i want to thank the washington college of law for hosting us. we have a 15 minute break prior to this talk. [applause] [inaudible] [inaudible] >> good morning. it is wonderful to feel such energy in this room. my name is camille and i'm honored to be the teen of american university washington college of law. it's my pleasure to welcome you

for this exciting culinary session the next step in health reform, 2017 conference. this year partnership with the american society of law, medicine and ethics with support for mark cosponsors we expanded the event to three day conference attracting speakers and attendees from multiple disciplines, the academy and practice. apparently, this conference is timed with the launch of our new health law and policy program. for faculty and students will be partnering with you on important work in the areas of healthcare law and economics. thank you, and join me in welcoming american university

provost who will introduce our american university president, sylvia matthews. [applause] >> thank you dean and can morning to all of you. it's my pleasure to introduce the next keynote speaker, sylvia matthews burwell, the 15th president of the university. president burwell is a visionary leader with extensive experience in public and private sectors. for careers a testament to a lifelong commitment to advancing solutions to pressing challenges. her 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. in the private sector she served as chief operating officer president of the global development program of the bill and melinda gates foundation. she's also served as president of the walmart foundation. response to the session on healthcare i like to highlight her accomplishment and expertise in the health sector. in her recent role as secretary of health and human services she helped shape the vision to ensure every american would have access to the building blocks of a healthy and productive life. to this end, she had oversight into agencies and programs which included the centers for disease control and prevention, the

centers for medicare and medicaid services, the fda and the national institutes of health. she oversaw implementation of the affordable care act which represents most complete overhaul of the health care system in our nation's history. the aca help more than 20 million americans obtain health coverage. improve 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. as a result, enrollment in aca which was previously a stumbling

block became more efficient and smoother. during her tenure, she oversaw the government's domestic and global response to two unexpected major health crisis, the able epidemic in the spread of zika virus. this response included working with other nations to slow the spread of disease. building the system to identify high risk individuals entering the united states. establishing a network of hospitals to serve as treatment hospitals and investing in the research of a vaccine. she let hss work to prevent and detect and respond to the zika virus including research, development, and testing of the zika vaccine. throughout her leadership she's had a significant impact on

safety and services provided for the well-being of americans of all ages, abilities, and socioeconomic backgrounds. perhaps the were closest to home wallet hhs lesser implementation the early childhood program, headstart's largest revision in 40 years. sylvia had her early education beginning at headstart and hidden, west virginia. she cites this program of sparking her love for learning, and she is carried that throughout her career in public service. this community is excited to have an outstanding public servant at our home. she earned her bachelor's degree at harvard university and a ba

in philosophy and economics from the university of oxford. her work has improved the lives of many in terms of health, and safety of millions of americans. join me in welcoming president sylvia burwell to the program is she seared shares her insights. >> thank you for those kind words and your leadership at american university. want to thank you for your advice and guidance the first few months as i have joined this family. i think the american society of law for bringing together such a great group of people and speakers and the health law and policy program. i don't have a law degree myself, but have more than my

fair share of supreme court cases name for me. if i could just log one complaint about my previous job, was that one, but two lawyers who failed to or me that once confirmed, all court cases switch to my name. the first, the burwell family council. the second, the 44th president of the united states of america. just saying, little heads up would've been nice. my transition to american universities interesting exciting and challenging. i gained a passionate engage community thinking learning and doing things about the world's most interesting and important problems.

i've taken on a new title without ever having gone to a diner in iowa. rather than look back, and please this conference is looking forward. our healthcare system has come along way in the past seven years. we help more people access coverage and care. we've improved healthcare coverage for families and we started to bend the cost curve. freeing up resources for working families and for future generations. when i say we, i mean our nation as a whole. this is a work of government or business alone. his work of physicians, advocates, attorneys, patients, families. they are not slowing down.

when i started planning for the remarks i look closely at the agenda. two things came to mind. first, jealousy is my team reminded me that i cannot block off two days on my schedule and listen to all the sessions. second, an appreciation for the ying and yang in healthcare. the few areas of policy once so complex and so simple. today's agenda speaks to the complexity. from payment incentives to coverage of young children, to the challenges facing providers. this conference gets into the notion of moral questions that churn every day in our healthcare system. the system is grounded in simple reality. in moments of joy like birth, pain of a sprained ankle or fear

and uncertainty is in a fight against cancer, we all count on the system to care for us and our loved one. when i worked at hhs the complexity surrounded us. we had late nights and early mornings going through briefings and studies things to the academics in the room producing those. we spoke to hundred thousand providers to get input on rulemaking. we tried to understand how the system was working, where opportunities and how we could use our short time to deliver meaningful impact to families. to the colic still there today, career public servants who deliver impact for the american people to those career staff let me say it was an honor to serve

alongside you. our nation is stronger for your service. [applause] at hhs, and impact was her northstar. her goal was to tether the conversation and analysis to facts, experience the reality on the ground. one sees the reality every day at hhs. you see it where nation's top medical researchers are crossing the next fight frontier through things like precision medicine. on the campus of the fda were safety a and innovation are front and center you see it in the men and women who packed their bags, left their families to say families in west africa from ebola and are ready to make

that journey when they get called. you see the reality and headstart classrooms where young minds have the chance to become our scholars and leaders of tomorrow. you sit in healthcare professionals in this audience this morning for trying to build a better healthcare system. this is the complexity of the system in simple outcomes that everyone is working towards. today i want to focus on what orients our discussion on where we want the future of healthcare reform to go. how we improve the access, quality, and affordability of our nation's healthcare system. i want to highlight how people can maintain the progress. first, access. in november last year uninsured rate drop below 9%. the lowest it had ever been.

between 2010 in the first quarter 2017 the uninsured rate fell from 16% to 8.8%. that's the largest decline since the launch of medicare or medicaid. still leaves more than 28 million americans uninsured. connecting people with coverage is a problem of will not strategy. we know how to maintain the progress we made a move forward. nearly half of uninsured adults and the cost is prohibitive. we can actively get the message out that coverage is available especially to communities were those messages don't reach. we need to raise awareness of financial assistance for people who shop on the marketplace to make sure more people know the financial assistant there today is available.

last year eight out of ten people qualify for financial help. most found a plan between $1500 per month. more awareness and more assistance will lead to more enrollees and more access. so for old times sake it's about to be november 1. the start of open enrollment. encourage your colleagues to go to healthcare.org. for those who are spanish speakers you can go to -- and shop around. since the law passed the share of americans who can afford care has fallen by more than one third.

affordability has matured just for the newly insured. for the hundred 57 million americans my premiums have grown at a rate of 4.5%, down from almost 8%. affordability extends to what taxpayers spends as well. medicare spent $473 billion less on personal expenditures between 2009 at 2014. in the context of budget conversations going on finally, the third way we can measure progress is quality. hospital acquired conditions like infections and pressure ulcers declined by 21% between

2010 and 2015. by linking those that decline prevented 124,000 deaths. most healthcare plans in the market do not cover maternity care, a third did not cover mental health and almost one intended not cover prescription drugs. while the laws imperfect others ways it can be improved and changes will make it better, there are some benefits of reality in a clear and simple reality. another reality is the direction the healthcare system is moving.

we often talk about reform separately, it's important to reflect it was a part of the act. some important changes to move forward come from provisions in the aca. like the center for medicare and medicaid innovation and the ability to support accommodations. they also stem from other laws. macro was passed with overwhelming bipartisan support. the support changes throughout the entire system. the healthcare system is undergoing a historic change. many of you are well versed, your research implications and advocated for them, some help set the policy to clear the path. whatever your perspective in the room is, it's clear the

healthcare delivery system is entering into a new error. we developed a three port strategy to support the healthcare system and making progress. first, change the way we pay for care so payers are rewarded for the quality of care rather than quantity of services. second, change the way we deliver care by promoting coordination and prioritizing wellness and prevention. third, unlock data and information so doctors can make informed decisions and patients can be active participants in their own care. we implemented the strategy with a simple philosophy, where we needed to get out of the way,

get out of the way. we committed to have 50% of medicare payments go through value -based contracts by 2018. when we left where had a schedule. commercial insurers were entering into value -based payments on their own. in january we estimated a quarter of healthcare spending -- are administration advocated for the democrats and republicans like my predecessor, former secretary mike leavitt and former senator, bill frist. the delivery system reform effort is what they called an empirical learning approach to health reform. based on experiments, evidencing careful observation and learning.

it's essential for this approach to continue to meet the nonpartisan goals a better care, smarter spending, and healthier people. delivery system reform requires persistence. i'm hopeful that the new administration settles in the see the same value that we did. an opportunity that that leaders from both parties have recognize. it's important to keep moving forward, supporting programs like bundles and aco's that we were providers for better care at lower cost. it's important to expand programs to improve healthcare like the diabetes prevention program that we model. as a title that we find better

healthcare while bending the curve. policymakers and leaders are moving forward. i've been encouraged by the bipartisan efforts of governors and people like senators lamar alexander and patty murray. this 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 in basic measures on access, affordability and quality. i've been encouraged by leaders step forward. we started a group called the healthcare payment learning action network. public-private partnership to encourage the adoption of alternative payment models. more than 6500 people joined including 130 organizations that set their own goal. after i speak you'll hear from dan who was ceo of independence

blue cross and in au along who has also step forward in the space. today there is no shortage of complexity, change in news. through the complexity simple reality remains. that's why i'm honored to welcome you to american university's campus. a little over a century ago young attorney they mesh -- jackson asked -- to prentice or as a student of law. these women have been denied admission to a number of law schools. legal professions for the women who did manage to study law were

few and far behind. so they hosted the first session of the women's law class. they believed in a simple truth. the system needed to change start with them. three years later the washington college of law was founded. it became the first law school in the world to be founded by women. the first law school with the women dean, and the first law school to graduate and all-female law school class. as ellen said, the keynote of success is the readiness for opportunity. our opportunity in healthcare is now. for years and decades had conferences and events to discuss the challenges that stand in our way.

with the leadership in the room and across the nation i believe we can overcome those. nation will be successful at building a better healthcare system. like ellen and those who came before, we are ready. thank you. [applause] >> good morning. i'm jean and for those who are here earlier will keep my introduction brief. i'm privileged to be here today to call you not madam secretary but meta- president. it has a nice ring to it. i'm here because i was able to witness your leadership, skill and tenacity at leading the

agency. what perspective do you have -- i wanna talk about your main focus on your remarks. i know it jumpstarted when you arrived. how did you develop that strategy? who is involved and how did you get results for quickly? >> want to say something about jean. i've had the opportunity to work with jean from the 1990s on. you will not find a person who knows the issues more in depth across the whole range. when you're she has an incredible wealth and dedication to the kind of change i was talking about.

[applause] in terms of question and putting together a delivery system. in putting together strategies at different places in organizations i generally think about what is the problem, what is the solution space, what are we good to? the objective is to get yourself for those three things to overlap. so important in a strategy process to be clear about where you're trying to go. the other thing that i've had the opportunity to learn from different types of organizatio organizations, the bill and melinda gates foundation is heavily focused on strategy. at walmart execution is a core

strength. you have to think about both of those at once. one without the other will not achieve the results. >> the regard to specific issue, there was a realization that we had a short time but is moving forward to implement parts of the affordable care act focus on the access part, we needed to have a focus and do it in a strategic way with priority so we could move forward. bringing together a number of parts and pieces we were fortunate at hhs tab patrick conway and karen who were partners in leading the effort. they'll tell you, it was a process. to get to that strategy into a quickly and engage whatever white house colic.

that was in part because when you get to the end is a strategy informed by all the players. the uniform by the real world was an important strategy. but we had doctors with practicing physicians and they brought a number of perspectives. those who work with me know i prioritize and i generally work in threes. getting this to the three things with the process. they were private arrangements in terms of what we did. is bringing people together working off where we have been, and a lot of work was done previously before we got there. a different approach occur but then we put together the strategy.

as we did the idea that we were going to set goals that i was gonna commit the federal government to something on a deadline was not necessarily a common thing to do during administration. but there was supported by an and it was important. having the three pieces of the strategy that action was important because it did two things. it was very important signaling of the commitment we're making that we're coming to the table. the federal government wasn't just saying you're all good. the kind of skin in the game is indicative over here is serious. the other thing is it indicated direction.

i know that's important we heard that in terms of certainty, predictability, where things going. that predictability is importa important. >> as you look at the priorities and problems facing your first day here in american university, what were the challenges you faced a secretary of hhs? >> there were a number of them. the first day i was confirmed around noon and went straight to a meeting. i had conversations with them because one of the immediate things were facing and that i would face was making decisions on the technology. in order for us to do end-to-end testing which i was insisting that we would do for the marketplace i had to make technology decisions.

my predecessors one and it to be my decision and felt it was appropriate if i was going to be responsible i need to be able to have ownership of those decisions. . . . . someone has injected 50 years and it's been on there for two days? [laughter] within 20 days i stood up the command center that stood up for almost all of my entire time is secretary for evil a and then not even a month later over the

children pouring across the border and what i think most people don't realize is that tens of thousands, over 40000 that year children under 18 coming across the border, children as young as four or five people don't connect is that is hhs people most people think it is d just because the border but dhs within 72 hours has to have those children with us because we care for them until we can place them in a place that they will be safe and cared for until they have their immigration papers. for me, it was the volume of crisis, the number and the volume of crisis was the first challenge. one walked into knowing the things around the portable care act that was an opening i think but it was the number in volume the challenge. >> as you know, the administration is looking for a new secretary of health and human services and that person,

he or she were sitting in this today what advice would you give to the? [laughter] >> run into the fire. that's my very strong belief and i would start by saying first and foremost, understand the incredible people that are at this organization. career, civil servants dedicated to better which administration in what point of view facts and substance. first, i would say though that you are walking into a place where there are incredible resources. number two i would say importance to be aligned with your president. understanding your president and having been able to know that

your going along the path and implement and that was my experience at hhs and that alignment really does contribute to and if you're not aligned to figure out how you can access and work through issues. that's another very important part. the third thing i would say is as much as you could get out. it is hard but it's a large department in your running and the more you can talk to whether ceos or headstart kids or a visit, that's an important part that of understanding what you're trying to get done. >> looking forward what do you think the stealth issues are facing help form? we know some of the issues about opening moment in the rulemaking and challenges to the environment but what else might be on the horizon that this team should be on guard for as well as the audiences they are doing their work in various fields?

>> i think instead of a specific issue it's a category of issues that i think are not always recognized which is change we're talking about when we get to five, ten, 15 years from now in our healthcare 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 and i think that is hard because whether you're in an organization and anyone in the organization your first answer is let's change the structure and let's change the people in the last thing is because it's the hardest thing is changing behavior. this will take change behavior of consumers and you will have to be more knowledgeable and you'll get information to be more knowledgeable and it will

be a change for provider and it will be a change for payers in insurers and it will have to be a change for pharmaceuticals and a change for everyone and that is the issue. it doesn't come out because we speak about this in specific terms. what we need is to pay in this way but i think one of the hardest issues to make that change there has to be behavior change i think that is hard. >> and its related question which is most of the discussion around the portable care act is about the axis component, not necessarily affordability. 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 and

how you go about fixing that lever, the lever of cost in terms of the axis issue for those who don't have access at all at least there is that you can is on and that is 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 in august. the affordability and quality, i think are sometimes harder because the levers are more [inaudible] in the other thing is i think we do struggle with measuring quality which is related to affordability because you don't just want portability and you never want to say one of the other. i think quality is hard to mention. >> then let's look for and what job in the audience can learn from it. what's the biggest surprise? i thank you held so many incredible different positions throughout federal government and in the private sector and 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 preparet omb in this administration it was the day i arrived it was an alternative sequestered day so most of the staff was gone and i arrived in crisis. some might say i like the guy with the cloud following him. the dust of the cloud. [laughter] it was a crisis i was used to do but i will say the volume of crisis was extreme. the ebola that was well. kids on the border in your fourth of july in her trying to figure out how to place four, five, six -year-old whose parents thought it was better to send them a thousand miles across mexico and to have them

stay with them. and you're trying to find a safe place for those little -- and they are alone. i had to keep asking if i have a ten -year-old and i kept asking they can't be alone. they have to be with the siblings. we just haven't match them up. there crisis and the second thing was the joy of the breadth and depth of hurtful things going on in the department. at hhs there's something called the ideas lap. that is a place where ideas and innovation we were encouraging those within our department and out of our department and this was started by my predecessor, kathleen and by the time i got there the conferences drew people from around the world. those kinds of things and the

story of the individuals from the center for disease control and prevention who wrote [inaudible] in liberia of rivers to get ebola samples to figure out if those people actually had ebola and i knew that seeing it is surprising. it's uplifting and great to see the positive things that are going on and a huge department. >> we are in mostly a conference of lawyers but describe a little bit of the role that will lawyers play in proposing health reform. >> an incredibly important -- i would start with the clinton administration i had a saying. a lawyer a day keeps the subpoena away. [laughter] >> it didn't necessarily keep

the supreme court cases away but what i believe is engagement with your attorneys i have always viewed lawyers and actually i'm not a lawyer but i've been given the gift of a black law dictionary when i left the treasury department years ago because i engage with lawyers but i believe your lawyers are your business partners. i believe lawyers actually have two functions that are important. they need to tell you the law and in issues like healthcare and healthcare reform it is extremely important whether that is in rulemaking or implementation or on a day to day basis. extremely important that they tell you the law. but they are people that see through your issues. your legal department is one of the most crosscutting departments in your entire organization wherever you are. having them join as a business partners and it is not get it. they can tell you when they are

saying this is the law. now let me tell you from experience and knowledge what i think will happen if you implement that way for if you read the law that way. i am here to give you legal advice but i'm here to give you broader advice and i found and at omb one of the most people never worked on it but some of the most complicated and best lawyering i've ever seen was during the government shutdown you are operating in an unnatural state that doesn't happen with questions every day from can you -- the coast guard first time in three years a coast guard vessel needs to be one back and no money to fight back so what do you do for the family. appropriations law and everything all coming together and then is it legal or is it

assisting funds to have someone else play and you want your lawyers and what they do in crisis and then on your day today and in government policy in general. >> we have scholars here because, as you mentioned the american journal of law and medicine and ethics is looking at issues in this conference and how did evidence inform your proposed [inaudible] >> every day. i bring up an issue that has been in the news today. opioids. as we put together our opioid strategy and yes, it was [inaudible]. as we put together that strategy that was and it was extremely important. the research on medication access to treatment as one of the key approaches to deal with those who have addiction in opioid space was the research that guided those priorities.

the question of does the locks in which is the drug that you give to save someone's life does that actually cause more addiction or not. these are the questions that these are scholarly questions that are analyzed and studied across the academy that inform your decision-making every single day. research on e cigarettes. as we look to make rulemaking in the tobacco at fda. in addition to the research itself we draw from these patterns. richard frank who is now back in the academy and maria can't steal who was at the administration for children and families built all of the modeling that we used to try to predict the flows of children. drawing from our colleagues at the department of homeland security estate department. she built a model.

academics and scholarly work use literally every day. >> my last question is will the drama around policies ever down down and? >> i would say that healthcare is a lifetime employment but i would kind of change beginning of that. i would change it because there is always going to the opportunity there will always be a place for us to go and do better because it is something that impacts everyone's life. excuse me. therefore i think there will always be credible opportunities and i am glad that so many people are engaged focused on these issues and i thank you hear my optimism about getting to a different place and you can start to see it and i think we will get there. >> thank you so much.

[applause] >> i am pleased to introduce the next session which is entitled getting healthcare right. now i might be biased but i think that 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 he is the president and chief executive officer of independent blue cross. one of the nation's leading health insurers. since he became ceo in 2010 the number of people the company and

its affiliates serve have tripled to nearly 8.5 million in 24 states and the district of columbia. he has more than 25 years experience in the field of healthcare, government affairs and including leadership positions at organizations such as where health, keystone mercy and blue cross blue shield association among many others. he is a dedicated to the transformation of healthcare in america seeking innovative technologies and new models of care that will both increase quality and lower cost. i think that is something we can all get behind. he is a sought after speaker on issues of leadership, healthcare and the role of technologies in big data. he has appeared in "the new york times", "the wall street journal", on msnbc and other national media. he is among a very select group

of nonpartisan healthcare leaders called upon often to inform government leaders and advise them on implementing healthcare reform. i am pleased to have him back here on campus today and i want you to please join me in welcoming him to the stage. thank you. [applause] >> good morning, ladies and gentlemen. it is still morning for a few more minutes. thank you for having me. dean, thank you and congratulations on this facility incredible program. i can't say enough about the work that you and vicki do on regular basis. thank you. it is my fate to follow great speakers. if we were in the well of the senate or the house of representatives i would definitely have exceeded my time to the president.

you had so much fun over there and we didn't always have fun when we met with you but you two had a lot of fun. [laughter] again, good morning. heading healthcare right is the challenge of our time. i believe this is a most important task for us as a society. similar to what sylvia said. there is no better place to talk about it then 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. it is where you live. the past eight years the american people have seen it nearly constant struggle over how law should interact with medicine. looming over the struggle are the most basic ethical questions. is healthcare right or a

privilege? is it acceptable for our leaders to turn healthcare into a political football mark how do we find a path forward from here. there is no turning back. i have 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 and that your voices be heard on these important issues. this debate will not is because to build a sustainable system that gives everyone access to high-quality, affordable care we will need input from every area of expertise represented in this room. both academics and industry and from the public and private sectors alike. future generations are going to judge us on whether or not we got healthcare right.

we are not doing a very good job of it right about now. health form has been a dominant legislative debate for eight plus years. that is five congresses into administrations dealing with these issues. yet, we have less clarity over the past year that we had at any point during that time. economic stakes are huge. 18% of growth gross tumescent product and some think it is between 25% for the year 2025 contracts. the public health stakes are just as high. we spent far more on health care then to our economic peers around the world. we all know the statistic. give the greatest clinicians and health system anywhere yet, by some measures are outclassed black. in the big picture, how we organize our health system will determine how effectively we respond to crisis like cancer,

diabetes, opioid addiction this crisis. for a potential major pandemic. we find ourselves in the self-perpetuating crisis if we can't fix it people get sicker and then they need more care and the system becomes even more costly and more expensive. dean, you and your team should be proud that the healthcare costs really slowed over your time in the white house. our window is closing and to preserve the gains and access we saw under the aca while getting control of costs which makes this a bad time to be unable to agree even on the basic foundation of federal legislation but i still believe a sustainable solution is within reach.

this is why we work on this every day with our colleagues in health insurance at the blue cross blue shield association, with our hospital and physician partners with legislators and community leaders and with our members. let me take a step back before i talk about what the solution looks like let me tell you about my perspective and how it was shaped at home. it seems i've always been involved or around big public policy questions in the healthcare industry. i am very comfortable at that intersection between politics and policy. in large part i can trace that comfort right here to american university where i got my masters degree in public administration and i know i don't look this old maybe i do but 1981 district anyone in the 1981 class desperate no, your all too young. i came here after graduating from st. joseph university in philadelphia in serving for

nearly two years as a jesuit volunteer in inner-city portland, oregon. i came here with great confidence in the promise of our democracy. i was honored to work on the hill from my hometown congressman and witnessed the conservative, republican president ronald reagan and a liberal democratic speaker of the house bridge the ideological divide. to move america forward. i loved every chance i get to come back here. i get that nostalgic rush of a different time in our nation's history. thank you to the washington college of law, the school of public affairs is everyone that americans are providing a venue. again, as sylvia said, for this critical discussion and frankly, for bringing me back, rekindling my optimism because it's hard to be optimistic most days on our inherent goodness as a people. together we can change our collective history for the better and it starts with healthcare. president is such a pleasant

pleasure to be able to welcome her to my university. her incredible service as secretary of hhs applies the leadership that our country so desperately needs and deserves. frankly, we need american universities to be at the center of this effort and you are off to a good start. this is incredible program. thanks again to asl for processing on health reform and thanks to all of you for taking the time to participate. there is a somewhat logical progression in my career path, even though it is played out over 36 years between my time in american university in the and my role as ceo independence health. independence has been covering people in the philadelphia area for over 80 years were coming up on 80 years. overall as vicki said we touch

more than 8 million lies in 24 states and the district of columbia. through our blue branded products and are of their health subsidiaries. our flagship brand of service 2.5 million people in greater philadelphia. we are the only insurer in south eastern pennsylvania on the commonwealth exchange. in new jersey, through our product we are one of two. by the way, we're not going anywhere. they can keep throwing changes as we were not going anywhere. [applause] in total, we cover over 300,000 people through the aca exchange. by the way, not that this is relevant but i feel i need to say this. probably, based on the way you hear me talking i am a republican. it is an important note because we have to change this dynamic.

i consider myself a john k sick type democrat. i love when he gets on tv and talks about the power of the private sector in partnership with government. if we peel away all the labels and we peel away the portal called frederick, what president obama, what his administration, what they did was create an opportunity -- it was not perfect and it still isn't perfect but in opportunity for the public and private sector to work together to make change. i want to script a little bit because it is important that we realize this is not a democrat, republican issue and i'll come back to that. independence and we have innovation investments in partnership across our region and around the country. through our mirror health subsidiaries we serve millions of medicaid recipients all across this great nation. most currently finishing up my tenure as chair for the blue cross blue shield association

and i'm delighted of the work the blues are doing to make sure that health is accessible to as many americans as possible. we, the blues, represent 36 independent insurers covering 105 million people, one third of the nation population. our brand is one of the most admired, highly recognized anywhere. i think what a solution looks like. all of those perspectives come into play. i'm a big believer in the power of private sector innovation. first, in partnership with government. i want to see a healthcare solution that harnesses the power to transform. as i worked with colleagues at the plants around the nation i see more clearly than ever the healthcare is best delivered at the state and local level, in collaboration with the federal government, guided by the federal government.

i want a solution that preserves flexibility for local healthcare solutions with federal support and again with guidance. i know that any solution to start the bipartisan agreement to do what is best for all americans. healthcare is not a republican issue or a democratic issue. healthcare is an american issue. nonetheless it is complex and rots 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 from both sides of the aisle like senators pat toomey, a republican in five cases, democrat who, i believe -- can you imagine? them in a room and say don't come out until you have a plan. they would get a plan done.

we need that bipartisan the and that type of solution. they are not alone. there are many in the halls of congress represent a district or where you live right now who are ready and willing to cross the divide, to come up with a workable solution. let's see if congress can come together. right, left and center around this measure. leader mcconnell, who i think is a traffic leader, please use these leadership skills. on the bill, save the affordable care act so that we can move on to an even better program for our country. the alexander murray plan is aimed at the right targets. short-term portability, increased flexibility and the time and stability to transition into what comes next. whether you call it repeal and replace or whether you call it fixing the aca, it doesn't

matter. from my perspective, whether it's a tax break or subsidy as long as we get under the system. let's move forward. i hope we can use it as a springboard to competence of solutions for the long-term because under our framework, forgetting healthcare right, any process must do three things. stabilize, transition and accelerate. number one, stabilize the system that is in a very precarious situation. i can't tell you the number of calls and erections are having with 300,000 people, not all of them but a strong number that don't know if they can sign up on november. aren't sure and that's how it was in year one. we should be well beyond that number two, manage a productive transition to whatever the next iteration of healthcare reform is and number three, accelerate innovation 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 a table and get it done. one of the key elements of stabilizing our system. let's start with the millions of newly insured americans in the aca. president burwell didn't really trumpet it enough. according to the national health interview survey there were 20-point to million fewer uninsured in 2016 than in 2010. truth is i like to look at it this way. when you look at the numbers of those who joined the exchanges, somewhere between 12 and 13 million, by our count and those who have been a part of medicare expansion somewhere around 16 million give or take a few but give me 8 million

americans today have coverage who did not have it prior to 2014. 28 million americans. for all the -- [applause] thank you, you all deserve that. for all the sustainability issues and these are real, 20 million covered is pretty exceptional. if we do not have these folks in the system, what does it mean? they again will show up in emergency rooms -- we are on the cusp of turning back the clock. we cannot do that. we can't let it happen. short-term stability also relies on private consensus on csr payments. these critical subsidies to the consumer have been used as a political cudgel. the aca envisioned a long-term transition to a market-based solution that will cover more people and hopefully bend the cost curve.

if the csr's were part of that transition to bring some of the most vulnerable people into the system and they have been part of our business calculations to set premiums that have maximum number of people can afford. for an audience of legal and ethical fingers the csr situation should raise obvious question, is that contract a contract? we have to live up to our contracts with our members and our customers and our vendors. shouldn't the government live up to its contract? shouldn't this debate be long over? does living up to that contract will be a huge step in reestablishing stability. once we do that we can talk about the logical transition to whatever comes next, that includes finding the balance between key trade-offs like federal uniformity versus state

flexibility, a focus on [inaudible] versus tax credits and where the financial burden system falls. the aca's health insurance taxes waive this past year, this year, but will be reinstated in the future. this added another element of instability and this tax being squarely at one stakeholder in the competitive landscape. it produces our ability to drive innovation and payment models and care delivery but i have to say this debate now where we are on the floor of the senate at the time that the senate bills found there was a number of senators talks about will not fill out the health insurance companies the truth of the matter is if you look from 2014 and i may be off by a few billion dollars but our cfo greg is here and forgive me for throwing numbers around but the insurance companies contribute

35, roughly $35 billion into the system but it wasn't the insurance companies. it was consumers of all through their rate supported the affordable care act. it makes my blood boil when this comes down to the will not do a health insurance bailout. it's not bailing out the health insurers. it is making the system sustainable by giving consumers the brake they need. shouldn't there be a funny process that all brings stakeholders to the table, providers, pharmaceutical companies, everyone? whatever the next iteration of healthcare looks like there needs to be a tremendous untrained transition. that gives everyone time to plan and keep continuity for people who need healthcare. because the victims of a chaotic transformation are not insurance companies even though we have to figure out how to operate in an unstable terrain they are not

the legislators of one party or another trying to defend their seats. the victims are people who lose coverage or have inadequate coverage if we cannot find a comprehensive solution with a reasonable transitional period. these issues of stabilization and transition are difficult and critical and they establish the baseline for long-term sustainable form. now the good news. the good news, the next step which we call acceleration, makes me excited to come to work every day. our goal is to accelerate the transformation of how we pay for and deliver healthcare in america. the kit key to long-term sustainability is not anything that congress does, the key is collaboration by private stakeholders acting on the ground in healthcare. insurers, doctors, hospitals,

pharmaceutical industry, device manufacturers and tech companies. we must work together, all of us, on new models to pay for and deliver care in the insurance industry, this is where we put our industry in every day. there was a broad consensus in what was supposed to happen to create long-term sustainability and we need a system that pays for value and outcomes rather than for -- cms put weight behind and you heard about that earlier. even though there has been mixed signals without the new administration value -based models are not going away. the insurance agency has made the request for valuing our own. we are doing it in partnership with healthcare providers which is critical.

we can't do it alone. they can't 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 combined our contracting health services and are [inaudible] into facilitated health networks. we built that function in rebuilding that function on principles of disruptive innovation. if you are familiar with the plate of [inaudible] at harvard, he put it down to three principles and applied it specifically to health care in his book the innovators prescription. in order to disrupt our healthcare providers you need all three principles. a new business model, backed by new uses of technology in a new type of network called the facilitated network. in our world we call those elements engage, enable and empower. engages the creation of new business model, untrained and

healthcare payment. we are implementing that model at the most basic level, our contracts with providers. we are going to the largest health systems in our market, places like the universe of pennsylvania health system and jefferson health. as their contracts come up for renewal we are telling them we cannot keep paying these accelerating rates increases every year. we have to control the base rates of reimbursements and these are the same type of conversations we are having with other players around our products. when a pennsylvania senator talks about capping the medicaid expansion at cpi urban consumer price index rather than cpi medical these are conversations about the business model and we need to engage the business model with the accessibility and come up with a middle ground

that works. at independence we put system together where we pay for outcomes, not for sheer volume, things like bundle payments and care and the transition to value -based care means we share responsibility for those outcomes. we share the risk. you know what? they all get it. they all understand it. the providers want to work with us. these outstanding healthcare systems know the economics just like we do. it makes us easier to move into a value -based world when we do it side-by-side with providers. in fact, it's the only way to proceed. the enabled part of an engagement is technology and health systems have electronic medical records of patients and everything that happens in the point-of-care and insurers have

planes data which is extraordinarily powerful. our data tells a story of what happens to our members every time you see a doctor, every time you have a test to fill a prescription. at every level we can link that data to democratic, democratic financial data and get a socioeconomic picture of a patient that helps diagnose care. when providers are willing to partner with us on a value -based care we can also exchange data and building a database around both claims data and emr data which is the holy grail we are starting to do that with these two organizations. we are in an ideal situation to develop this concept working with pen and jefferson where they also have world-class resources for understanding data. the final cornerstone of our approach is empowerment. before i move on, i want to give a quick highlight so we can begin to impact on some of these efforts. because we are sharing data with

the university of pennsylvania we have agreed to work towards episodes of care where we have a value. here's an example. they are so confident in their partnership that they agreed that they will cover any involuntary readmission up to 30 days. i think it is the first in the country. i don't no, jean, if anyone else is doing it but the truth of the matter is we calculated the impact. the impact is roughly $20 million a year in savings to the healthcare system. one hospital, one episode of readmission and think if you extrapolate that across the entire system, the billions of dollars in savings that we could find various episodes where we agree to partner between payer and provider. i lost my space.

i got excited about that one, i'm sorry. [laughter] i might be repeating here but [inaudible] health systems -- i already did that. in the ideal situation i talk about here i am. here is how we make sure this value -based model and all this data has 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 specials, nurses, social workers, community resources, health system around the consumer, around the member and the patient. we linked all these components to facilitate networks by technology and we are building that technology with these two provider systems. our chief medical officer chairs hsx which is the health and

information exchange for southeastern pennsylvania. under a health information exchange no matter where you wind up getting care or what hospital or doctor your medical records can travel with you. we also have clinical care transformation team which goes out to position practices and systems. it helps them implement the very collaborative, clinical model called for by or facilitated health networks. our clinicians and their clinicians are coming to the table to understand episodes of care and 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 there will talk to. we add pen and jefferson, two

with amazed nations most outstanding systems of the renewal this year. both of those partners, as i said, are now contractually committed to principles of value -based payment and data exchange and clinical collaboration. 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 and they are working on new ways to treat diabetes and populations and expanding the potential of telemedicine and biometrics for remote care. new genetic approaches to prostate cancer. there are great ways to integrate a value -based model and for these projects. we will find them. university of pennsylvania is raising the bar for shared risk. i talked about the program we are doing about readmission and this agreement, the jefferson agreement both start by lowering base rates and pain value, value, only one value is achieved we pay. it comes and we come together to

share data at a real time. the some of the most innovative american health systems in philadelphia and we are building a type of partnership with them that really has not been seen between insurers and providers. that is why i am so optimistic if we can get that basic foundation built and stable in the private sector than the insurers and health systems all the stakeholders have the ability to collaborate on a system that works. that is my perspective and i remain excited and committed to tackling this challenge of a lifetime. i am also lucky to be in this room of passionate, experts, researchers and thinkers. i like to open the floor for your comments and questions and learn from you but before i do, allow me to offer a brief call to action.

to begin with the same thing i tell everyone i speak with, we must demand that 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 you are doing and put the focus on health care reform and that it is in the context of our legal system. how it affects the health of populations and how it reflects the moral compass of our nation and how all these things are interrelated. do everything you can to inspire and encourage and support innovation and let us together continue to build partnerships, collaborative partnerships that will make our society stronger in our population healthier. thank you very much. [applause]

any questions? i know we are over time but -- here's one here. microphone is here. we'll get to lunch pretty soon. this is good. >> are you participating in any multi- payer demonstrations and what are your thoughts on trying to merge incentives? >> obviously, health insurance is a very competitive environment but we created an entity called [inaudible] health a few years ago. what we do is we go out to independent primary care practices. we are up to about 500 in five counties in the philadelphia area and we are giving them the tools and technology to build and interrelationship with their patient and with their health system they interact. we have decided that we wanted

an advantage for a period of time so it is just participating through [inaudible]. we are opening up to other insurers this year so that it will become agnostic. we believe the truth of the matter is these clinicians have patience all insurers. i don't know that we will let everyone on but it will be multi- payer system and we are very interested. for example, this is something that would be unheard of with the [inaudible] a few years ago. our pbm is up to max owned by united healthcare. when we -- when we acquired our pbm i said how can soon can we move in i received a call from the team and they said give us a chance and come see what we do. we were so impressed with them that we will keep them. i think competition at the

high-end will continue and we will fight hard to be united and they will do the same with us but when it comes to the back room and the things in the tools that we need to use to do everything i try to say this talk there is no reason that it can't be agnostic. our philosophy is that we will go down the path. thank you. thank you very much. have a great rest of the >> i'd like to get started with our lunch keynote address. my name is aaron and i'm an associate professor of medicine at harvard medical school