THE SYMPOSIUM FEATURES LEADERS IN TODAY’S ONGOING HEALTH CARE DEBATE.
The far-reaching nature of the Symposium’s scope necessitates input from authoritative voices–professionals with a depth of experience and expertise in America’s health care system. We’re extremely fortunate to report that these well respected and highly influential voices have agreed to join the Symposium to share their knowledge and insights with our attendees:
Dr. Douglas Holtz-Eakin
Dr. Holtz-Eakin’s Primary Recommendations:
Recognizing that the cost of insurance is driven by the cost of health care, re-focus reform efforts on fixing what’s wrong:
- In Medicare, stop paying on a on a fee-for-service basis
- Focus instead on compensating on the basis of quality outcomes
- Preserve Medicare Advantage and its prime directive of comprehensively treating seniors, caring about outcomes, and providing a better overall health care value proposition
Allocate more control of health care issues to the state level
- States are in a better position to address the health care needs of their citizens.
- Study and promote solutions like Health Indiana, Badger Care, et al.
- Enable states to fix Medicaid, specifically to improve access to care as a means to deter emergency room visits as a default.
Push back on the notion that the Affordable Care Act must be repealed.
- Instead, re-position large insurers as a driving force in health care reform.
- Consider plans that provide insurance as a lifetime proposition, rewarding continuity of coverage by providing economic incentives to the insured and to health care providers.
- Provide insurance products that can be tailored to the evolving lifetime needs of the insured.
Dr. Holtz-Eakin is President of the American Action Forum and most recently a Commissioner on the Congressionally-chartered Financial Crisis Inquiry Commission. He has a distinguished record as an academic, policy adviser, and strategist. Since 2001, he has served in a variety of important policy positions. Read Dr. Holtz-Eakin’s full biography here.
Robert E. Moffit, Ph.D.
Dr. Moffit’s Primary Recommendations:
- As a general consensus, move away from a centralization of financing and regulatory powers in Washington; devolve key health care-related decision-making back to individuals, families, employees, and employers. Revert to a federal system of government that promotes freedom to try multiple options to improve the performance of our health care system.
- Reform health insurance markets to allow all Americans to choose, control, and carry their own insurance plans with them from job-to-job and throughout their lives.
- Change the federal tax system so that the tax benefits now afforded to recipients of employer-based health care are made available instead as individual tax relief for all. Make this tax relief universally applicable to the purchase of health insurance from any source, and make it available to offset the cost of coverage. Also, allow benefits to be as portable as possible so that the playing field is leveled.
- Make the health insurance market a real market by removing regulators from the decisions on what kinds of plans are available. Ensure that insurance providers are responding directly to consumers in a national market, with large pools and higher risk diversification.
- Reverse the expansion of Medicaid, and reallocate the funding currently ascribed to Medicaid to young, low income, or non-insured consumers in order to create a defined contribution system that improves access to health care providers.
- Repeal the Affordable Care Act’s compulsory abortion funding provision.
Robert E. Moffit, Ph.D., is Senior Fellow in The Heritage Foundation’s Center for Health Policy Studies. With his background as a Reagan Administration appointee in U.S. Department of Health and Human Services (HHS) and the Office of Personnel Management (OPM), coupled with his extensive history as senior member of Heritage’s pace-setting health care team and director of Heritage’s Center for Health Policy Studies, Dr. Moffit share his viewpoints on today’s and tomorrow’s health care issues. Read his full background here.
Ms. Turner’s Primary Recommendations:
- Allow Medicare Advantage to continue as the foundation for future reform, recognizing that it embodies the free market at work. Medicare Advantage needs to have a level of freedom in which plans can compete, and people can have the ability to make their own choices and select plans that best meet their needs.
- Protect and develop Medicaid substitutes, like Healthy Indiana, as alternatives to mandated Medicaid expansion. Embrace plans that give Medicaid participants the dignity of private insurance, and gives them a vested interest in the plans they have.
- Return decision-making to the people affected and to the markets that provide the services. Enable free markets to police themselves as a way to tackle the problem of fraud and abuse.
- Encourage Republican leadership to shift their talking points away from budgetary issues and more toward people issues.
Ms.Turner is Founder and President of the Galen Institute, a public policy research organization dedicated to promoting an informed debate over free-market ideas for health reform. Ms. Turner’s experience as a member of the National Advisory Council of Healthcare Research and Quality and the Medicaid Commission, along with her role as founder and facilitator of the Health Policy Consensus Group will add substantially to the Symposium’s depth. Read more about Grace-Marie Turner here.
Lt. Gen Jack Klimp
Gen. Klimp’s Primary Recommendations:
- Join the Fight Fraud First movement
- Promote DoD Accountability:
- For under-execution and budget re-programming
- For how money is spent and efficiency of services
- Consolidate redundant, counterproductive Health Systems
- Promote better access to care when needed
- Dismantle the bureaucracy, build in accountability to ensure that veterans can obtain care when they need it
- Fix the Medicare physicians’ reimbursement (Doc Fix)
- Pursue a permanent fix in order to keep doctors in the system
- Promote advance treatment programs for TBI, PTSD, Degenerative Brain Disease, and Superbugs
- Continue research into the effects of “new” maladies
- Provide diagnostics and treatment for deactivated reservists
- Eliminate regulatory barriers to research into causes of, and treatment for, emerging diseases like Degenerative Brain Disease and antibiotic-resistant infections
- Continue focusing on reduction in backlog of veterans’ claims and resolve the extensive appeal cycle associated with denied claims
- Promote a seamless exchange of medical records between DoD and DVA
- Promote joint partnerships between DoD, DVA, and Civilian organizations
- Expedite recognition and treatment planning for illnesses resulting from long-term toxic exposure (e.g., Agent Orange, Gulf War Syndrome, etc.)
Lt. Gen Klimp, USMC (Ret.) is President of the National Association for Uniformed Services. After completing a distinguished U.S. Marine Corps career, with tours in Vietnam, Korea, and Desert Storm, Jack Klimp built a solid career in industry as CEO of AHRI, Inc. and, before that, senior VP of Phoenix House, overseeing more than 40 drug rehabilitation programs in the New York area. In 2009, he assumed leadership of Second Genesis, a substance abuse recovery program. Read Mr. Klimp’s full bio here.
Dr. Gottlieb’s Observations:
Dr. Gottlieb provides an extensive overview of the primary constructs that are defining the way the Affordable Care Act is being rolled out, with an analysis of how these notions and theories are likely to affect other, existing programs (like Medicare and Medicaid) and in the commercial insurance product marketplace in general. He suggests that even though the ACA might not directly affect everyone, this spill-over affect is something that people need to understand.
Key observations from Dr. Gottlieb include:
- The expected advent of narrow provider networks is materializing, along with restrictive formularies, and consolidation of providers in the marketplace. In this latter area, for example, he suggests that the small, physician-owned practice environment is diminishing and will continue to constrict in the future in favor of “concierge-type” approaches to health care.
- While the narrow network concept was envisioned as a cost control measure, the reality is that it ends up limiting the ability of insurers to take advantage of existing measures to reduce costs for subscribers.
- County-level bidding has emerged as a feature of coverage marketing, with the result being increased selectivity and the beginning of “exclusive provider organizations.” This approach has further narrowed provider networks, and presents potential problems for mobile populations.
- The county-by-county bidding process, with its bias toward large cities, tends to limit the range of provider choices available to many counties outside of large density population area. In some plans, the absence of choice can lead to considerable out-of-pocket costs that may not be applicable to deductibles.
- One of the general observations on the ACA is that the result has been an increase in health insurance cost, with a corresponding decrease in the quality of the underlying health care products.
- The various plan levels available via the ACA (i.e., gold, silver, platinum, etc.) are basically all the same with respect to drug formularies and physician networks; the only real difference is the co-pay structure. A more expensive plan simply amounts to paying higher premiums to buy down co-pays and deductibles.
- The possibility of a shortage of physicians is not likely to happen as forecasted, primarily due to productivity improvements continually being realized, as well as alternative forms of practice (e.g., Physician’s Assistants, Nurse Practitioners, etc.)
- The ACA contains closed formularies, meaning that drugs not on the narrow list will result in increased out-of-pocket costs.
Dr. Gottlieb, M.D. is a practicing physician and a Resident Fellow, American Enterprise Institute. He has has served in various capacities at the Food and Drug Administration, including senior adviser for medical technology; director of medical policy development; and, most recently, deputy commissioner for medical and scientific affairs. Dr. Gottlieb has also served as a senior policy adviser at the Centers for Medicare & Medicaid Services. Read his full biography here.
John C. Goodman
Dr. Goodman’s Primary Observations & Recommendations:
- One of the main problems faced by Medicaid recipients is their limited access to health care providers. Dr. Goodman describes the “minute clinic” concept in which patients are afforded priority care as cash-paying customers, with completely transparency pricing, but notes that access to this type of care is not available to Medicaid recipients due to lower reimbursement rates. It would make sense, he suggests, to allow these payments to pay the difference, rather than have them use emergency room as an alternative.
- Similarly, steps should be taken to enable doctors to re-package their services to meet market demand, rather than packaging services according to insurance-based payment plans. As an example, he notes, telephone consultations are considered non-billable activities, and therefore physicians tend not to use that method of communication.
- Dr. Goodman describes an example of a Camden, New Jersey doctor who has employed social work as a way to achieve dramatic reductions in the cost of caring for chronically ill health care abusers, by performing non-medical “social” activities. Despite eliminating substantial costs, he received no third-party payer reimbursement (primarily Medicaid). The medical profession, he suggests, should be free to pursue these approaches, with some type of compensation.
- The ACA faces six major problem areas: (1) insurers can’t change the packaging of plans to meet logical situations; (2) the system of subsidies is bizarre; (3) there are perverse incentives (over providing of services for the healthy, under providing for the sick) embedded in the plans and exchanges; (4) lack of enforcement of penalties; (5) rationing problems are likely (large increase in demand without a corresponding increase in supply); (6) impending caps on Medicare, Medicaid, and subsidies starting in 2018 will severely inhibit affordability of health care.
- The solutions to the ACA quandary lie in eliminating mandates in favor of individual choice, and promotion of fairness in choice and fairness—either fixed sums or refundable tax credits—in obtaining help from government. Another approach would be to let Medicaid compete with private insurance, and avoid trapping people in Medicaid. Finally, promote “real” insurance, similar to the way that coverage operates in Medicare Advantage.
John C. Goodman is widely known as the “Father of Health Savings Accounts” and most recently as the author of the new book, Priceless: Curing the Healthcare Crisis. Modern Healthcare named him as one of four people who have most influenced the modern health care system. Dr. Goodman received his Ph.D. in economics from Columbia University, and has taught and done research at Columbia University, Stanford University, Dartmouth College, Southern Methodist University and the University of Dallas. He regularly appears on the FOX News Channel, CNN, FOX Business Network and CNBC. He was a debater on many of William F. Buckley’s Firing Line programs. He is also a frequent editorial writer for The Wall Street Journal, the Health Affairs blog, and Townhall.com.
Dr. Beth Haynes
Dr. Haynes’ Primary Observations & Recommendations:
- There is a need to integrate the ideas of free markets and profit into the health care policy curriculum. There is an absence of a complete understanding of the broader subject of health care systems and basic economics in today’s academia.
- There is a critical need for greater balance in academic discourse on health care, with emphasis on the doctor-patient relationship as being the primary tenet in understanding medical ethics.
- The importance of messaging and communications needs to be reinforced in academia. The medical community’s general vision of health care for all needs to be examined in terms the economic issues in achieving that goal.
- The path to achieving affordability in medical care is through free enterprise (which is really a type of “crowd sourcing”) and removing the legal and regulatory obstacles to innovation that currently block the discovery and implementation of practical solutions to many of today’s problems. The best way to achieve progress in this regard is to promote access to free enterprise profit and loss as the driver of innovation and affordability.
Dr. Haynes is Executive Director at The Benjamin Rush Institute; Previously in private practice with board certification in both Family Practice and Emergency Medicine, Dr. Haynes has been working full time in health care policy for the past four years. She obtained her MD from the University of Cincinnati, College of Medicine and her residency training at University of Wisconsin in Madison. In addition, she volunteers as Senior Health Policy Analyst and Executive Board Member for Docs4PatientCare, and as an Executive Board Member of the Dr. Joseph Warren Institute. She is founder and president of the Black Ribbon Project, a movement addressing the shortcomings of the Patient Protection and Affordable Care Act, and has served as National Co-Chair of Doc Squads, a project to recruit and train doctors to lead the public health care debate. Find out more about Dr Haynes here.
Michael F. Cannon
Mr. Cannon’s Primary Observations & Recommendations:
- Technological innovation is fostered in a free market, and the evolution of virtually every product we use today is the result of market-driven technological innovation. While many authorities generally accept this premise, it is somehow felt that it does not apply to health care because “health care is different.”
- Using the marketplace for elective laser eye surgery as an example, Mr. Cannon explains that the cost for some medical technologies has dropped nearly in half as a result of market-driven competition. In addition, the quality of the procedures performed have also improved tremendously. The result, logically, is more affordable services brought about by the market pressure of needing to deliver better quality at lower prices.
- For non-elective surgeries, like coronary bypass, the same principle applies. Using angioplasty as an example, Mr. Cannon suggests that surgical procedures of this nature have likewise benefitted tremendously from technological evolution.
- Technology evolution enables lesser-trained professionals to perform medical procedures that were previously only in the domain of higher-priced providers; accordingly, many medical procedures and facilities are more affordable at significantly lower cost.
- A reason why these tremendous cost-lowering improvements do not translate directly into lower health care cost is that the proportion of payment out-of-pocket has dropped substantially (from 56% to about 14%) as a result of government intervention via intermediaries handling portions of the cost. As the portion of out-of-pocket spending drops, there is a natural tendency of not be concerned about total cost. This counter to a naturally operating marketplace. Medicare reimbursement rates are another contributing factor, since they tend to incorrectly reflect market prices.
- Government intervention in the actual practice of medicine also tends to drive up costs as a result of inconsistent limitations on mid-level practitioners. The question really is not who can do what, but who should decide who can do what…government or the competitive marketplace?
- Licensing laws should be re-examined—possibly repealed—since they essentially add nothing to the quality of medical care, and tend to increase cost.
- On the subject of “narrow networks,” the problem is not necessarily with restricted choices, but with the higher premiums that have resulted under the ACA, as well as the impact of “community rating” price controls.
Michael F. Cannon is the Cato Institute’s director of health policy studies. Previously, he served as a domestic policy analyst for the U.S. Senate Republican Policy Committee, where he advised the Senate leadership on health, education, labor, welfare, and the Second Amendment. Cannon has appeared on ABC, CBS, CNN, CNBC, C-SPAN, Fox News Channel, and NPR. Read more on Mr Cannon here.
Senator Kelli Ward (AZ)
Dr. Ward’s Primary Observations & Recommendations:
- Controlled Substance Databases offer a well-controlled method of monitoring the distribution of drug refills. Dr. Ward advocates this tool as a way to streamline the approval process for refills.
- Dr. Ward recently sponsored a bill to preserve direct primary control. Describing a service wherein individuals and families can register for unlimited care for a fixed price, she explained the interest that developed in regulating practices of this type as insurance products. Her bill, which was successful, blocked this and protected access to these types of plans. She suggests all states should look at this type of program.
- Dr. Ward described Arizona’s pre-ACA experience with Medicaid expansion, noting that the results were not favorable. She discussed Arizona’s Proposition 204, which extended Medicaid to everyone under 100% of the federal poverty level, primarily as a means to control over use of emergency facilities. The enrollment was triple the level expected, crowding out private insurance with no decrease in the rate of uninsured. The bottom line, she points out, is that Arizona’s Medicaid expansion has not achieved any of the hoped-for health care cost reductions expected.
- Similar to New Jersey and Pennsylvania, Arizona recently enacted legislation that protects physicians doing pro bono treatment work from civil liability. She encouraged other states to pursue this type of legislation.
- Dr. Ward encourages everyone interested in resolving the health care dilemma to become active–through involvement in organizations like AMAC–in the debate, and get to know their elected representatives and voice their concerns directly to them.
Dr. Ward was elected to the Arizona State Senate in 2012, following four years of service as Appointee to the AZ Regulatory Board of Physician Assistants. After earning her BS in Psychology in 1991 from Duke University, she attended the West Virginia School of Osteopathic Medicine and graduated with her Doctor of Osteopathic Medicine (D.O.) degree in 1996. She completed her Family Medicine Residency training in Garden City, Michigan. She founded Lakeview Family Health Care in 1999 and operated a private practice for ten years while working in primary and emergency care. While transitioning to public office, she worked as a physician in the Emergency Departments in both Kingman and Lake Havasu, AZ. She is Director of Medical Ed. at Kingman Regional Medical Center. Learn more about Senator Ward here.
Dr. Lee Gross
Dr. Gross’ Primary Observations & Recommendations:
- Dr. Gross described the ideal health care environment as being one in which health care is affordable, prices are completely transparent, your plan would be totally portable and can follow you wherever you go, would not be a fee-for-service program and would include a quality performance measurement, would not charge extra for pre-existing conditions, and would attract practitioners to the profession. The environment would also provide for access by Medicaid enrollees.
- Dr. Gross discusses the Epiphany plan, a membership based primary care program where doctors contract directly with their patients and provide a distinct primary care platform. He explains the manner in which the plan (visit epiphanyhealth.net for a complete description) lowers the costs of healthcare via a “monthly fee” concept.
Dr. Gross concludes his remarks with an explanation of the potential impact of the Epiphany concept on the cost of direct primary care country-wide. He suggests that making a plan of this type available to the estimated 58 million uninsured in American would be a workable solution to a major portion of today’s health care situation.
- Dr. Gross explains that while the Epiphany portion of his practice is roughly 10% of his practice, it accounts for approximately 50% of his net income each month. They are on a progressive track to increase the Epiphany portion, but are retaining their hybrid practice to continue serving an under-served community.
- In a non-hybrid practice, Dr. Gross estimates that roughly 1,000 patients per doctor would make the practice sustainable. He also noted that the Epiphany approach works well with Medicaid due to its affordability; with the nearest Medicaid provider an hour and a half away, patients have subscribed to Epiphany as an alternative in order to obtain service.
Dr. Gross is Co-founder and Senior Vice President of Epiphany Health. He received his Bachelor degree from The Ohio State University in Columbus, Ohio, and earned his medical degree from Case Western Reserve University. After graduating from medical school he completed his residency in Family Medicine at University Hospitals of Cleveland, where he was chief resident. He is Board Certified in Family Medicine. Dr. Gross has also been awarded Best Doctor in 2008 and 2010 by the North Port Sun-Herald newspaper. He currently serves on the Board of Trustees at Fawcett Memorial Hospital. Read more about Dr. Gross and Epiphany Health here.
Marc O’Connor’s Primary Recommendations:
Our Health Care System must treat the entire patient, not just the condition
- Provide dedicated patient care coordinator s for chronic disease state patients
- Licensed pharmacy techs
- 24-hour access to service
- Co-pay assistance, if required
- Provide medication therapy management
- Promote medication adherence
- Provide custom medication packaging
- Structured for the individual patient’s life style
- Delivered directly to the patient
- Measured and scheduled dosages
- Promote patient engagement technology
- Constant and consistent tracking of patient’s condition
- Use of wireless technologies to promote data capture and recording
Marc O’Connor is COO and Chief Strategy Officer of Curant Health, a transformational healthcare company focused on improving patient outcomes while reducing health care spending. With more than 20 years of executive management, coupled with a wealth of personal experience in chronic disease treatment and management, he leads Curant’s charge as a “disruptive force to the traditional care model.” He has been named to Catalyst’s “Top 25 Entrepreneurs and Ones to Watch” list, and is a frequent lecturer at the College of Engineering at the University of Florida. Read more about Marc here.
Ms. Serkes’ Primary Recommendations:
- Providers and insurers need to facilitate patient relations by promoting better, unambiguous pricing information.
- Patients, in turn, must become better “shoppers” when they contract for medical services.
- Patients need to take control of, and maximize the value of, the medical service they receive. To accomplish this, patients need to:
- Do their own research in advance of office visits
- Learn and apply the PQRST method of pain assessment prior to meeting with a practitioner
- Maintain a list of current medications and dosages
- Arrange for an advocate to accompany them on office visits, hospital admissions, etc.
- Develop questions in advance, write them down, and take notes on the responses and comments from practitioners
- Learn how to shop and price compare for drugs, procedures, diagnostics, lab work, etc.
With more than 17 years on the front lines fighting for freedom in medicine, Kathryn Serkes works tirelessly in the public policy and advocacy arena. Her credentials include representation of the Association of American Physicians and Surgeons, where she developed a highly acclaimed “THRIVE, Not Just Survive” independent private practice workshop oriented toward development of patient-centered practices, and is an Emmy-award winning producer and reporter. Academically, she is on the faculty of Bellevue Community College and a guest lecturer at George Washington University Graduate School of Political Management. She co-authored “Patient Power: The Patient’s Handbook,” and has appeared on many television shows, including “Larry King Live,” “The Today Show,” and “The O’Reilly Factor.” Read Kathryn’s full biography here.
Ratanjit Sondhe is founder and CEO of www.DiscoverHelp.com, as well as an acclaimed author, writer, and columnist. He has addressed a variety of international conferences and other forums as a keynote speaker on stress management, ethics, and applied spirituality. Sondhe is also a radio and television host and founder and chair of the Business Association of Sikh Enterprises. He is a board member of the American Red Cross and Project Love and serves as chairman of the board of the Guru Nanak Foundation. Sondhe is a charter member of TiE Ohio. He has Master of Science degrees in chemistry and polymer technology from universities in India. In addition, Sondhe is the founder and former CEO of POLY-CARB Inc., a material science company acquired by the Dow Chemical Company. Read more about Ratanjit here.