North Dakota Governor Doug Burgum Leverages Tech Career to Tackle Public Health and Opioid Crisis Issues

Andy Slavitt – former CMS Administrator

(Music)

Mark Masselli: This is Conversations on Healthcare , I am Mark Masselli.

Margaret Flinter: And I am Margaret Flinter.

Mark Masselli: Well Margaret it seems everywhere we turn we see an unbelievable
number of natural disasters happening in the wake of an already devastating hurricane
season with Harvey in Texas and Louisiana , Irma hitting large swaths of the Caribbean
Virgin Islands and Florida, a nother record - breaking storm Maria has battered the US
territory of Puerto Rico which has sustained significant damage .

Margaret Flinter: I know personally I can't recall another time quite like this . And then
add to this Mexico’s was a week after the southern part of the country was hit with a
massive earthquake , a 7.1 earthquake has hit the most populous region of Mexico city .
We understand thousands of buildings damaged and destroyed , hundreds of people
killed including children in school , just heartbreaking to see so much devastation in so
many regions of the globe .

Mark Masselli: Yeah that is truly heartbreaking . And these regions are going to need a
lot of aid and support to rebuild homes , schools , communities , years of reconstruction
ahead for many of these hardest hit areas .

Margaret Flinter: That is right Mark , and our hearts go out to everybody affected . And
there are -- tough hits in other areas to o, there is yet another attempt underway to
repeal the Affordable Care Act. This bill floated out by Republi can Senators Bill Cassidy
and Lindsey Graham has picked up traction and looks like it could be a very close
[Inaudible 00:01:28 ] pending on this latest repeal and replace attempt .

Mark Masselli: Although it hasn't yet been rated by the Congressional Budg et Office
and may not be as we understand that , Graham Cassidy proposal looks by all accounts
to be as disruptive to healthcare as its predecessors . It will dramatically increase cost
and out - of - pocket expenses for people with pre - existing conditions and lead to tens of
millions of Americans losing health coverage .

Margaret Flinter: And that has our guest today up in arms , Andy Slavitt is the former
acting administrator for the Centers for Medicare and Medicaid under Pres. Obama ,
now he is a senior advis or to the Bipartisan Policy Center and he has been studying the
fine print of this bill. I think it's safe to say he has a pretty unvarnished view of what the
Graham Cassidy bill could do, we are looking forward to hearing his assessment .

Mark Masselli: And we also will hear from Lori Robertson who stops by , she is the
Managing Editor of FactCheck.org , but n o matter what the topic, you can hear all of our
shows by going to chcradio.com.

Andy Slavitt – former CMS Administrator

Mark Masselli: And as always if you have comments, please email us at
[email protected] or find us on Facebook or Twitter because we love to hear from
you. Now we will get to our interview with Dr. Andy Slavitt in just a moment.

Mark Masselli: But first here is our producer Marianne O'Hare with this week's headline
news.

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Marianne O'Hare: I am Marianne O'Hare with these healthcare headlines. Just when
you thought it wa s safe to move past the repeal discussion of the Affordable Care Act
it ’ s back on the table just a few weeks past what looked like the end of the GOP effort s
to repeal the Affordable Care Act and earlier bill offered by Louisiana Republican Sen.
Bill Cassi dy has resurfaced he teamed up with fellow Republican Lindsey Graham and
it's a last - ditch effort to repeal Obamacare before the end of the month . They are not
yet scored by the Congressional Budget Office , the bill would eliminate the Medicaid
expansion by 2020 , would shift the Medicaid program over to the block grant system ,
put caps on lifetime payouts and would charge significantly higher rates and increase
out - of - pocket expenses for people with pre - exis ting conditions .

This time around the votes may stack up a bit differently Sen. John Mc C ain recently
diagnosed with an aggressive form of brain cancer gave a famous thumbs down to this
skinny bill that went to fail in the senate leaving most observers see mingly resigned to
the end of repeal efforts . Meanwhile Congressman Paul Ryan has said they will not
support any bipartisan efforts to shore up the weak spots in the healthcare law and as
for the bipartisan efforts underway in the senate HELP Committee ch aired by republican
Sen. Lamar Alexander and ranking minority member Democrat Patty Murray the
Whitehouse has said it will not support their efforts either .

Meanwhile healthcare costs continue to rise for Americans who gain coverage through
their employer s Kaiser Health News has come out with an analysis have projected out -
of - pocket health costs for 2017 for the 1 50 million Americans who get their coverage
through their employers , a number of observations from the Kaiser report premiums
increased only 3% o n average this year . But the uptick was a shade higher than
inflation and growth in wages , meaning healthcare still takes a significant chunk and
growing one out of people's paychecks . Despite the slow premium growth employees
have been bearing more of t hose costs the average premium of job - based coverage for
family in 2017 was $18,700 up about 3 1/2% from 20 1 6 . Employers paid for about 70%
of their cost but they have been passing more of the costs onto their workers choosing
high deductible plans as a way to defray the cost and usage of healthcare services .

Andy Slavitt – former CMS Administrator

And thinking about inking that lovely skin of yours , well you want to think again , there is
evidence now that the ink from tattoos seeps into the bloodstream and can lodge in
lymph nodes and other places you may not want to deposit that in k tatting up may
actually serve to clog up your endocrine system over time . I am Marianne O'Hare with
these healthcare headlines.

(Music)

Mark Masselli: We are speaking today with Andy Slavitt former acting administrator for
the Centers of Medicare and Medicaid Services at HHS under Pres. Obama . Mr. Slavi tt
now serves as senior advisor to the Bipartisan Policy Center with a focus on building a
sustainable high - quality health system available to all Americans . Mr. Slavi tt spent 10
years at the United Healthcare Group where he served as Group Executive Vice
President for Optum which he grew to $40 billion enterprise . Mr. Slavi tt founded and
was CEO of HealthAllies the first online marketplace for health services which was
acquired by United Healthcare . He earned his BA at Wharton School and his MBA from
Harvard School of Business . Andy welcome to Conversations on Healthcare .

A ndy Slavitt: Thank you.

Mark Masselli: You know I remember when my daughters were younger they watched
Twilight , and there was always a conversation a round the table how do we kill the
vampire . And I sort of feel the same way with how do we kill the repeal and replace of
the Affordable Care Act, we thought we'd seen the end of it in dramatic fashion when
Sen. John McCain now iconic thumbs down motion seeking that effort . But much to the
surprise of many Repub lican Senators Lindsey Graham and Bill Cassidy have
resurrected a version of the Sen. Cassidy's earlier Health Reform Bill the so - called
Graham Cassidy Bill in this last - ditch effort to replace the Affordable Care Act . I wonder
if you could give our liste ners an assessment of this latest iteration and what are the
chances of it surviving a floor vote ?

Andy Slavitt: Well you are right things do contrast [PH], t he Graham Cassidy bill look s
a n awful lot like the prior version s of the repeal of the ACA that we have seen, and if
anything it ’ s worse. Some new information came out this morning about the bill which I
think is even more surprising while the CBO will not be given enough to score the bill
which itself is a red flag , we will see over 30 million Amer ican lose coverage , insurance
premium rise by about 20% next year . And most important protection s of American
value , the protection s that prohibit discrimination for people with preexisting condition or
prohibit lifetime caps, those will be e liminate d. And then finally I think the thing that got

Andy Slavitt – former CMS Administrator

America up in arms over the summer was a really significant set of cuts to the Medicaid
program . It will be a huge feature of this bill as well as suppose a -- what's called the
block grant and a per captia cap so that will be moving and cutting the funding for
people with low income , kids and people with dis ability and seniors, those are certainly
most important points.

Margaret Flinter: Well Andy, on the opposite side of the aisle Sen. Bernie Sanders has
laun ched his own seemingly improbable campaign , but after the failure of the last
s enate measure Sen. Sanders launched his own rally and cry for single - payer approach
to healthcare or Medicare for all . And he's got some growing support from at least
some of h is colleagues on the Hill, his own State of Vermont had tried to pass a state -
based version of single payer . But he put this idea squarely in the middle of the national
debate and I am really curious what you r thought s are about this development and how
d oes this Medicare for all proposition that the center has put forward skew the health
reform discussion as we move forward .

Andy Slavitt: I think o ne of the exciting things we observed in the country over the last
number of months is you know American s got to h ave the debate in a more real way
than they probably have had before for the question that, is healthcare is something that
American s should view as right Affordable Care Act or is it something that they should
view not as right but only something that should be available to the people who can
afford it. I had observed that we're much closer now than we have ever been to
suggesting that -- and we have got to figure out this about the healthcare for all
Americans, Sen. Sanders’ bill I think is an en ormous statement in that direction. We will
see other statements, other bills coming from Sen. Brian Schatz from Hawaii , Sen.
Chris Murphy from Connecticut and a number of other s.

So there is a lot of them, and a lot of others will get there , the debate I think is just
beginning , right now I think the attention is to Graham Cassidy Bill but at some point I
think it has to turn to how do we get through this.

Mark Masselli: Well you know there's -- the health law has survived a lot from the
Supreme Court decisions , numerous repeal attempts , but you know embedded in that
legislation it gave the executive branch enormous amount of power . And it seems like
the Trump Administration is exercising [Inaudible 00:10:11 ] the ACA enrollment to just
six weeks reduce the marketing budget for that a nd there's also ongoing uncertainty
over the cost sharing reduction payments continue into next year . And I understand
you've launched your own social media campaign to get the wor d out about the
upcoming enrollment and some other issues . I wonder if you could tell us a little more

Andy Slavitt – former CMS Administrator

about what you're doing through the Bipartisan Policy Center as well , as well as your
own personal efforts.

Andy Slavitt: You know there is concerted effort by the Trump Admin istration to
depress enrollment, again the last open enrollment period and this open enrollment
period there has been a 90% cut in outreach budget as well as a very big cut to in
person assistance. Those are not funds by the way t hat come from taxpayers , those
are funds that come from insurance company user fees so there is no reason to cut
them . And there's new data out this morning which shows a report that Trump
Administration had which shows that that was money that was well spent and the fact it
was – I think it's something that should make us concerned and a little bit suspicious.

So we are going to have to rely on many others to get the word out and I think you'll
hear starting in October some effort s to do that and to explain to people that the majority
of American s can access h ealth coverage for under $100 a month . And they can get
themselves covered. And when they know that , most people would want to buy
insurance.

Margaret Flinter: Well Andy, one of the things that both sides of aisle do seem to agree
on is that we need opportunities for the states to move forward with innovations and
health reform. And I am not sure how much people appreciate the degree to which
state - based innovation w as baked into the Affordable Care Act and we have seen some
interesting state - based innovation since the Affordable Care Act . And several of the
nation's governors have testified before the Senate Health Committee that there were
ways that they could impr ove upon the law and better serve their constituents but they
needed more flexibility to do so . Are there some state - based innovations that you are
aware that you think could be scalable and help us make some progress forward ?

Andy Slavitt: Well when the law was written it was written in such a way that it had a
provision to say to a state, if you can meet the same objectives of the ACA which are
basically covering more people with better coverage , and you can do it as affordab ly for
people are better , you should do so , s o there’s enormous opportunity for state s to do
that. And I think some of the most interesting thing s that have had happened with the
first couple came out of Hawaii and Alaska but you know really the princip a l innovation
that I think is scalable is using reinsurance to bring down the cost of premium for
everybody.

Mark Masselli: We are seeking to day with Andy Slavitt, former acting administrator for
the Center for Medicare and Medicaid Services at HHS under P res. Obama . Mr. Slavi tt
now serves as a senior advisor to the Bipartisan Policy Center with a focus on building a

Andy Slavitt – former CMS Administrator

sustainable high - quality health system available to all people . And Andy you are known
somewhat as a tech geek in the health policy world , y ou are known as a prolific user of
social media to get the message out . And you have brought some technical expertise
to the Center for Medicare and Medicaid Services during your tenure and you were
initially brought in to advise the team fixing www.healthcare.gov . I wonder if you could
share with us your sort of view on how technologies lovers we have had Anish Chopra
and Todd Park on who have all been sort of thinking about the disruptive capability tha t
technology brings , what ’s captured your attention in your interest in this area ?

Andy Slavitt: Well look the thing we have to understand about technology is when it
adds time to our lives and make s our day better , we like it , and that is indeed the
promise of technology in healthcare as well . Only , you know in healthcare a lot of the
technology that’s been recently built still isn't adding time to the day of the doctor and
physician. And it's still not in a position where we are allowing patient experiences to be
better a nd I think that’s a real problem , it a real challenge, and it's something we need to
talk more about . When our practice doesn't equal our potential there is something
wro ng , our healthcare system will not get where it's going to go unless this more
productively , catch diseases earlier and if you can see people in their homes instead of
in hospitals that will take technology to work better .

Margaret Flinter: Andy you are now working at the Bipartisan Policy Center to promote
sound policies that will improve American healthcare you know we are seeing some
interesting partnerships formed in some pockets of cooperation . We saw Republicans
McCain, Murkowski and Collins vote a gainst the so - called “ skinny health bill ” in the
Senate siding with the Democrats and therefore we are also seeing some bipartisan
gubernatorial collaborations I think we would say most notably Republican Gov. John
Kasich of Ohio and Democratic Gov. John H ickenlooper of Colorado who co - created
their own policy initiative . I don't think we be ready to say bipartisanship is now the
norm but it's refreshing to see some shifts in that direction , can you talk a bit about
some of these bipartisan negotiations at play and what looks promising to you?

Andy Slavitt: Well look, I thing we all can agree on is we need to rescue our healthcare
system from the back - and - forth partisanship of the purely li ving where one party gets to
stand on the sidelines and criticize the other and seek refresh [PH] every election from
policies we don't like . We all need to get our fingerprints on this and I think it's very very
important and I think I would encourage pe ople that even if we come away with 80% of
what we want and if we do it in a way that everybody has some skin in the game that ’s
going be better . I have been hopeful that the Alexander -- Murray negotiations which
are ongoing right now are going to be bea r fruit and the people came to the table in
good faith. But the White h ouse and the Republican leadership pulled the negotiating

Andy Slavitt – former CMS Administrator

team away from the table and said they prefer a partisan route they want to going to
Graham Cassidy instead. And it's really unfortunate you know I now that Patty Murray
and the Democrats will remain at the table after the republicans are going to come back
but we need to build trust back again and yesterday was not a good day for building
trust .

Mark Masselli: You know as you 're saying that we needed to rescue the healthcare
system from its partisanship and try to make it more bipartisan and also thinking that we
needed to rescue the sort of escalating cost within healthcare which has become an
ever larger part of the US econo my . And it seems to be unsustainable that it hasn't
really changed , you know a couple questions here; one , if we could get the outcomes
that Western Europe got with our expenses I think we would be happy , but we ’ re not
getting good outcomes at all , w e've not figure d that part of the equation on . And I am
wondering if you could share with us some of the goals for your activity moving forward
as you think about the reform of health policies in your personal vision of how we
advance the health policy discuss ion and where you're focusing and applying your
talents in the months and years ahead.

Andy Slavitt: Into my mind if there is one major difference between what we do in
United States and what we do in other part s of the world that we had to try to emulat e,
i t's really understanding the impact of what people talk about is the social determinants
of health but the non - health care factors and how those impact healthcare system . Ou r
problem is that the country is not the 60 - year - old jogger with two Fitbits , our problem is
the woman that lives two bus stops away from her dialysis center and if she misses her
second bus she goes into kidney failure . We have to start focusing our innovation
efforts on caring for people that are more – the most vulnerable part s of the population ,
those that don't get the care that the rest of us get. Unless we can conquer that and
invest in those types of services , we are going to continue to struggle and see cost go
up and not be able to know how to control it.

Margaret Flinte r: Well you are singing certainly from the songbook of community health
centers and I don't think Americans necessarily appreciate the role that federal agencies
can play in innovation as well , but you have the understanding of just how engaged
CMS was in trying to drive innovation in healthcare whether it was around wellness ,
elders or building more of a team - based care in primary care . I wonder if you would like
to take a minute to talk from your perspective of the role of CMS in driving innovation
and maybe you how effective some of the innovations that CMS has been driving for
both Medicare and Medicaid been, what's hopeful that ’s been happening though?

Andy Slavitt – former CMS Administrator

Andy Slavitt: Well , I think we need to figure out how we change the way we pay for
healthcare , we need to give more time back to physicians and I think we need to bring
some more respect back to the care equation . These are not complex things, these are
things that we can control based upon how we organize ourselves and how we care for
our system and how we pay each other . And you know there's lots of interesting ideas
out there that are all fairly new paying for prevention , for example instead of paying just
throw when people get sick, paying as a bundle or some what entire experience of care
as o pposed to paying in little pieces . We are starting to see that those things work and
those are the things we should continue to invest in and that we should invest in them
aggressively because if we don't I think we're going to find we are not making enough
progress.

Mark Masselli: We have been speaking today with Andy Slavitt, former acting
administrator for the Center for Medicare and Medicaid Services and senior advisor for
h ealth at the Bipartisan Policy Center . Y ou can learn more about their work by going to
www.bipartisanpolicy.org or you can follow him on Twitter at @A Slavi tt, Andy thank you
for the work that you do and for joining us today in Conversations of Heal thcare .

Andy Slavitt: Well thanks for having me.

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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 jou rnalist 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 we have seen plenty of claims over the years about premiums for
those who buy their own insurance on the individual market the employer insurance
market however has experienced six years of very modest increase . The latest annual
survey from the Kais er Family Foundation and the Health Research and Educational
Trust was released in September. It found that annual family premiums for employer -
sponsored insurance increased 3% on average in 2017 , that’s a bit more than the
increase in wages 2 .3% and infl ation 2%. The total average premium including both
employer s and employee s premium contribution i s $18,7 6 4 for family plans, the
average premium for a single person increased by 4% this year to $ 6,6 90 . These are of
course averages and the premiums for in dividual worker s vary.

Andy Slavitt – former CMS Administrator

A press release from the survey said, the latest figure s continue “ A remarkable s low
down” average family premium s have gone up by 19% from 2012 through 2017 , but
they went up 30% over the five years before that and 51% for the five years before that .
The amount employees pay for premiums has been increasing faster than the amount
employers pay however. In 2017 employees paid 31% of family coverage premium,
about 151 million Americans get health insurance through their employers, the largest
source of insurance for the country covering 49% of the population . 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 c ountry'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
here on Conversations on Healthcare.

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Margaret Flinter: Each week Conversations highlights a b right idea about how to make
wellness a part of our communities and everyday lives. Well more than 20 million
Americans have gained coverage under the Affordable Care Act , some 30 million
remain uninsured and many of these are either immigrants or without the resources to
purchase coverage . While most can access primary health care in the nation's
community health centers and safety net hospitals , many more with complex condition
simply can't afford access to specialty care . Entrepreneur Jayanth K omarneni decided
to create a virtual way to bypass the system and founded the Human Diagnosis Project ,
a network of volunteer specialist s around the country offering virtual consult s for the
neediest patients .

Jayanth Komarneni : The human diagnosis proje ct is an online system built by the
world's doctors to understand the best steps to help any patient . In the process of
developing the Human Diagnosis Project we began talking to the world's leading
medical stakeholders . We realize d that there is an oppo rtunity to develop a system that
can ultimately help solve the problem for those people who won't have access to
specialty care .

Margaret Flinter: Dr. Shantanu Nundy is direct or of the Human Diagnosis Project , he is
a front - line primary care provider in a safety net clinic who saw the opportunity to
provide specialty care in a cost effective way through volunteer participation from
specialists .

Andy Slavitt – former CMS Administrator

Dr. Shantanu Nundy : The way the system works is safety net providers like myself can
freely exchange electroni c consultations with volunteer specialist s from around the
country so that the expertise that those specials have that are uninsured patients
currently can have access to becomes available .

Margaret Flinter: It's estimated that roughly 35% of specialist s visits can be done
virtually , the Human Diagnosis Project offers an opportunity to create real savings in the
healthcare system while effectively bringing treatment to millions of the most vulnerable .

Jayanth Komarneni : So there is a very real and large portion of situations in which
providing an electronic perspective on that given problem will actually solve that
problem for many patients .

Margaret Flinter: The Human Diagnosis Project has earned recognition as a finalist in
the MacArthur Foundation's 100 & Change competition , a free online portal linking safety
net providers serving underserved populations to specialty care expertise , improving
outcomes for millions of uninsured and vulnerable patients and improving care
outcomes in the process , now tha t's a bright idea .

(Music)

Margaret Flinter: This is Conversations on Healthcare, I am Margaret Flinter.

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

Conversations on Healthcare, broadcast from the campus of WESU at Wesleyan
University, streaming live at www.wesufm.org a nd brought to you by the Community
Health Center.