Centers & Institutes
2009 Health Care UST MBA Policy Seminar Summaries, Slides and Podcasts
For more information on the Health Care UST MBA, which this policy seminar is a part of, visit the program's Web site.
Sunday, April 19
| 1:00 p.m. | Introduction to Washington, D.C., Health Policy Seminar Hon. David Durenberger Senior Health Policy Fellow, University of St. Thomas |
| 1:15 – 2:15 Download the podcast (30 minutes, 28MB) |
Change We Can Count On: An Insider Look At the “NEW” Washington Al Eisele, Editor-at-Large, The Hill Al provides his perspective on the “1st 100 days of the Obama Administration, 89 days in.” He believes this is already shaping up to be a transformational presidency. Although there have never been so many challenges that need to be dealt with all at once, he believes that health care will ultimately be the issue on which Obama’s presidency is judged. |
| 2:15 – 3:15 Listen to streaming audio of Ms. Brownlee's presentation Download the presentation slides (PPT, 6MB) |
National and State Health Policy Reform Shannon Brownlee, Schwartz Senior Fellow, New America Foundation, author of Overtreated: Why Too Much Medicine is Making Us Sicker and Poorer Ms. Brownlee presents key findings from her book, notably that what accounts for the majority of the cost variation of health care throughout the country is “supply sensitive care.” Local practice patterns and local capacity drive utilization. The fee-for-service model drives over-capacity. There is a strong correlation between integrated hospital systems and lower spending per capita. High-utilization areas spend a lot of money, but actually have reduced quality outcomes. More is NOT better. However, “One man’s waste is another man’s revenue stream.” |
| 3:30 – 4:30 Download the podcast (42 minutes, 38MB) |
Congress and Politics Ralph Neas, Chief Executive Officer, National Coalition on Health Care Mr. Neas represents a coalition of over 80 organizations, including physicians, pharmaceuticals, health plans, and many more. All recognize that the current health care “system” is broken and needs a legislative vehicle around which to organize. He believes that bipartisan support is critical and that Pres. Obama is off to a promising start in deferring to congress to lay the foundation for finding common ground. Jack Ebler, Chair, Henry Waxman, Vice Chair, Medicare Payment Advisory Commission Mr. Ebler discusses some of the “lessons learned” from the Clinton Health Reform initiative. The key lesson: don’t “foist” legislation on congress. Currently, each of the five key committees in congress is trying to have health care bills ready to reconcile in June. Mr. Ebler shares his perspective on this process. |
Monday, April 20
| 8:00 a.m. Download the podcast (27 minutes, 26MB) |
Reform this Year Sen. Tom Daschle, Special Public Advisor, Alston and Bird, author of Critical: What We Can Do About the Health-Care Crisis Sen. Daschle discusses the stages of health care reform. First, parties must agree on the problem, which he defines as access, quality and cost. Second, parties must define the goal, which he defines as a “high performance, high value system based on high quality, better access, and lower cost.” He discusses the four factors that will determine if this can happen: 1) Economic environment (is health care part of the problem or part of the solution?); 2) Budget; 3) Ideology (ability to find middle ground); and 4) Appropriate legislative strategy (policy track vs. budget track). Finally, Sen. Daschle shares his view of the areas of general consensus regarding health care reform and the areas in which he sees no consensus. |
| 9:00 – 10:00 Download the podcast (30 minutes, 28MB) |
Journalists Perspective Julie Rovner, Health Policy Journalist, NPR Ms. Rovner discusses the biggest hurdles to health reform: money and bipartisan politics. She voices her opinions of the dirtiest words of health reform: redistribution and rationing. Laura Meckler, Writer, Wall Street Journal Ms. Meckler notes that a lot of interest groups actually want health reform to happen this time around. She sees the following as the “big” issues: 1) Whether to include a government-run public health plan; 2) The issue of mandates—both individual and employer; and 3) How to pay for it (cuts & taxes). The “littler,” but still potentially explosive issues, include 1) immigrant issues and 2) the generosity of benefits. Ceci Connolly, National Staff Writer, Washington Post Ms. Connollyi discusses the challenges of reporting today, including new business models for the industry, fewer reporters, loss of journalistic expertise and increased pressure to post news quickly. She reflects on the “inside” game (posturing of Washington) vs. the “outside” game (the messaging to Americans), of which she expects to see much more of in weeks to come. She recommends several news sources, including American Health Line, the New England Journal of Medicine Web site, and the New America Foundation Web site. |
| 10:15 – 11:45 Download the podcast (33 minutes, 33MB) |
Health Reform Veterans Tom Scully, General Counsel, Welsh, Carson, Anderson & Stowe, former Administrator of CMS Mr. Scully is not optimistic that health reform can happen this year but feels it might happen after mid-term elections in 2011. He believes that the personalities involved and the lack of relationships between key policymakers is the problem. He shares his belief that the wealthiest people are over-subsidized in the current system, but sees a tax cap on employer benefits as “brutally tough” for politicians to support. Chris Jennings, President, Jennings Policy Strategies, Inc., former Senior Health Policy Advisor to President Bill Clinton Mr. Jennings focuses his comments on what’s different from the ’93-’94 health care initiatives: process and personnel. From a process perspective, the president is allowing Congress to act and parties are not saying, “my way or the highway,” as they were 16 years ago. From a personnel perspective, the key players are knowledgeable and are industry insiders that can work across the aisle to get things done. Although “it’s always less likely than likely,” he states that “now is about as good as it’s going to get.” Chip Kahn, President, Federation of American Hospitals Mr. Kahn views health reform as an interactive system which, like an accordion, can be made bigger or smaller. Coverage, financing, benefits definition, regulatory overlays and quality issues are all interrelated. He shares his belief that there will be Medicare legislation passed this year and that there will likely be something for proponents of the Medical Home model. |
| 12:00 p.m. Download the podcast (20 minutes, 18MB) |
Reform reflections from Minnesota's Senator U.S. Senator Amy Klobuchar (D-MN) Senator Klobuchar outlines her views of the health care problem and her belief that there is political will to make reform happen because all parties agree that the status quo is not acceptable. She notes that Pres. Obama queried, “Why should we punish Minnesota for being efficient?” Her priorities include 1) Enhancing incentives that reward quality care; 2) Rethinking payment procedures to enhance coordination of care; 3) Addressing the shortage of primary care practitioners; 4) Continuing the expansion of Health IT; and 5) Elder care issues. |
| 2:00 – 3:00 (no recording) |
White House - Old Executive Office Building Nancy-Ann Min DeParle, Director, White House Office for Health Reform |
| 7:00 (no recording) |
Reception and Dinner U.S. Representative Pete Stark (D-CA), Chair, Ways and Means Health Subcommittee |
Tuesday, April 21
| 8:00 – 9:00 a.m. Download the podcast (38 minutes, 38MB) |
Health Maintenance and Improvement Panel Sara Rosenbaum, JD, George Washington University Public Health and Policy Ms. Rosenbaum argues that medicine needs to turn attention away from itself and towards the social conditions that breed its patients. She articulates the need to impact the living and economic circumstances that cause chronic conditions and advocates an expectation of “public service for clinicians.” She discusses the redefinition of the insurance industry and the “four layer cake” of needed reforms/modifications: 1) An “exchange” for small / medium-sized markets; 2) Medicaid; 3) Employer-sponsored insurance; and and 4) Medicare. |
| 9:15 – 11:00 (no recording) |
Health Access and Coverage Panel John McDonough, Ph.D., Senior Health Advisor to Senator Ted Kennedy Speaking off the record, Dr. McDonough outlined the following issues of “substance:” 1) Coverage, defined in three interlocking steps: insurance market reform, individual responsibility to buy insurance when affordable, and subsidies for those below poverty level; 2) Delivery System reform, including a series of interventions around providers, chronic disease management, transparency, Health IT, and Comparative Effectiveness Research; 3) Prevention / wellness; 4) Long-term support & services for the disabled; 5) Healthc are fraud & abuse; and 6) Financing. From a “process” perspective, Mr. McDonough reports that the Senate Finance Committee (led by Sen. Baukus) and the Senate Health Committee (led by Sen. Kennedy) are in close collaboration and plan to be marking up legislation in early June. The three House committees are also working collaboratively and looking at July deadlines. “There is no villain: we’ve met the enemy, and it is all of us.” Barbara Lyons, Ph.D. Vice President, Henry J. Kaiser Foundation & Deputy Director of the Kaiser Commission on Medicaid and the Uninsured Dr. Lyons’ presentation is on Medicaid as a Platform for Health Reform. She describes Medicaid’s role and scope today and details why it is a logical building block to broadening coverage. She discusses ways to strengthen Medicaid’s protection for low-income people and how Medicaid financing can support health reform goals. Stabilizing and enhancing Medicaid financing, perhaps including an automatic counter-cyclic indicator to stabilize Medicaid financing during economic downturns, would support national coverage goals. Download Dr. Lyon's presentation slides (PPT, .5MB) » Joe Antos, Ph.D., Wilson H. Taylor Scholar in Health Care and Retirement Policy, American Enterprise Institute Dr. Antos discussed the problems of non-group insurance as issues of medical underwriting because of inadequate risk-pooling in this market. The current system lacks subsidies for non-group insurance. Problems with group insurance include the need to have a good job, the difficulty in changing jobs for fear of losing coverage, the lack of individual choice in plans, and the entitlement mentality that these plans breed: “You paid for it, you better use it!” Potential solutions include 1) developing high risk pools – basically extracting the “uninsurable” from the rest of the pool and heavily subsidizing this coverage; 2) developing “connectors” to create bigger pools of individuals and connecting them with affordable options (like in Massachusetts); 3) having a public plan option--creating a much bigger risk pool for those that can’t currently get adequate non-group insurance; and 4) expanding Medicare / Medicaid eligibilities. Bob Berenson, M.D., Senior Fellow, Urban Institute Dr. Berenson discussed the challenges and issues he sees in addressing health care payment reform. He states the two main issues as: “How to finance?” and “How to accommodate the various views on a government plan?” He believes that there will be some form of payment reform this year, likely including correcting fees in RBS to move money into primary care. Medical home models for chronic care will also likely be addressed. (He referenced Medicare’s Physician Group Practice Demonstration project in which 10 integrated systems have been piloting a shared savings program. This project has had promising results regarding aligning incentives to improve quality of care. However, participating systems have had to bear the full financial risk of direct project costs and lost potential revenue from hospitalizations and other complex care.) |
| 12:00 p.m. | Lunch with Congressional Staff Senate Finance, House Ways and Means, House Energy and Commerce, Senate Health, Education, Labor and Pensions |
| 2:00 Download the podcast (first three speakers, 60 minutes, 57MB) Download the podcast (last three speakers, 30 minutes, 30MB) Listen to streaming audio of Dr. Clancy's presentation Listen to streaming audio of Mr. Guterman's presentation |
Financing and Reform Panel Carolyn Clancy, M.D., Director, Agency for Healthcare Research and Quality (AHRQ) Dr. Clancy’s presentation is titled, “Evidence-Based Medicine: Making Today’s Goals Tomorrow’s Reality.” She outlines current challenges, including variations of care, uncertainty about best practices, and translating scientific advances into usable information for clinicians and patients. She describes the role of Comparative Effectiveness in the context of the Recovery Act and discusses ways to enhance quality efforts and the challenges of the future. The 2009 AHRQ Annual Conference will be held Sept. 13-16 in Bethesda, MD. Download Dr. Clancy's presentation slides (PPT, 1.5MB) » Stuart Guterman, Senior Program Director, Program on Medicare’s Future, The Commonwealth Fund Mr. Guterman discusses the Medicare system and possible approaches to reform payments to elicit effective health care delivery. He discusses payment reform ideas, including a move from fee-for-service toward more bundled payments, different ways of structuring physician and hospital fees, and opportunities with actual and virtual integrated delivery systems. His comments on system reform include quality standards and reporting, transparency, information technology, and comparative effectiveness research. Download Mr. Guterman's presentation slides (PPT, .5MB) » Karen Pollitz, Research Professor at Georgetown University’s Health Policy Institute Ms. Pollitz outlines the four ways to pay the $1.5 trillion price tag associated with health care reform (which includes subsidies to cover the uninsured and setting standards of health insurance to address the underinsured.) This conversation includes 1) deficit financing, 2) paying through taxes and government cuts (offsets), 3) cost containment efforts, and 4) less reform. John Rother, Director of Legislative and Public Policy, American Association of Retired Persons (AARP) Mr. Rother gives his perspective on the differences in process and policy of health care reform today vs. 1994. In ’94, he characterized the process as “us vs. them,” with most individuals believing the status quo was the “next best option” to their proposals. Today, most believe they “can’t afford to fail…they need to make substantial progress, but it does not need to be perfect.” The ’94 plan was led by a polarizing figure and much was done in secret meetings in the executive branch. Today, Sen. Kennedy is seen as a rallying figure and congress is the driving force. From a policy perspective, the scope of today’s reform objectives is more modest. The employer-based insurance market will be largely left alone, with focus on the individual and small group markets. Today, “value” is the key word, with focus on cost containment as much as coverage. He discusses numerous options, including employer mandates, savings from efficiencies, and changes in the tax code to make a portion of the value of employer-based benefits taxable. Richard Sorian, Vice President for Public Policy and External Relations, National Committee for Quality Assurance (NCQA) Mr. Sorian shares his views on our healthcare system, including his assertion that the U.S. does “rescue care” better than anyone in the world, but we don’t do well in prevention or the care of chronic conditions. In general, we don’t do well “in transitions” (between providers, from hospital to home, etc…) He tackles the question of “how do we address quality?” by looking at ways to change the payment system and ways to measure performance. He notes that the AMA is now embracing the development of measures to assess the performance of physicians, hospitals, and health plans and that just providing the feedback to organizations creates a process of improvement. |
