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0:57

This is

1:04

In the Bubble with Andy Slavitt.

1:19

Welcome

1:21

to our Monday episode. Thanks

1:23

for all the emails. Keep them coming, andy,

1:26

at lemonadamedia.com. Today

1:29

is

1:30

my what if episode. What

1:34

if? Imagine

1:37

if you will that we

1:39

had

1:40

a really healthy country

1:42

and a really

1:43

well-functioning healthcare system. Probably

1:46

hard to imagine what that is

1:48

and what that would look like. But

1:50

that's what we're going to explore today because

1:53

we need it. We desperately need

1:55

it. So work with me on this.

1:58

We have a healthcare system now. that

2:00

works in the following way. When

2:03

you get sick, you

2:06

access the healthcare system and

2:08

they do stuff for you. Sometimes

2:11

by the time you get to it, it's

2:14

too late. Sometimes what

2:16

the healthcare system does to you just kind of

2:19

repairs you a bit and gets you out

2:21

of the hospital or out of the doctor's office kind

2:24

of with milder nagging complaints.

2:26

Very rarely does

2:29

the healthcare system work to help

2:32

you maintain your health, keep

2:34

you healthy, prevent you

2:36

from getting sick. We're just

2:38

not oriented that way. Very

2:41

rarely does it say to someone

2:43

in their 40s, let us help work

2:45

with you now so you can live better

2:48

in your 60s and 70s, which

2:50

is, I think,

2:51

a more enlightened view of how a healthcare

2:53

system would work.

2:56

And the reason for this is many fold,

2:59

but it's really because we've got a lot

3:01

of money and expense designed

3:05

into a system that

3:07

is rewarded for doing more

3:10

things for you, doing

3:12

more tests on you, giving you more medications,

3:16

giving you more surgeries, keeping you in the hospital.

3:20

That is a quantity-based

3:23

healthcare system, more, more, more,

3:25

more, more.

3:26

And not surprisingly, what

3:29

effect does that have on us? Well,

3:32

it keeps us away as long as possible

3:35

because we don't like that stuff happening to us. And

3:38

when we stay away, it is

3:40

not because we are actually

3:42

staying healthier, it's because we

3:44

are avoiding learning what's going on

3:47

in our bodies. So now here's

3:49

the work with me part. Here's

3:51

the what if part. And here's what we're gonna talk

3:53

about today with my two guests. What

3:55

if healthcare system worked exactly the other way? What

3:58

if the healthcare system was about...

3:59

health and not care. What

4:02

if the healthcare system was rewarded and

4:05

designed

4:07

to find something that was about to happen

4:09

to you and prevent it? Prevent

4:12

your blood sugar from going up. Prevent

4:14

your arteries from getting clogged. Prevent

4:17

Alzheimer's and dementia from taking hold.

4:20

Prevent a mental illness before it became

4:24

so excruciatingly challenging

4:26

that it became too hard to deal with. But

4:28

really got to stuff early. Maybe

4:31

even before an inkling that

4:33

there were things that were wrong. That

4:36

wouldn't be a quantity-based

4:38

system. That would be a quality-based

4:41

system. Quality of your life.

4:44

Quality of your

4:47

well-being. Quality of your later years.

4:49

And your interactions with the healthcare

4:51

system would be very different. You'd be interacting

4:53

probably more using technology

4:55

from home to just check how you're doing.

4:58

You'd be interacting more with people

5:00

in the community. They may be

5:03

prescribing activities like walking and

5:05

hanging out with friends as opposed

5:07

to really dire things that are

5:09

happening in big scary buildings.

5:13

Healthcare systems can work that way.

5:15

Ours doesn't, but it doesn't mean that

5:18

it can't. There was some groundbreaking

5:21

research

5:22

from an organization called United States of Care.

5:25

Full disclosure, I was

5:28

one of the founders of that organization

5:30

about five or six years ago. I'm not involved

5:33

with it today. It's run by a wonderful, wonderful

5:36

CEO named Natalie Davis. We've had her on the

5:38

show before. We'll have her on again. They

5:40

did some groundbreaking research on what it is that Americans

5:43

want

5:44

from the healthcare system in a really transformative

5:46

sense. Not give me the small change,

5:49

but what do I really want

5:51

from how health and healthcare would work? And

5:53

the answer was people actually want

5:56

a system

5:57

that works easier for them and focuses

5:59

on on the quality of their life, not

6:01

on the quantity of things done to you.

6:04

Pretty interesting. Okay,

6:06

so how do we get there? Mara

6:08

McDermott is

6:11

the CEO of an organization called

6:15

Accountable for Health. And

6:19

Susan DelBene is a congresswoman

6:21

from the first district of Washington

6:24

that be the state of Washington because

6:27

Washington, DC has no congresswomen. Or

6:29

congressmen. Susan

6:31

DelBene is pioneering efforts

6:34

to transform the healthcare system within the congress.

6:37

And she is leading a set

6:40

of quiet but steady members

6:46

on this quest, on this journey.

6:48

And why do I say quiet? Because what

6:50

we tend to hear from Washington is not about this

6:53

better system, but it's about the fights

6:55

we have between Republicans and Democrats on

6:59

things like

7:01

Obamacare and single payer

7:03

and repealing Obamacare and whatever

7:06

else it is that pulls people apart. But

7:09

there's a set of people,

7:10

apolitical people I believe, who

7:13

say

7:13

stop talking about the politics and start

7:15

talking about how we make the healthcare system better. That's

7:18

what congresswoman DelBene is doing

7:21

with the emphasis and push coming

7:24

from Mara McDermott.

7:26

So if you are still with me

7:29

and you are interested in a topic like this,

7:31

this is a great show. It's

7:34

a great show. It follows nicely after

7:36

our episode with Zeke Emanuel, which I

7:38

think you can listen to, talks a little bit about changes for the

7:40

future of healthcare.

7:42

But I love this one. And

7:45

it's exactly the kind of creative,

7:47

original, new programming

7:51

that you should find in In the Bubble. And

7:53

it's a special Monday episode for you. Here

7:57

goes.

8:07

Congresswoman Susan Del Bene,

8:10

welcome to The Bubble. Thank you, excited

8:12

to be here. And Mara McDermott,

8:15

welcome to The Bubble. Thanks

8:17

for having me, Andy. Mara,

8:20

maybe I'll start with you. You know,

8:22

when Americans think about their healthcare,

8:24

a lot comes to mind.

8:27

You know, we're on the back of a pandemic,

8:30

been through plenty of crises. We all go through

8:32

personal crises in our own lives. We've got

8:34

a healthcare system that's expensive. We've

8:36

got aging parents and kids with needs.

8:39

It just doesn't quit. And it's, of course, a very expensive

8:42

system, and we all pay that

8:44

price too. But there's been a recent

8:46

study on

8:48

what Americans really want from the healthcare

8:50

system that I found very interesting. Tell

8:52

us about it. Yeah,

8:54

so our colleagues at United States

8:56

of Care have shared some research with

8:59

what Americans want out of their healthcare system.

9:02

And to me, and Andy, I'd love to hear your thoughts, but

9:04

for me, it really confirmed a lot of what I

9:06

hear every day in talking to people about

9:08

their experiences with healthcare, which is that it

9:11

is confusing. The expectation

9:14

and baseline assumption is that it's going to be hard

9:16

to access and a difficult experience.

9:19

It is not patient-centered enough. It is not

9:22

attentive enough to their needs. And their total

9:24

care needs, right? Not just the immediate

9:27

healthcare need, but also the social

9:29

needs and other things that play into people's health.

9:32

Another interesting, I know some of the frame for our conversation

9:34

today is around value-based care,

9:37

and we'll certainly get into what that is. But

9:39

another interesting takeaway for me from that

9:42

study was that people really don't respond well

9:44

to the term value, that that terminology

9:47

in particular is signaling for them a bargain

9:50

or

9:52

kind of low-quality option

9:56

when I think many of us have been historically

9:58

using the term value-based care to mean something very simple.

9:59

different. So lots of great takeaways

10:02

there and excited to dive into this topic

10:04

today. One of the headlines

10:06

that seemed most interesting to me was

10:09

this notion of what

10:12

Americans want is more

10:15

of a

10:16

healthcare system that focused on the quality of

10:18

what they get than

10:19

simply quantity. Was

10:22

that surprising to you and can you just talk

10:24

about what do you think that headline

10:26

really says? That's

10:30

not surprising to me. I think more

10:32

and more Americans are experiencing

10:35

healthcare that feels duplicative,

10:38

right? Like they feel like their providers are

10:40

not talking to each other. They're

10:42

answering the same questions over and over

10:44

again. I'm sure that you and the congresswoman

10:47

have people in your lives who have had those experiences, right? Very,

10:49

very frustrating experiences. So

10:52

that focus on quality

10:54

and I think, you know, maybe reading into it a little

10:56

bit more outcomes, what

10:59

is happening to

10:59

you as a result of that visit, wasn't

11:02

surprising to me. I think it is very nice to have

11:04

it articulated in that way and enables

11:07

us to kind of focus some of the policy incentives

11:09

differently.

11:10

Interesting. Congresswoman

11:12

Del Bennett, first of all, for those who

11:14

don't have the pleasure of knowing you're doing your

11:16

work, tell us a little bit about yourself and your district

11:19

and your time in Congress.

11:21

Sure. I'm from the great state

11:24

of Washington and have been in Congress

11:26

since 2012 and I serve

11:28

on the Ways and Means Committee and one

11:32

big area on the Ways and Means Committee has

11:34

been looking into issues of health,

11:36

Medicare specifically, to make

11:39

sure that we continue to have

11:41

healthcare that works for everyone. And

11:43

I think as we look at this conversation,

11:47

understanding what we can do to continue

11:49

to make sure people are getting quality

11:51

healthcare, that they're getting great outcomes,

11:53

that our system is adapting to the

11:56

world as we learn what works and doesn't work. And

11:59

we need policy. to help do that

12:01

too to make this all work. So I think there's

12:03

a huge role we can play in policy to help

12:06

incentivize

12:08

providing great care. You know,

12:10

if I were to stop someone on the street and

12:13

say, when you think about healthcare

12:16

and Congress, what

12:18

comes to mind? I bet

12:20

that for most people they'd say, well,

12:23

maybe the effort to

12:25

repeal the Affordable Care Act or

12:28

Obamacare, or maybe the effort

12:31

to pass Medicare for all,

12:34

you know, would be what they'd come up with. They would probably

12:37

tend to think about

12:39

how Congress focuses

12:41

on

12:42

either expanding coverage or reducing

12:45

coverage, as the case may be in

12:47

either of those two examples. Your

12:50

work is really focused in a really

12:52

different area, which is the quality

12:54

of what people experience in the healthcare

12:57

system and how to make that system

12:59

better.

13:00

Can you talk a little bit about the

13:01

part of Congress's work on

13:04

healthcare that people don't see, that

13:06

effort that's not so focused on those headline

13:09

grabbing issues?

13:11

Well, absolutely. I think one,

13:14

a patient experience and a quality

13:16

experience is really important. And when we talk about

13:19

a quality experience, it's making sure that

13:21

we are using the tools that we have

13:23

in our healthcare system to give people the

13:25

best possible healthcare

13:28

resources that are available

13:31

throughout the country. And

13:34

to do that takes a lot of things. When

13:36

we talk about the patient experience, part of that

13:38

is making sure providers, their doctors

13:40

and nurses and healthcare professionals

13:42

are able to do the work they need to do. One

13:45

thing we also look a lot in Congress

13:48

is how bureaucratic the

13:50

system has become where providers

13:52

spend so much time doing paperwork on things they

13:54

don't have time to actually do the work that

13:57

they went to school to do to help patients.

13:59

So collectively, I think

14:02

that make sure the resources we're putting

14:04

to the healthcare system are giving us a

14:07

great return, giving taxpayers a great

14:09

return, giving patients a great return, giving

14:11

providers a great return, better

14:13

outcomes are all the things that we need

14:15

to be looking at. And I believe

14:18

in a model kind of where we look at

14:20

what's working and what's not working, and

14:23

we adjust. And maybe one of the challenges

14:25

we've had in healthcare for a long, long time

14:28

is we kind of keep doing things the way

14:31

we've always done it, because it's easy

14:33

to leave things that way, but we have a huge

14:35

opportunity to do things better

14:38

and to make sure we incentivize movement

14:40

towards quality care. And that's what I

14:43

think Mara was talking about at the very

14:45

beginning, what can we do? And what you saw

14:47

in the survey, that's what patients

14:50

want to see. I think that's what people want

14:52

to see across the country. We want to see for ourselves

14:54

and for our family members. So

14:56

how can we make changes in policy

14:59

to incentivize that change to a system

15:02

that's kind of become ingrained

15:05

in fee for service, in doing

15:07

stuff, not necessarily looking at outcomes.

15:11

Mara, the last

15:14

decade or so, there have been

15:16

efforts, there have been policies,

15:18

there's been laws passed, there's

15:20

been things done by various administrations

15:24

to start to tackle this

15:26

issue that people have addressed here, of wanting

15:29

to see a more quality

15:32

driven system than a more quantity driven

15:34

system. I want to just

15:36

make sure that I understand and the audience

15:38

understands the general conflict, what we're talking about

15:40

here, which is that

15:43

today

15:44

a doctor or a clinician of any type

15:47

will essentially

15:49

get paid as much money as

15:51

as many things as they do,

15:53

regardless of what happens to

15:56

the people under their care. what

16:00

you're suggesting here is

16:03

that if say a doctor

16:05

is taking care of a hundred people, if

16:08

at the end of a year

16:10

those hundred people have seen improvements

16:12

in their health

16:13

then that's how we should be looking

16:16

to

16:17

pay for health care and if they

16:19

have seen the worst you know deterioration

16:21

in their health then that should be reflected

16:23

as well.

16:24

So is that roughly the kind of thing we're

16:26

talking about and if so, correct

16:29

me where you think he's got it wrong but what works

16:32

and doesn't work about that? What have we learned? Yeah

16:36

I think that's roughly right that we are trying

16:38

to move away from incentivizing

16:41

more things being done to people

16:43

and towards better population health

16:45

outcomes and we've seen

16:48

a lot of success out of accountable

16:50

care organizations in achieving that.

16:52

In terms of specific

16:55

things I think we've seen be successful, more care

16:58

coordination so people who are discharged

17:00

from the hospital for example you know

17:02

we've all we've all been in this situation you have somebody

17:05

discharged from the hospital

17:06

they go home they don't know what to do. In an accountable

17:09

care organization you would see a

17:11

provider maybe visit that patient

17:13

at home, reconcile their medication,

17:16

make sure that their home is safe or their return

17:18

from the hospital and that they have

17:20

a follow-up appointment. So those are

17:22

the types of successes we're seeing in terms

17:25

of care delivery. There are also

17:27

cost savings to the Medicare program and to other

17:29

payers. I think we've gotten perhaps

17:32

overly focused on that as a metric

17:34

of success you know when when I talked to my parents

17:37

about their experience with Medicare, savings

17:39

to Medicare maybe lower on the priority

17:41

list than that care experience and transforming

17:44

the way that care is really delivered. But

17:47

I think we've seen successes across the board in

17:49

terms of specifically expanding access

17:51

so more primary care after

17:54

hours appointments that care coordination

17:56

transitioning and coordinating across

17:59

care settings.

17:59

better health outcomes.

18:02

So we are seeing population health

18:04

improve in these areas where

18:06

we have robust ACO adoption

18:09

and lower cost.

18:10

So you're saying that

18:13

the evidence is that in the last

18:15

few years since

18:17

people have been trying out these different

18:19

approaches, doctors and their care

18:21

medical teams are actually providing

18:24

more services and taking care of people in

18:26

a more coordinated way when

18:29

they're getting evaluated based upon the

18:31

health of their population.

18:33

That's right. We see a lot

18:35

of evidence of that, an expansion of services.

18:37

And I would say for, not

18:40

to get too wonky, but for traditional Medicare,

18:42

fee for service Medicare, ACOs

18:44

are able, for example, to deliver some

18:47

of the, what we would think of in Medicare advantage

18:49

language as supplemental benefits. So to

18:51

make that concrete meals,

18:53

transportation, connection to community-based

18:56

organizations that are

18:58

not possible or likely in

19:00

a true fee for service based

19:02

environment,

19:03

where it's, you come in, I

19:05

do my one piece of your healthcare and send you on

19:07

your way. This is a more holistic

19:09

approach that is giving folks

19:12

access to more services than they

19:14

would have had in a fee for service based

19:16

reimbursement system.

19:17

Congressman Dobani, is that the

19:20

idea? Is that where we

19:23

think the answers are headed? Is

19:25

that where Congress and the folks that

19:28

you're working with in Congress would

19:31

like to see things move?

19:32

Yeah, we wanna make sure the incentives

19:35

are there to focus on quality

19:37

care. And since right

19:39

now the way kind of payments

19:42

work, they're really focused on fee for service, it

19:44

makes it harder for providers

19:46

who want to provide comprehensive

19:49

care like Maura's talking about, because

19:51

they aren't necessarily rewarded for that. So

19:54

that's where these alternative payment

19:57

models have come into play. And what we

19:59

need to do at Congress. services, make sure that those actually

20:01

do reward folks like

20:04

accountable care organizations who are delivering

20:06

these comprehensive services, make sure that

20:09

they are reimbursed appropriately

20:11

for the great work they're doing. And we

20:13

know just in 2021, ACOs generated $3.6 billion

20:16

in gross savings. That's hugely

20:24

important because not only getting better outcomes,

20:27

but also providing money. And that's money that

20:29

can go towards continuing

20:31

to make sure we're serving populations,

20:34

providing more services. But

20:37

when you don't get paid to coordinate

20:40

care to make sure that you follow

20:43

up after a patient got a particular

20:46

procedure, then we don't see those

20:48

great outcomes. So we need to make sure

20:51

our

20:51

payment models are consistent

20:55

outcomes. And we're still

20:57

working on that. We have that in place.

20:59

There's more we can do. There's legislation

21:01

we're working on now that I

21:04

have introduced in the past and we continue to work

21:06

on to make sure that

21:08

we support these models so that

21:11

folks are rewarded for doing a great job.

21:13

And that's work that we need to do in

21:15

Congress to make sure they're rewarded for that

21:18

and have the right incentives.

21:20

Let's take a quick break. I want to come back and talk

21:22

about whether or not these efforts

21:25

enjoy bipartisan support or whether they're like everything

21:27

else in the healthcare system. We'll be right back.

21:37

I'm

21:39

MSNBC's Ali Velshi. A book

21:41

banning epidemic is infiltrating our

21:43

classrooms with 1,500 titles banned last

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year.

21:48

Let's take a quick break and we'll come back and talk

21:50

about whether or not these efforts

21:53

enjoy bipartisan support or whether they're like everything

21:56

else in the healthcare system. We'll be right back.

22:07

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23:49

I want to ask you about some of that legislation in

23:51

a second, but I'm curious about something else.

23:55

One of the things that frustrates me, probably frustrates

23:57

a lot of people, it's how it seems like

23:59

every time a house...

23:59

healthcare issue services,

24:03

it immediately becomes partisan. That

24:07

for whatever reason,

24:08

the health of people in this country is

24:11

a political issue. And

24:14

it shouldn't be surprising because we're in a very polarized

24:17

time and there probably

24:19

aren't a lot of issues that don't get polarized.

24:22

Yet I think here it feels like,

24:25

whether it's

24:26

Medicare or whether it's Obamacare,

24:30

it's really difficult

24:32

to find people

24:33

who are of different parties embracing

24:36

and agreeing in these ideas. Is

24:38

that the case here or is this

24:40

an area where actually you're

24:43

finding that Democrats and Republicans

24:46

have some level of agreement and there's some hope of some

24:48

really bipartisan progress?

24:49

This has actually been very

24:52

bipartisan to your point, which

24:54

is important and very refreshing

24:57

because we really should be continuing

24:59

to work together to move a healthcare

25:01

system forward that works for

25:04

the American people in all areas. And we

25:06

can do that by actually

25:09

looking at the results we see, looking

25:11

at what's working, what not working and move forward,

25:13

but there've been kind of these ongoing efforts

25:15

to kind of whiplash, I would call

25:18

it, to say, if that was your idea,

25:20

then I got to get rid of that

25:22

and put my idea in place. I think one

25:25

of the nice things here is we have data, we

25:27

see what's working, we have the information, how

25:30

patients feel, we understand how providers

25:32

feel about being able to provide comprehensive

25:35

care and we have bipartisan

25:37

support for legislation to make sure we

25:39

continue to move the right financial

25:42

models forward to help incentivize

25:44

quality care. So that's

25:46

very, very helpful for all of

25:49

us that we can come together

25:51

to do that and do something that will really

25:54

move our healthcare system in a direction that's

25:56

great for patients. And as I said, also

25:58

great for the folks.

25:59

providing healthcare, because that's

26:02

why they want to do a great job too,

26:04

and they want to make sure they have the time to do

26:06

that, and making sure our financial models do

26:09

that, meaning that they're not kind of focused or told,

26:11

you've got to just do stuff, because that's the only way

26:14

we can keep the lights on. Instead,

26:16

we're going to be rewarded and

26:18

financially rewarded

26:19

for doing great jobs for our patients. So

26:23

if the study that Murrah referred to

26:25

at the beginning from the United States of Care is

26:27

a call, if you will, for

26:30

change to say, you know, we want

26:33

a experience that's more focused on

26:35

our needs, on our relationship with our care team.

26:38

We want that, I think, Murrah, the example you used

26:40

is really a terrific one, which is,

26:42

hey, you know what, I just got discharged from the hospital,

26:45

someone calling me or my mom and making

26:47

sure that she knows how to change her

26:49

bandages okay, and that she

26:52

gets the follow-up medication she needs,

26:54

and that she has the instructions and

26:56

a follow-up visit so that she doesn't end up back

26:58

in the hospital needlessly. We'd

27:01

all want that to happen, and I think that's what

27:03

the survey is telling us. So let's talk

27:06

about some of the legislation, Congresswoman,

27:08

that you have proposed in the past

27:10

and that you've reintroduced the Value Health Care Act

27:12

in 2023.

27:13

Absolutely. That's the

27:15

Value and Health Care Act is

27:18

to create those models, the incentives

27:21

to help health care providers

27:24

be able to provide

27:26

comprehensive care and focus

27:28

on quality of care and quality of

27:30

outcomes. We saw that

27:32

back in 2017, Health

27:34

and Human Services, the inspector

27:37

general there, did a report

27:39

that showed that 98 percent of

27:41

accountable care organizations, Medicare's

27:44

main value-based care model that we've

27:46

been talking about, met or exceeded quality

27:49

measures and outperformed P for service

27:51

providers on over 80 percent

27:53

of quality measures over a three-year period.

27:56

So we have data showing that the

27:59

focus on... Moving to these types

28:01

of models really has great

28:04

outcomes and delivers savings. What

28:07

our legislation does, some of these incentives

28:09

that were put in place to help people provide

28:11

care, quality care incentives

28:15

to use an ACO

28:17

model, some of those are expiring,

28:20

some of the incentives need

28:22

to be adjusted so that we can continue

28:24

to help healthcare systems that are trying

28:27

to move to provide quality

28:29

care but have to go through a lot of

28:31

change in terms of how their models work. We

28:34

need to make sure that they have the incentives to

28:36

be able to do that. So our legislation

28:39

is to help people go through that

28:41

kind of transformation and make sure they're

28:43

financially healthy while they go through that

28:45

and that they're

28:46

rewarded with their success.

28:49

And part of that reward when they're able to save money

28:51

and have better outcomes, they get some

28:53

of that savings back and they can

28:55

use that to continue to help in providing

28:57

great healthcare for their population, providing

29:01

great healthcare in terms

29:03

of coordination of care like Mara was talking about

29:05

earlier. So we want

29:07

to make sure that those incentives stay in place

29:10

and that's what our current legislation

29:12

is about, to make sure we can continue to move in that

29:14

direction and that the financial

29:16

changes as folks go through that aren't the obstacle

29:19

for them being able to provide quality

29:21

care.

29:23

How should we think about the

29:27

portion of people in the country that can expect

29:29

to be cared for in these,

29:31

you talk about these as models and

29:33

you talk about accountable care organization as

29:36

a model

29:37

and I take that to mean it's a way of

29:40

medical community working together and

29:43

having a shared incentive to keep people healthier.

29:47

Mara, what portion of the

29:48

public has been in models

29:51

like this

29:52

and how will some of the

29:55

legislation that Congresswoman

29:57

DelBene is talking about potentially accelerate

30:00

that. So,

30:02

in traditional Medicare, it's about half

30:05

of the population that's now in some form

30:07

of alternative payment model. And

30:10

as you both know, the administration has set

30:12

forward a goal of having all

30:15

Medicare beneficiaries in an accountable

30:17

care relationship by 2030.

30:21

That like we talked about with the bipartisan support

30:23

for these.

30:24

So let me just just clarify, I'm

30:26

sorry, you're talking about people who are 65

30:28

and over.

30:30

Or who have a disability. And there's,

30:32

you know, tens of billions of people we're talking about

30:35

that

30:35

are covered by that program. Yes.

30:38

Thank you.

30:39

I was just going to say that that is a

30:41

bipartisan goal. We've seen previous administrations

30:44

have similar goals of getting everybody

30:47

across programs in Medicare

30:49

and most everybody in Medicaid

30:52

into these types of accountable care models. Lots

30:55

of efforts with commercial payers and employer-sponsored

30:57

coverage. So I think

31:00

what we are seeing is broad enthusiasm

31:02

to move as many people as possible,

31:05

as quickly as possible, into these forms

31:08

of accountable care models and,

31:10

you know, sort of a better patient experience.

31:13

And the legislation that the Congresswoman is talking

31:15

about is an accelerant to do that. So

31:18

I think what we've seen historically is that Medicare

31:20

is a leader and many other payers

31:22

follow the example that Medicare sets because

31:25

of the number of people and sort

31:28

of the consistency that it sets as a bar. So

31:30

I think that legislation and other

31:33

bills that will continue that transformation

31:35

and to move it along more rapidly

31:37

will make a big difference

31:39

in terms of adoption of this model of care. So

31:42

do you see a point where

31:44

all the care in the country

31:46

or substantially all of it is

31:48

out of this

31:50

sort of quantity-based system and

31:53

in a system like the one you're talking

31:55

about?

31:56

Can it happen, say, in the next decade or

31:59

is that too much?

32:00

Is it too much of a projection? I

32:04

mean, I hope so. I hope we can get there.

32:06

I don't know if that's 10 years

32:08

or 15 years or

32:10

something more, but I

32:12

think we are making steady progress. I

32:15

think that there are things that Congress can be

32:17

doing in the short and long term to continue to

32:19

accelerate that progress. Building

32:22

on those incentives, like we've talked about,

32:24

this work doesn't happen overnight and it does take some

32:26

investment to get providers to

32:28

talk to each other and have electronic medical

32:30

records that communicate and share information. None

32:33

of that is easy and none of that is fast. But

32:35

what I would say, Andy, is we see

32:38

just a ton of enthusiasm in the provider

32:40

community

32:40

and you're hearing it in the United States

32:42

of Care survey from the patient

32:45

or consumer community around

32:47

these goals and that something different is needed

32:50

and is wanted and more quickly. So

32:53

I remain optimistic that we're going to get there, everybody

32:55

will have the opportunity to participate

32:58

in a better healthcare experience and

33:00

therefore receive better health outcomes as

33:02

a result. All right,

33:04

let's take one more break and then I want

33:06

to come back and I want to play devil's advocate a

33:08

bit

33:09

on what people should be worried about in

33:11

this new fangled approach you're trying

33:13

to hoist on us here. And then I

33:16

want to talk about some of the other topical things going on,

33:18

such as the new drug osemic, whether

33:21

that'll be paid for for everybody, how people

33:23

might get that. We'll be right back.

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35:04

I think people feel relatively insecure

35:06

about changes

35:08

to the way the healthcare system works. Might they

35:10

lose something that they have? And

35:13

of course, there's always bad actors, which

35:15

Congress has to always be wary

35:18

of, that someone will try to take

35:20

advantage of a new system in some way. So

35:23

there are obviously safeguards that you've gotta think

35:25

about. Congresswoman, are

35:27

there things that come to mind that concern you or

35:30

that

35:30

should be on the concern of the mind of the public?

35:33

I'll give you one example of questions that's been asked

35:35

of me, which is, if doctors

35:38

are gonna get paid more,

35:39

if their population

35:42

is healthier,

35:43

if I get sick, are they gonna drop me?

35:46

And so I think there's those kinds

35:48

of concerns that could

35:50

take something that, well, it sounds pretty good at

35:53

the high level, but then when

35:55

you get into some of the details,

35:57

people might worry about. So how do you think about...

35:59

what concerns might people have or safeguards?

36:03

You know, I think the

36:05

real important things are the metrics that we

36:07

put in place to make sure that we measure

36:10

what the experiences that's provided

36:13

to make sure that they are continuing, that

36:15

there isn't an incentive to

36:17

just say, oh, if someone's not feeling

36:20

well that we drop them, making

36:22

sure that this is about comprehensive care

36:24

of everyone, it's not about not

36:26

providing care, it's about doing

36:29

a great job of provided coordinating

36:31

care and quality. And so the focus

36:33

is on the outcome, not that someone might be

36:36

sicker because of a variety of reasons,

36:38

but are they getting the best healthcare to provide

36:40

the best outcome? And that's where

36:42

the incentives need to be. And that's

36:44

why as we work on legislation and incentives,

36:47

it's important that we continue to make

36:49

sure that folks are rewarded for that. Right

36:52

now, we are spending more and more money

36:54

on healthcare and we are

36:56

not seeing

36:58

improvement in outcomes for patients. So

37:01

you also talked about where we're at today, people

37:03

can do a lot of things, they

37:05

can provide a lot of services, but

37:08

just doing that and the money we spend on that

37:10

doesn't mean that people are getting better healthcare

37:13

either. So I'd say the current

37:15

system, is it the North Star

37:17

that you look at saying it's providing

37:19

great care? I think

37:22

we know there's a way

37:24

that we can bring healthcare

37:26

together, providers together to do the work that

37:29

they really wanna do and provide comprehensive

37:31

care and we can reward for those. So the

37:34

incentives are to make sure that patients actually get

37:36

better and are getting the best care they need.

37:39

And that's really what we'll

37:41

continue to work on and make sure is

37:43

the guiding light for the

37:45

work that's happening here. And

37:48

right now, frankly, providers can't

37:51

always get an accurate picture of

37:53

a patient's health because they're only looking at one piece

37:55

of it. And so if we can look at things

37:57

comprehensively, we have much.

37:59

better outcomes across the board. And

38:02

many of the cases, we have folks with

38:04

chronic diseases where that

38:07

management is so important. And

38:09

we've seen with ACOs and

38:12

with folks who are implementing comprehensive

38:14

models, this ability to be able

38:16

to do a better job of managing chronic

38:18

care. So I think fundamentally,

38:21

to your point, it's going to come down to

38:23

anyone, individuals experience

38:25

with their healthcare provider. And

38:28

if they have a better experience, that's where they're going

38:30

to want to continue to

38:32

be. And that's why we see movement

38:35

to different types of organizations because people

38:38

are getting the type of healthcare that better

38:41

serves their needs.

38:44

Let me close by asking

38:46

you about a big topic in healthcare

38:49

today, probably the sneaky

38:52

number one topic on people's minds, which

38:54

is the coverage of these new medications,

38:58

Ozempic

38:59

and Wigovi. For

39:01

those who don't know, you're probably living

39:03

under a rock. These are medications

39:05

that were originally one

39:08

of them for diabetes, the other for

39:10

weight loss. And there's a new study out

39:13

which shows

39:14

that there is a controlled

39:17

randomized trial, I believe a 20% reduction

39:20

in heart disease outcomes, which

39:23

is major, major, major, major

39:25

among people with obesity. And

39:28

so there's

39:29

a big push starting to say,

39:31

hey,

39:32

these drugs ought to be covered for everybody because

39:35

they keep

39:36

people healthy. They will prevent heart disease.

39:39

People will be in a more healthy weight. They'll

39:42

prevent people from getting diabetes in the first place. You

39:44

can hear all of the arguments. Of course,

39:47

the reality is that these medications

39:49

cost $1,200 or

39:51

so per month

39:54

for a patient. And you can imagine

39:56

the expense to the Medicare system alone,

39:58

let alone, you know. all Americans,

40:02

and

40:03

of course if you stop taking the medication, the

40:06

medication no longer works. And

40:08

so while we don't have long-term studies yet on

40:11

how long people should be on these medications, this

40:13

of course seems to be an issue that

40:15

seems to be going to be crashing in

40:18

front of us

40:19

that we're going to have to deal with.

40:21

And if it's not this, there'll be other things,

40:24

which is very expensive, evidence-based

40:27

medicine that science tells us will keep

40:29

us healthier,

40:30

but will be very, very expensive to

40:32

pay for.

40:33

So as two leading

40:36

health policy

40:38

experts who've been working on complex

40:40

issues a long time, I'm just curious what

40:43

your thoughts are. Maybe

40:44

Mara,

40:46

starting with you,

40:47

how should the country

40:49

think about this? There's going to be an awful

40:51

lot of pressure for these things to be covered.

40:55

Yeah, I certainly don't have the answers for

40:57

that. I would say from an accountable

41:00

care perspective, the

41:02

drug spending piece is really the next frontier,

41:04

I think, that hasn't been tackled yet and

41:06

is something that many of our member

41:09

companies have been thinking about for a long time, but

41:11

we certainly don't have

41:14

answers. It's such a complicated problem. And

41:17

you brought up two examples, or certainly

41:19

others that we've tackled as a society recently

41:22

around Alzheimer's and other things. So not

41:24

a real satisfying answer, but I agree with

41:26

you that it is a huge problem and one we need to

41:29

bring into focus more.

41:30

Is Congress starting to talk about this,

41:33

Congresswoman?

41:34

I think we're talking about

41:36

it. The public is talking about

41:38

it, so it's a broad conversation.

41:41

I think there's multiple aspects we have to look

41:43

at from one is making sure

41:45

that we're providing preventative care. How do

41:48

we make sure people stay healthy in the first place?

41:52

Sometimes certain types of drugs don't necessarily,

41:54

they may treat symptoms, but they don't necessarily

41:57

cure the underlying problems. that

42:01

maybe we could do prevent in a preventative

42:03

way, you know, help make sure that folks

42:06

don't get diabetes or heart disease

42:08

or other things by doing great preventative

42:11

care ahead of time. And so that's

42:13

one of the examples where some

42:16

of the work that we can

42:18

do and make sure when we have comprehensive

42:20

care is make sure preventative care is

42:22

happening to help. We have incredible

42:25

breakthroughs, scientific breakthroughs. I

42:27

started my career as a scientist

42:30

doing biomedical research. I mean, there are great

42:32

breakthroughs happening right now. We

42:35

need to follow the science, understand

42:38

where these new treatments

42:40

and therapies can be impactful

42:43

and help where they can't or other uses.

42:46

Are there other things we can do that give better outcomes

42:49

for patients? And look at that. So

42:51

this is going to be something that's constantly evolving.

42:54

And with the rate of innovation, we're going to see

42:56

many of these types of issues comes up. So

42:58

it's not a one size fits all,

43:01

but they're definitely a

43:03

part of what we can

43:06

do to provide health care to folks.

43:08

And, you know, some things can be expensive,

43:11

but they might be cheaper than

43:13

the other types

43:15

of care that folks are getting. And that's also

43:18

relatively, we have to understand kind of where

43:20

that fits. I talk, you

43:22

know, I'm the co-chair of the Kidney Caucus. And

43:24

we talk about kidney disease and dialysis,

43:27

which is incredibly expensive. If

43:29

there are things we can do to help

43:32

people so they don't end up with,

43:35

you know, renal disease, don't need to be

43:37

on dialysis.

43:37

These treatments appropriate for where are they really

43:40

beneficial to your point? Maybe

43:42

where do they save money

43:44

down the road? What things should people be doing

43:46

first before they go on a treatment like this? But

43:49

there will be certainly pressure and

43:51

gamesmanship, right, if people want to be on these medications.

43:54

And look, if you told someone who has a difficult

43:56

time losing weight that they could reduce

43:59

their chances

43:59

dying prematurely of heart disease by 20%

44:03

and they've got kids and maybe grandkids

44:05

someday that they want to see that's an awfully

44:08

compelling thing so not

44:10

easy. I have one other one for you Congresswoman,

44:13

particularly because you're located in Washington

44:16

State so this is something that's close

44:18

to your world which is AI. The other

44:20

topic that I think is is

44:22

a big topic in Congress and it's a big topic in healthcare

44:25

circles which is how to think about

44:27

the appropriate use

44:28

of artificial intelligence, generative

44:31

AI, particularly when it comes

44:33

to healthcare. People are experimenting with all kinds

44:35

of things now. Are there

44:37

any conversations underway and what are the

44:39

state of those conversations and how do you think about

44:42

AI and what

44:44

its power and its pitfalls are?

44:46

Absolutely lots of conversations

44:48

and I think a lot of learning happening right now

44:50

as folks are trying to understand the impact

44:53

that AI can have in so many different

44:55

areas. When we

44:58

talk about healthcare I think we've already

45:00

seen we were talking about

45:02

breakthroughs, huge breakthroughs because a lot of understanding

45:05

and kind of diagnosing

45:07

disease, what causes certain types of disease,

45:10

what types of treatment works, means

45:12

going through tons of data and

45:16

one thing AI

45:16

can do is sift through that data

45:19

much more quickly and kind of understand

45:21

where there are anomalies in that

45:23

data that may actually pinpoint

45:26

areas that we can focus on to provide treatment.

45:29

Even out our way we've seen great research.

45:32

We have the Fred Hutchinson Cancer Research

45:35

Center here. You know

45:37

they've been able to go through tons of data

45:39

and see that one type of cancer that we

45:41

thought was one type of cancer is actually

45:44

five types of cancer and that if you treat

45:46

them differently you get better outcomes

45:49

as opposed to assuming they were all the same. Those

45:51

are the types of things that I think AI can

45:53

really help us dig into

45:55

more deeply, more

45:58

quickly and get in and out.

45:59

incredible outcome. We

46:02

also know that we

46:04

have areas where

46:07

folks are trying to understand what types of treatments

46:10

should be available. We

46:12

have insurance plans with

46:14

prior authorization delaying care because

46:17

they have to look at it. What if we can move that more quickly

46:19

so we make sure that people are getting access

46:21

to the care they need and we can show that you know

46:24

moving forward in a certain way is a common

46:26

regularly used type

46:28

of procedure

46:29

so that we kind of get rid of some of these backlogs

46:32

that are in place. But one thing

46:34

that I think is critically important underlying this

46:36

and not just in health care but health care

46:39

maybe a very cute area is privacy

46:42

is very critical and

46:44

AI is driven by data and

46:46

one thing we have to do is also make sure people's data

46:48

is protected. We don't have

46:51

a federal data privacy law in our

46:53

country. I think that's very very important.

46:56

We have protections for health care but it's really

46:58

more of that data that your doctor

46:59

has. It's not necessarily the data

47:02

that your watch is tracking

47:04

on your health and so we have to be thoughtful

47:07

as lawmakers too and I don't think we've done enough

47:09

here to put other rules

47:11

of the road in place like on privacy so

47:13

that your privacy is protected, your

47:15

health care information is protected and

47:18

then also use AI in ways that we can

47:20

to to dig in and come

47:22

up with new types of

47:25

treatments and cures. You

47:28

know you just made a great argument for

47:30

why we all need to elect

47:33

really smart highly functional

47:36

intelligent representatives like yourself

47:38

because these issues are not easy and they're not going to get

47:40

any easier and and you want a functional

47:43

Congress who can talk about these matters

47:45

and dig into them and regulate them appropriately

47:48

because this is complex stuff.

47:51

I don't think anybody knows how it's going to turn out. Mara

47:53

I want to give you the last word maybe you

47:55

can just close by giving us a sense

47:57

of what the agenda is.

48:00

for the next year plus going

48:02

forward to push for some of the

48:05

really transformational

48:07

things that you've been championing along

48:09

with the Congresswoman in health

48:12

care. What are the things to watch for

48:14

now that the public

48:15

is sort of attuned to this effort

48:18

in these initiatives? What

48:20

should people be paying attention to

48:22

and if they're so inclined how can they

48:25

lend their support?

48:27

Sure, well I think the most

48:29

immediate thing is to pass the Value in Health Care

48:31

Act by the end of the year so I would put in a

48:33

plug for that. Beyond

48:35

that one we are looking for

48:38

and working on legislation that will accelerate

48:40

this transformation we've talked about today

48:42

in Medicare and

48:44

in Medicaid. Folks who want to get involved

48:47

in those efforts could certainly check us out

48:49

at accountableforhealth.org. We'd

48:51

love to connect. I think for those

48:54

in your audience who are

48:56

involved in accountable care whether

48:58

that is receiving that care, providing

49:01

that care, pushing for policy, the

49:03

most important thing to me right now

49:05

is to connect with your members

49:07

of Congress, your local representatives

49:10

and tell your stories. As we've talked

49:13

about today this language gets very wonky

49:15

and it gets very technical and it's payment and it's

49:17

benchmarks and it's all these things but

49:19

at the end of the day what we're talking about

49:21

is a better care experience for

49:24

the provider and for the patient

49:26

and the more that our advocates

49:29

and people who are having these experience can

49:32

share what is happening on the ground, how

49:34

that transformation feels, what that looks

49:36

like in real terms, the better

49:39

off we are all going to be in accelerating

49:41

this movement.

49:42

Well

49:45

thank you so much both of you. I hope

49:47

that people listening got a sense of that

49:50

there are people pushing for a better health care system

49:53

underneath kind of the very public fights

49:55

that they may perceive to be happening at

49:57

the level of you know Bernie

49:59

Sanders when he's on the show talking about the things

50:02

C champions but that there is a

50:04

undercurrent of

50:06

place where I think it's quite encouraging

50:09

to hear that there's bipartisan interest

50:13

in

50:13

creating a healthcare system that's

50:15

just easier for people and it gives people

50:17

more of what they want and the

50:20

fact that it can do that and show

50:22

some

50:22

financial savings

50:24

I think is it's pretty hopeful and

50:27

I don't think people are used to hearing about hopeful things in healthcare

50:30

so I'm gonna summon all of the

50:32

listeners by wishing you incredible

50:34

good luck in pushing for

50:36

this agenda and to keep us posted and in

50:38

the bubble thanks for being on the show

50:40

thanks Andy

50:54

thank you so much to congresswoman Del

50:56

Bene thank you so much

50:59

tomorrow McDermott I really

51:01

hope you learned a lot from this episode

51:03

we continue to go deep

51:05

here as we've got new stuff to report

51:08

but give me your feedback send send us your emails terrific

51:10

guests terrific show another

51:13

one on Wednesday Dan Buettner a real

51:16

treat

51:16

he's the Blue Zones guy then

51:19

we've got Labor Day coming up or

51:21

as I guess it's now being called AI day

51:23

I don't know why they changed the name that's

51:25

weird and then we got

51:27

new shows in September lots of them

51:29

including a great one with Caitlin Jettalina coming

51:32

up talking about what's happening

51:35

with this very interesting new

51:38

variant that could be hitting us in a

51:40

winter wave or maybe not maybe

51:42

it's a successor to Omicron or maybe not

51:45

we will see

51:46

anyway I know what you're thinking I'm not

51:48

gonna hear from Andy again for a week but you'd be wrong

51:51

but you'd be wrong you can't hear from

51:53

you again in two days isn't that great news I

51:56

know I miss you guys too all right we'll talk

51:58

to you Wednesday

52:04

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