Shes president of American University in washington where the event was held. I dont have a law degree myself. Though, i have more than my fair share of Supreme Court cases named for me. If i could just log one complaint about my previous job it was not one but two lawyers who failed to warn me that once confirmed, all court cases switched to my name. The first, the burwell family counsel, my husband, steven burwell, the second the 44th president of the United States of america. Im just saying, little heads up would have been nice. My transition to American University is interesting, exciting and challenging. I joined a passionate engaged campus, community, thinking, learning and doing. Things about the world most interesting and important problem. One of those were talking about here today. I taken on a new title without ever having gone to a diner in iowa. Rather than look back i am pleased this conference is looking forward. Our nations Healthcare System has come a long way in the past seven years. We helped more people access coverage and care. Weve improved the quality of healthcare coverage for American Families and we have started to bend that cost curve. Curve. Freeing up resources for todays working families and for future generations. When i say we, i mean our nation as a whole. This isnt work of government or business alone. Its the work of policymakers and physicians, advocates and attorneys, patients and families. As this conference proves theyre not slowing down. When i started planning for these remarks, i looked very closely at the agenda. Two things came to mind. First, jealousy as my team reminded me that no, i actually could not block off two days and come and listen to all the sessions. Second an appreciation for the the ying and yang. There are few areas of policy that are so complex and actually so simple. Todays agenda speaks well to the complexity. From payment incentives to federal and state coverage of Young Children to the challenge facing payers and providers. This conference dip into the vast ocean of complex regulatory questions. But this complex system is grounded in a simple reality. In moments of joy like birth or pain rained rain sprained ankle. We all count on the system to care for us and for our loved ones. When i worked at hhs, the complexity surrounded us. We spent late night and Early Morning wading through reames of briefings and studies. We spoke with over 100,000 providers to get their input on rule making. We worked to try to understand how the system was working where there were opportunities and how we can use our short time at the helm of the ship to deliver meaningful impact to American Families. To those colleague who are still at hhs today, career Public Servants who deliver impact for the American People through transitions and transfer the power to those career staff, it was an honor to serve alongside you and our nation is stronger for your service. [applause] at homework hhs impact was our north star. Our goal was to tether our conversation and analysis to fact, to experience and to the reality on the ground. One see this reality everyday at hhs. You see it on the campuses, the National Institutes of health. Where our nations top medical researchers are crossing the next frontier of understanding the and cures. On the campus of the food and drug administration, where our nation safety and innovation are front and center. You see it in the fearless men and women who pack their bags, left their own families to save families in west africa from ebola. And ready to make that journey whenever they get called. You see the reality in as head start classrooms. Where young minds of today have a chance to become our scholars and leader of tomorrow. You see it in the healthcare professional. Some in this audience who are out there trying to build a better Healthcare System. This is the reality of the complexcy of our nations Healthcare System and outcomes that everyone is working towards. Today, i want to focus on a simple frame on our complex system. When orients are discussion on where we want the future of healthcare reform to go. I want to talk about how we improve the access, quality and affordability of our nations Healthcare System. I want to highlight how leaders in washington and American People can maintain the progress. First access in november of last year, our uninsured rate dropped below 9 . The lowest its been. Between 2010 and First Quarter of 2017, uninsured rate from 16 to 8. 8 . Thats historic progress. The largest decline in uninsured since launch of medicare and medicaid. Its still leaves more than 28 million americans who are uninsured. Connecting these people with coverage is a problem of will, not strategy. We know how to maintain the progress weve made and move forward. Nearly half of uninsured adults say, that the cost of coverage is prohibited. Our nation can take steps to help them. We need to actively get the message out that coverage is available. Especially communities where those messages dont often reach. We also need to raise awareness and potentially Financial System for people who shop on the market place and make sure more people know that the Financial Assistance is there today is actually available. 8 of the of 10 people shopping on the marketplace qualify for financial help. Most can find plan somewhere between 50 and 100 per month. More awareness and more assistance will lead to more enrollees. Therefore more access. Which reminds me just for old time sake, its about to be november 1st. The start of open enroll empty. Encourage your friend and family and facebook followers to go to healthcare. Gov. For those of you who are spanish speakers shop around. The affordability of our Healthcare System is intricately tied to people getting coverage. Since the law passed, share of american who cant afford the needed care has fallen by more than one third. Affordability hasnt improved for the newly insured. 157 million americans thats most of us who has Health Insurance through their employer, family premiums have grown average rate 4. 5 since 2010. Down from an average of almost 8 over the previous decade. Affordability extends to what taxpayers spend. Medicare for example spent 473 billion less on personal healthcare expenditures between 2009 and 2014. Thanks to the lower rate of cost. In the context of the budget conversations going on think being that 473 billion number, can put it in context. Finally, the third way that we can measure our progress is quality. Hospital acquired conditions, infections and pressure ulcers, declined by 21 between 2010 and 2015. By linking those accomplishments to morality statistics, that decline prevented 124,000 deaths. Before the law, most healthcare plans in the individual market didnt core maternity care. A third didnt cover mental health. Almost one in ten did not cover prescription drugs. Under the aca there is coverage. The law isnt perfect and there are many ways it can be improved and changes will make it better there are indeed, some benefits that are a reality. A very clear and simple reality for many American Families. Another reality is the direction that our Healthcare System is moving. We often talk about the Delivery System reforms separate federal the discussions of the aca, its important to reflect that it was a part of the act. Some of the most important changes and models that were using to move forward on affordability and quality comes from provisions in the aca. Like the center for medicare and medicaid innovation. And the ability to support Accountable Care organizations. They also stem from other laws like the medicare access and chip reauthorization act. That was passed with overwhelming bipartisan support. These changes are part of and support the change that is occurring throughout our entire Healthcare System. Our Healthcare System is undergoing what i believe is a historic change. Many of youre well versed in currents of change. You researched implications. You advocated for them. Some have helped set the policy to clear the path for them. Whatever your perspective in this room is, its clear our nations healthcare Delivery System is entering into a new era. While i served at hhs, we developed a three part strategy to support our Healthcare System in making progress. First, change the way we pay for care. Dot payers are rewarded for the quality of care rather than the quantity of services. Second change the way we deliver care. By promoting coordination and prioritizing wellness and prevention. Third, unlock healthcare data and information. Doctors can make the most informed decisions and patients can be active participants in their own care. At hhs we implemented this strategy with a philosophy. Where we need to lead, we would lead. At hhs we committed to invest 50 medicare payments when we left, we were ahead of schedule. At the same time, commercial insurers were occur venturing into valley based payments. In january of the Delivery SystemReform Movement crosses ideologies. Our administration advocated for it as democrats and republicans like my predecessor who started some of the efforts and former senator bill fritz. They wrote in a new england journey of medicine piece. The Delivery System reform effort what they called an empirical learning approach to help reform. Its based on experiments evidence and careful observation in learning. As they concluded, it is essential for this approach to continue to meet the nonpartisan goals of better care, moderate spending and healthier people. Delivery system reform requires persistence. Im hopeful that this new administration sellings in. They will see the same value in alternative payment models that we did. It will be porn to important to keep moving forward. It will be important to fully expand programs that are proven to reduce cost and improve healthcare like the Diabetes Prevention program. It will be vital that offices like cmmi to continue to innovator and find new ways of providing better healthcare while bending that cost curve. Many policymakers and private sector leaders are moving forward. Ive been encouraged by the bipartisan efforts of a number of governors and people like senators Lamar Alexander and senator patty murray. Their marketplace stabilization bill it represents the way we can get things done. Together, with more than 20 cosponsors across both parties, they have the opportunity to make improvements on top of the basic measures of access, affordability and quality. Ive been encouraged by entrepreneurs and private sector leader who stepped forward on Delivery System reform. We started a group that was called healthcare payment learning action network. It was a Public Private partnership to encourage the adoption of alternative payment models. More than 6500 people joined. Including 130 organizations that actually set their own goals in this space. I know that after i speak youll hear from friend and colleague dan who is the ceo of Independence Blue Cross and an au alum who is also step forward in this space. Today in American Healthcare, theres no shortage of complexity, change and news. But through all of this complexcy, i think a simple reality remains. That simple reality is actually why im so honored to welcome you to american universities campus. It was a little over a century ago in 1895 that a young attorney asked a woman Ellen Spencer to apprentice her as student of law. Shes been denied of admission. Legal professions for the women who did manage to study law were few and far between. They enrolled two more female students. The barriers that stood between these young women and success in the legal field were numerous and quite complex. Their students believed in the simple truth. The system needed to change. It would start with them. Three years in later in 1898, the Washington College of law was founded. It became the First Law School in the world to be founded by women, the First Law School with a woman dean. We now have two. The First Law School to graduate an all female law school class. The keynote of success is the readiness for opportunity. The simple reality of American Healthcare is our opportunity is now. For years and for decades, weve had conferences and events to discuss the complex challenges. With the leadership in this room and across the nation, i believe that we can overcome those challenges. I know that our nation will be successful at building a better Healthcare System. Because like, Ellen Spencer, and pioneer women that became here at our law school, were ready. Thank you. [applause] good morning. Im jean. Im a senior fellow at the century foundation. But also former Deputy Assistant to the president of Health Policy. Im privileged to be here today to call you not madam secretary but madam president. Which is fun. Its able to witness your leadership and skill and tenacity at managing an agency. That perspective is you on had healthcare debate. I want to begin my questions for you with a main focus of your remarks. Which is Delivery System reform. I know that was jump started when you you a rivered. You arrived. I do want to Say Something about jean. I had an opportunity to work with on issues with healthcare. You will not find a person who knows the issues more indepth across the whole range when one is working at hhs and have had from omb time to policy time. Just an incredible wealth and incredible dedication to the kind of change that i i was talking about. I do want to thank you. Im putting together Delivery System reform strategy and say few things about strategy making in general and specific examples. In putting together strategies in different places and organizations that have had chance to be i think about three circles. What is the problem . What is the solution space . What are we good at . Get myself where those three things overlap. Importance in a strategy process to think about where is it you trying to go. That is big part what the problem is about. Other thing i had the opportunity to learn from different types of organizations, is the bill and Melinda Gates foundation. Very heavily strategy focused. One of their core strengths. At walmart where i was, what i find in strategy, you have to think about both of these at once. The one without the other will not actually achieve the results. Big picture thought. With regard to the specific issue when i came to it, there was the realization that we had a short period of time. As we were moving forward implementing parts of the Affordable Care act that were so focused on the access part. Afford the and quality we needed to have deep focus. We needed to do in a strategy way with priorities that we can move forward over limited period of time. Bringing together a number of different parts and pieces, we were very fortunate at hhs at that time to have patrick conway, and Karen Desalvo who were partners leading that effort. It was a process. To get to that kind of strategy and do it quickly, and the engagement of our white house colleagues. Jean and others were engaged from the beginning. That was important because when get to the other end, you want a strategy thats important by all the parties and players. Being informed by the real world was very important part of the strategy. Dr. Salvo and dr. Conway were practicing physicians. What we tried to do was get a number of pieces and perspectives around the room. Those who worked with me, they know i prioritize. I generally work in threes. Getting this to the three things were the process. Its fair to say, there were five. That was about bringing the people together, working off where we had been and lot of work has been done previously before we got there. Different approach in terms of how active we would be occurred. We decided and put together the strategy. As we did and jean, youll probably remember when you got the phone call that said i wanted to set the medicare goals, the idea that we were going to set goals that i was going to come in. The federal government on a deadline. Was not necessarily a common thing to do during an administration. There was complete support and buyin for doing that. It was important. When i look back at the strategy, having three pieces of the strategy. That was important. It did two things. It was very important signaling. We were coming together. The federal government wasnt just saying, okay, everybody you all go do. This was us and we would have to meet it. That skin in the game, i think its indicative where were here and serious. It indicated direction. For everyone on the outside, i know thats very important thing. We heard that in terms of certainty, pre