mr. hartsig:. snoo well, good morning, everyone -- >> well, good morning, everyone. this is an important moment. senator wyden has always been a proud supporter of families and understand why. good morning, everyone. president of the bipartisan policy senator and i am here to that is t something going right here in washington, d.c., authentic collaboration, all know, isn't easy. principle, patience, reate activity -- creativity, empathy and the tolerance for discomfort if you are trying to somebody who has similarly strongly held views in disagreement. but more than anything it requires leadership. morning to ic this onor chairman orrin hatch and senator ronwiden -- ron widen. support from johnny isakson, they led the effort to the chronic act of 2018. who respects a good acronym, so i should share with you that the full name of the is creating high-quality results and utcomes necessary to improve chronic care. and if that's not a demonstration of good staff i don't know what is. o just a couple of words about the actual accomplishment. when fully implemented, the law health vide broader services for the chronically it will support those served by medicare and medicaid. it will expand the independence home program, which will increase the quality and dignity and it will provide telehealth to millions of americans. we were proud to have the with unity to work senators and their staff and pleased that about a dozen of recommendations of the bipartisan health team found their way into the final package. but, senator hatch, this morning wonderful us a opportunity to recognize your long and distinguished career in the u.s. senate. chronic act is but one of hundreds bipartisan efforts that steered to success over 42 years, from working with one founders, senator dole nd senator h.w. bush to bring the americans with disabilities act and working with senator children's health insurance program and worked waxman to enact legislation that made it easier drugs into the market. you can be partisan, a leader, statesman. and we thank you. mr. chairman, i'm also struck by wrote ng you recently when you stated although nowhere andated in the constitution, civility is no less essential to the functioning of our government than any court ruling or act of congress. to thank you for youru service to our country and to aur state and thank you for what you have done to advance health advocating civility in words and deeds over 40 years. so, senator, it is my honor on behalf of our forefounders an olleagues, senator bob dole, senator baker and tom daschle to present you this award. also just note that we forged it out of crystal so that to see the able freedom ial medal of right behind your counter. supposed to smile posterity. would you like to say a few words? senator hatch: i would. have my body o senator wyden here. never thought we would get along with anything, but he was a lot better than i thought he was. he's a wonderful man, very, very thinker, and one of my dear friends in the u.s. senate. jason, for that kind introduction. you at o thank all of the bipartisan policy center for arranging this event and thank recognizing a landmark piece of legislation that i was proud to coauthor, chronic care act. with your steadfast support, and it, we were able to include the chronic care act budget act signed into law earlier this year. this bill was the culmination of a bipartisan committee-wide care, to streamline coordination services and outcomes forh care medicare beneficiaries living with chronic conditions. the most is one of important bills we passed this year, and, frankly, i worked good friend, senator ways. in so many i have great admiration an love as a and love for him human being and friend. outcomes for ed beneficiaries living with hronic conditions like never before. like many americans with multiple chronic conditions come into this program, my colleagues and i wanted to ensure that medicare would work for them. moment and take a thank you spectacular to ranking member wyden, who is me together. we worked together well for a long time. people didn't think we would. he finally saw the truth and worked with me. truth too. saw the we delighted in working together. very, very human, good man. his wife owns the strand bookstore, and that was good enough for me. loved to go up there and brows around. they loved to shower me with books and i will count on that retirement. we worked together for a long important issues and we were able to make a real difference in the lives of living with chronic ands conditions -- chronic conditions. evidence that congress can identify a problem, address about it in ething a bipartisan manner. administrator is doing her best to ensure that beneficiaries get the improved that congress intended. i commend her also for the work to build off the bill byinitiated by the taking additional steps to focus on those with chronic conditions. i would also like to thank isakson and warner who dedicated so much of their own this n an effort to bring legislation to fruition. they will never know, i don't fully, how much i appreciate it. this is likely one of the last will address you as chairman of the finance committee, and i cannot think of better legitimative accomplishment to be celebrating ear the end of my service than this one. i'm so grateful to be with all you, especially senator wyden. we'd never get along together. we get along really well, mainly because he's such a really good person, no question about it, his wife's bookstore too. i just want you all to know that efforts that the you have all put forward and we couldn't have done this without your help. you do is really while, it, it is worth is crucial to us all on capitol hill, and i think to the whole, and ple as a not just the american people but people around the world who benefit from good health care in the united states of america and from the great ideas that we come up with as we work together. so thank you so much. i salute my friend, senator get the heck off the stage so that you can get some speakers up here. thanks so much. it is great to see you. >> thank you, chairman hatch. it is an honor to be one of the last places that you are addressing the public in your as chairman. so i get a chance now to say a senator words about youn -- as i think thank of know, senator chairman was a health care before coming to congress. helped americans as o-director of the oregon gray panthers and we think it is a real testament to his unrelenting is determination and, frankly, down ight stubbornness that four decades you are continuing to champion the needs of senior citizen. are proud to work with the this legislation and on the home program which is one the fundamental changes. s with senator hatch, the chronic care act is one of your any, many achievements and emblematic of a career in bipartisanship. lindsey you joined graham and trent lott to enact the improvement and act senator wyden introduced the healthy americans as i think you all know, the ffordable care act was bipartisan for a while until it -- 't and senatorswiden and bennet wyden and senator --owed mreksibilitiy in dmin lexibility in dmin administering the law. has been bold in moving health care policies forward with the construction of rivelan, senator wyden paul ryan to develop a cost constraint legislation premium support, a good fight that is not over. senator wyden has always strived health care better for families. i think the chronic act is another accomplishment in a journey. journey is not over. we are eager to support you in honorourney, and it is my on behalf of the founders of the to and board of directors award you this bipartisan leadership in health care award. senator wyden: jason, thank you so much. and i'd like to begin amidst all the bouquet tossing that we're seeing this morning, i'm start by offering a few facts about able health policy this year. you had said in the winter of 2017 that the senate finance write a would ipartisan improved ten-year reauthorization of the chip, ifs health bill, you had said the finance would produce bold welfare that ld mariannewrite adelman had dreamed about for and if you would have would at the committee launch a bipartisan of medicare to update the medicare guarantee, said all that would 2017 and 2018, verybody after they heard it would be rolling their eyes and are hallucinating. you've got to be kidding me. it can't possibly happen in this kind of political environment. ten-year reauthorization of chip, transforming the child updating the , medicare guarantee, nobody would possible in that 2017. because of ppened ne person, and that is my friend chairman hatch. and chairman hatch had a lot on his plate early in 2017. all of the k off him, s that has consumed and when we started talking hand, the opic at whole question of transforming could e, the chairman have easily said, you know, i'm it. sure we can do let's think about that for a while, which in the senate a no ge is about as blunt as you can get. he knew that during my 20-minute reign as finance the chairman committee, because as you know, hairman baucus retired, and then i took it for a short period of time. it wasn't possible to move something like this. had the hairman hatch gavel, i went kind of hat in said, pretty humble, and mr. chairman, because everybody ability to build big coalitions, would you be on and to take this maybe -- maybe we could make it a committee-wide effort, which the chairman t decided to do. nd he brought in mark warner, and, of course, senator isakson stayed with it. chairman was e willing to take the time to do has done over the years, history mentioned that with senator kennedy and at one him, mr. chairman, kennedy, but i'm sure interested in trying to build coalitions with you. said, that's man what i want to do. so we're off to the races. all kind of started that with an awareness both democrats and republicans what medicare has become. 1965, and i was director of the gray panthers in 1970's, and i had a full rugged good and looks. part-b. was part-a and and as the chairman and i that's not medicare. today most of it goes to heart stroke, chronic pulmonary disease. 2018 is hugely different than medicare from 1965. and the chairman said, we can build on that. now and try to build a bipartisan coalition. and without that decision by the chairman, we would have kept treading water on medicare. have been doing piecemeal things. e would have continued to tinker with position payments, kind much modernizing them. tinkered with edicare advantage, the reimbursement rates and the like, but we won't have gotten what medicare has become had the chairman not been willing to say i want to invest and i want to invest my this.al in it is fair to e, say basically a chronic care program. i don't know any other way to say it. eniors with four or more chronic conditions accounted for 6% of traditional medicare spending in recent years. so a little bit about looking back. now i want to start kind of moving forward for just a minute i promised the chairman that i would keep this filibuster-free zone. today every senior receives the card, but they get in different ways. so the chairman and i said, with the support of our colleagues, come out of the gate and say that for all of the major which seniors get their medicare, we're going to start headed in care bill the right direction. know, we did, as you there's traditional medicare, that's basically deeper service, there's accountable care, that involves the providers, and then there's medicare advantage, and the chairman and i have always been interested in that. has the third highest percentage of seniors in the country. so we said let's start by putting some points on the board of medicare. so for traditional medicare, we -- inble, and the chronic the chronic care bill, to benefits for telehealth for people who suffered from stroke and kidney who wanted to get their dialysis treatment at home. nd we were able to expand primary care services to seniors called through what is independence at home, then moved the more hich is recent effort of private plans coordinated coverage to seniors. expand were able to supplemental benefits that offer nontraditional services that shown to improve seniors's health. and b.p.c. has been very in this, looking to expand things like nutrition safety measures at home. then we were able on the m.a. red tape for the seniors who get medicare and the dual what's called eligible so we could better care, and we eir gave those plans more flexibility so that a senior get more tailor-made coverage to their kind of chronic illness. chairman and i said we've got to move to the accountable care organization, so what we said there was arrivals on cent the health care scene would be up the bills for seniors primary care visits. we also gave to the ccountable care organizations more flexibility to offer telehealth. and i could give you more examples, the chairman could, to each one of the a littleas, but that's bit of a bird's eye view of how we tried to do it. said everybody got the same medicare card, but they get their care in different ways and let's start marching up the hill together, led by the chairman, try to update the system. nd as i say to all of my gray panther friends, what we're saying is that we're updating the medicare guarantee. is a guarantee. kitchen tables from tor portland -- maine and count on it. i would like to tell you about from here. it seems to me the first step we sure that a s make person is empowered for all advocate to their make sure that all of their care on the s are pulling same end of the rope. chairman nt guard, hatch and i are basketball fans, coordinate with a senior's ensure that to every provide had up-to-date treatment plans that would complement each other. .a. plans, accountable care organizations, obviously, making progress on this. make sure that seniors in traditional medicare have that option as well. a second area that needs mprovement is care for seniors hospital.y leave the four in ten medicare seniors -- seniors on medicare who are to a at home prior hospitalization and subsequent aren't able toay home ndependently at again. medicare spends $60 billion a them after they leave the hospital. unfortunately, a lot of those get the do not always quality of treatment they deserve. you i hear about it from hospitals. i know the chairman does. you've got seniors who have been in a hospital and when on their way out the door and discharged, people the records to send to because there is no little coordination. again, medicare advantage has a little bit better results right coordination the effort. but we want seniors who prefer theitional medicare to have same chance as anybody else to tripme after they've had a to the hospital. any vantage point would prefer that. point is, i think there's an opportunity to update guarantee.e in a bipartisan way to make sure that seniors, including those in m.a., would have palative and s to congress ervices, and obstacles tove the seniors and improve access to hospice. the care choices program that i in the affordable care ct really tried hard with the demonstration project to get hat off the ground, but there were a lot of challenges with sure t to m.a. in making that seniors had those options. i think, and the inspector general has raised questions to make suree want that we address this question of hospice coverage and m.a. and it i think, an area where, again, there's been leadership. mentioned johnny isakson. mariner akson and mark -- warner have a long interest interested in hospice care and end of life issues that not to ople together, generate the polarization and animosity that we've had from to time. i won't mention sarah palin. last point is just this. awayere's anything to take rom my remarks, it is the tra -- it is that traditional medicare cannot be left behind. advantage offers flexibility for plans to try new the , but it can't come at expense of the 60% of seniors who count on traditional or an accountable care organization for their care. i think it is important to bring up as we get ready to close n light of the recent reports the health and human doing this over medicare. medicare has got to be sfrat for straight for seniors about all of their health care options. i just want to emphasize that. that's not partisan. that's not political. it is medicare, c.m.s., h.h.s., seniors ht with the about all of their health care federal ith the government not favoring one type of medicare over another. state, which like the chairman's, has a high level of we're the vantage, third highest. medicare advantage may not be he most attractive option in all corners of the state. medicare and for edicaid services cannot become an advertising arm of private insurance or any other type of the role is to seniors get t straight talk about all of their options. the days lot to do in that and i'll tell you, hen the finance committee convenes in 2019, and chairman worked on d i have lots of issues, pharmaceutical issues and the like, and he gavel, i'm going to hink about my long-time friend chairman orrin hatch. this is some kind of public ervice career that we are honoring this morning, and ted kennedy used to tell me all the ted kennedy and chris dodd used to tell me all the time, well, you know, we're to orrin.king you should keep that up. ell, that's one of the things we won't have in the u.s. senate want to be i just nancy say, and i know joins me in this. we're expecting to see the wonderful d his elaine, nancy's going to see you store, and there will be plenty of books on hand. we want to wish them all the years ahead. we know that they are going to issues and lots of lots of projects, but i want to his friendship, i want to thank him for staying in winter of 2017 that the chairman wanted to buy the odds defy the odds and make sure that the finance of ittee was on the side folks that so often didn't have have political't action committees, that the chairman made sure that they got shake, and i want to thank him for it. >> good morning. bill hoglan. had the pleasure of working with our health team here, and that oud of the work as erine haste and -- hayes dlin and shley r id others. their policy recommendations orking with a number of people here in this audience too were in the ed directly development of that -- of that inalization of the chronic illness care act. want to thank the scan found san diegos, the -- foundation, foundation.oods finally, before i introduce the administrator, as a former long-term senate staffer, want to express my incere appreciation to the chairman and senator wyden for heir kindness and their ourtesies they gave me as a lowly staffer and i know i speak hayes when she was finance committee. verna join us . briefly. is here shortly and will not be able to take questions. help but the dministrator oversees a $1 trillion budget. that's one-quarter of all ederal spending in this one person. and i can't help but note that ado tly there was much about the fact that amazon and market cap exceeded $1 trillion. has fallen back recently here on tuesday, but it administrator vena's budget exceeds $1 surely grow it will in the future. she joined the trump dministration in 2018 and focused on digital health information, reducing paperwork, burdens, ative advancing bundled payments, prescription drug costs, and week i was able and thankfully was able to attend sessions onistening the issue dear to my heart and rural health. i share her interest in rural come largely because i from a rural part of indiana and that home where the family farm is still located and operational on the banks of walbash. administrator also hails rom indiana where she helped another friend of b.p.c. design medicaid program. well come fellow hoosier. >> well, good morning. am truly honored to be here with you today. to add my st like congratulations to senator wyden chairman hatch on their awards. they have helped countless americans and i appreciate their commitment to good policy. know, i am knew to -- i am new to d.c. been f my experience has on the state level. there i worked to pass the first consumer-directed medicaid program, and that was done on a bipartisan bafs. -- basis. so that's the environment i'm used to working in. based on what i have been told and read in the news, i expected a very different environment i came to d.c. ut actually what i have found is pin spiering because -- is inspiring, because what i see, disagreements, while heated as they are sometimes, energy of our e arts are not borne from a but from need to win, a sincere desire to do what is american people. and while we might disagree on our policies would benefit country, we find common ground n our commitment to improving the lives of americans, and this is why i continue my work and energized. this sense of purpose gives me no idence that there is problem that we cannot solve and we can't ge that overcome. and this event is especially country mourns the loss of president george man whoselker bush, a life was dedicated to serving is country and to public service. and those of you in this room, honor ooes, r two relate to rees can the thankfulness that comes to public service, but i'm sure you relate to the sense of purpose of all that you have in the service to others. time in public life is finite, but the legacies of public servants, such as president george bush, will live on. speaking of dedicated public servants, i would like to thank senator hatch. than 40 years in the senate, he leaves a powerful significant bipartisan accomplishments for the health care system. he's worked across the aisle time and time again on so many medicare, medicaid, the chip program, and he will be missed. would like to applaud both senator hatch and senator wyden leadership in advancing innovative efforts to modernize medicare that will real impact on our beneficiaries. of we appreciate the work senator isakson and senator arner who led the senate finance committee's chronic care working group. together, their work brourn out a the commit -- bourn out of the -- helping others, helped to develop the chronic care act of 2017 that was passed as part of the b.b.a. of 2018. was originally designed over 50 years ago to serve people with acute illnesses, but of our population have changed over the years and now ten adults in the united states have a chronic illness have two or en more. chronic diseases such as heart diabetes ancer, and are the leading causing of death and disability in the united and they account for 90% nation's 90% of the 3.3 trillion in annual health costs. good policy e that -- really good policy is bipartisan because when you get both sides will love it and the b.b.a. is a great solid policy.d, this legislation modernizes address the needs of the millions of americans living with chronic disease. lead to improvements of innovation and quality of care or the millions of americans dealing with chronic conditions every day. t c.m.f. we understand that relentless innovation is a crucial driver in creating value just like in other industries, and supporting part of our larger vision of moving to a system hat is value based, that rewards value over volume by bringing the best to patients. start paying for value, we will foster innovation to roviders look for ways compete for patients by providing the highest quality cost.at the lowest and there are many components of the b.b.a., but i want to call provisions that i think offer tremendous opportunity to advance improve the lives of our beneficiaries. senator wyden,om the first area is telehealth which is a particular area of one of the and is most promising way that current technology is changing the very and we knowth care, that guided by what is best for patients, telehealth innovations usher in a new world of health care that is embraced both patients and providers that identifies new avenues of delivery and that improves chiefing of care by its quality while lowering its costs. elehealth gives patients choices. it gives patients another way to access care and puts them in the seat as they seek out new options. for ourrticularly vital elderly populations and transportation issues can be a barrier to receiving care. chronic managing a disease can connect more frequently with their health care team from home and spend their me going to doctor's office. wound care, mental health counseling, questions and challenges related to medication adherence, lifestyle coaching, hese are all areas where telehealth is helping patients and helping providers deliver to their patients. telehealth is not just a rural who has sue, anyone faced d.c. traffic can understand that. from thean all benefit innovation of telehealth. now ith the b.b.a., we can allow access to telehealth services whether a patient lives areas or not and they can even receive these services directly from their homes. also want to call out the supplemental benefit flexibility this particular change is a game changer for the program. increaseses flexibility for medicare new tage plans to offer benefits to chronically ill enrollees.dvantage this is critical as we're addressing the social -- determ nants of health. very person wants to be independent and stay in their homes. allowing plans the flexibility new types of benefits is just a ramp, transportation surgeri. a meal after these are very small things that an make a huge difference in improving health outcomes, keeping people healthy and out independent, al, and will ultimately lower health care costs. provisions will allow for better integration for care are eligible for edicare, medicaid by simplifying the process. and the dual eligibles are one most complex populations and they are one of our most well.iest as so these changes will make a the difference in improving lives of those individuals. and we appreciate the extension of the vitally important home ndence at demonstration which improves care for medicare beneficiaries chronic iple conditions, and it is allowing us to test innovation, figuring people to support remain in their homes as long as possible. congress has also provided us with new flexibilityies with a.c.o.'s, particularly to allow patients to benefit from savings a.c.o.'s chieved by through new beneficiary incentive programs. it alliance the incentives for providers and patients to seek high-quality care at a lower cost. so it is not just the provider the payer, t just but it is actually the patient engaged in seeking value. and collectively the b.b.a. changes will modernize the new are program, bring benefits to our beneficiaries that will improve health costs and d lower bring us closer to a value-based system. thank all of those who were involved in advancing this work nd appreciate the efforts to advance good policy on behalf of the american people. done becauseis not at the end of the day, every merican is concerned about the growing costs of health care, 2026, our c.m.s. actuaries predict that we will $1 in every $5 on health care, than is not our country.or i hope that we can all come together again, just as was done b.b.a., to advance good policy that will improve the american people while also addressing the rate of growth of health care in our country. so once again, i applaud and thank senator hatch and senator their leadership in advancing innovative efforts to odernize medicare and supporting innovation that will have a real impact on our eneficiaries, and the bipartisan policy center for your continued efforts to move thend politics and focus on policies that will advance the health and well being of the american people. thank you very much. > thank you, madam administrator. we appreciate you taking the over and we appreciate you taking the time these critical issues. agnus kerry. please join us. needs no real introduction to those who follow her coverage related to health in her current position as senior correspondent ith kooizer -- kooiser news -- kaiser news network and has in ed with newspapers pennsylvania and connecticut to capitol hill bureau chief for congressional quarterly, and as a reporter for the dow jones news wires. pleased that we would take the time to moderate our panel discussion. introduce the panel the ey discuss implementation of the chronic act. >> thank you. i will introduce our panelists so we can talk about the key issues. e heard the chronic care provisions. atkins, he is larry is the executive director of the alliance and ity they are improving quality of chronic eople with health conditions. next is allison schwartz, she member of the house of representatives for pennsylvania. congresswoman schwartz is the medicare alliance. ean kavanaugh is the chief administrative officer of aladad health actices with centers and clinics to build accountable care organizations primary focused on care. walker is vice president of health security at aarp. i'm going to start this morning with a few questions. i promise you the audience will involved. so if you hear something nteresting, make a note, and we'll have microphones to circulate when the time is there. to talk would like about this major component that plans, which covers bout one-third of medicare beneficiaries to target the nonmedical but health issues. to offer these benefits to all enrollees but hey can target them to the people who might need them. for example weeshgs just heard -- the e example of the administrator used was a plan may dvantage cover the cost for a wheelchair to ow-assault meal delivery people with hypertension. larry, i know your group did a at plans.king i will start with you, but i in te the panelists to jump any time. m.a. plans offering in 2019 and what will they offer in 2020? >> the chronic care act is a game changer as i think the pointed out. what i think it does significantly is shift the gravity in the medicare program toward home community based care. supplemental e enefit, the flexibility supplemental provides plans an opportunity in the context of the medicare program to start to cover some of the nonmedical benefits that are often for have complext only care needs and chronic very ions, but, you know, significant functional limitations to be able to provide some of the support they remain in the home and to be able it to meet their needs. -- our study interviewed -- studied seven plans in depth. of those seven that we interviewed, only three were bids for 2019,ng and a lot of that was due to the time frame and these were plans that had not been doing these kinds of services so they ly before needed the time to understand. that they r services are offering in 2019 are, i to k, conservative effort move into the space. they are -- they are things know, some limited food because there's an opportunity to do post medical of the post-medical food, limited transportation, they are ses where providing transportation to covered services, things like services.t day so it is relatively conservative this year. a lot of enthusiasm in the plans across the board for this space, and so i think in 2020, a number of them this tching to see how kind of plays out and also doing in work they need to do order to do good estimates on these benefits. think, ou will see, i much more interesting kinds of benefits being offered in 2020, see a lso think you will lot more plans engaged. want gressman schwartz, i to go to you next. what are you hearing about their interest in 2020. you think we might see? i i think it is exciting, and think, as was pointed out, we will see more activity on the in 2020 tal benefits after the law kicks in. under ee an expansion current rules and it will include home modification. i would like to say two things about this. one is, and i think you heard senator wyden and from he administrator, that in an integrated system where there is are coordination and risk strati if i indication -- strategy, we can identify -- patients you are responsible for and you are paid capped amount for and you can identify with sharing nformation between payers and providers, which is wonderful is involved n that in medicare advantage. you can identify this. otherwise the traditional health are system is, you get sick, don't feel right, you call for health care or you don't or you really sick u're and call 911 and go to the hospital. the current condition under medicare. it is different when you go to a physicians and clinicians that have responsibility for paying for your care over time. what's been happening already in medicare advantage is the interest of, all right, what are needs.tient's we also have a lot of providers alliance identifying what need and want to be able to address that. we have seen providers in plans mplementing supplemental benefits that are not available in traditional medicare. i will see, as a former member congress, we sort of made fun fitness wellness programs that were for the young healthy. is they work for the older. healthy.nt to stay >> if you take care of your diabetes and your cardiac copd, you name it, walking, on, socialization, eating right, all of these things matter. when you're 450 and maybe -- 50, maybe more so when 70.re just to back up to understand why this is a good fit. for the tunity supplemental benefits, this isn't completely a free-for-all. c.m.s. does a good job, sometimes we want more do a goody of -- they job of assuring are these -- possible.ntify what's let's look at what's happening and create some rules around this, which is what they've done. the expansion of those rules to nonspecifically health-related, all related to chronic conditions, but the ability to provide services like or even like meals. and it is interesting the saying, she was was still tied to post hospitalization. for we're really hoping that c.m.s. is not going to wait have the surge rip and allow when gery, and allow it someone is frail and has food insecurity and might end up in first.pital, to do that flexibility, ional maybe someone will -- but we are excited for it. a small upticken in 2019. e have a report that is available, i believe, on our web 100 that talks about the plans -- there are actually more than that that are growing what but 100 plans, particularly care in the home caregiver support. so there's tremendous interest in really what happens in the to make what we can do sure that the plans and providers can do together to patients where they are. >> terrific, we look forward to that. i know you had your hand up. join in. feel free to i want to emphasize what other before, thise said is a tremendous opportunity. e have looked at the data of some of the 2019 offerings, and hat is really amazing is about 15% of the plans offering caregiver support services. mentioned that they have seen that in the data as well. and this is completely different what has been traditionally in red in m.a. plans, even traditional medicare. so it is great, and we definitely are excited about headed. is i think others have pointed out hat m.a. is one-third of the medicare population, so we still of the medicare population and how can we build that into the traditional medicare. so i think that this is a -- had great opportunity to think evaluate these new benefits? you know, how can we -- this is what for us to look at new benefits are being offered, how does it affect overall how does it ding, affect caregiver well being? how does it affect the patient's of care?e and then with that experience and that evaluation, how can you then -- can we think about offering that greater the traditional program? -- st want to point to the to what the analogy with telehealth. telehealth is being offered more broadly in m.a., but then experimentation through the aco, and i think that is an at. to look >> can i chime? i share the support of everyone provision. my caution would be, you are not them offer everything that seniors need. they will offer seniors they need on what has the plans and the world doesn't know a lot about that. don't worry i about what we'll see in the next year or two. i think we all need to give this for the plans to learn what works within a confined budget, return on development. i think -- investments. from now it years will change and we'll all benefit from that. i think the interest of you had and, sean, extensive experience with medicare innovations. in the discussion, has the guidance from c.m.s. sufficient? what is the appropriate balance right providing the level of flexibility and of rmining what level benefits to offer and how m.a. ervices can provide these services without fear of audit or sanctions? for the reason we all talked it should be fairly broad. one,000 e should allow flowers to bloom. >> have we seen that? little inly it was a narrower than we thought for 2019. hoped that they would include meals and transportation a little more broadly. it is important to get it right. it is getting right oversight to give h guidance plans and providers some risk -- guidance about what's allowed and what is expected, and also to create the right for patients. i mean, you're right about that too. chance to innovate and see what works and to learn from that. oth of you have talked about that, the needs to build the evidence to see what is most particularly for high-risk cost patients. the plans implement see responsibly, you will increased responsibility from c.m.s., it is unlikely to lead higher spending. >> it is really -- >> i think the real challenge learn things in an m.a. context, just as you said, into theleed them over a.c.o. program? and this really comes down to of, you know, risk are providers willing to take on. i think you see both the administration and congress the g more flexibility to m.a. plans because it -- because chance to drive up spending is limited. how do we take that and ntegrate them in a different environment? >> larry, i know you want to jump? make a great point. but these are supplemental benefits. upplemental benefits are offered on an annual basis. necessarily going to be a lot of room in the bid because they will offer the first which entals is more attractive. and then to the extent they have room in the bid, then they can offer these. so i think is it a test. we're going to be able to develop evidence around the relationship between the benefits and medical savings and whether or not it makes sense to move from there to build these benefits into the essential benefits and give the plans flexibility to develop around individual care plans the kinds of services that people need to support. think that's where -- > well, let's -- >> let's keep moving. we have a lot to get to. know this is exciting. >> going back to sort of for patients. one of the changes is these supplemental benefits can be targeted. and i think that's really key because there needs to be, i tremendous s is a opportunity, as we said, but guidance s to be around how it is marketed to patients. >> exactly. that is one of the areas. sure. >> it is not clear if somebody will have -- be eligible for the the it or the extent of benefit. >> who do you protect beneficiaries who think i and perhaps his they find out they don't? let's get into some of this idea concerns, eting beneficiaries, see it leads them to think i'm going to get the new benefit, sign up for the plan, supplemental benefits everyone.over how do you protect beneficiaries? >> one of the big issues is that have been pushing the benefits and pushing it in a will ey, sign up, and you get all of this -- you think -- you can get a personal caretaker your home. i do think there's a disconnect the very starred wen -- targeted benefits an limited benefits. get all the e you personal care assistance you ever need. a challenge and plans are sensitive to this and finder being able to communicate that level of detail communicate so you don't have people signing up with the expectation. there is a little bit of concern about in the communication that you start to attract -- you everybody magnet for who has an early complex care need in the community and -- whether ot there's enough in the risk djusters to be able to really take into account these -- this. one thing i would say, it seems harder when you're looking at things reich home -- at hings like home modification, but the value of being able to target people who need it. in health care, we all the etically think we have right to get an m.r.i., but in reality someone has to suggest a good idea for you and you have to learn the pros and it.s of it is not like everyone gets an ma'ama grams, y, i think we pies, need to be careful about the arketing and say this is targeted for people with chronic conditions, if you don't have a chronic condition but would love to have a housekeeper, that is not what's intended. ut i think people understand probably because it is coming from medicare that is health-related. know, this came out of the chronic care act. there is a targeted audience for this. i do think the plans want to arket this, but they are very concerned that they don't want to oversell it either many they have unhappy beneficiaries because they are housekeeper.r a we have some responsibility in both making sure that the that andis clear about not overstating it and at the same time being willing to say targeted at someone who is much sicker than you. >> sure. > i would like to go back to larry's point about the risk profile about who would be these benefits. it is interesting. t is not offering a gym membership or kickboxy benefit. his really is for people who have multiple chronic conditions, so it could change the risk profile. as you noted, y, the benefits right now are quite limited. and see hows a wait the plans start to develop these benefits and not sure the scope of the services that's being offered. not sure to what extent the isk profile of the population in the plan would change. from k this is different the previous concerns we worried about, the self selection. say eyeglasses, i only get them when i need them, but we not have a return on investment if they are not targeted. think it should be part of a strategy that health plans have. i don't think it should recruit patients. >> sean, i think that's a good point. know, plans can programst are clinical in the m.l.r. or with the benefit part of the m.l.r., they consider it part of the benefit. in those cases they are offering care f these things like management and some of these other limited services, but it a clinicalcontext of program so there's an individual care plan where it is identified is important to be able to bring in individually. that's different than a benefit, supplemental benefit. so that issue about targeting, yes, you can target it, but if offer it and if you offer it to a specific type of opulation, you have to kind of provide it to them and the question is can you get it into the care plan? something o move to listening and is very important here, this idea of better benefits, trying reduce confusion for people who for health plans, want plan health-related services, supports. services and the law requires integration of those plans. what oes integration, should it look like? should it be a single entity, plans coordinate an offer these services even if they are not one in the same. are the challenges to reating, if you can, a single pathway -- a single point of communication, especially for the duals? big question. who wants to start? all right, you're next to me. you get to go. it is a huge question. you know, so i think integration with of the things integration is communication coordination, which is really do if l and it easier to you have the panel of physicians -- if you have the person's your panel and -- in your network and you have the relationship with them. so if you're an -- a t.s.s. plan and you're providing and support, ices you also want to have the health benefits for dual he'lling ibls we're -- eligibles. talking about people in both the health u want benefits as well for both to coordinate. across o do it loosely organizations is very difficult or with fee-for-service is very difficult. is i think the other thing capturing the medical savings because at the end of the day head.s where this has to we have to show these services when provided result in a return on investment. >> think about the beneficiary experience in trying to find the group. > we hear from beneficiaries who -- what they like -- what things e -- one of the they like about medicare advantage is a system, talk about the networks, good or bad, the good of this they can talk to each other, there's a set of rules. appreciate the care coordination, they appreciate the simplicity. m.a. and part-d. are m.a. part-d plans. there is the annual limit on on co-pays make more sense to them. but the most important thing is try to be agnostic about what's the best care model. talk to our providers, each one have a different one, they describe it differently. essentials that make it work -- make this work really primary care team that coordinates your care. we should be willing to say that, that's really what it takes, and then a network of meet the needsan of those needs. it has -- it is more they can do it with community partners, the apacity of all of these partners to meet these goals is a challenge. but, in fact, that is the challenge, is he how do you integrate other services? these not integrate traditional clinical services into that care model? and it is actually happening in of situations. we're going to learn from this. key t is elements of a primary care team that knows you nd works with you and coordinates your care is essential to making this happen. >> thoughts on integration? from my experience at c.m.s., which is -- it is universally cknowledged from the beneficiary perspective, it should be unified, it should be seamless. from an administrator's perspective, it is a mess. here are really well-intentioned people in tates and at c.m.s. who have been working on this for years and it is really hard. ome of it is statutory, fundamentally medicare, medicaid re two different sets of requirements, when you get the authority to waive a lot of different cultwo urs. i think it is -- cult urs. working on.s worth when i looked in, i used to hink, maybe we need to start from scratch. there ought to be -- forget reconcile two things and find a program that works. i think it is really important to have three principles of. whatever the process it has to be transparent to the beneficiary. how it e to understand is being changed or how it is being laid out, and the second to be easy t it has for them to understand and navigate. about alignment and sort of time frame for medicare medicaid, thinking about a single coverage determination process. and then thinking about cultural competency and ensuring or any kind of process documentation is available to people whose language -- english language or who have hearing imparments or other impairments or other impairments. undamentally the goal is to support individuals, these are individuals who have dual chronic conditions. we need to think about ensuring that they have the highest level of protection. i know you want to jump in but to continue, what happens to integrate?fail to might some plans cease to exist? quickly. >> let me quickly say that we have fully integrated plans that number of places today in the financial alignment nitiative and in states like massachusetts and minnesota and of all duals in the country are enrolled in integrated plans. sean, you made the point, what else would you have for them? that s the only model really makes sense to put these two pieces together. o the question is, so if you could really drive, and this legislation is intended to drive integration and to drive to more intergrade level as -- integrated level as what is acceptable under integration, these special needs plans who serve the duals population, it is intended they a contract with the medicaid program or they are integrated in some way with the and so at somem, point the dual snips that don't away.that go and so there is some attrition environment ip intended. >> okay. was to actually encourage more and to actually in some cases to have an integrated coordinated office that really allows them do it. we're seeing a lot of medicaid managed care. that is fee-for-service downstream. how do you -- these things that have the same ames but are really quite different. how does the beneficiary figure that out. they might all have different and be the same thing. the need to simplify and to kind of he right information for bishsryes is -- hugely aries is important. think the social security social security has a huge role in this as well. you get e first letter when you turn 65, and they tell you you have decisions to make. not just paying part-b, you have other decisions to make the majority now -- the majority of people -- eneficiaries in secret service -- traditional secret service don't even know there are other options. even explored other options and peep don't know if should -- people don't know if they should sign up for a special needs plan. provide long way to the information about what the options are for beneficiaries so understand in ways that are consumer friendly. >> what i would like to do is go a audience questions in just minute. but before i do, i want to give opportunity to talk very quickly about the sxans of of telehealth n and what it means for the plans you deal with, the plans you represent. asked you a lot of questions. i want you to go quickly. huanger, maybe -- lena walker, maybe you can start. the 're happy about extension in telehealth. i think it improves access, and cannot underestimate just how the aided convenience improvement. know, not just that, you people want convenience for convenience sake, but people who functionally having ifficulty, mow p biblt -- mobility issues, caregivers who have dedicated themselves to taking care of the family members. the ability to access telehealth be ices in their homes will a significant improvement of their quality of life and the will y of care that they get. one thing that i would want to say is sort of an opportunity to about improving it in the implementation stage is that it imperative that the beneficiaries understand that and that theyoice have a choice of having an a telehealth t or visit and that there are no artificial barriers elected. for instance to steer them one way or the other, and also an of who their providers are. so think one opportunity -- oncrete opportunity where we can really see some improvement is in the provider directory, instance, you know, being clear who's offering telehealth it updated. have updated so that you know it is -- in -- it is in real time. in, id you want to jump sean? >> i think we need to think about thinking of telehealth a benefit to it being able help other provisions. we should have moved long past this. fact, we are so obsessed with otheralth, we are missing technologies. create as tried to telehealth. how i get to 65, lord knows i will communicate with my doctor, but it won't be through a t.v. screen. big thing. we need to move past that. quickly. >> this is an example of where edicare advantage can perform fee-for-service many medicare advantage particulars -- picks this up. is of the issues is what telehealth, what is another ine, what is mechanism for calling your doctor. i think it is important because seeing, it is picking it up more than fee-for-service were taking a risk. it was added to the ee-for-service, which is just fine. >> great. toyou don't mind, we will go the audience. so we have mics. an mic.ve tell us quickly who you are and no comments. on time.rt i see somebody here. ait for the microphone so we can all hear you. >> rick flake, strategic health resources. meeting comes on the heels of another meeting last week national office of the coordinator for health i.t. had their annual meeting. guys talk about integration and all of that kind f stuff, i think of real pipelines and -- and these pipelines are not nearly as integrated to take we need.- even this as i mean, we have five major and all kinds of disconnected systems. so my question to you is, is kind of -- chronic care act a beginning or an end? >> so how do we pull it all the existing streams of information? >> i think what you're putting a on, what i characterize in the home is really the last frontier. the health care system and it is disconnected. electronic e.l.s. initiative to try to create between the information we're collecting and the medical team, if you're going to integrate, information is crucial to that. he information exchange and information sharing and connectivity. we're a long way. we're really at the very start point. i mean, there's not even electronic data in a lot of places. but i do think that the act helps to push more in that direction. i think telehealth is a major part of that, but i think there are other aspects of that. we have this law from the careers act -- from the cures 20th century cures act electronic visits and whether we can use that to information and flow back and forth will be big. >> sean, go ahead. all been pushing for echosystem to e be supportive of value-based care. are making users their living off of the fee-for-service. only they can say these tools are wholly the tools will adapt. you will know what that balance echosystem the adjusts to it. >> we had a hand over here. yes, please. cook.chael i'm a health care lawyer and head of practice at -- at a national firm. i also sit on virginia's medicaid board. mistake of writing an article immediately when -- right to your question because we're short on time. talked about providing personal care ultimately as a benefit under m.a. getting tons of calls. who do i talk to? and i know it is not a simple but within a plan is there a classification where you're likely to get somebody have the time to talk to these folks about, a, we do it, and b, wla kind of of data do we need o we can circumscribe who can access this service? >> congressman schwartz? have the right i answer to that. i think that -- i think if ou're interested in any of these innovations, whether it is from a home care -- i mean, you check out the plan, look t the specific plan and what are they offering, and, you know, trying to have -- it is this, this about isn't a benefit that you can days. certain number of it is not defined that way. it might be. c.m.s. will w what do. they might say you can do it for months or forhree these category of patients. we hope they'll be more flexible than that. end of the day, these kind of benefits are treated like clinical benefits when you need them, when you are at get ight eligibility to them. that will differ by plans too. there is no general answer. c.m.s. be specific with plans to say you need to provide am of -- amount of staff time or this amount of people in a call center, that kind of thing? >> i think it is the same answer. guidance and enough flexibility to see what matters and works. can't tie our hands until we know the answer to that. > i agree on giving plans flexibility to build out the program, but i think the -- i the issue is how you convey that information to beneficiaries o and there needs to be, i think, c.m.s. really needs to take the here and provide some spell out how plans what's available, note the limitations of the coverage. can offer -- plans offer -- there are a lot to sell plans even if there are small differences plans. it could be really difficult and hallenging with the proliferation of different options and different iterations the same benefits for beneficiaries. we do need more guidance. you're not in a plan and you're shopping plans, you plan finder n the and get the coverage of the plans and it should be described there. if you're in a plan, they robably should go to their primary physician because they are using that as a focal point when someone is eligible. lso the sum dwrltal -- supplemental benefits are marketed so it should be available. about four minutes left. rother, you're waving at me. there is and stated tension here between kind of different flexibility. i'm a big supporter of the chronic care act. 'm a big supporter of flexibility. but sean's definition of we're this and to talk about we're going going to do -- going o do services that produce short-term returns is very different than thinking about terms of a in health system and makes sense nd that is different from a third approach as to what people actually need in their lives to theyand have well being as get older, which really is social services more than health care. there's these three levels of nterventions and policy that don't always fit together very well. >> so how do we combine all of elements you're talking about to work for beneficiaries, goals, sh all the same is that what you're saying? >> of course, but it does come right?o money, as to how much money we have to commit to this. >> okay. larry. >> it does come down to money, but also, when we talk to plans, of the things that came through that sort of surprised want to work with and attract this population. this is a certain amount of low-hanging fruit, if these poorly re being served and if we can keep them out of the hospital, there is money to be had there. is it also about opportunity. their idea is to improve health. take the population that has the most complex health care needs and see if you can't make a difference. an interest ere's to moving this aer not just for - area not just for the money, but they are so -- have to go ori.nd they are learning too, you know lot of keen a interest and some of this has grown from the plans and drivers saying this is what people need. e are giving them the clinical advice. they don't have any of the supports they need. we're going to see them in the at the end of the moventsdz r month. so it is very real once you have taking this seriously, and we're seeing that. interest. genuine i do think that sean is also right -- i guess i won't worry much. it too i think you're right to -- i would say let's see where this goes. think somebody said it was -- somebody said it is not going to solve every problem out there. is not going to solve every housing problem, it is not going solve every social support problem. solve how to g to take care of my mother who lives 500 miles away. but it has a chance to address keen problems that could improve outcomes for a complex population -- >> i want to reiterate my point. these things will have an r.o.i., or plans will be raising bids to pay for new stuff. i think the former is are more likely than the latter. back, there is a continuum of social needs that arm grabve, putting an in the shower is pretty traightforward, worrying about whether there is an apartment to put that arm grab in is very different. is a long-term discussion about how to better coordinate been and people have talking about health care addressing social needs. in listening and hospital we didn't run the hospital very well, you don't running your apartment. there should be a division of labor. >> last word. like to say that i think this opportunity of testing and evaluating and the evidence shouldn't be just kept within the plan itself. think a lot of times evaluate new will approaches and so in this case -- are definitely go going going to evaluate the r.o.i. but there needs to be here is where a cms can play a role in which they can provide the independent reviewer or a evaluation to provide the benefits. what will be the impact on the caregiver? not all of them will produce the types of savings or improvements in experience in care -- they will vary and i want to end with the note that a third of the medicare population. opportunity to see what could work or be experimented beyond this population. that, i turn things over to catherine hayes. >> thank you very much and please join me in thanking our panel and thank you for attending. great job. thank you. >> in washington today, a labor department released the latest employment numbers. the unemployment rate for november related -- remained at 3.7% for the -- straight month. were in healths care. jobs slowed in construction and the service sector. >> sunday, on q&a -- people,ked with four future presidents, jimmy carter, bill clinton, barack obama, and to my surprise, donald j. trump. >> publisher of many best-selling nonfiction books -- >> i also came to understand about donald trump and this is profoundly important for how things work now. donald trump in his heart of hearts believes he always wins. here is a guy who has been in new york real estate but gambling real estate, boxing, wrestling, beauty contests, television, construction -- never has been the target of a criminal investigation. that is astonishing in new york city. >> a conversation with peter oz those, sunday night at 8:00 eastern on c-span's q&a. generaled air force philip breedlove on the ukraine-russia conflict and potential international responses. he commanded nato supreme ute

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