To order. Today the finance committee focuses its attention on what in my view is the biggest challenge ahead for medicare and the future of Americas Health care system. That is managing chronic illness. To understand why this is a growing issue, one need only to look at how medicare has changed over the years. When the Medicare Program began, in those early days i was codirector of the cancer, full head of hair and rugged good looks. Medicare was mostly about caring for seniors who needed to go to the hospital. If a senior slipped on the Kitchen Floor and broke an ankle for example and head to the hospital, they would get treatment and they would head home. In 1970, nearly 70 of medicare spending was for hospital care. Now that number is close to 40 . The change shows how medicare is very different than it was for four decades ago. Other than broken ankles or new money medical care is dominated by chronic conditions such as cancer, diabetes and Heart Disease. More than two thirds of those on medicare id dealing with challenging multiple chronic conditions. That care accounts for almost all, 93 of medicare spending and we are going to hear today that it is not just seen years who are affected by chronic illness. Half of all American Adults have at least one chronic condition. These diseases account for 70 of deaths, limit the activities of tens of millions more americans, and cost the economy billions each year. The problem is only going to be calm counted as chronic illnesses become more common. In fact the number of Health Care Experts warn that this generation could be the first in modern times with shorter lifespans than their parents and this is not just the health issue. The growing prevalence of chronic disease is a major driver of Health Care Costs that are putting a growing burden on the government, business and family budgets. Here is my bottom line. The way health care in america is delivered has got to change. I will repeat that. They have to change. Doctors and hospitals often dont coordinate care or even talk to one another. Patients receive medication for one disease that conflicts with another. Paper medical records for time and energy away from patient care only to be sent on burdensome red tape, there is even data showing caregivers and those with chronic Disease State higher rates of stress and depression and higher mortality rates. Virtually all americans get touched by these kinds of issues and certainly those suffering with chronic disease are hurt the most by the flaws in American Health care. A look at the problems faced by millions of americans every day as they try to navigate, navigate americas chaotic system of treating chronic illness. The committee will hear how chronic disease is exemplified by a single mom who before her 31st birthday has major heart surgery, can no longer work and even drive a car because of the onslaught of these diseases. People with multiple conditions left on their own to shuttles themselves between a whole array of different providers that often i located hours away from each other. The life struggling to take care of a husband with alzheimer is, make sure the doctor appointments are kept, medication is taken and the marriage is intact. We all understand this is not something that is going to be solved overnight. This chronic care hearing marks the beginning of what will be a bipartisan effort to address the dominant problems in Americas Health care system that practically everyone over the last decade has managed to ignore. In the months ahead the committee and find Bipartisan Solutions to meet the challenges, strengthen the American Health care system and very much committed to working with senators on both sides of the aisle and let me recognize senator hatch. Thank you. I am pleased we are including a Health Care Hearing today. Frankly i think this committee should hold more hearings on health care. We all know the implementation of obamacare has come under intense scrutiny but for good reason in my view. Is imperative that the senate start exercising proper levels of oversight to determine whether the law is working as promised. I dont say this out of politics or partisanship but because patients, taxpayers and policymakers deserve honest answers. This committee has an opportunity to delve into the very important topic of chronic illness. This is one area if we choose to Work Together the committee can find real Bipartisan Solutions that not only improve care coordination but lower overall Health Care Costs and give complex patients better tools to more effectively manage or navigate the Health Care System. The medicare payment advisory commission, feeforservice medicare creates silos incentivizing providers to deliver more care, not necessarily Higher Quality coordinated care, to successful Medicare Advantage programs that give patients the option to receive benefits from private plans that are incentivized to manage care across all settings. Traditional medicare fails to encourage providers to laborintensive and time consuming patient care communication. Medicare advantage enrollment increased by 9 to 14. 5 million patients. That is 20 of all medicare enrollees. Even with these advances, todays Health Care System remains fragmented and very significant evidence that communication between providers is lacking in the Medicare Program and the private sector. The medicare payment advisor recondition estimates medicare patients with five or more chronic conditions cn average 13 provisions and fill an average of 50 prescriptions each year so there is no surprise patients with chronic conditions routinely visit multiple specialists and repeat medical histories and tests, receiving consistent medical instructions, did not get health transitioning from one side of care to another, and use more extensive care settings when it may not be necessary. Today one remarkably brief patient as well as a devoted and loving care giver will share their personal stories with us. Their testimony will show the current Health Care System does not serve all patients well but there is hope. They will talk to a medical provider about promising efforts underway to address the unique needs of chronic care patients. I applaud these innovative approaches but we all need to know there are no easy answers. Developing and implementing policies to improve disease management, streamline care coordination, improve quality and reduce medicare costs is a daunting challenge. Based on past experiences with Medicare Program, in particular, much more work to be done. For more than a decade the centers for medicare and Medicaid Services has tried numerous demonstration programs to find out what does and does not work to improve care coordination for patients with chronic diseases. These demonstration programs have shown mixed results. According to the Congressional Budget Office cms has paid 34 programs in six major demonstrations to provide disease management or Care Coordination Services in traditional medicare. On average the 34 programs had little to no effect on hospital admissions or medicare spending. In 2010 obamacare created Accountable Care organizations that allows certain providers to coordinate and integrate medicare services. These provider groups must meet specific quality standards in order to share any savings or share in any savings they achieve for the Medicare Program. The initiative is relatively new. There is no definitive data to prove they improve quality. If they show any promise to save medicare money or if they are simply failing. The jury is out whether they produce results, obamacare a health and Human ServicesBroad Authority to create and implement new medicare pilot programs. Through the center for medicare and medicaid innovation, the Obama Administration is conducting care coordination programs in various medicare settings. My hope is my research will yield results. As we all know Health Care Costs please enormous strain on the federal budget by identifying costeffective data driven away is to improve patient health, pharmaciesmakers can better target scarce federal resources to get more value for their dollars spent. U. S. Health care spending grew 3. 7 in 2012 reaching 2. 8 trillion or 8,915 per person. In fact total Health Care Spending consumes 17. 2 of the nations Gross Domestic Product or gdp. Adding insult to injury last year the Medicare Trustees issued a report showing the Hospital Insurance trust fund deficit reached 28. 3 billion and will be exhausted in 2026. Given the current fiscal reality we have to find ways to provide highquality care, greater value and lower costs, all heading to the deficit so i am glad we us holding this hearing to understand problems but we cant stop there. I believe this must be a start of a longterm transparent discussion with additional stakeholders including the administration, cbo and others that will allow us to Work Together to identify solutions in an open and transparent way. Thank you for holding this hearing today and i am looking forward to the panel of witnesses, it will be very interesting. Thank you, senator hatch and dublin to recognize your years of advocacy to come up with fresh creative approaches for Health Care Challenges and for our witnesses you should know i am essentially flanked by three on this side senators who have real roots in terms of challenging the status quo and looking at fresh approaches and chronic disease and Health Care Services and the same is true on the other side, 6 of the United States senate cares passionately about these issues and i am pleased that all of you could be here. We are going to hear from stephanie dempsey, a chronic patient, miss dempsey is currently taking on coronary Artery Disease, lupus, a seizure, disorder, arthritis and very much appreciate your being willing to come, and Mary Margaret lehmann is the care giver for her husband, can who is facing alzheimers disease. My mother faced, and dr. Bill bornstein is chief medical officer and chief quality officer for every health and finally cheryl demars, president and chief executive officer of the alliance is here. The alliance is a cooperative of employers focus on the delivery of health care benefits. I also want to note that the president and ceo of care first Blue Cross Blue Shield is scheduled to testify, and the skies burst open. Senator isakson we have two witnesses from georgia. You have a lot of work on these issues and i appreciate it. And lets hear you introduce miss dempsey and dr. Bornstein. Georgia is fortunate to have two of r 24 Witnesses Today and im pleased to introduce both of them to the committee and the audience. Stephanie dempsey lives in blairs ville, ga. The capital of the blue Ridge Mountains of north georgia and the rural part of the state. She deals with multiple conditions and can talk firsthand about the challenges of having multiple conditions and reaching services in a whirl area of the state. Dr. William bornstein is a tremendous individual you and i have met before because he was at our rollout when we brought a coordinated care bill first to the committee. He is the chief quality medical officer for and mori health care in atlanta which is the home of the Emory University hospital. And a major system that provides health care to significant portion of our 10. 2 million citizens in georgia. He is an International Recognized leader in the use of Health Information and technology to drive Better Outcomes and decisions and the committee will really like hearing from him because he is not just talking about doing it, he has done it and implement successful systems throughout the maury Health Care System and were glad to have him here today. Thank you, mr. Chairman. Thank you for your good work on these issues and i could literally go around the room and point to the efforts of every senator who is here and i appreciate your leadership. Let me also say to our witnesses that your statement be included in the record automatically, all that you have put together for your written statement and summarize your key views and oral presentations, that will be welcome and lets start with you and miss dempsey. I think it is going to be hard to hear you. Let the microphone on. If you will speak in to it. You have an important story to tell and i do not want people to miss it. There we go. Ranking member hatch, members of the committee, thank you for allowing me the opportunity to testify today. My name is stephanie dempsey. I am 44 years old. I live in blairs ville, georgia and i have been battling multiple chronic medical conditions for much of my life. I have always considered myself a middleclass american. I have a well paying job. I owned my own home and was happily married. Unfortunately this is not the case today. The very illnesses that i battle every day have taken that from me. I have lost my independence, my Financial Security and most importantly my family. I hope my story can help you and those listening to a better understand what people with chronic medical conditions faced day in and day out. I hope my story gives you some sense of the challenges that i and so many others go through daily. I would like to take a few minutes to share my story with you. I was diagnosed with coronary Artery Disease at the age of 21. My Heart Disease is hereditary and has impact all of the women in my family. My only sister died at the age of 28 from Heart Disease. My mother who is 69 underwent quadruple bypass surgery at the age of 48 and my maternal grandmother died at the age of 72 from coronary Artery Disease. At the age of 30 i underwent quadruple bypass surgery for severely blocked arteries caused by high cholesterol. Since then i have had the placement of 27 stands. Another bypass surgery in countless other medical procedures. I take 15 different medications in the morning and an additional four in the evening. Plus a multitude of supplements recommended by my doctors. At times as you can imagine it is difficult to keep track of all the medicines so i use these different baskets to keep track and every one is labelled by condition, with my coronary can i ask a question . That basket is what you tapped to navigate through on a daily basis . Absolutely every day and every night. They are labeled by conditions so that i can say organized because there are so many. In addition to Heart Disease i am fighting the effects of lupus, arthritis and a seizure disorder. All of which have become debilitating. I can no longer work although i would desperately like to and i depend on my parents to help care for me. I always believed as i am sure some of you have that you would be taking care of your parents and i always knew that i would be taking care of my parents as they grew older. Instead they are taking care of me because i had no other choice. This has been difficult to accept but this is my reality. That link a number of complex elvises has not only taken a toll on me, it has taken a toll on my entire family. As you might imagine my medical expenses are significant and are becoming more significant by the day. We fell behind on our mortgage and we were forced to sell our home. It was difficult to make ends meet. At the time my First Priority was to buy medicines that my son who is now 20 years old needed for his own health condition. Is required us to scrape money together to make sure that he has the necessary medicine that he requires. Pain for my numerous costly medication was out of the question. Therefore i was unable to purchase them. As a result i was hospitalized five times over the course of six months which resulted in five additional stands. As it became more difficult for me to manager my illnesses, the growing burdens became overwhelming for my husband. And after 21 years of marriage, he decided to walk away. I had no choice but to move from South Carolina to georgia to live with my parents. I now live in the rural mountains of georgia and although my primary care physician is nearby i have had to travel over two hours to see my specialists and because of my seizure disorder i depend on my parents to take me to my appointments. In addition to my primary caregiver, i actually messy multiple doctors. I have a cardiologist who helps me manage my Heart Disease, a neurologist and neurosurgeon who help me manage my seizure disorder and i had a rheumatologist who helps me manage my lupus and arthritis. I inte