850 formally submitted comments. In december of 2015, the working Group Released a comprehensive document. In october of last year we issued a legislative discussion draft. Soon after that we finalized four of our policy proposals in its 2017 medicare physician fee schedule rule, and twon provisions from our discussion draft where included in the 21st century cures act which president obama signed into law this past december. In other words, sefrlt working groups policies have already been enacted and were working to get rest signed into law fully implemented. Toward that end, we introduce the latest version of the chronic care act, the bill that encompasses the working groups proposals in april. The legislation currently has 17 bipartisan cosponsors and has been endorsed by numerous organizations in the Healthcare Community. Today, is the latest step in our in our efforts. The next step will come later this week, as weve noticed a markup for thursday morning. I want to thank my colleague Ranking Member senator widen for his work on this matter. His passion for improving care for those with chronic conditions has been a driving force behind this effort. And of course i want to thank senators isakson and warner whofz worked tirelessly to lead our working group. Through their ef forts the committee has not only learned about the Patients Living with chronic conditions but also identify new policies to improve care coordination, increase value and lower costs in the Medicare Program without adding to the deficit. Todays hearing will provide us with an opportunity to examine these policies more extensively so we can better understand how they will help patients and enable providers to improve care and produce better outcomes. The bill includes a number of policies that would improve care for the chronically ill through increased use of telehealth by giving Medicare Advantaged plans and certainly Accountable Care organizations enhanced flexibility to target Telehealth Services to medicare patients with chronic conditions. Senator schatz and wicker have been instruments in this particular effort and im pleased to have them here with us to talk about how the chronic care act advances their policy goals. Now, i would be remiss if i did not also recognize the finance Committee Members po who have joined senators schatz and senator wickers efforts to promote the increased use of Telehealth Services. In that regard we appreciate the leadership of senator thun, cardin, and womaner aern on the matters. I want to thank the fine institutions in utah for their help, specifically on the quote telestroke, unquote, policy. Specifically i want to recognize dr. Jenny ma jess sick and dr. Nicholas johnson at the university of utah as well as dr. Kevin call with intermountain healthcare. I appreciate their willingness to share their kpers and expertise using technology to properly diagnosis individuals presenting stroke symptoms and i look forward to hearing more on this particular aspect of telehealth here today. Of course our bill goes beyond telehealth making improvements for beneficiaries, including fee for service, Accountable Care organizations, and Medicare Advantage. We have a panel of recognized experts here before us today to discuss all of these issues and i want to welcome each of our distinguished witnesses. Obviously im well aware that there are some contentious debates going on in the healthcare space these days, and there there is no shortage of political and partisan points that people would like to make in a venue like this. However, for todays hearing i sincerely hope that we can maintain the bipartisan spirit that has driven our efforts on the chronic care act. Toward that end, i respectfully ask that members of the committee focus their questions on the policy areas specifically addressed in the bill. With that, im going to turn the time over to senator wyden for any opening remarks he would like to make. Thank you very much, mr. Chairman. I want to thank you, your staff, senator warner, senator eyesic son. This san extraordinary hearing and ill touch on why, but it could not have happened if you hadnt been willing to initiate a committeewide process. So. Thank you, senator. To begin i want to thank you. Thank you. For all of the efforts to make this morning possible. Colleagues, ive looked forward to today for many years. Thats because the finance committee is now beginning to tackle the premier challenge of American Health policy. Specifically, by updating the guarantee of medicare to better serve seniors with chronic illness. When i was codirector, medicare had just two parts, arks a and b. If you broke your ankle and had you surgery in the hospital, with you were covered by part a. If you got a really bad case of the flu, and you went to the doctor, you were treated by the doctor in their office and that was part b. That is not medicare today. Today, medicare is cancer, its diabetes, its Heart Disease, its strokes, and its other chronic conditions. Seniors who have two or more of these chronic conditions now account for more than 90 of all medicare spending. And today older people get their care in a variety of different ways. Theres still fee for service and theres also Medicare Advantage, Accountable Care organizations, and a host of innovations being tested across the country. Because medicare is a guarantee, a promise of defying benefits, its pastime to update this promise so as to deliver to patients with chronic conditions the best possible care in the most efficient manner. So as the chairman touched on, the legislation today begins this transformation. Older people will get more care at home, less in institutions. There will be expanded use of lifesaving technology, thats why its so good to see senator schatz and senator wicker here to talk specifics. There will be a stronger focus on primary car and expanded use of nonphysician providers. Now, in my view, still to come is ensuring that each senior with multiple chronic conditions has an advocate to guide them through what can be a teeth gnashing experience of trying to navigate American Healthcare. Two final points. One, picking up on the debate about the Affordable Care act, i would just say, colleagues, this is the way to do it right. Doors were open here, not closed. There was bipartisan cooperation, not partisan reconciliation. The public was asked to shape the bill, not taken for granted. And finally, i want to thank our partners, chairman hatch and i, senator warren and senator eyes sack son coordinating this effort. The chairman has made mention of the fact that many colleagues both on and off the finance committee have really helped to produce what our witnesses are going to call this morning a model for how to take on tough challenges. Its been an honor for me to be part of this bipartisan effort on and off the committee. And like you, mr. Chairman, im very pleased that our colleagues senator schatz and wicker are here with us today. Thank you, senator. Were pleased to welcome senator smats and wicker to our hearing today. As i mentioned in my opening statement, these two senators have done a lot of work on telemedicine and telehealth issues. We appreciate your support and your input today and we look forward to hearing your remarks on these important issues and your perspectives on this topic. Senator wicker will provide his statement first and followed by senator schatz. Senator wicker, if you would, please proceed with your remarks and well take senator shoots schatzs next. Thank you mr. Chairman, my distinguished colleagues its a pleasure to be here. Thank you for allowing me to share with you what we already know in my home state of mississippi, telehealth works. Im glad to be here to discuss the promises of telehealth and to celebrate the progress your committee is making with the chronic care act, which i have enthusiastically cosponsored. I would like to command the leadership of the Senate Finance committee for their years of work to address the cost and quality of chronic care in america. Today is the testimony to your efforts. Im pleased to be here today with my friend senator brian schatz. He and i lead the commerce subcommittee on communication, technology, innovation and the internet. In the commerce committee, we have worked tirelessly to provide innovation by removing barriers to connectivity and expanding access to rural broad band. In fact, it was during a 2015 hearing of our subcommittee on the potential of telemedicine when senator schatz and i decided to join forces to reform how medicare reimburses hell telehealth. We were fortunate to get a team and if was the secretary for health act, a widely supported legislative proposal for telehealth. Connect for health s 1016 is a pro duskt hard work and determination. It is designed tacoma prove quality of care and cut costs. I thank the committee for including telehealth provisions inspired by our connect bill in the bill we are discussing today. In so doing, youre recognizing the promise of telehealth. I became interested in this topic because my home state of mississippi has led the nation in maximizing technology to improve patients health. The university of Mississippi Medical Center . Jackson has been a leader in telehealth for over a decade. The team there has managed to increase access to quality care and cut costs by using Services Like remote patient monitoring, and teleemergency reaching some of our states most rural, vulnerable and costly patients. Mississippi say very rural state and, in fact, we have some of the toughest Health Problems too. We have the fewest providers per capita, and the highest rates of Heart Disease and type ii diabetes. These Health Disparities and barriers to access are what drove university of Mississippi Medical Center to experiment and innovate with telehealth. One of the many mississippi telehealth Success Stories is the diabetes telehealth network. A Remote Patient Monitoring Program that provides rural mississippi patients who have uncontrolled diabetes with routine access to a provider through a medical tablet. This Partnership Began following 200 chronically ill patients in the underserved mississippi delta. The technology allowed providers to monitor and care for the patients remotely on a daily basis following their vital signs and intervening when things didnt look good. Throughout the course of the first year, zero of the 100 patients were admitted to the hospital. Think about that. No emergency room visits for any of these previously chronically ill patients. This is an excellent care that can improve patientss life. In fact telehealth can save money also. The Mississippi Department of medicaid found that if this remote Monitoring Program were extended to just 20 of mississippis diabetic medicaid population, the state would save 189 million per year. So mississippi medicaid, like Medicaid Programs in virtually every state, is expanding access to and coverage for telehealth and remote patient monitoring. However, medicare is behind the curve limiting access for millions of seniors. Emergency the incredible impact that this technology could have if medicare would allow its most vulnerable beneficiaries to use Something Like remotepatient monitoring. Im confident that the success we have seen in mississippi can be replicated for patients across the United States. Upon enactment of the chronic care act and ultimately enactment of connect for health. We are still looking for cosponsors, mr. Chairman, and we will not stop until access to quality care through telehealth is realized for medicare patients. The chronic care act is a step in the right direction. We have more work to do in this space and i look forward to continuing to work with each of you. Thank you, sir. Thank you. I think im a cosponsor if not put me down, okay. Senator schatz, well thank you now and then were going to turn to senator warren who has played a significant role in this. Thank you, chairman hatch, Ranking Member wyden, distinguished colleagues, members of the finance committee for holding this important hearing on bipartisan legislation. Im happy to cosponsor the chronic care act a bill that can help improve outcomes and disease management for people on medicare who have chronic illnesses. Right now progress and modern technology has not translated into progress across the Healthcare System. That impedes the Health Systems ability to provide highquality care, improve access to care, and to lower costs. And so its time to bring medicare into the 21st century by taking full advantage of telehealth and remote pashlt monitoring. When were talking about telehealth, were talking about using technology provide Clinical Services to patients remotely. Telehealth more broadly can also include nonclinical Services Like provider training. One type of telehealth relies on live video or audio or visual technology, its like using a secure version of skype or face time so that a patient can connect with his or her healthcare provider. When these substitute for a traditional inperson visit they can save er kperngsz, they save travel time and fut put patients back to work more quickly. They can also use store and for technology, another type of tej health which is exactly ha it sounds like. Providesers can take an imagine or other clinical picture, store it and send it to a specialist anywhere on the plan. He theres also remote patient monitoring. If a highrisk patient with a chronic disease needs to have her Blood Pressure or blood sugar monitored, she is use a device at home to collect and sthaend data remotely and continuously. This improves the outcomes for the patients with chronic conditions and it saves money too. The vet vans administration, the department of defense, and the private sector are all taking advantage of telehealth and remote patient monitoring and improving access to care, improving quality of care, and saving money. The problem is, that medicare is not. Its limited by an old law, section 1834 m of the Social Security act which put which puts restrictions on the use of telehealth. The law says that patients must be located in certain originating sites in order to use telehealth. They cant be seen at home and can only be located in certain rural areas. Only certain types of physicians and practitioners can use telehealth under medicare, physical therapists or Occupational Therapists for example cannot, and remote patient monitoring is hardly covered at all. And thats why senators wicker and i along with senators cochran, cardin, thune and 13 other members of the state and three dozen members of the house and everybody is invited to cosponsor the connect for health act after the past two years. Our bill would lift restrictions on telehealth and improve coverage of remote pashlt monitoring. I know the Chronic Care Working Group has worked in a similar bipartisan fashion to find ways to advance legislation. There are four provisions in both the chronic care act and the connect for health act that would help patients to lower costs. These include lifting 1834 m reinstructions that hold back patients of who had acute strokes and need dialysis. People enrolled medicare. While these are an important first step, we still have further gore. We look forward to working with this committee to continue to advance the important provision dollars in the connect for health act including improving coverage of remote patient monitoring, lifting 1834m restrigss and giving the skekt of human Health Responsibility of 4ri69ing these costs if quality measures are met. Thank you to all the members here for the privilege of speaking before you today, and especially thank you to my partner on this legislation, senator wicker. Well thank you both very much. Were very appreciative that you would come and appear before the committee and give us your excellent remarks. Well turn to senator warner now for whatever hed like to say. Im proud to you one of the original cosponsors and i think its great to see that you both wore purple ties today, think that color coordination gives it a little certain extra. So did the chairman. So did the chairman. Its a trip let. I should be mention toad, i think. This shows when theres a will theres a way to get to things. This chronic care topic is obviously extraordinarily critical and i want to particularly thank the chairman and the Ranking Member for asking senator isakson and i to work with both ever you on this group. I know senator isakson is not here this morning yet but as in so many projects ive worked with him hes been a great partner, as have you senator chairman and wyden. I echo what senator schatz and wicker said in terms of telehealth being a critical part of how we deal with chronic care and how we get medicare right. The truth is, as our population ages and americans survive account illnesses, to an extent previously unimaginable, we need to make meaningful reforms to our Health Programs so we can move healthcare into the 20 u. N. St century to keep prourmszs and the ensure high quality care. All hoe though the rate anyone crease may be slowing, our aging population and uncertainty around 8 ford able care act means that our p