Please come to order. We have a vote at 11 45 but that should leave us an opportunity to hear from our witnesses and have good time for questions. I told our witnesses that i was to d lited to be talking about something other than the individual Health Insurance market. And im really quite serious about that because we know that the larger issues in health care are much more than the 6 of the people whom have to buy their Health Insurance in the individual Health Insurance market. So were glad to have this discussion and a subject on which both republicans and democrats have a lot of interest and we look forward to your advice. Today were holding a hearing to look at what can be done to encourage people to make healthier lifestyle choices to help prevent serious illnesses and reduce Health Care Costs. Senator murray and i will each have an Opening Statement and then well introduce the witnesses. After the witnesses team, senators will each have five minutes of questions. Let me say i want to thank senator murray for her leadership and being a straight forward negotiating partner on our efforts to present to the senate a limited bipartisan bill during 2018 and 19. She and i will go to to the senate floor todayali alitt 1 0 make a brief statement and put the text of the legislation in the congressional records. The senders can examine it. Well also list a significant number of republican and Democratic Co sponsors for the legislation. And our hope is that now that weve put a proposal on the table that the senate will consider it and the house will consider it and the president will consider it. I talked to the president last night and he encouraged the process, which he asked me to begin. And said he looked forward to considering it. I said if you have suggestions for improving it, thats certainbly your puraugative to do and thats what we would expect in the legislative process. So i thank senator murray and other members of the committee that have been involved in it. Over the last seven years weve endured this political stalemate over the Affordable Care act with much of the disagreement being over very small part of the Health Insurance market where 6 of americans buy their insurance. Our stalemate has really been over all of health care. The fact that weve had that stalemate makes this even more refreshingi to talk about. An area of health care on which doctors, republicans, democrats agree. That consensus is that a Healthy Lifestyle leads to longer and better lives and are edeuces the Nations Health care costs. According to the centers for medicaid and medicare services, Health Care Spending in the United States has grown from consuming 9 of the Gross Domestic Product in 1980 to nearly 18 or 3. 2 trillion in 2015 and predicted 20 in 2025. Cleveland clinic, which is represented by one of our Witnesses Today has said if you achieve at least four of six normal measures of good health and two behaviors youll avoid chronic disease about 80 of the time. The six indicators of good health are familiar, Blood Pressure, cholesterol level, body mass index, smoking status and your ability to fulfill the physical requirements of your job. Two behaviors are seeing your primary care physician regularly and keeping immunizations up to date. If you had had four of the six and keep up the two behaviors, according to the Cleveland Clinic, youll avoid chronic diseases 80 of the time. This is important because we spend more than 84 of our Health Care Costs, our 2. 6 trillion treating chronic diseases. Thats something on which almost everyone agrees. So lets add to that another obvious fact. About 60 of americans get their Health Insurance on the job. So if we really want to focus on improving health care in america, why not connect the consensus of wellness to 178 million americans get from their job. Thats precisely what the Affordable Care act sought to do in 2010. Its one of the only areas everybody seemed to agree on. Todays hearing is how successful wellness initiatives have been. And what we can do to encourage people to live healthier lives and reduce Health Care Costs. Many employers have reduced Wellness Programs. These programs may reward behaviors such as exercising, quitting smoking or offer employee as percentage of their insurance premiums for doing things like maintaining a healthy weight and keeping cholesterol levels in check. These have potential to improve the health and well being of their employees. A ceo of safeway visited with many of us a few years ago and started a Successful Employee Wellness Program after he left safeway. Thats one part of it. Id also like to hear what communities in federal government are doing to encourage had Healthy Lifestyle choices. I know Blue Cross Blue Shield of tennessee partner would organizations to Fund Community level organizations across the state such as fitness zones in chattanooga, promote Healthy Habits and an interactive Elementary School program to keep kids moving. An example of improving wellness is the Diabetes Prevention program, an Intervention Program medicare recipients diagnosed as prediabetic to prevent type 2 diabetes. Medicare spent an estimated 42 billion more on people with diabetes than it would have if they did not have diabetes. There are other ways to encourage healthier behavior but its hard to think of a better way to make a bigger impact than to conelnect the consensus of wellness to the insurance of 178 billion people. Senator murray. Well, thank you very much, chairman alexander, to all of our colleagues and witnesses for joining us today. We often think of health care as something you need when you get sick. But we should be thinking a lot more about ways we can prevent families from getting sick in the first place and ending up in the Doctors Office or the hospital. So im really kblglad were hav todays hearing because the truth is we all have a role to play in supporting efforts to make healthy choices. And certainly businesses employers who can promote Healthy Behaviors in partnership with their communities. So i look forward to a robust discussion around wellness and Public Health efforts that improve access to healthy, affordable food. Reduce tobacco use and a lautd more and i will work on providing the local state efforts and that includes Grant Programs by the is centers for Disease Control that invest in Community Health centers as well as the prevention in Public Health fund that has made such a difference. Given the nations High Health Care costs and that so many can be attributed to chronic diseases, it is critical we do more to support Public Health efforts focussed on Health Education and promotion. We have to do it in a balanced manner and make sure we are protecting workers civil rights and privacy. I know for a lot of my colleagues, the fact employer Wellness Programs could inflict significant penalties on workers who do not wish to Share Health Information is a concern. I want to hear more what we need do to make sure we find this right balance that protects workers rights and hippau and the Genetic Information nondiscrimination act. Three laws that were written and passed by this committee. And i have to be clear responsability for making sure the rights of workers with disabilities and those do not wish to share Genetic Information are protected and respected in these programmed will rest with the trump e, oc. Which is why they push so hard to the eoc nomoinees who dont show theyre committed to protecting those from discrimination. We need to work on it and figure it out. I appreciate all of our witness whose are being here to help share your information with us. And mr. Chairman, i do have a letter from aarp i want to submit for the record. Thanks, senator murray. Wed ask each witness to sums are your remarks in about five minutes. That will give us more time for questions back and forth. First member is founder and ceo of bird health. Many of us met him during the debate of the Affordable Care act, both the democratic and republican halls with a message about wellness. Second well hear from dr. Michael rosen, the chief wellness officer at the Cleveland Clinic, a program i just described in my opening remarks. Executive director of Penn Medicine Center at the Health Care Innovation school of medicine at the Horton School at the university of pennsylvania. Hes a leading behavioral economist with Much Research on Healthy Lifestyle choices and then Jennifer Mathis is director of policy and legal advocacy at the judge azlon senter for Mental Health law and engages in advocacy. Why dont we start with you, mr. Bird. Welcome. Er for. I think the first think id like to say is i very much appreciate the tuntd with the committee here. I really want to applaud your willingness to work in a bipartisan fashion to improve the health of americans and ultimately legislation that attaches to that. Im going to go quickly through a little bit of background in what ive done since i left safeway in the ceo position. Secondly, i want to talk about why we pick wellness as a real important area. Third, im going to cover the elements that we introduced at safeway. I think its most instructive because weve had a 10year run so we know what the statistics look like after some 10 years and finally im going to speak to the results we achieved, which i think are extraordinary and initdicative of what others can do. And finally i want to talk about what i think are the five keys to success in a Company Wellness plan because most people have failed at this and i know michael and i and maybe others here that will testify have succeeded. After leaving safeway, while at safeway as the chairman indicated, i got very involved in health care and discovered that it was a fast needing area, a great opportunity improve the health, improve care without adding to cost and dramatically lower cost. So i have now spent four in my space. What i wanted to do was tell you briefly what we do. Were able to low arcompanys or organizations cost actually 40 to 50 simultaneously lower the employees expense about 6 to 10 and capable of improving the care they receive and we have profound effects on the productivity of that work force. I picked wellness in 2008 because we took note that about 70 of all Health Care Costs are driven by health care behavior. So we thought with the right to design a plan, however we chose, we could actually effect behaviors and people would become hethsier. I know you will at some point want to understand how you can reduce costs. There are other ways to reduce cost more significantly. The first one i would mention is plan discipline, plan design and then wellness. In the next five to 10 years i would put it probably close to second place or third place. Trrs so theres an opportunity there. On the wellness front we put together a program at safeway and we made it a voluntary program, which im not sure everybody understood at the time and 85 opted into this plan and 70 of the spouses opted into this plan. We rewarded people for achieving certain biometric standards with about 600 worth of reward and when we polled people, about 78 viewed the program as very good or excellent and waut we measured was Blood Pressure, cholesterol, tobacco use and the results were amazing. Frrsh of the people that failed, they maintained that over the balance of the program. Prediabetics, of those that failed, 45 passed two years later. Cholesterol level, 43 of those passed two years later. Smokers ive got a number of 35 but in fairness you can beat that test and so while we did improve the smoking, 35 is a bit strong. And then we took the obesity rate down to 21 . If we were a state, wed be it lowest obesity rate. So we matched colorado at 21 . I want to move quickly because it says i have nine seconds left. Why do we succeed . First of all we rewarded a participation. The vast majority of programs say theyre outcome based, theyre not. Theyre participation based. We had to put a meaningful amount of money at stake. We needed to provide support tools that would allow people to actually change their behavior and enhance their state of health. And then we needed to surround it with an ecosystem that constantly convinced the employee that we cared about their health. We could talk more about that in the q and a. I did this when i was about 57 years of age and i understood that my fitness level down the road was going to be stable. And lastly it needs leadership and i practice this with clients today and if you dont have ceo leadership, it just doesnt work. In my experience you have to do all five. Thank you. Chairman alexander, Ranking Member murray, my name is dr. Mike roizen and i thank you for the opportunity to testify today before your committee. Since 2007 i have served as the chief wellness officer at the Cleveland Clinic. I lead the clinics work in preventing illness and helping people live longer, healthier lives. We give people more time. Keeping people well and enabling them to live their best lives is not just my professional goal, its my passion, my lifes work and the passion of the Cleveland Clinic. Thank you for your leadership in holding this important hearing. In fact the title of the hearing incapsulates the Cleveland Clinics story. How healthy choices can imp prove Health Outcomes and substantially reduce costs. We hope we can demonstrate that we as a nation can have real impacts on the health of our people while resulting in hundreds, literally hundreds of billions in savings for both the private sector and the federal government. For years the Central Health care debate in washington has been about what role government should pay in providing health shurnls. But if they dont address the sky rocketing costs of health care, it wont matter whetheric bills. Unless we do something to bend the cost curve, well all be bankrupt from this influx of chronici disease that is growin five to seven times faster than the population. There is something both the federal government and private insurers could do right now to significantly reduce Health Care Costs across the country. Something that could save. The Cleveland Clinic began an ambitious experiment. The clinics reward for Healthy Choice Programs, rewards employees who voluntarily choose to do so with compensation for reaching several outcomes. Wellness outcomes and medical outcomes that you mentioned each year. The program is born of a few key insights about the causes of chronic disease and the drivers of Health Care Spending. It starts with the fact that 84 of all Health Care Costs are due to chronic disease and six measurable factors. Your Blood Pressure, body mass index, your fasting hemoglobin, your ldl cholesterol, whether you smoke or not and unmanaged stress. These six predictors of chronic dg zeez are controllable in well over 90 of individuals. The Cleveland Clinic rewards for Healthy Program folkishes on helping the 100,000 employees and dependents get and keep these six measurements normal, seeing a primary care provider regularly and keeping immunizations up to date. The Clinic Program helps emplois get the six normals. The way we do it is we pay employees. That is we incents have employees and we started very small but ended up increasing payments to about the same number as mr. Bird to achieve the six normals and the two behaviors. Since the onset of thegram, the Cleveland Clinic has saved 64 million in direct medical costs. This year well save over 1 had50 million more verses the bench mark. As more of our employees get and stay healthy. Further unscheduled sick leave and the 62 m of clin