health need, and then how to meet those needs. And it's a real need. It's not that we're just, better at recognizing the behavioral health needs. It actually is increasing in prevalence and incidence. So that's definitely one of the top priorities I have right now. Doctor, what have you learned on that front from talking with colleagues at other health systems? Yeah. This is kinda nationwide. You know, it's coast to coast, border to border. I think all of us are thinking about how to incorporate, behavioral and mental health issues. So if you think about it with children, most of the behavioral health needs are in the mild to moderate range, and primary care providers can usually assess early onset anxiety and, affective disorders like depression. So a lot of this care needs to be at the primary care level, but then there are, you know, more serious, moderate, and serious or intensive problems. So we we need to have a system of care approach that incorporates, primary care with the general pediatrician and then a multidisciplinary approach to kids that have, more severe or, issues. And, you know, as you think about that, that kind of physical health, mental health divide really needs to break down. So most of my colleagues across the country are dealing with this as well. We have the system of care approach where you have, kind of a pretty inclusive thought process in terms of who's on the team. So you need psychiatrists, psychologists, licensed clinical social workers, psych techs, and then you also need to have the more typical, health providers like physicians and nurses and clinical social workers involved. So we're really kinda thinking about how to assess the kids, decide what they need, and then get them to the right level of care. So that's kinda somewhat new ground for many of us. So there's been a fair amount of investment in learning about that and then thinking about that. The good news is that legislators and regulators are seeing this issue as well. So they're trying to be good partners and making it a bit easier to stand up these services to allow professionals into this practice area. And what we need to have happen is we need to have the finances follow this. The payers and the insurance companies need to now kind of come up with ways for a variety of professionals to, be able to code and bill for these services. It's certainly, doctor, encouraging to hear that an awareness is growing, and hopefully that only continues. On that note, how do you anticipate your role and and the role of your team is gonna evolve over the next 18 months or so, whether it's with respect to mental and behavioral health or on other fronts? Well, you know, certainly in the mental and behavioral health, front, we're thinking about, the kinds of programs we need and the services, that we have to stand up. I would say, you know, just in general, being a chair of pediatrics, I'm always thinking about recruitment and retention of both faculty and staff. And that has certainly been a challenge more and more because there's a lot of options for people that are well trained. So what we've kinda found is our secret sauce is we're super transparent around what the job expectations are, because, again, the newer generations actually expect a lot of clarity, around what they're being asked to do at the get go. We're trying to be super transparent around the compensation models, so that people understand not only what we're asking to do, but also how they'll be compensated. And then we're really focusing a lot on kind of their wellness, I guess, is the best term to use. So, obviously, when they're at work, we need them to work super hard, but we also want them to understand we've built time in to their annual calendar for time off for professional development opportunities. And when they take time off or if they're at a conference, we want them to be free of the work back at home. So, we have, I think, kind of a pretty good model for thinking about maintaining their resilience and wellness. And I think if we were talking 15 years ago, I won't be using these words. So we're definitely thinking about that. And then I guess the only other thing I would add that's really top of mind is, is keeping up with the technology that just keeps in, kind of rolling out. So, of course, there's a lot of talk about, artificial intelligence and ambient listening systems that have AI as their backbone, so that we can hopefully reduce the documentation burden that a lot of these frontline clinicians have. And that's a godsend, because so much of a clinician's time is now taken up with the documentation and the electronic medical record and then the coding and billing. So if we could relieve that, and AI seems to be, like, perfectly designed to do that. We're really interested in learning more and more about that. Certainly, a lot of clinicians that we have spoken to at Becker's will relate to that doctor. Shifting a little bit here. So I'd like to ask you, what makes you nervous and what makes you excited right now? You can take that in either order that you wish. Well, I I think, you know, I'm I'm delighted that we're starting to pay attention to, the mental and behavioral health needs the kids have. So I think that's a really good thing. We're a little bit short on the programs and the staff to do that, but it's a good thing that that's being focused upon. I think what I'm really worried about or what I'm nervous about is, the the finances that we have to support all this work just seem to be under duress right now. So the margins, as you know, are shrinking. And whenever they're shrinking margins, and again, the reasons for that are clear, coming out of the pandemic, the workforce issues are pretty standard conversation for all of us. The supply chain issues are standard conversation for all of us. The kind of the health systems working with the payers seems to be kind of at a particularly tense point. So the margins are shrinking. And when that happens, then the programs we need to stand up, particularly those that need a supplement from the hospital, tend to be under pressure. So I'm a little worried about that, and I'm hopeful that, we'll be able to, find a a path forward where the services that we need can get appropriately paid for, within the kind of the system that we have. But I am really concerned about the shrinking margins in health care, particularly at the hospital level. Lastly, doctor, I wanna ask you what issue in health care, particularly pediatrics, merits a brighter spotlight in this point in time? Well, you know, I'm really thinking a lot about the Medicaid system. And that may be surprising, but, you know, it's it's it's probably about 40% of the children in the US are covered under Medicaid, and that's that joint federal state program. And because it has a state component, it's under a lot of pressure every year because, state budgets always have to be balanced. So I worry about the current social and political environment where kids that are from traditionally disadvantaged backgrounds, might not be the highest priority, and then that impacts the Medicaid program. And so many of us in pediatrics depend on a robust and healthy Medicaid program that truly serves as the safety net for the kids that live at or below the poverty line. Doctor, thank you so much for joining us today and being so generous with your time and your insights. We absolutely cannot wait to share them with our audience, and we can't wait to connect with you again soon. Well, thanks, Chris. I appreciate you giving me a little bit of time to talk about these important issues.