Transcripts For CSPAN3 Fmr. HHS Secretary Burwell At Health Care Policy Conference 20171030

Burwell shares her experiences from implementing the Affordable Care act. After her remarks, well get a presentation from the ceo and president of independence blue cross. Good morning good morning it is wonderful to feel such energy in this room. My name is camille nelson, and im honored to be the dean of American University Washington College of law. It is my great pleasure to welcome you to American University Washington College of law for this exciting Plenary Session of the next steps in Health Reform 2017 conference. This year, in partnership with the American Society of law, medicine, and ethics, and with the generous support from our cosponsors, we are thrilled to have expanded the event to a threeday conference, attracting speakers and attendees from multiple disciplines, the academy, and practice. Importantly, this conference is also timed with the launch of our new health law and policy program, and i know that our faculty and our students will be partnering with you on your very important work in the areas of health care, law, and economics. Thank you, and please join me in welcoming American University provost, dr. Scott bass, who will introduce our American University president , Sylvia Mathews burwell. Thank you. [ applause ] thank you, dean nelson, and good morning to all of you. Its my pleasure to introduce the next keynote speaker, Sylvia Mathews burwell, the 15th president of American University. President burwell is a visionary leader with varied and extensive experience in public and private sectors. Her career is a testament to a lifelong commitment of advancing solutions to some of the worlds most pressing challenges. Her vast government experience includes positions such as the secretary of health and Human Services, director of the office of management and budget, deputy chief of staff to the president of the United States, chief of staff to the secretary of the treasury department, and special assistant to the director of the National Economic council. In the private sector, she served as chief operating officer and president of the Global Development program of the bill and Melinda Gates foundation. She also has served as president of the walmart foundation. In response to todays session on health care, id like to take a few minutes to highlight president burwells accomplishments and expertise in the health sector. In her recent role, the secretary of health and Human Services, she helped shape the vision, which is to ensure that every american would have access to the Building Blocks of a healthy and productive life. To this end, she had oversight and management of the departments agencies and programs, which included, among others, the centers for Disease Control and prevention, the centers for medicare and medicaid services, the fda, and the National Institutes of health. She oversaw the implementation of the Affordable Care act, which as this audience knows, represents the most complete overhaul of the Health Care System in our nations history. The aca ultimately helped more than 20 million americans obtain Health Coverage. It improved the quality of Health Coverage and made improvements to bend the cost curve. When she assumed leadership of hhs prior to the second open enrollment of aca, one of the first priorities was improving Service Delivery of the healthcare. Gov website. As a result, enrollment in aca, which was previously cited as stumbling block for the programs success, became more efficient and smoother. During her tenure at hhs, then secretary burwell oversaw the governments domestic and Global Response to two unexpected major health crises, the ebola epidemic and the spread of the zika virus. This response included working with other nations to slow the spread of ebola in west africa, building a system to identify highrisk individuals entering the United States, establish a network of hospitals across the country to serve as treatment centers, and investing in the research and development of an ebola virus vaccine. Similarly, she led hhs work to aggressively prevent, detect, and respond to the zika virus, including research, development, and testing of a zika vaccine. Throughout her leadership, Sylvia Burwell has had a Significant Impact on the safety and Services Provided for the wellbeing of americans of all ages, abilities, and socioeconomic backgrounds. Perhaps the work that was closest to home for her while at hhs was her implementation of the Early Childhood program, head starts largest revision in nearly 40 years. You see, Sylvia Burwell had her Early Education beginnings at head start in west virginia. She cites, this program is sparking her love for learning a foundational tool, and she has carried that throughout her career in public service. This au community is excited to have such an outstanding and accomplished Public Servant at our helm. She earned her bachelors degree in government at Harvard University and a ba in philosophy, policy and economics from the university of oxford as a rhodes scholar. Her work has touched and improved the lives of many in terms of health and safety of millions of americans. Please join me in welcoming president Sylvia Burwell to the podium, as she shares her insights on the future of health care. Thank you. Thank you, provost bass, for those kind words and your leadership here at American University. I also want to thank you your advice and guidance in these first few months as i have joined this American University family. I want to thank the American Society of law, med sip and ethics for bringing together such a great group of both people and speakers. I also want to thank American Universitys Washington College of law and the health law and policy program. I dont have a law degree myself, though i have more than my fair share of Supreme Court cases named for me. If i could just log one complaint about my previous job, it was not one but two lawyers who failed to warn me that once confirmed, all court cases switch to my name. The first, the burwell family counsel, my husband, steven burwell. The second, the 44th president of the United States of america. Im just saying, a little heads up would have been nice. My transition to American University is interesting, exciting, and challenging. Ive joined a passionate, engaged campus, community thinking, learning, and doing things about the worlds most interesting and important problems. One of those we are talking about here today. Ive taken on a new title without ever having gone to a diner in iowa. Rather than look back, i am pleased this conference is radioing forward. Our nations Health Care System has come a long way in the past seven years. Weve helped more people access coverage and care. Weve improved the quality of Health Care Coverage for american families, and we have started to bend that cost curve freeing up resources for todays working families and for future generations. When i say we, i mean our nation as a whole. This isnt the work of government or business alone, its the work of policymakers and physicians, advocates and attorneys, patients and families. As this conference proves, they are not slowing down. When i started planning for those remarks, i looked very closely at the agenda. Two things came to mind. First jealousy as my team reminded me, no, i actually could not block off two days on my schedule and come and listen to all the sessions. Second, an appreciation for the yin and yang in American Health care. There are very few areas of policy that are at once so complex and actually so simple. Todays agenda speaks well to the complexity. From payment incentives to federal and state coverage of Young Children to the challenges facing payers and providers, this conference dips into the vast ocean of complex legal, regulatory and moral questions that churn every day in our Health Care System. This complex system is grounded in a simple reality. In moments of joy like birth or pain, as in a sprained ankle, or fear and uncertainty as in a fight against cancer. We all count on the system to care for us and for our loved ones. When i worked at hhs, the complexity surrounded us. We spent late nights and early mornings waiting through reams of briefings and studies thanks to all the academics in the room producing those. We spoke with over 100,000 providers to get their input on rule making for macra. We worked with how the system was working, where there were opportunities and how we could use the short time at the helm of the ship to deliver meaningful impact to american families. To those colleagues still at hhs today, career Public Servants who deliver impact for the American People through transitions and transfers of power to those career staff, let me say it was an honor to serve alongside you and our nation is stronger for your service. [ applause ] at hhs, impact was our north star. Our goal was to tether our analysis to fact, to experience, and to the reality on the ground. One sees this reality every day at hhs. You see it on the campuses at the National Institutes of health where our nations top medical researchers are crossing the next frontier of understanding of diseases and cures through things like precision medicine. On the campus of the food and drug administration, where our nations safety and innovation are front and center. You see it in the fearless men and women who packed their bags, left this own families to save families in west africa from ebola and are always ready to make that perilous journey whenever they get called. You see the reality as provost mentioned in head start classrooms where young minds of today have a chance to become our scholars and our leaders of tomorrow and you see it in the health care professionals. Some in this audience this morning who are out there trying to build a better Health Care System. This is the duality of the intricate complexity of our nations Health Care System and simple outcomes that everyone is working towards. So day want to focus on a simple frame on our complex system, one that orients our discussion on where we want the future of Health Care Reform to go. I want to talk about how we improve the access, quality, and affordability of our nations Health Care System. I want to highlight how leaders in washington, our nations businesses, and the American People can maintain the progress. First access. In november of last year, our uninsured rate dropped below 9 , the lowest it had ever been. Between 2010 and the First Quarter of 2017, the uninsured rate fell from 16 to 8. 8 . Thats historic progress. The largest decline in uninsured since the launch of medicare and medicaid. But it still leaves more than 28 million americans who are uninsured. Connecting these people with coverage is a problem of will not strategy. We know how to maintain the progress weve made and move forward. Nearly half of uninsured adults say the cost of coverage is prohibitive. Our nation can take steps to help them. We theyd to actively get the message out that coverage is available, especially to communities where those messages dont often reach. We also need to raise awareness and potentially Financial Assistance for people who shop on the marketplace and make sure more people know that the Financial Assistance this is there today is actually available. Last year eight out of every ten people shopping on the marketplace qualify for financial help. Most could find a plan somewhere between 50 and 100 per month. More awareness an more assistance will lead to more enrollees an therefore more access, which reminds me, just for old times sake, its about to be november 1st, the start of open enrollment. Encourage your friends, your family, even random twitter and facebook followers to go to healthcare. Gov or 18003182596. For those of you who are spanish speakers go and shop around. Just have to. Old habits diehard. The affordability of our Health Care System is intricately tied to people getting coverage. Since the law passed, the share of americans who cant afford care has fallen by more than onethird but affordability hasnt improved for just the newly insured. For 157 million americans, thats most of us, who have Health Insurance through their employer, family premiums have grown at an average rate of 4. 5 since 2010, down from an average of almost 8 over a previous decade. Affordability extends to what taxpayers spend as well. Medicare, for example, spent 473 billion less on personal Health Care Expenditures between 2009 and 2014 thanks to the lower rate of cost growth. In the context of the budget conversations going on, thinking about that 473 billion number can put it in context. Finally, the third way we can measure our progress is quality. Hospital acquired conditions like adverse drug events, infections and pressure ulcers declined by 21 between 2010 and 2015. By linking those accomplishments to mortality statistics, that decline prevented 124,000 deaths. Before the law, most Health Care Plans in the individual market didnt cover maternity care. A third didnt cover mental health. Almost one in ten did not cover prescription drugs. Under the aca, there is coverage. While the law isnt perfect, and there are many ways it can be improved, and changes will make it better, there are, indeed, some benefits that are a reality. And a very clear and simple reality for Many American families. Another reality is the direction that our Health Care System is moving. We often talk about Delivery System reforms separately from the aca, its important to reflect it was a part of the act. Some of the most important changes and models that we are using to move forward on affordability and quality come from provisions in the aca, like center for medicare and Medicaid Innovation and the ability to support account able care organizations. They also stem from other laws like medicare access and c. H. I. P. Reauthorization act. I probably didnt have to say that here, macra would have done but passed with overwhelming bipartisan support. These changes are part of an support the change that is occurring throughout our entire Health Care System. Our Health Care System is u. N. Going what i believe is an historic change. Many of you are well versed in undercurrents of change. Youve researched implications advocated for them, some have even helped set the policy to clear the path for them. Whatever your perspective in this room is, its clear our Nations Health care Delivery System is entering into a new era. While i served at hhs, we developed threepart strategy to support our Health Care System making progress. First, change the way we pay for care, so that payers are rewarded for the quality of care rather than the quantity of services. Second, change the way we deliver care by promoting coordination and prioritizing wellness and prevention. And third, unlock Health Care Data and information so doctors can make the most informed decisions and patients can be active participants in their own care. At hhs we implemented the strategy with the simple philosophy, with we need to lead, we would lead. Where we needed to convene stakeholders, we would convene them. When we needed to get out of the way, get out of the way. At hhs 50 of medicare payments go through valuebased contracts by 2018. When we left, we were ahead of schedule. At this time commercial insurers were venturing into valuebased payments on their own. In january of 2016, estimated a quarter of all Health Care Spending was in alternative payment models. The Delivery System Reform Movement crosses ideologies. Our administration advocated for it as democrats and republicans, like my predecessor who started some of these efforts, former secretary mike levitt and former bill fritz. As a few of my colleagues recently wrote in new england journal of medicine piece last week, the Delivery System reform effort is what they called, quote, an empirical learning approach to Health Reform. Its based on experiments, evidence, and careful observation and learning. As they concluded it is essential for this empiric approach to continue to meet the nonpartisan goals of better care, smarter spending, and healthier people. Delivery system reform requires persisten persistence. Im hopeful as the new Administration Settles in, they will see the same value in alternative payment model that is we did. Its an opportunity that leaders from both parties have recognized. It will be important to keep moving forward supporting programs like bundles and acos that reward providers for better care at lower cost. It will be important to fully expand programs that are proven to reduce cost and Health Care Like Diabetes Prevention program that we modelled. And it will be vital that offices like cmmi can continue to innovate and find ever new ways of providing Better Health care while bending that cost curve. Many policymakers and private sector leaders are, in fact, moving forward. Ive been encouraged by bipartisan effort of a number of governors and people like senators Lamar Alexander and senator patty murray. Marketplace stabilization bill and the process through which it came together represents the way that we can get things done. Together with more than 20 cosponsors across both parties, they have the opportunity to make improvements on top of the basic measures of access, affordability, and quality. Ive been encouraged by entrepreneurs and private sector leaders who have stepped forward on Delivery System reform. While i was at hhs we started a group that was called Health Care Payment learning action network. And it was a Public Private partnership to encourage the adoption of alternative payment models. More than 6500 people joined, including 130 organizations that actually set their own goals in this space. I know that after i speak, youll hear from friend and colleague dan hillferty, au alum, who also stepped forward in this space. Today in American Health care, theres no shortage of complexity, change, and news. But through all of this complexity, i think a simple reality remains. That simple reality is why im so honored to welcome you to American Universitys campus. It was a little over a century ago in 1895 that a young aspiring attorney named Delia Sheldon Jackson asked a woman, Ellen Spencer musey to apprentice here. Many had been denied law schools. Women who studied law were few and far between. So musey and with a partner hosted the first session of the womens law class. They enrolled two more female students. The barriers that stood between these young women and success in the legal field were numerous and quite complex. But musey, gillette and students believed in a simple truth, the system needed to change, and it would start with them. So three years later in 1898, the Washington College of law was founded. It became the First Law School in the world to be fountained by women. The First Law School with a woman dean, as we now have two, and the First Law School to graduate an all female law school class. As Ellen Spencer musey said, the keynote of success is the readiness for opportunity. The simple reality of American Health care is our opportunity is now. And so for years and for decades at conferences and events like this to discuss complex challenges that stand in our way. But with the leadership in this room, and across the nation, i believe we can overcome those challenges. I know that our nation will be successful at building a better Health Care System, because like Ellen Spencer musey and pioneer women who came before here at our law school, were ready. Thank you. [ applause ] well, good morning, i am jane lambrew, for those earlier ill repeat my introduction, senior fellow at the Century Foundation but also former Deputy Assistant to the president for Health Policy and i am privileged to be here today to call you not madam secretary but madam president , which is fun. Has a nice ring to it, president burwell. But i am here in part because i was able to witness your leadership and skill and tenacity at managing a lead agency for Health Policy in the nation. That perspective gives you a lens on this Health Reform debate that few others have. So i want to begin my questions for you with a main focus, which is Delivery System reform. I know that that was jumpstarted when you arrived. Wed all like to know how did you develop that strategy, who was involved, and how did you get results . Before i answer the question, i do just want to Say Something about jeanne. A modest person who i have had the opportunity to work with jeanne 1980s on forward in health care. You will not find a person who knows the issues more indepth across the whole range, when one was working hhhs from omb to pollty times but just an incredible wealth and incredible dedication to what i was talking about in my remarks. Putting together strategy and make a specific example. In putting together strategies at different places and different organizations that ive had a chance to be in, i generally think about three circles, what is the problem, what is the solution space, what are we good at and get myself the objective is to get your self where those three things overlap. Important in a strategy process to think about being clear, what are you trying to go . The other thing ive had the opportunity to learn from different types of organizations, the bill and Melinda Gates very heavily strategy focused. One of their core strengths. At walmart, execution is one of their core strengths. What i find in strategy you actually have to think about both of those at once. The one without the other will not actually achieve the results. So some big picture thoughts. With regard to the specific issue, when i came to it, there was the realization that we had a short period of time. But as we were moving forward implementing parts of the Affordable Care act so focused on the access parts that affordability and quality we needed to have deep focus and we needed to do it in a strategic way with priorities that we could move forward over an unlimited period of time. So bringing together a number of different parts and pieces, we were very fortunate at hhs at that time to have patrick con y conway, who many of you know and karen desalvo, who were partners leading that effort. Im looking to see if any of the team that were part of this, they will tell you it was a process. To get to that kind of strategy and do it quickly and the engagement of our white house colleagues. Jeanne and others were engaged from the beginning. That is important because when you get to the other end you want a strategy important by all the parties and players. Being informed by the real world is a very important part of the strategy. Dr. Desalvo and conway were practicing physicians in addition to the roles that they had. So they brought a number of perspectives. What they tried to do was get a number of pieces and perspectives around the room. For those that worked prioritized and thats important and i generally work in threes. Getting the two, three things is a process. Easy to see five iterations in terms of what they did. That was about bringing the people together, working off of where we had been and a lot of work had been done previously before we got there. A different approach in terms of how active we would be occurred. We decided and put together the strategy. As we did, and jeanne youll probably remember when you got the phone call to set the medicare goals. The idea that we were going to set goals, that i was going to commit federal government to something on a deadline was not, you know, necessarily a common thing to do during an administration. But there was complete support and buyin for doing that and it was important. That when i look back at the strategy, having three pieces of the strategy, that action was important because it did two things. It was very important signaling of the commitment we were making, that we were coming to the table. The federal government wasnt just saying, okay, everybody, you all go do. This was us and we would have to meet it. That kind of skin in the game i think is indicative of were here and were serious to play. The other thing, it indicated direction. For everyone on the outside, i know thats a very important thing and we heard that in terms of certainty, predictability, where are things going. If youre running a business, a provider, a consumer, that predictability as much as we can support. That was a choice you made as you looked at the array of priorities and problems facing you as secretary. You recently had your first day here at American University. What were the challenges you faced not by choice but necessity on your first day . So there were a number of them. The first day actually i went and met i was confirmed probably around noon and then went straight to a meeting with one of the insurance groups and went and had conversations with them because one of the immediate things we were facing and that i would face in the next few days was making decisions on the technology. In order thats june. In order for us to do end to end testing, which i was insisting we would do for the marketplace, i had to make the technology decisions. My predecessor secretary sebelius was great in that she wanted those to be my decisions. She got everything as ready as she could but felt it was appropriate if i was going to be responsible, i needed to have ownership of those decisions, so immediately needed to make decisions on the technology and what we were going to do in the marketplace. At the same time actually within ten days there was a little decision hobby lobby versus burwell. You may have heard of it. In this same period of time, smallpox was discovered in a refrigerator that fda and nih shared. Like somebody hasnt checked it for 50 years and im this for 10 days. Then within 20 days, i stood up, the command center that states stood up for almost all of my entire time as secretary for ebola. And then not even a month later over the children pouring across the border and what many people dont realize, it was tens of thousands. Over 40,000 that year. Children under 18 coming across the border, children as young as four or five. What many people dont connect thats hhs. Most people think dhs because its the border. Dhs within 72 hours has to have those children with us, because we care for them until we can place them in a place they will be safe and cared for until they have their immigration proceedin proceedings. So for me it was the volume of crisis, the number and the volume of crisis was the first day challenge. One expects and one walked into knowing the things around the Affordable Care act. That was a very eyeopening. It was the number and volume that was challenging. As you know the administration is looking for the new secretary of health and Human Services as we speak. If that person, he or she, were sitting in this chair today, what advice would you give to that person . Thats me. Run into the fire. A wonderful place. Actually my very strong belief. I would start by saying first and foremost understand the incredible people that are at this organization. Career Civil Servants dedicated no matter. First, know youre walking into a place where there are incredible resources. Number two, i would say its very important to be aligned with your president. Understanding your president and having being able to know youre able to do along path, omb, hhs, that kind of alignment really does contribute to if youre not aligned figuring how you can access and work through issues is another very important part. The third thing i would say, as much as you could get out. Its hard. Its a Large Department youre managing and running. The more you can talk to, whether its ceos, head start kids, or visit the tribes, that is an important part of really understanding what youre trying to get done. Looking forward, what do you think the stealth issues are facing Health Care Reform. We know issues about open enrollment, rule making and challenges to the environment. What else might be on the horizon that this team should be on guard for as well as the audience doing their work in their various fields . I think its actually instead of a specific issue, its a category of issue that i think is stealth and not always recognized, which is a change that were talking about. When we get to five, ten, 15 years from now and our Health Care System looks differently with the consumer at the center and the way we do it very differently, it will happen because of true behavior change. I think thats hard. When youre in an organization and leading anybody in an organization, your first answer is, okay, lets change the structure. Your second answer is maybe lets change the people. The last thing, because its the hardest thing, is changing behavior. This is going to take change behavior of consumers. Youre going to have to be more knowledgeable. Youre going to get information, more knowledgeable. Its going to be take change for providers. Its going to have to be a change for payers, insurers. Its going to have to be a change for pharmaceuticals. Its going to have to be a change for everyone. I think thats the stealth issue that doesnt come up. We speak about things in specific terms. What we need is we need to pay in this way. But i think one of the hardest issues is to make that change, there has to be behavior change, and i think thats hard. And a related question, which is most of the discussion around Affordable Care act is about access components and not necessarily portability work that we did. Which do you think is harder, expanding access or affordability . I think both are harder. Both are very hard. But i do think with access, we understand a single very important lever. How you go about fixing that lever, the lever of cost, in terms of the access issue for those who dont have any access at all, at least there is that that you can focus on. I think thats why when one looks at the progress of the Affordable Care act against the three measures, i think our best progress was against that one, because it could be targeted and focused. The other, affordability and quality, i think, are sometimes harder because the levers are more diffuse. The other thing is, i think we do struggle with measuring quality, which is related to affordability, because you dont just want affordability. You never want to say one without the other. I think quality is very important. Then turning more to kind of the job and what this audience can learn from it, what was the Biggest Surprise . Youve been in government, again, held so many incredibly different position s throughout federal government and private sector, was there something uniquely surprising about being secretary of health . I would say two things. One goes back to your first question, which is i was prepared when i arrived at omb in this administration, this was the sequester was implemented. The day i arrived at omb was an alternative sequester day so most of the staff was gone. I priced in crisis. Some might say im like the guy in the peanuts that the cloud kind of follows. Not the dust but the cloud. So crisis was something i was used to. I will say that the volume of crisis was extreme. The ebola, that was wow. The kids on the border. Your fourth of july trying to figure out how to place four, five, and sixyears old whose parents thought it was better to send them 1,000 miles across mexico than to have them stay with them. And youre trying to find a safe place for those little they were alone. I had to keep asking. I have a 10yearold. I keep asking, they cant be alone. They have to be with a sibling but we just havent matched them up. No. The crisis. But the second thing was the joy of the breadth and depth of incredible things going on in the department. At hhs there is something called idea slab. That is a place where ideas and innovation, we were encouraging that both within our department and without our department. By the time this was started by my predecessor, kathleen sebelius, by the time i got there the conferences drew people from around the world in terms of how to use technology or other innovation. So those kinds of things were going on or the incredible things like the story of the individuals from the center for Disease Control and prevention who rode canoes in liberia up rivers to get ebola samples to figure out if those people actually had ebola. So that, i knew it, but seeing it is surprising. Its uplifting and great to see the positive things that are going on every day in a Huge Department thats that large. We are mostly in a conference of lawyers. Im also not the lawyer who came to value them. Describe a little bit of the goal that lawyers play in policy and Health Reform. An incredibly important. I would start in the clinton administration, when i worked in the clinton administration, i had a saying, a lauwyer a day keeps the subpoena away. It didnt necessarily keep all the Supreme Court cases away. But what i believe is engagement with your attorneys, i have always viewed lawyers. Actually im not a lawyer but i was given a gift of a blacks law addictary a few years ago because i so engage with lawyers. I believe your lawyers are your business partners. I believe that lawyers actually have two functions that are quite important. They need to tell you the law. In issues Like Health Care and Health Care Reform, it is extremely important, whether that is in rule making or implementation or on a daytoday basis. Extremely important that they tell you the law. They are people who see your issues. Your Legal Department is most important crosscutting in the organization wherever you are. Having them join as business pashs, too, its not complicated. They can tell you when they are saying this is the law. Let me tell you knowledge what will happen that way or read the law that way. Im here to give you legal advice but broader advice. I found our attorneys there and omb. Some of the people, you would never reflect on it but some of the most complicated and best lawyering ive ever seen was during the government shutdown. Youre operating in an unnatural state that doesnt happen with questions every day from can you the coast guard first time in three years coast guard needs to be flown back, the body needs to be flown back, what do you do for the family. Appropriations law, everything coming together. Then is it legal or assisting funds to have someone else play. To get somebody to pay for that in one phone call but is that legal . Your lawyers and what they do in crisis and on your day to day in government and policy in general extremely important. We also have scholars, ethics, how did lawyers inform your policymaking . Every day. Ill bring up an issue thats in the news today. Opioids. As we put together our opioid strategy and, yes, it was three parts as we put together that strategy, that was extremely important. The research on medication assisted treatments, to deal with those who do have addictions in the opioid space it was the research that guided those priorities. The question, does nil oxon, the drug you give to save someones life, does that cause more addiction or not . These are the questions. They are scholarly questions that are analyzed and studied and inform your Decision Making every single day. Research on ecigarettes, as we look to make rule making in the tobacco space at fda. In addition to the research itself we draw from the academy, richard frank, now back in the academy, maria at administration of children and families built all of the modeling that we use to try and predict the flows of children, drawing from our colleagues at the department of Homeland Security and the state department. She built the modeling. So academics and scholarly work used literally every day. My last question is will the drama around Health Policy ever die down and is Health Reform a lifetime employment. I would say health care is a lifetime employment, but i would kind of change the beginning of that. I would change it because theres always going to be opportunity in the space. Theres always going to be a place for us to go, move, and do better, so it is something that impacts everyones life every day. So therefore i think there will always be incredible opportunity. Im glad so many people are engaged and focused on these issues. You hear my optimism about getting to a different place. You can start to see it. Thank you so much. Thank you. [ applause ] now i might be biased but i think we brought one of our esteemed alums to campus to speak on this issue and dan is the perfect person to lead this session. As sylvia mentioned, dan is the president and chief executive officer of independence blue cross, one of the nations leading health insurers. Since he became ceo in 2010, the number of people the company and its affiliates served has tripled to nearly 8. 5 million in 24 states. He has leadership positions in amer health, keystone mercy and Blue Cross Blue Shield organization among others. Mr. Hilferty is dedicated to transformation of health care in america seeking Innovative Technologies that will increase quality and lower cost. I think thats something we can all get behind. Mr. Hilferty is soughtafter speaker on issues of leadership, health care and the role of technologies in big data. Hes appeared in the new york times, wall street journal, msnbc, and other national media. Hes among a very select group of nonpartisan Health Care Leaders called upon often to inform government leaders and advise him on implementing Health Care Reform. Im so pleased to have him back here on campus today and i want you to please join me and welcome him to the stage. Thank you. Good morning, ladies and gentlemen. It is still morning for a few more minutes. Good morning and thank you for having me. Dean knell sentence, congratulations to you on this incredible facility, the incredible program. Lindsey, i cant say enough about the work you and vicki do on a regular basis. Its my fate to follow great speakers. If we were in the well of the senate or house of representatives, i would definitely have ceded my time to president burwell. Jeanne, the two of you had so much fun we didnt always have fun when we met with you but you two had a lot of fun. So again, good morning. Getting health care right is the challenge of our time. I believe this is the most important task before us as a society, similar to what sylvia said. And theres no better place to talk about it than with this group in this venue, because the key issues of Health Reform land right on the intersection of the American Society of law, medicine, and ethics. Its where you live. Over the past eight years, the American People have seen nearly constant struggle over how law should interact with medicine. Looming over the struggle are the most basic ethical questions. Is health care a right or a privilege . Is it acceptable for our leaders to turn health care into a political football. How do we find a path forward from here. Theres no turning back. Ive been sharing my thoughts on these issues as a ceo dealing with them every day as well as a concerned citizen. We should be concerned. Frankly it is essential that your voices be heard, your voices be heard on these important issues. This debate will not end, because to build a sustainable system that gives everyone access to highquality, Affordable Care, we will need input from every area of expertise represented in this room. From both academics in industry, and from the public and private sectors alike. Future generations are going to judge us on whether or not we got health care right. Were not doing a very good job of it right about now. Health reform has been the dominant legislative debate for eight plus years. Thats five congresses and two administrations, dealing with these issues. And yet we have less clarity over the past year than we had at any point during that time. Economic stakes are huge. 18 of gross domestic product, some think between 20 and 25 , by the year 2025 if unchecked. The Public Health stakes are just as high. We spend far more on health care than our economic peers around the world. We all know the statistic. We have the greatest clinicians and Health Systems anywhere. Yet by some measures our outcomes lag. The big picture, how we organize our Health System will determine how effectively respond to crisis like cancer, diabetes, opioid addiction, this crisis. Were a potential major pandemic. We find ourselves in the selfperpetuating crisis. If we cant fix it, people get sicker and they need more care and the system becomes even more costly, even more expensive. Jeanne, you and your team should be proud statistics found increase in Health Care Cost really slowed over your time in the white house. Our window is closing for the gains and access under aca while getting control of cost, which makes it a bad time to be able to agree even on a basic foundation of federal foundation. I believe a sustainable solution is in reach. This is why we work on this every day with our colleagues and Health Insurance at Blue Cross Blue Shield association with hospital and partners, legislative and Community Leaders and with our members. Let me take a step back. Before i talk about it let me talk about my perspective and how it was shaped and honed. Ive always been involved in Big Questions around health care industry. Im comfortable between pl particulars and policy. In large part i can trace that to American University where i got my masters degree in public administration. I know i dont look this old, maybe i do, 1981. Anybody from the class of 1981 . No, youre all too young. I came here after graduating from st. Josephs in philadelphia an serving for nearly two years jesuit volunteer in the inner city in portland, oregon. I came here with great confidence in the promise of our democracy. I was honored to work on the hill for my hometown congressman and witnessed a conservative republican president , ronald reagan, and a liberal democratic speaker of the house, tip oneal, bridge the ideological divide to move america forward. I love every chance i get to come pack here. I get that nostalgic rush of a different time in our nations history. Thank you to the Washington College of law, the school of public affairs, and everyone at american for providing a venue, again, as sylvia said, for this critical discussion. And frankly for bringing me back, rekindling my optimism. Its hard to be optimistic most days on our inherent goodness of people. Together we can change our collective history for the better, and it starts with health care. President burwell, its such a pleasure to welcome it was such a pleasure to be able to welcome her to my university. Her Incredible Service as secretary of hhs exemplifies a leadership our country so desperately needs and deserves. Frankly, we need American University to be at the center of this effort, and youre off to a good start. This is an incredible program. Thanks again to asle focusing on Health Care Reform and thanks for all of you for taking time to participate. So there is a somewhat logical progression in my career path even though it played out over 36 years between my time and American University and the building and my role as ceo in Independence Health group. Independence has been covering people in the philadelphia area for over 80 years, coming up on 80 years. Overall as vickie said, we touch more than 8. 5 million lives in 24 states in the district of columbia, through our blue Branded Products and subsidiary. Our flabship brand serves 2. 5 people in greater philadelphia. We are the only insurer in southeastern pa on the commonwealths exchange. In new jersey through our merrill product, were one of two. By the way, were not going anywhere. They can keep throwing change at us, were not going anywhere. In total we cover over 300,000 people through aca exchange. By the way, not that this is relevant but i feel a need to say this. Probably based on the way you hear me talking, im actually a republican. No, its an Important Note because we have to change this dynamic. I consider myself a john kasich type democrat. I love every time he gets on tv and talks about the power of the private sector and partnership with government. If we peel away all the labels, if we peel away all the political rhetoric, what president obama, what his administration, what they did was create an opportunity. It wasnt perfect, it still isnt perfect, an opportunity for public and private sector to Work Together to make change. And i want to script a little because its so important that we realize this is not a democrat, republican issue, and ill come back to that. Independence, we have innovation investments in partnerships across our region and around the country. Through amer Health Subsidiary we serve millions of medicaid recipients all across this great nation. Im finishing up my tenure of care with the Blue Cross Blue Shield organizations. Im delighted the work the blues are doing making sure health is accessible to as Many Americans as possible. We the plblues represent 36 independent insurers covering 135 million of the people, onethird of the population. Our brand is one of the most admired and highly recognized anywhere. So when i think about what a solution looks like, all those perspectives come into play. Im a big believer in the power in partnership with the government. I want to see Health Care Solution that harnesses that power to transform the system. As i work with my colleagues at blue plans around the nation, i see more clearly than ever that health care is best delivered at the state and local level in collaboration with the federal government, guided by the federal government. So i want a solution that preserves flexibility for local Health Care Solutions with federal support, and again with guidance. I know that any solution must start with bipartisan agreement to do whats best for all americans. Health care is not a republican issue or a democratic issue. Health care is an american issue. Nonetheless, its complex and wrought with emotionally and politically charged rhetoric. That being said, i was encouraged by the Alexander Murray plan just last week. I know in pennsylvania, for example, we have leaders on both sides of the aisle like senators pat toometoomey, a republican ab casey a democrat. I believe can you imagine, you put them in the room with secretary mike levitt and secretary Sylvia Burwell and say dont come out until you have a plan. They would get a plan done. We need that bipartisan view, that type of solution. They are not alone, though. Casey and toomey are not alone. There are many in the halls of congress, many that represent the district where you grew up or where you live right now who are ready and willing to cross the divide to come up with a workable solution. So lets see if congress can come together, right, left, and center around this measure. Leader mcconnell, who i think is a terrific leader. Please use these leadership skills, run the bill, save the Affordable Care act so we can move onto a Better Program for our country. The Alexander Murray plan is aimed at the right targets, shortterm affordability, increased flexibility, and the time and stability to transition to what comes next. Whether you call it repeal and replace, whether you call it fixing aca, it doesnt matter. From my perspective whether its a tax break or subsidy, as long as we get people into the system, lets move forward with it. I hope we can use it as as springboard to comprehensive solutions for the longterm, because under our framework for Getting Health Care right, any process must do three things, stabilize, transition, and accelerate. Number one, stabilize a system that is very precarious right now. I cant tell you the number of calls, interactions were having with 300,000 people. Not all of them but a strong number of them who dont know if they really can sign up on november, arent sure how. Thats how it was year one. We should be well beyond that. Number two, manage a productive transition to whatever the next iteration of Health Care Reform is. Number three, accelerate innovations and care delivery and payment models to create true sustainability in the long run. You just heard that a few minutes ago. None of that can happen without a bipartisan agreement right now. We should demand it. Whoever you can talk to, demand they sit around the table and get it done. What are the key elements of stabilizing our system . Lets start with the millions of newly insured americans since aca. President burwell didnt really trumpet it enough, according to National Health interview survey, there were 20. 2 million fewer uninsured in 2016 than 2010. Truth is, i like to look at it this way. When you look at the numbers of those who have joined the exchanges, some are between 12 and 13 million by our count. Those who have been part of medicaid expansion, somewhere around there, 22 million americans today have coverage that did not have it prior to 2014. 28 million americans. [ applause ] thank you. You guys deserve that. For all the sustainability issues, and these are real, 28 million covered is pretty exceptional. If you dont if we dont have these folks in the system, what does it mean . Will they again show up in Emergency Rooms . Were on the cusp of turning back the clock. We cant do that. We cant let it happen. Shortterm stability also relies on finding consensus on csr payments. These critical subsidies to the consumer have been used as a politic political cudgil. A longterm marketbased solution that will cover more people and hopefully bend the cost curve. Csrs were part of that transition to bring some of the most Vulnerable People into the system. They have been part of business calculations to set premiums that a maximum number of people can afford. From an audience of legal and ethical thinkers, csr situation should raise an obvious question. Is a contract a contract . We have to live up to our contracts with our members and our customers and our vendors. Shouldnt the government live to its contract . Shouldnt this debate be long over . Just living up to that contract will be a huge step in reestablishing stability. Once we do that we can talk about logical transition to whatever comes next. That includes balance between key tradeoffs, federal uniformity, state flexibility. A focus on subsidies versus tax credits where the financial burden of reforming a tax system falls. Acas Health Financial burden where it falls, acas health tax this year and last year but reinstated in the future. This added another element of instability. This tax being squarely at one stakeholder in the complicated landscape reduces our ability to drive innovation and payment models and care delivery. But i have to say this debate now where on the floor of the senate, at the time thatten wo of the senate bills failed, there were a number of senators talk about not going to bail out the Health Insurance companies. The truth of the matter is when you look at 2014 to 2016, may be off by a few billion dollars but not much cfo is here, forgive me, greg, for throwing numbers around, the Insurance Companies contribute 35 roughly 35 billion into the system. But it wasnt the Insurance Companies. It was consumers of all ilks. It makes my blood boil when it comes down were not going to do Health Insurance pailout. Its not bailing out insurers, its making the system sustainable by giving consumers the break they need. Shouldnt there be a funding process that brings all stakeholders to the table, providers, pharmaceutical companies, everyone . Whatever the next iteration of Health Reform looks like, there needs to be a transition period that gives everyone time to p n plan they are not legislators of one party or another trying to defend their seats. The tries to defend their seats. Victims lose coverage if we cannot find a comprehensive solution within a reasonable transition period. These issues are difficult and critical and only establish the baseline for longterm sustainable reform. Now the good news. The good news, the next step, which we call acceleration actually makes me excited to come to work every day. Our goal is to accelerate the transformation of how we pay for and deliver health care in america. The key to longterm assisting ability is not anything that congress does. The key is a collaboration and innovation by private sta stakeholders actually on the ground in the health care city. We must Work Together on new models to pay for and deliver care. In the insurance energy, this is where we put our energy every day, into innovations that create quality, affordability and sustainability. We need a system that pays for value, for outcomes rather than for volume. Cms put its weight behind a value based world with macra. Though there have been mixed signals under the new administration, value based models are not going away. The Insurance Industry has made the quest for value our own. We are doing it in partnership with health care providers, which is critical. Partnership is critical. We cant do it alone, they cant do it alone. We have to move into this world together. Our company has put value based models at the heart of our business. We put everything into one function we call facilitated health networks. Were building that function on principles of disruptive innovation. If youre familiar with the work of Clayton Christiansen at harvard, he in order to disrupt how health care is provided, you need all three principles, a new Business Model backed by new uses of technology and a new type of network called a facilitative network. In our world we call those le d elements engage and empower. We are implementing that model at the most basic level, our contracts with providers. We are going to the largest Health System in our market, places like pennsylvania Health System and jefferson health. As theyre contracts come up for renewal, we tell them we cannot keep paying these accelerating rate increases every year. We have to control the base rates of reimbursement. These are the same type of conversations were having with other payers around our products. These are conversations about the Business Model. We need to engage the Business Model with the accessibility and come up with a middle ground that works. At independence were saying, lets put systems together, things like bundled payments, episodes of care. And the transition to value based care means we share a responsibility for those outcomes, we share the risk. They all get it. They all understand it. The providers want to work with us. These outstanding Health Systems know economics just like we do. In fact, its the only way to proceed. The enable is technology. Health systems have Electronic Medical records of patients, everything that happens at the point of care. Insurers have claims data, which are also extraordinarily powerful. Our data tell a story of what happens to our members. Every time you see a doctor, every time you have a test or fill a prescription, at the next level we can link that data to demographic and Financial Data and get a socioeconomic picture of a patient that helps guide care. So when providers are willing to partner with us on value based care, we can also Exchange Data and building a database around claims data and emr data, which is the holy grail, were starting to do that. We are in an ideal situation working with penn and jefferson where they also have world class resources for understanding data. The final cornerstone of our approach is empowerment. I want to give a quick highlight so we can begin to put an impact on some of these efforts. Because were sharing de ininei heres an example. They are so confident in the partnership that they agreed they will cover any involuntary readmission up to 30 days. I think its the first in the country. I dont know if anybody else is doing it, one of the first. The truth of the matter is we calculated the impact. The impact is roughly 20 million a year in savings to the Health Care System. One hospital, one episode of readmission. But think if you extrapolate that across the entire system, the billions of dollars in savings that we could find from various episodes where we agree to partner between payer and provider. All right. I lost myspace. Okay. I got excited about that one. Im sorry. I might be repeating here. Were in the ideal situation, i talked about here i am. This is how we make sure that this new value based and Business Model and all this data have an impact at the point of care. This means building a facilitated network, which is a network of networks really. It means connecting the primary care provider, the specialists, the nurses, social workers, community resources, Health System around the consumer, around the member, the patient. And we link all these components of networks by technology and were building that technology with this two provider system. Dr. Rich snider chairs the Health Information exchange for southeastern pennsylvania. Under a Health Information exchange, no matter where you wind up getting care, what hospital or doctor, your medical records can travel with you. We also have Clinical Care Transformation Team which goes out to Physician Practices and Health Systems and helps them element the collaborative clinical model. O our clinicians are coming to the table to figure out how we define outcomes and pay for them. As i said, we are out in the real world doing this, doing what president burrwell talked about. We had penn and jefferson, two of the nations most outstanding systems up for renewal this year. Both are contracturally committed to principles of value based payment. Our teams are exploring exactly what the value based models look like as we go through implementation. With jefferson, they are a dynamic, innovative system that has grown quickly. Theyre working on new ways to treat diabetes in populations, expanding the potential biometrics for remote care. There are great ways to integrate a value based model into these projects and we will find them. The university of pennsylvania are really raising the bar for shared risks. I talked about the program were doing about readmissions. This agreement, the jefferson agreement, both start by lowering base rates and paying value for value, only when value is achieved do we pay. We come together to share data at a realtime. Some of the most innovative america Health Systems are in philadelphia. We are building a type of partnership with them that really has not been seen between insurers and providers. Thats why im so optimistic, even though the legislative side of Health Care Reform is still not settled. If we can just get that basic foundation built and stable, then the prieflt sector, the insurers and Health Systems, all of the stake holders have an ability to collaborate on a system that works. That is my perspective. I remain excited and committed to tackling this challenge of a lifetime. Id like to open the floor for your comments and questions and learn from you. Before i do, allow me to share a call to action. We must demand of congress that they reach a bipartisan agreement on the issues in front of them. Your opinions carry a lot of weight, so please make your voice heard. Beyond that, keep doing what youre doing, keep putting the focus on Health Care Reform, that it fits in the context of our legal system. How it affected the health of populations, how it reflects the moral compass of our nation and how all these things are interrelated. Do everything you can to inspire, encourage and support innovation and let us together continue to build partnerships, Collaborative Partnerships that will make our Society Stronger and our population healthier. Thank you very much. [ applause ] any questions . Are you participating in any multipayer demonstrations and what are your thoughts on trying to merge insecentives at least . We created an entity called tandime health a few years ago. Were going out to independent primary care practices. Were up to about 500 in the philadelphia area. And were giving them the tools and the technology to build an interrelationship with their patient and with the Health Systems that they interact with. Weve decided that we wanted an advantage for a period of time. So its just us participating through tantime. Come th were opening it up to other insurers. These clinicians have patients from all insurers. I dont know that were going to let everybody on, but it will be a multipayer system. We are very interested. This is something that would be unheard of with the blues a few years ago. Our pbm is owned by United Health care. When they first acquired our then pbm, i said to our team how soon can we move. I received a call from the team. They said give us a chance, come see what we do. We were so impressed with them, were going to keep them. I think competition at the high end will continue. Well fight hard to beat utilitied autility united and theyll do the same for us. Theres no reason that it cant be agnostic. Our philosophy is were going to go down that pathway. Thank you. All right. Thank you very much. Have a great rest of the conference. Later today, defense secretary james mattis and secretary of state Rex Tillerson will be on capitol hill to testify on the authorization for the use of military force. The Senate Foreign Relations Committee hearing will begin at 5 00 p. M. Eastern live on c span. You can also watch streaming live online at cspan. Org. Tomorrow morning on cspan fema administrator block long testifies before the senate Homeland Security committee on this years response to the hurricanes