Dr. Wendy Everett, CEO, Network for Excellence in Health Innovation

( Music)

Mark Masselli: This is Conversations on Health Care. I am Mark Masselli.

Margaret Flinter: And I am Margaret Flinter.

Mark Masselli: Well Margaret, there has been more talking of sweeping changes
at the Veterans Health Administration, receiv ing more evidence of entrenched
culture of long waits and severe shortage s of primary care practitioners
throughout the tax ed VA system.

Margaret Flinter: Well that’s right , Mark. And the realities of what’s happening in
the VA health system are startin g to sink in . The VA operates 150 hospitals
around the country but currently report a shortage of 400 primary care
practitioners which is not only a problem at the VA but it’s a problem nationwide ,
and apparently having quite a bit of trouble finding the professionals to fill these
post s .

Mark Masselli: There is a very heavy patient load which is one of the key
contributing factors leading to longer wait times.

Margaret Flinter: And it should be noted Mark that according to a recent survey ,
w hile most veterans don ’t like the long waits , they are satisfied with the care that
they get once in the system , so a conundrum but one that needs to be solved
and soon.

Mark Masselli: Meanwhile , Margaret, measure s are being put in place to
address some of the pr o blems including veterans being allowed to seek care in
the private sector if they are be ing forced to wait that long.

Margaret Flinter: And of course , members of Congress are w eighing in the
Restoring Veterans Trust Act, which seeks to rapidly address so me of the most
pressing issues . The bill would make it easier for the beleaguered Department of
Veterans Affairs to hire and fire employees , lease new space for clinics and
hospitals and send veterans to outside providers if care is not available with in 3 0
days.

Mark Masselli: And since there ha s been an uproar from both sides of the aisle, I
suspect there will be some quick action to approve the necessary funding.

Margaret Flinter: The name says it all , Mark . Restoring the trust of America’s
veterans is just paramount to successfully putting this problematic issue to rest.

Mark Masselli: Another area of health care that is indeed of gaining trust is the
realm of telemedicine and telehealth, still a fledgling aspect of health care but
one that is poi sed to grow over time.

Margaret Flinter: And that ’s something that our gues t today knows quite a bit
about . Dr. Wendy Everett is the Chief Executive Officer of the Network for
Excellence in or NEHI, a nonprofit, nonpartisan health policy institute that’ s
focused on enabling and supporting innovations that improve the quality of care
and lower the cost .

Mark Masselli: We will also hear from Lori Robertson , m anaging editor of
FactCheck .org .

Margaret Flinter: And no matter what the topic , you can hear a ll of our shows by
going to www.chcradio.com .
Mark Masselli: And as always, if you have comments, please email us at
www.chcradio.com
or find us on Facebook or Twitter beca use we love hearing
from you.
Margaret Flinter: We will get to our interview with Dr. Wendy Everett in just a
moment.
Mark Masselli:

But first , here i s our p roducer Marianne O’Hare with this week’s
Headline News.
Marianne O’Hare: I am Marianne O’Hare with these Health Care Headlines . The
cost of inpatient procedures at the nation’s hospitals went up almost across the
board in 2012, and in many cases, it rate almost 4 times the national rate of inflation. According to the study , hospital s charged mor e across the spectrum of
98 common procedures from hip replacements to chest pain. Charges for chest pain r ose on average 10% across the country in 2012 alone , based on data
released from the recent Medicare billing data dump . It does a ffect the
individu ally i nsured and the millions of Americans who are now paying much
higher deductibles and out of pocket cost s for health care .
An other health care cost increase story , insurance premiums. Health insur ers
are already ready ing rates for 2015 and the early signs point to a double digit
rate increase for 2015 . Arizona is already seeing rate increase requ est for next
year of between 10 % and 25% . Meanwhile folks aren’t just buying insurance on
the exchanges by the millions , many s ought to purchase health plan s privately
through insurers. Kaiser Family Foundation estimates between 3 million and 3 ½
million new people signed up for health insurance either through insurance companies or brokers in March alone.
Death, dying and doctors . Turns out most would shun aggressive treatment at
the end of life. They have seen the suffering of their patients at the end of life
and say they want no part of it. In fact , nearly 9 in 10 young physicians just
finishing up residencies or fellowships say they wouldn’t want to r eceive life

prolonging CPR. The study published in the journal PLOS ONE notes the
disconnect between the aggressive care the average person receives in the
health care system in their last month of life and what d octors say they want for
themselves .

And if you think teenagers are becoming weaklings, you are right. Less than half
of youth , between the age s of 12 and 15 , are even close to be ing aerobically fit.
According to data released by the Centers for Disease Control, that’s down from
52% of young te enagers in 1999 , the last time this survey was conducted , it
measures adequate levels of cardiorespiratory fitness which children need not
only for sports but overall good health. Girls were particularly out of shape, just
34% of them hav ing adequate card iovascular health compared with 50% of the
boys , but even 50% says the CDC is not good enough. I am Marianne O’Hare
with the se Health Care Headlines .

( Music)

Mark Masselli: We are speaking today with Dr. Wendy Everett , Chief Executive
Officer of the Ne twork for Excellence in Health Innovation, NEHI, a nonprofit,
nonpartisan health policy institute focused on enabling innovations that improve
the quality and lower the cost of health care. She is the Director of the Institute
for the Future, overseeing t he creation of a 10 year national forecast in health
and health care. Dr. Everett earned her Master’s and Doctorate in Public Health
at Harvard. Dr. Everett , welcome to Conversations on Health Care .

Dr. Wendy Everett: Thank you so much.

Mark Masselli: You are at the h elm of one of the largest multi - stakeholder
organizations in the country, really focused in on the critica l issues of cost , safety
and quality . And here we are at the time of great transformation in health care
system and who are the col laborative stakeholders at NEHI and what kinds of
policies are you focused in on actually having the power to influence innovation
in health care.

Dr. Wendy Everett: NEHI is a member - based organization with just under a 100
different members from all acr oss the health care spectrum . So our mission very
specifically is to save li v e s by speeding the adoption of valuable innovation. Our
member s represent health plans , service delivery providers , physicians,
manufacturers , biopharmaceutical companies, patie nt s and consumer groups ,
and our goal is to bring everyone to the table so that we can use the combined
intellect of all of these people to reach consensus on solving these critical
problems in health care . We work in five main areas . The first is improv ing the
delivery of health care . The second is ensuring the responsible use of
medicines . The third is reforming payment systems in health care . The forth is
advancing technology and then the fifth is that we work hard to promote heath
and wellness. So we are very interested in policies that speed or accelerate the

adoption of innovation that will help patient s. So as an example , it ’ s well known
that up to 50% of patient s don’t take their medication as it ’ s prescribed by the
physician. This results in just under $ 300 billion worth of waste in the system.
We have worked overtime to identify that about $ 2 billion in waste ful spending
result s in roughly 100 , 000 avoidable deaths annually.

Margaret Flinter: Well Dr. Everett , you had coauthored a report not long ago in
Health Affairs with actually two former guests on the show, Joe Kvedar from the
Center for Connected Health and Molly Coye, the Innovation Director at UCLA .
And the report looks at how we can improve patient health and outcomes with
more o f a focus in us e of telehealth and telemedicine strategies. Where are the
partnerships in play right now and what kind of results are you seeing and how
will you bring this one to the fore if that’s a focus area of yours?

Dr. Wendy Everett: So if we loo k at something as simple as using home
telemonitoring system, a scale that’s connected to a telephone line , that
transmits just the w eight, many time s translates those data over a very simple
telephone li n e to the p hysician ’ s office so that a patient can b e monitored on a
daily basis. There ha s been a lot of research showing that this is an extremely
e ffective tactic to keep congestive heart failure patients out of the hospital and
really manage them effectively at home. So Joe has used many of these
diffe rent process es with his patient s and partners and through this telemonitoring
process they have reduced hospital readmissions by 44%. A second great
example of a good partnership is the Veterans Health Administration . And what
they have done particularly in the southwestern rural areas is to use
telemonitoring both for their chronically ill patients but also for their returning vets
with post - traumatic stress syndrome. And by doing that, we are able to attain a
25% reduction in the number of bed days, an d a 19% reduction in hospital
admissions. I think the Center for Connected Hea l th Partners has been the gold
standard as a model and if the delivery systems around the country were able to
use telemonitoring and telemedicine appropriately, that we could s ave up to $4
billion annually.

Mark Masselli: The Industry Organizations recently outline d guidelines for
governing the use of telemedicine. The American Telemedicine Association and
Federation of State Medical Boards offered proposals that would clear up some
of the confusions . I wonder if you could outline for us what some of these new
recommendation s are and how the payers are involved and how you see these
rules precipitating more use of telemedicine protocols moving forward, Wendy.

Dr. Wendy Evere tt: So telemedicine has a great deal of promise but much of the
regulation is done at the state level. Those state laws at the moment are quite
inconsistent and govern how physicians both can practice medicine and how
they get paid. That has been a sign ificant barrier. The Federation of State
Medical Boards very recently revised their model policy of the appropriate use of
telemedicine technologies and in that they provided some guidance and a basic

roadmap . I think most of us feel that the State Medic al Board Federation didn’t
go far enough . So the guidelines that they promulgated really described
telemedicine as applying to secure video conferencing rather than going a bit
further and saying that it also applied to email or telephone communication or
even thinking about some of the basic , Skype or Facetime technologies that are
already in wide use. There is a new study by Deloitte that predicts by 2014 there
could be up to 75 million electronic visits in North America , and that would
represent about 25% of the market. So we need to work pretty quickly to
address this physician to physician telemedicine consultations and the physician
to patient electronic communications that fall far short of the secure video
conferencing that was endorse d by the fed eration.

Margaret Flinter: Maybe just let me pivot a little bit away from telemedicine to
just the use of data, which is another area that your organization is really
stepping out in a leadership role to say what is this evolving landscape in health
refo rm and yet sometimes our ability to actually make use of the mountains of
data that we have is limited. What are you doing at NEHI? What’s your focus in
this area of facilitating better understanding and then release and use of these
mountains of data th at are now available to us?

Dr. Wendy Everett: I think that there is enormous potential for big data to give us
some information that will allow us to move forward with innovations much faster
th a n we have in the past . However, there is a n important lim itation to it right
now , which is that there are virtually no standards around the me thods and the
interpretation of data that are being collected by various organization s around the
country . There is absolutely no standardization about the quality of wha t those
data should be and what conclusions can be drawn from it . Now there obviously
are a number of very important groups in the country (inaudible 14:4 2 ) being one
of them, the Institute for Clinical and Economic Review being another that have
develope d highly rigorous and standardized ways of looking at these data . But
other th a n that , it’s a little bit of the Wild West out there. I think we are taking a
pretty conservative view and saying very early days , and our job as a health care
industry at lar ge is to develop some standards for data collection and analysis
that have to be pretty broadly accepted before they can have a major influence
on our health care decision making.

Mark Masselli: We are speaking today with Dr. Wendy Everett , Chief Executi ve
Officer of the Network for Excellence in Health Innovation, NEHI, a nonprofit,
nonpartisan health policy institute focusing on enabling innovations that improve
the quality and lower the cost of health care. Wendy, focus a little on one of the
five are as that NEHI is interested in and that’s payment reform. While we have
seen a diminishing of health spending, we haven’t necessarily seen changes in
payment reform or cost containment in health care. May be you can share with
our listeners some of the inn ovative payment models emerging now and where
you see the best hope for payment reform.

Dr. Wendy Everett: Any payment arrangement that really incentivizes and
rewards physicians, nurse practitioners, providers to integrate care and deliver a
higher qual ity level of care is a very promising model . So we were fortunate in
that there were many great examples of these payment models that we re
showcased at our summit, including the pioneering Alternative Quality Contract
that was created by Blue Cross Blue S hield of Massachusetts a nd reall y the
concept of global payments for managing populations of patient s over time . And
one of my very favorite parts of the summit this year was the population health
session that featured Dr. Rushika Fernandopulle of Iora He alth . And I know you
have had a chance to have him on your show as well.

Rushika is doing just very interesting things with primary care and population
health, but he is able to do that because he is working with self - insured
employers directly and they are paying him on a capitated basis to provide these
services to their employees . So he is able to use health coaches and to identify
not only the patient s that are sick but also the patient s that might not yet be in
need of care so that they can do a lot of preventive work . And he ha s been able
to decrease his overall cost by 10% to 15%. We also had a panel on State
Health Reform Initiative and you may know that there are four states in the
country that have passed legislation on health reform that is g eared toward cost
control, Massachusetts, Oregon, Maryland and Vermont. I think people believe
that the government can through these new innovative and different regula tory
changes can not only encourage payment reform but it can really encourage
innovati on in the delivery system to provide that care at a high quality but a lower
cost . So I think that th is new payment model , they have not only the opportunit y
to put a cap on cost and limit cost growth but they have a little mini disguised
engine in them t hat is pushing the providers , the integrated delivery systems to
say wow, maybe we should be looking at remote monitoring of our intensive care
patient s because it will prevent expensive complications .

Margaret Flinter: We have been speaking with Dr. Wen dy Everett , CEO of the
Network for Excellence in Health Innovation or NEHI. You can find out more
about their work by going to www.nehi.net . Dr. Everett , thank you so much for
joining us on Conversations on Health Car e today.
Dr. Wendy Everett: Thank you for inviting me . It was a pleasure.
( Music)
Mark Masselli: At Conversations on Health Care, we want our audience to be truly in the know when it comes to the facts about health care reform and policy. Lori Rober tson is an award - winning journalist and managing editor of
FactCheck.org, a nonpartisan, nonprofit consumer advocate for voters that aim to reduce the level of deception in US politics. Lori, what have you got for us this week?

Lori Robertson : Well the re is a new ad airing in Michigan that claims insurance
premiums are up by nearly 40% in the state . But that figure comes from an
unscientific survey on premiums in the individual market. The ad marks the
second time we have seen Americans for Prosperity citing this survey in an
attack on a Democratic Congressional candidate. The ad leads to false
impression that the rate increase applies to all premiums, but it only pertains to
about 5% of Michigan residents who buy their own insurance on the individual
market. In fact, employer sponsored premiums have been growing at historically
low rates in recent years. And the 40% figure comes from a survey of six
insurance workers in the state by Morgan Stanley to guide investor decisions on
stocks. One polling expert told us the survey had no scientific validity particularly
with the states results being based on fewer responses. A footnote in the
Morgan Stanley report gives a similar warning. Unfortunately, there are no
reliable apples to apples comparisons o f rates in the individual market before and
after the Affordable Care Act exchanges launched. It’s quite likely that rates
have gone up as the law requires a minimum set of benefits . That’s one reason
the before and after comparison is so difficult. Som e will pay more and some will
pay less d epending on circumstances such as health condition s. Even if the
40% figure were accurate , it doesn’t account for government subsidies which
80% of those in the exchanges are expect ed to receive according to the
Con gressional Budget Office. And that ’s my fact check for this week . I am Lori
Robertson , m anaging editor of F act C heck.org .

Margaret Flinter: FactCheck.org is committed to factual accuracy from the
country's major political players and is a project of the Annenberg Public Policy
Center at the University of Pennsylvania. If you have a fact, that you would like
checked, email us at www.chcradio.com . We will have FactCheck.org's Lori
Robertson check it out for you he re on Conversations on Health Care .
( Music)
Mark Masselli: Each week , Conversations highlights a bright idea about how to
make wellness a part of our communities and everyday lives. The US boast
among the highest rates of teen births in the world’s ind ustrialized nations. And while those numbers have been declining in recent years, it’s still a significant health issue in this country. According to a recent study, the decline in teen birth rates in this country can be attributed in part to the launch of the popular MTV
show 16 and Pregnant and the subsequent Teen Mom. MTV launched the series in 2009 to show the challenges and harsh realities of teen pregnancy and teen parenthood. Researchers at the University of Maryland and Wellesley
College conduct ed an empirical study to determine what if any impact the show
has had on the decline of teen pregnancy and birth. Wellesley College
economist Phillip Levine found that much of the decline in recent years is the result of the great recession but that it d idn’t account for all of the decline. They decided to utilize Google data tracker and Twitter Activity around the airing of the

shows which developed a loyal following and consistently high ratings, so they
call it the Nielsen rating data.

Phillip Levine : If you see these enormous spikes in activity about 16 and
Pregnant the day the episode airs, you can see this huge spike in activity and
that also tends to correlate with people doing things like searching and tweeting
about birth control.

Mark Massell i: More interestingly were the social media conversation
surrounding themes explored on the show , loss of freedom , theme s that really
drove the challenge of teen motherhood home to billions of young vulnerable
viewers.

Phillip Levine: It really illustra tes the life choices that these girls have made and
what outcomes it has on their lives in a way that a reality TV show can do.

Mark Masselli: They determine d the show led to a 5.7 drop in teen births from
2009 to 2012 in the relatively short period of t ime . The study Media Influences
on Social Outcomes: The Impact of MTV's 16 and Pregnant on Teen
Childbearing can be found in the National Bureau of Economic Research. A
media outlet utilizing airwaves to reveal the risk of teen pregnancy, thus creating
a platform for dialogue for teen s to address this potential ly life changing event ,
leading to a significant reduction in teen pregnancy, now that’s a bright idea.

( Music)

Margaret Flinter: This is Conversations on Health Care. I am Margaret Flinter.

M ark Masselli: And I am Mark Masselli, peace and health.

Conversations on Health Care, broadcast from the campus of WESU at
Wesleyan University, streaming live at www.wesufm.org and brought to you by
the Community He alth Center .