Were not always being taped live by cspan. Were delighted to have them all here today. This is a particularly exciting entry in our longstanding Public Health rounds that are sponsored by our Health Society and medicine program. The focus today is the inaugural report of the aspen Health Strategy group. The name, Health Strategy group, is taken from the aspen Strategy Group, for those of you familiar with American Foreign policy, you probably know about the aspen Strategy Group. It is undoubtedly the leading Bipartisan Group of its kind looking at Critical Issues of Foreign Policy and we establish the Health Strategy group with that in mind to bring together remarkable people from across different sectors in the American Health and medical landscape to look at the most pressing problems and to come together with different perspectives to make recommendations for change. This particular Strategy Group is cochaired by former secretaries of hhs, and also former governors, both kathleen sebelius, who of course is with us today, and tommy thompson. The mission is to promote improvements in policy and practice by providing leadership and counsel, and then specific road maps, when possible, on the most Critical Issues that we face. As youve seen, we have an extraordinary lineup. 23 outstanding senior thought leaders from different sectors, including health, business, media and technology. Just as in the aspen Strategy Group in Foreign Policy, we recognize how important it is to have critical people, not just from one particular aspect of this multifaceted area, but from all aspects. The focus of the inaugural launch year of this group was end of life care. It is an incredibly difficult and complex issue, of course, as all of you know in this room. Not just medically, but socially, ethically, politically, economically. The report you are going to hear about today reflects what we think is some of the best thinking of some of the smartest and most sensitive people on this enormously difficult issue. You will hear more about these efforts from our panelists. Let me just say though now how excited we are to see this new Strategy Group and the aspen firmament beginning its work to actually lead to changes in policy. Let me just give you a headsup the focus of this group this summer at its meeting is going to be on the opioid problem which of course is a National Epidemic in myriad different dimensions. I was going to say that our moderator for today is the director of the aspen Health Strategy group, allen wile. All evof you know allen, editorn chief of health affairs, the countrys premier Health Policy journal. He has a personal issue that just developed this morning that may make it impossible for him to be here. Although we hope he will come in the door at some point. If he does, there will be a little bit of musical chairs. But if he doesnt, ruth katz, director of the Health Medicine society program, will do, im sure, a terrific job moderating. And of course, i will leave it now to ruth to introduce our two panelists, kathleen sebelius, the cochair of the aspen Strategy Group, and dr. Victor zao, member of the aspen Health Strategy group and, of course, the president of the National Academy of medicine which was, until recently known as the institute of medicine. Just one little housekeeping note, as i already noted, we are delighted to have cspan with us here today. Hoping that those recommend da recommendations are going to make an impact on what has been the most problems of medical so i will turn it over. For folks standing in the back, we got seats up front and over on the side if you want to move up this way. I think well get some more people floating in, terrific. Thank you all for being here and as allen pointed out, i am not allan. Hes dealing with an american si situation with his family. I am stepping in and hopefully he will join us in a little bit. I am going to do a little introduction of our two panelists today. I am going to take a little bit of time, giving questions and discuss the reports and recommendations. We want to leave time to ask questions as well. Please have them ready and we have an interactive session here today. So first let me introduce captain both of these people need no introduction but let me add a few word, ckathleen of former government, shes an expert on Health Policy and healthcare reform and human sir vis liberties. She searched as secretary of 2009 to 2014. She currently serves on numerous boards. From 2003 and 2009, she was governor of kansas. Thank you kathleen. Doctor victor zao as you heard is president of the National Company of medicine. Most of us known it as the institute of medicine. Hes the former ceo of the duke Health System. He was professor of chair medicine at Harvard Medical School as well as stanford university. For those of you who dont know, hes done an incredible work relating to medicine thats led to widely used and life saving drugs. Thank you for joining us as well. Thank you. One other housekeeping thing. On your chair, we have xerox for you came out of the Aspen Institute report. This is what it looks like and the full report includes the background paper that well repair for the initiative. What you have is the summary of the five big ideas that this group came up with at the conclusion of its meeting last june and aspen. Before we get to all that. Kathleen, tell us a little bit about the Strategy Group and how we arrive at this topic and how we did our work and well look to victor to talk a little bit about recommendations. First of all, thank you. Fort worth for more importantly aspen Health Strategy group, i think came out of the big idea. After two years of spotlight trouble which has been now multi day program of ideas, focus specifically on a whole range of Health Issues that became an enormous popular forum. I think it was ruth suggested that maybe we have a Health Strategy group kind of mirroring what had been very successful done years ago in the International Policy area now with the aspen Strategy Group. A Bipartisan Group and being talked about of challenges and issues and not necessarily trying to run a drive but particular a program really convening around ideas and then moving that forward. She approached me and governor thompson and we kind of mirrored both. We ran various Health Programs and both of us served secretary of hhs and wanted of republican and add mip strags, administration. We then look around the country for various leaders who not necessary were focused on health but broad perspectives and business. They were authors and economies and some are into the Health Business as leaders of big Health System or ensurers, providers and invited people to become part of this, not as necessarily of their expertise and knowledge, but because of a broad background they bring to the table. We really talked a lot about initial initial initially, of tl governor and i talk about what kind of topics we try to focus on and deciding it is not a great idea to duplicate what was hot in the legislative arena but commenting this from a lens of we are challenging the issues that did not blend themselves to specifically political discussions or conversations and needed a jump start and needed a conversation input. I think i had a very personal interest in end of life and most of us do as we had deaths of near and dear ones and gone through that experience and a policy interest. I am the death panel lady. [ laughter ] that became an illustration of just how elected this issue is when it comes into the government spear and how difficult those conversations can be so i was interested not only in the policies side but also in the practical side. We decided that the way we would operate differently than a lot of groups was to engage experts over the course of year to do a deep dive of various aspects of a topic. And then have a convening mid year by telephone and once a year in person of our group to really dive in and that rather than producing a lengthy report that would sit on somebodys shelf. Look at this as ideas and seems to fit in well with the aspen theme. We came up with the notion that well try to generate around consensus operations and a number of big ideas to put forward and not that people had thought about it before and that they did not have to be particularly unique. If you were to only do a handful of things. What were the challenges that were facing patients and providers. Our first year we spent as we have said the report is now online. It is in front of us and one of them more interesting things, we looked around the table at aspen and realized in addition to try to generate conversations with the outside world and the policymakers in washington and in the administration around these ideas, everyone in our group have some capacity to move forward in his or he her organization. One of the commitments was individual members would indeed turn around and go do these initiatives in their organizations. There is no conversation about advance directives. There is no generalized discussions in the hr department. They want to set aside money for this insurance or have this kind of program or ira. No one talks about this herb. That can become apart of that routine hiring decision that this can be a conversation that they would urge their member to do that. Indeed, and the feeling that if you are going to normalize the conversation, thats a great place to do it. We tap into a lot of the expertise that was around the country and people who were already very much engaged in this work when we came together and one of the great opportunities was to look at the work, victor, was leading in the National Academy in medicine. Theyre ahead of our Strategy Group and organizing they have gone through a series of convening and had a whole host of National Organizations lined up and on board and he is a member of the group with those ideas to the initial aspens Strategy Group and membership. We feel like the work that we ended up doing dub tails very well into victors work so the way we are going to operate today is i want to lay a little bit of a background and how we got here and what initiative pushes forward and turn to victor who was going to cover the specifics and we can hopefully go back and forth. Before we do that. No, no, thats great. One thing that you may want to mention of the work that we did was the opening invitation of the public. This is quite unique to this group of what it is doing. In addition to our own membership, we felt that whether it was life care or any other kind of Health Policy challenge and again, i may have said this. If i did not, the notion was to take one topic a year. And knowing a lot of people were involved in that topic. Put on the aspen website of what the topic is. Invite everyone to send their own big beyond all doubts in and to ask our members to send to their email list to use the entire aspen list to get in the press and the public. It is not just the 23 members and chair people sitting around the table, it is we go got hundreds of ideas, we have a lot of input from a lot of people and even inaugural effort and we are hoping the effort to reduce an outreach to the public and to invite people also to submit ideas and niche tifr those are all processed and pulled together and part of the information that we looked at when we come together in addition to four very deep dives from expert who is are engaged in looking at aspects of the topics. That format seems to work very well. We have keen expertise, we have a lot of information thats average to the public. We have membership to really bring your own initiative forward. Indeed, it worked very well and some of the big idea that we got from the big Public Incorporated in to the big ideas that we came up. As kathleen is pointed out, go to the aspen website, we got it up for year two and we encourage people to send along good ideas on how he can address that problem as well. Victor, talk a little bit about where we ended up and how we got there and how we can help advance this issue. First, let me say that what a great choice of a topic. Congratulations on the leadership and secretary thompson and yourself. This is such a personal issue, i would say that very few issues of life defense illness, i bet you that everyone in this room have some experience with their loved ones and family members who has gone through this. We can all recognize this is a different topic. But, as luke at this size of the issue and particularly as we gain the complexity of healthcare and social environment, it is getting bigger and bigger. We are dealing with 2. 5 million of all ages. Majority of people over 65 and yet, another 8 Million People are suffering from advance illness which are moving towards end of life. [ inaudible ] we are dealing with a very, how do you call that . It is Public Health issue. I think it is a national priority. If you look at this issue and the fact that most of us say is difficult enough to deal with this but when you have to deal with the care aspect of it, most of you will say how fragmented and how difficult it is. So i think both personal issues but also it is an issue that we, the nation needs to figure out how to make it this much easier. Take the fallen. We are becoming a diverse country myself being an immigrant born in china so you think of all different types of cultures and religion and family cultures. We dont socialize it and make it a sentence and homogenize it. An important issue to recognize this to be personal. I would argue with you that we have a system of care that has not adapted to environment. After all, medicare and 50 years ago. That time, there were not that many People Living a long life of chronic diana costarakis. Looking at the way that medicare looks at and how to pay and support services is not that up to date if you will for this population. So, for example, kathleen is the expert and i would love for her to tell you more about this. We do know medicare does not provide social support. Just think about the experience. The risks for families and care givers and the time for activities and thats one of the big problems that we found in this report in looking at how difficult it is because we have a fragment of the system. Second is, within the medicare or for that matter of the elt system itself of the insurance as well. The coordination of care which is so important. It is also not there. It is also fragmented. And of course, we also dont have enough providers understanding this issue. From experts of care expert. I just described to you some of the problem we face is not just an issue of difficult time for us personally. We are not helping by helping the system and the support and the families. I think that is the issue, i think thats why a number of organizations including. We all cared about this. I say whats techniques unique experience as aspen dprup pointed out 23 people are all different backgrounds. Together we try to solve the problem together. We have a lot of things to work with. We spend a lot of work leading up to that meeting and that meeting to me is unbelievable. Let me say the following. This one is dynamic. Because what happens is you bring in people to say you prepare to begin with and the first day, we have people telling stories and role play. I thought that was really good because it warms you up. Second day, we have experts to giver papers and talking about the backgrounds that we are talking about. Them we are prime to say what problems are we trying to solve and how can we make a difference. And things that we feel can make a difference and implementing this and following through. What are those big ideas. Maybe we just read them to you. First, advance planning. If you look at certain populations, thats even lower. So that means people are just not prepared. Think about this, if you got sick and you go to through end of life and doctors are trying to decide what to do. Without advance directive, theyll compel to give you everything they could do and sometimes unwarranted. So at least a process of something who can coordinate in the conversation. The first recommendations to say what do we mean about that . Well, when did you start thinking of this . Most of us getting into a certain age like me. You can plnot plan when you liv and die. You know you can be in a car accident and whatnot. The idea that it should be part of your conversations all the time. And so, for example, if a young person at age 18, getting their drivers license, is that a good time to say have you thought about this. Sbr integrating advance planning in your life is really important. It is going to help you. If you dont have that and given the fact that we have the care coordination problem, when your loved ones get sick, who do you call to make what decision. Without directives and teams. You are getting yourself in a sequence of care that may or may not be what your loved ones desire. I will put them out of sequence first. I will leave the policy side particularly for severeness to talk about. So training doctors and nurses to have every opportunity, and