Janet Marchibroba, Executive Director of CEO Council on Health and Innovation at the Bipartisan Policy Center

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Mark Masselli : This is Conversations of Healthcare . I am Mark Masselli.

Margaret Flinter : And I am Margaret Flin ter .

Mark Masselli: Well Margaret its October, which among other things is national
domestic violence awareness month, a topic th at has been very much in the
news lately with sports figures embroiled in, domestic violence, controversies,
spearheading the national discussion on the topic.

Margaret Flinter: Well Mark , 1 in 4 American women will experience some kind
of domestic viole nce event in her lifetime. This leads to millions of hours of los s
productivity in the work place and a host of physical and behavioral damage as
well for adults and children alike is a very heavy load.

Mark Masselli: Victims are often afraid to seek he lp fearful their actions will yield
more repercussions or harm that might come to them and their children if they
speak up.

Margaret Flinter: And the department of health and human services has
domestic violence screening be included as a regular prevent ive service for
women as we have done for many years , and there is a lot of great information
for providers or for any concerned individual at the national coalition against
domestic violence website that’s www.ncadv.or g . It is extremely important that
people who are going through this know the resources that are available to them or their loved ones wherever they live. So true Margaret, knowledge is power and speaking of power some of the nations leading CEOs have ga thered together to lend their expertise to the task of transforming the healthcare system .
The Bipartisan Policy Center CEO counsel on Health Innovation and Reform just
released a detailed report on ways to improve the healthcare system.

Mark Masselli: Our guest today, Janet Marchibroda is The Executive Director of
the CEO council which includes CEOs from Verizon, Bank of America, Coca
Cola, and Johnson & Johnson and others. She will be talking about work they
have just included that is a call to action for others in the business community to
collectively participate in the conversation on providing healthcare for their employees and in providing solutions to this costly aspect of doing business in America.
Mark Masselli: Lori Robertson , The Managing E ditor of FactCheck.org also
stops by examining misstatements spoken about health policy in the public
domain but no matter what the topic, you can see all of our shows by Googling CHCradio.

Margaret Flinter: And as always if you have comments please e - ma il us at
chc radio.com find us on Facebook or Twitter. We love hearing from you. We will
get to our interview with Janet Marchibroda in just a moment.

Mark Masselli: But first , here is our producer Maria n n e O’ Hare with this week ’ s
Headlines News.

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Maria n n e O’ Hare : I am Maria n n e O’ Hare with the se Healthcare Headlines. Data
detailing payments made to providers by pharmaceutical companies ha ve started
to be published online as part of the Government’s Open Payments Program,
information would be m ade public on 10s of 1000s of doctors who received some
4 billion dollars in payments by drug companies and medical device
manufactures. The law mandat es a disclosure of payments made to doctors,
dentists, chiropractors, podiatrists, and optometrist for e verything from
promotional speaking to consulting to meals and research. Investigat ive
journalism website for public access has tracked 3.4 million payments to health
professionals since 2009. More than half of that amount was for research. And
consumer seeking information on physician quality are going to have a hard time
finding complete assessments on line. The ACA also provided a provision that
requires centers for medicaid and medicare to provide a database of physician
quality data but the site is still incomplete. The CMS data only includes 66 group
practices and 140 one accountable care organizations. There were about 600
thousand doctors in the US, 10s of thousands of group practices and more than
600 ACOs. And looking for way to help kids to do better in school , the answer
may not lay another standardized test. A study of middle school aged kids show,
those who engaged in physical activity for an hour after school each day were
more likely to perform better and another study showed 20 minute - burst of
activity during the day improved academic performance and behavior as well. I
am Maria n n e O’ Hare with these Healthcare headlines.

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Mark Masselli: We are speaking today with Janet Marchibroda, Director Health
Innovation and Executive Dir ector of the CEO Council on Health an Innovation at
The Bipartisan Policy Center, which conducts research and collaborates with
experts to develop policies that support improvement in healthcare. She was
The Executive Director of Doctors Helping Doctors a nd served at the office of
The National Coordinator. She was Chief Healthcare Officer for IBM and chief
executive officer at the National quality forum. Ms. Marchibroda was named by
Modern Healthcare as one of the top 25 women in healthcare. Jenet welco me to
Conversations on Healthcare .

Janet Marchibroda : Oh i t’s a pleasure to be here.

Mark Masselli: Your group is made up of some very impressive captions of
industry from Horizon CEOs, Coca Cola, Johnson and Johnson and more and
you know, they all rep resent organizations that spent a lot of money on
healthcare and because of that they have particular knowledge not only business
but also in healthcare and after your collaborating the CEO council just released
a report recommending guidelines for improvi ng healthcare industry across
multiple platforms and tell us a little more about the make up of a council and
how you are able to get so many very impressive CEOs committed to this task
and the process that let to the report.

Janet Marchibroda : Well the CEO council on health and innovation is actually a
group of 9 chief executives that some of the nation’s largest employers and you
mentioned some, including Bank of America, Aetna , The Coca Cola Company,
Johnson & Johnson, Verizon , Walgreens and others. A nd if you look at them
together they employ more than a million people and provide healthcare
coverage for about 150 million individuals in the United States. You know, why
did they come together as you may know, employers along with their employees
repre sent about 45% of our nation’s healthcare , and they came together because
they believed that the health of the n ation is vital to maintaining our
competitiveness in the global market place today and they wanted to take action,
they wanted to do something, instead of what can the g overnment do to address
some of our healthcare challenges. So how did this all come about. What did
we do? Actually the CEO council members had their first meeting last July The
Bipartisan Policy Center convened and pulled quite a deliberative process to not
only enable sharing of their own strategies but then to identify the actions that
would have the most impact.

Margaret Flinter: Well Janet 150 Americans still get their insurance through their
employers, that’s a tremendous amount of buying power and the cost of
Healthcare certainly is significant buying power and the cost of healthcare is
certainly a significant motivator given the impact on the company’s bottom line. I
wonder if you could share with us some of the strateg ies that some of these large
employers have utilized to actually improve the health of their employees in an
effort to reduce cost s ?

Janet Marchibroda : If one looks at the report there are a whole range of
strategies falling into the three primary areas. The first improving the health and
wellness of individuals, the second improving the health of communities , and the
third improving the healthcare system , and in that first category , Aetna is
implementing voluntary programs that help to address something called
metabolic syndrome, which is one of fastest growing health issues , and they
demonstrated pretty positive results. Also on the health and wellness side you
can hear the story of Bank of America nearly half of all of their employees
participated in a voluntary program focused on physical activity. Very good
results in addressing probably one of the most difficult challenges that employers
have around these health and wellness programs and that is around participation

or engagement rate. When you wo rk at the second category around improving
the health of communities, we have got a lot of examples in there ranging from
Horizon applying technology and mobile health clinics to connect children with
quality h ealthcare to T he Coca Cola Company bringing fi tness programs and
equipment to thousands of people in 12 cities in neighborhood. And then finally
there are terrific stories within the report, I will highlight one The Blue Cross Blue
Shield plans across the country are creating stronger relationships b etween
patients and their primary care physicians and that just helps with supporting
better care coordination and improving h ealthcare outcome s .

Mark Masselli: Janet: Your report is titled Building Better Health Innovative
Strategies from Americas Busi ness Leaders , and share with our listeners the
recommendations on how to better improve the health of individuals and what
kind of innovations does the report call for that might lead to significant
behavioral change of individuals?

Janet Marchibroda : We ll on the first area , around improving the health and
wellness of individuals , they call for all employers to both implement and track
and share the outcomes of comprehensive health and wellness programs that
really fall into four areas. Programs focussed on nutrition and physical activity,
the second tobacco cessation, the third programs focused on emotional and
behavioral health , and in the fourth area is dealing with chronic disease and
management of those issues.

Margaret Flinter: So Janet moving fro m the individual to how corporations and
communities can collaborate, I want to go a little bit deeper on that one too , and I
thought the comment of Muhtar Kent , Coca Cola’s CEO who said that this is this
golden triangle that we need of Government, busines s and civil society to kind of
really work together to improve healthcare is absolutely right on and yet, the
journey from inside the corporation to inside the neighborhood and the
communities can be fraught with challenges right. How do you move outside say
the beautiful headquarters of Coca Cola into communities to make these
programs real?

Janet Marchibroda: Something unique and exciting about the CEO Council was
really focusing on that second pillar, how do we improve the health of
communities? You know if you think about the corporate foundations and the
work that they do in the communities, there are a number of actions that they can
take collaborating with local leaders on the ground to prioritize their investments
in three areas number one health behaviors. You know with the focus on
physical activity, nutrition and tobacco use, pretty similar to the priority areas
under the first pillar. The second is they wanted to focus on clinical care and
health outcomes and they did prioritize things like access to care, preventive
services, prevalence of chronic disease and then the third is so much of what
drives healthcare outcomes is outside of the healthcare realm and really focuses
on social and economic factors that have been shown to improve the hea lth of

communities. So they’ve talked about focusing on areas such as education,
housing, access to nutritious foods and childhood poverty. One of the things that
was important to them and you will see this and is called action was the
measuring their nu mber of matrix that folks like The Robert Wood Johnson
Foundation , Kaiser, Family, CDC, The Centers for Disease Control and
Prevention have a number of states regional community based matrix and part of
this called the action is to pay attention on how we are doing on those matrixes in
neighborhoods and communities across the country. It links to decision making
around where to build new plans you know the economic development piece and
paying attention to some of those factors.

Mark Masselli: We are spe aking today with Janet Marchibroda, Director of
Health innovation and Executive Director of the CEO Council on Health and
Innovation at the Bipartisan Policy Centre. Janet we are seeing so much
transformation in healthcare certainly when the Affordable Ca re Act kicked off,
they provided enormous amount of money for technology trying to lay the
platform of sharing quality information between providers, between organizations
so often in healthcare, we just don’t have the right data points to work on
improvem ent processes. Talk to us about the larger framework that the CEO
Council is trying to cultivate around the country around getting baselines of data
that we can all agree on?

Janet Marchibroda: They have a range of actions that they’ve laid out in this
area and including those related to performance measurement and all of it
actually relies on performance measurement as a foundation, what they have
committed to and they are asking other employers to do is to make value based
purchasing a factor in their purchasing for health plans. So if you look at how we
pay for healthcare today, so much of it is based on volume and they are calling
on employers to partner with their health plans to increase the percentage or
share of payments that are really based on outcomes as supposed /opposed
[PH] to volume and in doing so in collaboration with that, is to really promote
reporting of meaningful performance data on things like quality efficiency,
productivity, patient engagement and satisfaction as well as health out comes.
So to promote reporting on those measures and to make them transparent to
employees as they are making decisions about which health plan to choose or
even what procedures or where to go in order to get healthcare. The business
community has long b een using the best practices around measurements. You
know this is how they manage the rest of their business and so it’s no surprise
that you know trying to apply this to healthcare is very important.

Margaret Flinter: Well Janet, we will go back a lit tle bit to its roots and founding
in 2007 by a handful of US Senators from both parties who emerged from a
Congress I think we can say understood the importance of working across the
aisle to reach consensus and we haven’t seen that kind of relationship mu ch in
the last couple of years. We’ve been somewhat in the throws of Congressional
grid block and the healthcare law The Obama Care, The Affordable Care Act

anyway you call it passed by some marginal and largely evolving party lines.
How is the CEO Counc il addressing this kind of entrench dysfunction among
policymakers?

Janet Marchibroda: So there are a couple of things in terms of process at the
Bipartisan Policy Centre. As you mentioned, you know we are a nonprofit
organization formed by former Senat e majority leaders on both sides of the aisle
and our approach across the board is to really drive principal solutions through
very rigorous analysis, reasoned negotiation and a respectful dialogue and to
address how the council itself has this lack of agr eement among policymakers,
they did not want this project to be about recommendations for what the Federal
Government should do but instead they wanted to focus on what are the things
that we can do and other employers, private sector employers across our
country, what actions can we take to improve health and healthcare in this
country. That said if you look at the actions across all three pillars, I think there
are a number of nuggets there that could be helpful and inform what other
decision makers and policy makers do.

Mark Masselli: Janet, the CEO Council appears to be taking the long - term view
of transforming healthcare , and I believe it was Aetna CEO, Mark Bertolini said,
“It’s got to be a three - pronged approach of payment reform ” , more
comprehensi ve care focused on smaller percentages of the most costly
population, the chronically ill , and the third approach which he calls the most
difficult part is to shift the country’s focus from sick care to wellness which he
expects to be a 20 to 25 year journ ey and what are the recommendations for
getting us to that goal and what role will small businesses, nonprofits and other
organizations within the healthcare system play as well?

Janet Marchibroda: So when we talked about wellness as opposed to sick care ,
the CEO Council is committing to calling on other employers to focus on health
and wellness programs. Things like nutrition and physical activity, emotional and
behavioral health as well as chronic disease management and so there is a host
of -- a very deep - held menu of the actions that can be taken along those lines,
the importance of tracking outcomes and sharing those outcomes because there
is a lot of learning that needs to happen in order to drive improvement and we
also plan to launch some pilots i n that area as well. We actually have a number
of nonprofit CEOs, including the American Heart Association, the American
Diabetes Association, and the Cancer Society and many of the clinical groups.
Medical Societies advise the council helping to get the word out and coming
together around these three key actions is critical because what are the first
principals of the CEO Council is this is something that we all need to work on
together. It’s not just employers; it’s not just the healthcare delivery sys tem. It’s
really all of us working together to drive change.

Margaret Flinter: We have been speaking today with Janet Marchibroda, of
Health and Innovation and Executive Director of the CEO Council on Health and

Innovation at the Bipartisan Policy Centr e which has just released a report
‘Building Better Health, Innovative Strategies from America’s Business Leaders’.
You can access the report and find out more about her work by going to
www.bipartisanpolicy .org . Janet, thank you so much for joining us on
Conversations on Healthcare t oday.
Janet Marchibroda: It was a pleasure.
[Music] Mark Masselli: At Conversations on Healthcare , we want our audience to be truly in the know when it comes to the facts about Healthcare reform and policy.
Lori Robertson 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 U . S . politics. Lori, what have you got for us this
week? Lori Robertson: Well, birth control has become an issue in a few senate races across the country and some Republican candidates are proposing the sale of oral contraceptives or the pill over - the - counter without a prescription. The idea
isn’t new. Reproductive Health Organizations formed a working group to explore
the issue a decade ago they support over the counter birth control pill as a way to increase access for women. But Congress can’t make this happen. Instead it’s
up to a drug manufacture to submit an application to the stude nt drug
administration and the FD A to then review and approve it , and when it comes to
the pill there are many different brands and formulations that would have to go through the same process. In Color ado, R epublican Cori Gardner has been
pushing the idea and says over - the - counter sales would make the pill cheaper,
but it’s not clear whether that would be the case. The available research is mixed , and it doesn’t specifically address the pill. Research from 2005 found out
of pocket cost decreased for antihistamines for the 2002 study found consumers cost went up for certain drugs that moved from prescription to over - the - counter
status. Emergency contraception or the morning after pill went up a bit in price when it became available without a prescription. Under The Affordable Care Act, most private insurance plans are required to cover the full cost of female contraception, including the pill, sterilization, IUDs and more with no cost sharing.
W hat wo uld happen if the pill were sold over - the - counter ? Gardener’s says he
wants women to be able to be reimbursed through their insurance but that didn’t stop Planned Parenthood vote from saying in the TV ad that he wants women to “Pay for all of it.” That’s not what Gardner has proposed. And that’s my Fact
Check for this week; I am Lori Robertson, Managing Editor of FactCheck.org.

Margaret Flinter: FactCheck.org is committed to factual accuracy from the
country’s major political players and is a project o f the Annenberg Public Policy
Center at the University of Pennsylvania. If you have a fact that you would like

checked, e - mail us at chcradio.com , we will have FactCheck.org’s Lori Robertson
check it out for you her e on Conversations on Health Care.

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Margaret Flinter : Each week Conversations highlights a bright idea about how to
make wellness a part of our communities and everyday lives. Healthcare
providers are forever on the look out for that magic elixir that can cure a host of
chronic ills in one step. And in the case of obesity, depression, anxiety, and
stress that elixir could be turns out a number of steps as in taking a hike. A large
study conducted by several institutions including the University of Michigan and
(inaudible 22:31 ) University in the UK looked at the medicinal benefits to arrive
from regular group hikes conducted in nature.

Dr. Sara : This study had enough people in it and following them overtime that
we could see that these two diff erent types of health for a mental well being they
are operating independently, that means that if we go out in nature for a while we
are getting an additional boost to environmental well being.

Margaret Flinter : Researchers evaluated some 2000 participa nts in a program
called working for health. In England responses some 3000 walks per week
across the country.

Dr. Sara : You know, this is a national study in the UK. There was investment in
these walking groups and training leaders to take people on wa lk, finding trails
that were good for people to do even if they had health problems.

Margaret Flinter : Dr. Sara Warber [PH] Professor of Family Medicine at the
University of Michigan School of Medicine said this study showed a dramatic
improvement in the mental well being of participants especially those who have
recently experienced something stressful.

Dr. Sara : Depression was reduced. Perceived stress was reduced, and people
had experienced more positive feelings and positive emotions , and it has be en a
really lovely research that’s shown that when we have positive emotions we
actually have better health over the long run.

Margaret Flinter: The participants almost universally reported reduced stress
and depression after participating in group natur e hikes, and the effect was
cumulative over the time. Other studies have shown a link between mood and
exercise but Dr. Warber says this is the first study that revealed the added
benefits of group hikes in nature and significant mitigation of depression.

Dr. Sara : Because we are really interested in whether if you are more stressed
would you get some better benefit from being in nature and (inaudible 24:16 ).

Margaret Flinter : Walk for Health a simple guided group nature hike nature
program which incen tivizes folks suffering from depression and anxiety to step
into the fresh air with others to talk out their thoughts while taking a hike,
improving their mood, reducing their depression and increasing their overall
health at the same time, now that’s a br ight idea.

This is Conversations on Health c are, I am Margaret Flinter.

Mark 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 Health Center.