Good afternoon, well get started while ruth is getting taped. Im elliott gurstein and delighted to see you all today. You know we dont usually start quite this promptly but were not always being taped live by cspan. Were delighted to have them here today. And this is a particularly exciting entry in our longstanding Public Health rounds 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 who are familiar with American Foreign policy. Probably know about the group, its undoubtedly the leading Bipartisan Group of its kind looking at Critical Issues of Foreign Policy and we established the 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 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, 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 and business and media and technology. Just as in the aspen Strategy Group and Foreign Policy, we recognize how important it is to have critical people not just from one particular aspect of this multifacetted area but from all aspects. The focus of the inaugural launch year of this group was end of life care. Its an incredibly difficult and complex issue, of course, as all you know in this room, not just medically but socially and ethically and 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 most smartest and sensitive people on this enormously difficult issue. Youll hear more about these efforts from our panelists. Let me just say though now how excited we are to see this new Strategy Group in the aspen firm ament begin its work actually leading to changes in policy. Let me just give you a heads up that 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 of different dimensions. I was going to say that our moderator for today is the director of the aspen Health Strategy group, alan whooil, all of you know alan, editor and chief of Health Affairs which is the countrys premiere 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 stomt, if he does, there will be a little bit of musical chairs, but if he doesnt, ruth katz, the director of the 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 zal, a member of the aspen Health Strategy group and of course the president of the National Academy of medicine, which was until recently known as you know as the institute of medicine. Just one little housekeeping note as i already noted, were delighted to have cspan about with us here today. Many, many other people will be able to hear what they have to say and most importantly hoping that those recommendations are going to make an impact on one db on what has been one of the most intractable problems in american Public Health. Let me turn it over to ruth katz. Thank you, elliott. For folks standing in the back, weve got seats up front and over on the side. If you want to move up this way. I think were going to get more people floating in. Ter terrific. Im not alan while, hes dealing with an emergency situation with his family so im stepping in hopefully he can join us in a little bit. But let me tell you how were going to proceed. Im going to do a little more introduction of our two panelists today. Im going to take little bit of time giving asking them questions to discuss the report and recommendations but we do want to leave time for all of you to ask questions as well. Please have them ready and we very much want to have an interactive session here today. So first, let me introduce both of these people need no introduction. But let me add a few words. Kathleen in addition of course to being former governor and former hhs secretary, she is an expert on Health Policy and Health Care Reform and Human Service delivery and executive leadership. She served as hh secretary from 2009 to 2014. She currently serves on numerous boards and from 2003 to 2009 she was governor of kansas. During her career, kathleen has led numerous efforts on Early Childhood initiatives and Womens Health and mental Health Policy hiv aids, polio and the list goes on. Dr. Victor zal, of the National Academy of medicine, most know it as the institute of medicine. Hes the chancellor ee meritous of Duke University and former ceo. Duke Effort Health system. He was professor and chairman of medicine at harvard as well as Stanford University and for those who dont know, hes done incredibly important work related to cardiovascular medicine that has led to widely used and life saving drugs. Thanks for joining us as well. One other thing, one other House Keeping thing. On your chairs we have zeer ox for you provided five big ideas that have come out of the report and the full length report, it includes the background papers prepared for this initiative but what you have is the summary of the five big ideas that this group came up with. Before we get to that, tell us how we arrive at this topic and did our work and well look to victor to talk more about the recommendations. The idea came out of an idea of ruth katz after two years of spotlight health which has been now multiday program before ideas fest in aspen, focused specifically on a whole range of Health Issues and that became an enormously popular forum. It was wruj who suggested what was done years ago with the aspen Strategy Group, a Bipartisan Group of folks that convene and talk about challenges and issues, not necessarily trying to run or drive a particular program but really convening around ideas and moving that forward. We both have been governors and ran Medicaid Programs and various Health Programs and both of us served as secretaries as hhs, one in a Democratic Administration and one in a republican administration. We seem logical to be the bipartis bipartisan cochairs moving forward. We looked around the country for various leaders from business, they were authors and economists and they were some are into the Health Business as leaders of presystems or insurers, providers and invited people to become part of this not necessarily because of their expertise and knowledge of end of life care but really because of a broad background that they could bring to the table to look at challenges and issues. We really talked a lot initially, the governor and i about what kinds of topics we would try to focus on. And decided that it was probably not a great idea to try and duplicate what was hot in the legislative arena, in the political arena but maybe come at this from a lens of what were challenges and issues that maybe didnt lend themselves to necessarily political discussions or conversations. Needed aid jump start or conversation or push. I think i had a very personal interest in end of life care as most of us do if weve had deaths of near and dear ones and gone through that experience. As you remember im the death panel lady and that became an illustration of how electric this issue is within the government sphere and how difficult those conversations can be. So i was interested not only in the policy side but also in the practical side. We decided that the way we would operate a little differently than a lot of groups was to engage experts over the course of a year to really do a deep dive on various aspects of a topic. And then have a convening midyear by telephone and once a year in person of our group to dive in and rather than producing a lengthy report that would sit on somebodys shelf. Look at this as ideas and it seemed to fit in well with the aspen theme. We came up with the notion that we would try to generate around a consensus operation they wouldnt have been to be particularly unique. If you were to do a handful of things, what could move the conversation down a line and what were the challenges that were facing patients and providers . So our first year was spent with end of life. The report is now online. Its in front of us. One of the more interesting things we looked around the table at aspen and realized in addition to trying to generate some conversation with the outside world and policy makers in washington and in the administration around these ideas, everyone in our group had some capacity to move these forward in his or her own organization. One of the commitments was that individual members would indeed turn around and go do these initiatives in their organization. And by example Toby Cosgrove realized in the Cleveland Clinic among his own employees there is no conversation about advance directives and no generalized discussion in the Hr Department for instance when people fill out forms and decide they want to set aside money for this insurance or have this kind of program or an ira. No one talks about that this issue and that could become part of their routine hiring discussion that this would be a conversation indeed he is carried forward own that feeling that if youre going to normalize this conversation, thats a great place to do it. We also know a lot of expertise that was around the country and very much engaged in this work when we came together and want to be great opportunities was to look at the work victor was leading in the National Academy on medicine. They were out ahead of our Strategy Group in organizing and had already gone through a series of convening and he as a member of Group Brought forward those ideas to the initial aspen Strategy Group membership. We feel the work we ended up doing dovetails very well into victors work. The way were going to operate today, i wanted to lay a little background an how we kind of got here and what initiative pushes forward and turn to victor who was going to cover some of the specifics and then we can hopefully go back and forth. Sfl one thing you might want to mention, the open invitation to the public for big ideas. Because this is quite unique to what this group is doing. In addition to our own membership, re wwe felt whethert was end of life care or health or policy challenge we might tackle in the futurity and i may have said this but if i didnt, the notion was to take one topic a year, not try to do a whole host of things but focus on one deep dive knowing lots of other people were involved in the topic. Part of the process and it will it has launched again for year two, which is going to be on opioids to actually put on the aspen website what the topic is that the group will be discussing in june of this year. We did this last year also and invite everyone to send their idea in and use the entire aspen list to get it in the press and public so it is not just 23 members and chairpeople sitting around the table. Its we got hundreds of ideas submitted. We have lots of input from lots of people and even inr inaugural effort. Were hoping that that effort to do some outreach to the public will be extremely beneficial and those were processed and pulled together and part of the information that we looked at when we came together in addition to four very deep dives from experts who were engaged to look at aspects ever the topic and that format seemed to work very well. We had some very keen expertise and mbship to bring their own initiatives forward. It did indeed work very well. Some of the big ideas from the general public were incorporated into the final set of big ideas we came up with. As kathleen has pointed out, go to the aspen website, we have it up for year two enencourage people to send along good ideas ho to address that problem as well. Victor . Yes. Talk about how we got there and how we can help advance this issue. First, let me say congratulations on the leadership that secretary sebelius and secretary thompson and youth yourself and adam, this is such a personal issue. Very fewish yau as personal as advanced illness end of life. Ill bet you everyone in this room have some experience with a loved one or Family Member who has gone through this. We can all recognize this as such a difficult topic. As you look at the size of this issue, particularly as the complexity of our health care and social environment, i think its going to get bigger and bigger. Were dealing with 2. 5 million americans die every year of all ages, majority of causes people over 65. And yet another 8 Million Advanced illness, moving towards end of life. And 11,000 a day turning 65. I dont want to say young people dont die, they sure do. But i think were dealing with a very were dealing with a i guess you could this a Public Health issue. Absolutely. I think its a National Priority because if you look at this issue and the fact that most of us say its 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 difficult it is. I think to me its both the personal issue but also its an issue that we the nation needs to figure out how to make this much easier. Take the following. Were becoming a very diverse country. Myself being in an immigrant born in china and all of the different types of culture, religion, family structure, we dont specialize it and make it patient centered and you can imagine its not going to work. Very important issue is to recognize it has to be personal, patient centered and family centered and of course you know, how do most people want to die, to show that 60 and 90 say i would rather die at home. With dignity. Everyone wants to do that. This is happening in this country is the question. I would argue that we have a system of care that hasnt adapted to the environment. After all, medicare, 50 years a ago, there with respect as many that lived such a long time, looking at the way in which medicare looks at how to pay and support services is probably not that up to date if you will, particularly for this population. So something has got to give. And so for example, kathleen is the expert and i would love for her to tell you more, medicare does not provide for social support. Think about that experience when an elderly patient had to navigate the social services and medical services and the res pit for family caregiver, time for in fact activities of daily living, thats one of the big problems that we found this this report in looking at how difficult it is because we have a fragmented system. Second is, even within the medicare or to that matter the Health System itself, other insurance as well, the coordination of care, which is so important, right, its also not there. Its fragmented. And of course we also dont have enough providers who understand this issue from experts like palliatif care experts or every day you know, im a doctor, never trained to think about this area or talk to people about have you got planning and spend time doing this . And do we have enough time . Everybody tells you, youve got to kind of get the patients through in ten minutes, not spending enough time helping people. I have just described to you some of the problems we face. Its not just an issue of a difficult time for us personally but without helping by not having the system to support the patients and families and et cetera. This is why a number of organizations say this is the topic and thank you, kathleen for choosing it. We all care about this. I say that whats unique about my experience with the aspen group is that people with all different backgrounds, everybody has personal experience. In addition to bring in the perspective from different sectors, business, Health Policy, ethics, et cetera, together we try to solve the problem together and leading up to this is in fact this call for ideas from both sides. We have lots of things to work with. And we spend a lot of work leading up to that meeting and that meeting to me is really unbelievable. We do a lot of reports over the year but this one is dynamic. You bring people in to say youre prepared to begin with and then the first day we have people tell the stories and role play. I thought that was really good because it winds you