And ceo of independence blue cross. This is one hour and 20 minutes. Good morning. It is wonderful to feel such energy in this room. I am honored to be the dean of American University and it is my great pleasure to welcome you to American UniversityWashington College of law for this exciting Plenary Session of the next steps in Health Reform 2017 congress. At this year in partnership with the American Society of law, medicine and ethics and generous support from our cosponsors, we are thrilled to expand to a threeday conference attracting speakers and attendees from multiple disciplines in the academy and practice. This conference is also timed with the launch of our new health, law and policy program. I know the faculty and students will be partnering with you on the very important work in the areas of healthcare, law and economics. Thank you and please join me in welcoming American University provost doctor scott bass who will introduce the American University president , Sylvia Burwell. Thank you. [applause] thank you, dean nelson and all of you. It is my pleasure to introduce the next keynote speaker, Sylvia Mathews burwell come at the 15th president of the American University. President but while is a visionary leader with varied and extensive experience in the public and private sectors. Her career is a testament to the lifelong commitment to advancing solutions to some of the worlds most pressing challenges. The government experience includes positions such as the secretary of health and Human Services director of the officee of management and budget, deputy chief of stafdeputychief of stat of the united states, chief of staff to the secretary o secrete Treasury Department and special assistant to the director of the National Economic council. In the private sector, she served as chief operating officer and president of the Global Development program of the bill and Melinda Gates foundation and also served as the president of the walmart foundation. In response to todays session on healthcare, i would like to take a few minutes to highlight the accomplishments. In the recent fulcrum of the secretary of health and Human Services she helped shape the vision which is to ensure that every american would have access to the Building Blocks of a healthy and productive life. To this end, she had oversight and management of the departments agencies and departt agencies and programs, which included among others the centers for Disease Control and prevention of the centers for medicare and medicaid services, the fda and National Institutes of health. She oversaw the implementation of the Affordable Care act which as this audience knows presentst the most complete overhaul of the Health Care System in the nations history. It improved the quality of Health Coverage and made improvements to bend the cost curve. When she assumed the leadership prior to the second enrollment, one of the first priorities was improving Service Delivery of the healthcare. Gov website and as a result, the enrollment that was previously cited as a stumbling block for the Program Success became more efficient and smoother. During her tenure at hhs, she oversaw the governments domestic and Global Response to the two unexpected major health crisis, that ebola epidemic and the spread of the virus. This response included working with other nations to slow the spread on west africa and to identify highrisk individuals entering the united states. Through her leadership, Sylvia Burwell has had a Significant Impact on the safety and Services Provided for the wellbeing of americans all ages, abilities and socioeconomic backgrounds. Perhaps the work that was closest to home for her was her implementation of the Early Childhood program, headstarts largest revision in 40 years. Sylvia burwell had her earlier education beginnings at headstart in west virginia. She cites this program as sparking her love for learning a foundational tool and she has carried that throughout her career in public service. From the university of oxford as a Rhodes Scholar her work has touched and improved the lives of many in terms of health and, safety and millions of americans. Please join me in welcoming president Sylvia Burwell to the podium. [applause] thank you for those kind words and your leadership at the American University and i also want to thank you for your advice and guidance in the first human as i joined the American University family. I want to thank the American Society of ethics for bringing together such a great group of both people and speakers. If i could log one complaint about my previous job, it wasnt one but two lawyers who failed to warn me that once confirmed, all court cases switch to my name. First, the burwell family council, my husband, the second, the 44t 44th president of the ud states of america, and im just saying a little headsup would have been nice. My transition to American University is interesting, exciting and challenging. Ive joined a passionate campus, community and thinking, learning and doing things about the worlds most interesting and important problems. And one of those, we are talking about here today. Ive taken on a new title without ever having gone through a diner in iowa. Weve helped more people access coverage and care. Weve improved the quality of Health Care Coverage for the American Families and we have started to bend the cost curve freeing up resources for todays working families and for future generations. When i say we, i mean the nation as a whole. This is in the work of the government or the business alone. Its the work of policymakers and physicians, advocates and attorneys, patients and families and as the conference proves they are not slowing down my team reminded me i couldnt walk off two days of my schedule to listen to the session. But second, and appreciation for the inherent American Healthcare. There are very few areas of the policy that are so complex and actually so simple. Todays agenda speaks well to the complexity from the payment incentives to federal and state coverage of children to the challenges facing the payers and providers. This conference fits into the vast ocean of complex legal regulatory and moral questions that churn every day in our Healthcare System. This system is grounded in a simple reality. In moments of joy or pain as a sprained ankle or fear and uncertainty as a neophyte. When i worked at hhs, the complexity surrounded us. We spent late nights and early mornings waiting through the reams of briefings and studies thanks to all the academics in the room. We spoke with over 100,000 providers to get their input on the rulemaking. We work to try to understand how the system was working, where there were opportunities and how we could use our time to deliver meaningful impact to American Families and to those colleagues are still there today to deliver impact for the American People to transition power to those staffed with me say it is an honor to serve alongside you and our nation is stronger for your service. [applause] hhs impact was our northstar. The goal was to tether the conversation and an analysis to experience and to the reality on the ground. One sees this reality every day. You see it on the campuses of the National Institutes of health where the top medical researchers are crossing the next frontier of understanding the diseases and disorders to things like position medicine. The nations safety and innovation are front and center. You see it in the men and women that pack their bags and left their own families to save the families in west africa and are always ready to make that journey whenever they get call called. You see it in the healthcare professionalshealth careprofesss audience this morning who are out there trying to build a better Healthcare System. This is the duality of the intricate complexity of the Healthcare System. I want to highlight how the leaders in washington and the businesses and the American People can maintain the progre progress. Between 2010 and the First Quarter of 2017 the race fell from 16 to 8. 8 . That is historic progress. We know how to maintain the progress weve made and make forward. Nearly half of the uninsured adults say the cost of coverage is prohibited. The nation can take steps to help them. We need to get the message out that the coverage is available especially to the communities where those messages dont often reach a. Most can find a plan for somewhere between 50. 100 per month. Its about to be november 1, the start of open enrollment. For those of you that are spanish speakers and shop around, old habits die hard. The share of americans who cant afford needed care. Its for just the newly insured for the 157 million americans. Those that have Health Insurance through their employee or family premiums have grown an average rate of 4. 5 in 2010. Its what the taxpayers spend as well mitigate for example spent 473 billion less on personal healthcare expenditures between 2009 and 2014 thanks to the lower rate of cost growth and in the context of the budget conversations thinking about the 473 billiondollar number. Finally the third way that we can measure progress is quality. Thdeclinersthe decline is by 21n 2010 and 2015 and by linking those accomplishments to the mortality statistics, that decline prevented 124,000 deaths. Before the law most healt healte plans and individual market didnt cover maternity care. A third didnt cover mentalhealth and almost one in ten do not cover prescription drugs and under the aca, there is coverage and while the wall is not perfect and there are many ways that it can be improved and changes will make it better, there are indeed some benefits that are reality and a very clear and simple reality for many American Families. Another reality is the direction the Healthcare System is moving. The models we are using to move forward on affordability and quality come from these revisions 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 reauthorization act. I probably didnt need to say that here. That was passed with overwhelming bipartisan support. These changes are part of and support the change that is occurring. If Healthcare System is undergoing what i believe is a historical change. Whatever your perspective in this room is, it is clear the Nations Health care Delivery System is entering into a new era. While i surf at hhs, we developed a threepart strategy to support the Healthcare System and making progress. First, change the way we pay for care so that they are rewarded for the quality of care. Second, change the way we deliver care by promoting coordination and prioritizing wellness and prevention and third, unlock healthcare data and information. So doctors can make the most informed decision and patients can be active participants in their own care. We implemented th a strategy wia simple philosophy where we need to leave we would lead him to convene stakeholders we would convene them and when we need to get out of the way, get out of the way. At hhs, we committed to have 50 of payments go to valuebased contracts by 2018 and when we left we were ahead of schedule. At the same time, commercial and sugars were venturing into the valuebased payments on their own. A quarter of the spending was an alternative spending models. Like my predecessor started some of these efforts, the former secretary and former senator bill frist. The Delivery System reform effort is what they called an empirical learning approach based on experiments, evidence and careful observation and learning. As i concluded it is essential for this approach to continue to meet the nonpartisan goal of better care, smarter spending and healthier people. Delivery system reform requires persistence, and im hopeful that as the new Administration Settles in, they will se see the same value and alternative payment is that we did. It is an opportunity that leaders of both parties have recognized. It will be in working to keep moving forward, supporting programs like the bun olds that reward providers for better care at lower cost. It will be important to fully expand the programs that are proven to reduce cost and improve healthcare like the Diabetes Prevention program that we modeled and it will be vital that the office is like cmi may continue to innovate and find ever new ways of providing better healthcare while spend in the cost curve. Many policymakers and leaders are moving forward. Ive been encouraged by the bipartisan efforts o efforts ofr of governors and people like senators Lamar Alexander and senator patty murray market place stabilization bill is the process for which it came together 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 to affordability and quality. Ive been encouraged by entrepreneurs and leaders whove steppewhohave stepped forward oy system reform. While at hhs the start of a group called the healthcare payment learning action network. It was a Publicprivate Partnership to encourage the adoption of alternative payment models. More than 6500 people joined. They set their own goals in this race and i know that after i speak you will hear from my friend and colleague who is the head of blue cross and in a alumni who has stepped forward d in this space. Today in American Health care there is no shortage of complexities change or news. The reality is why i am so honored to welcome you to American University campus. It was a little over a century ago in 1895 a young aspiring attorney named Delia Jackson asked a woman to apprentice her as a student of law. They had been denied admission to a number of law schools. Legal professions for those that did manage to study law were few and far between so they enlisted a part in her to host first session of the class and they enrolled to more female students. The barrier between these young women and the success in the field were numerous and quite complex but the students believed in a simple truth. The system needed to change and it would start with them. It became the First Law School in the world to b be founded by winning for the first with a woman being in First Law School to graduate an allfemale law school class. The keynote of success is the readiness for opportunity. The simple reality of American Health care is opportunity is now. So, for years and decades, we have had conferences and events like this to discuss the complex challenges that stand in our way but with the leadership in this room and across the nation, i believe we can overcome the challenges and i know that our nation will be successful at building a better Healthcare System because we are ready. Thank you. [applause] good morning. For those of you earlier i will repeat my objection at the Century Foundation tha foundatie former Deputy Assistant director for Health Policy but im privileged to be here today to call you not madame secretary but now im president. I am here in part because i was able to witness your leadership and skill and tenacity of the Health Policy in the nation. That prospective gives you a lens on the debate. I want to begin a with the Delivery System reform. I know that was jumpstarted when you arrived and we know how you developed the strategy and who was involved and how did you g