[Congressional Record (Bound Edition), Volume 159 (2013), Part 9]
[Senate]
[Pages 12636-12640]
[From the U.S. Government Publishing Office, www.gpo.gov]




                              HEALTH CARE

  Mr. WHITEHOUSE. Mr. President, my colleagues and I have come to the 
floor to talk about an issue that is at the heart of the discussion of 
our national debt and deficit; that is, health care spending.
  These days around Washington, there is a regular refrain echoing 
through the hallways: In order to fix our deficit, we must cut Medicare 
and Medicaid benefits. That is wrong. That idea is, according to the 
former CEO of Kaiser Permanente--somebody who knows a little something 
about health care--and I will quote him:

       . . . so wrong it's almost criminal. It's an inept way of 
     thinking about health care.

  I could not agree more.
  It was put this way by Froma Harrop, who is a columnist for my 
hometown paper, the Providence Journal. I will quote her: ``The dagger 
pointed at America's economic viability hasn't been the existence of 
government programs like Medicare, it's been the relentless rise in 
health care costs that plagues not only Medicare and Medicaid, but 
everyone who uses health care.''
  Attacking Medicare and Medicaid ignores the fact that our health care 
spending problem is systemwide and not just unique to Federal programs. 
Our colleague Senator Angus King has used the colorful metaphor that to 
go after Medicare and Medicaid when the problem is our health care 
system would be like attacking Brazil after Pearl Harbor--wrong target. 
It ignores the fact that we operate a widely inefficient health care 
system: 18 percent of our GDP compared to only 12 percent for our least 
efficient international competitors.
  So how can we continue to stem the rise in costs and improve our 
wildly inefficient health care system?
  Thankfully, many of the tools necessary to drive down costs have an 
interesting collateral benefit. They actually improve the quality of 
care for patients. The Affordable Care Act included 45 different 
provisions dedicated to redesigning how health care is delivered for 
the benefit of patients and taxpayers. These reforms support and 
encourage an ongoing delivery system reform movement--and there truly 
is a movement out there--driven by dedicated providers, payers, 
employers, and even some States that have worked for years to improve 
the quality and the safety and the effectiveness of health care.
  We are not discussing hypothetical improvements. We are not 
discussing theoretical cost savings. Today I am joined on the floor by 
colleagues who have seen how delivery system innovators in their States 
have achieved real improvements to quality, real improvements in 
patient outcomes, and real cost savings. In Congress, we can't get over 
yesterday's quarrels about repealing or defunding ObamaCare, but out 
there in the real world health care leaders across the country are 
innovating forward, places such as the Cleveland Clinic in Ohio, 
Intermountain Healthcare in Utah, Geisinger Health System in 
Pennsylvania, Gundersen Lutheran in Wisconsin, Palmetto Health in the 
Carolinas, and in Rhode Island, among other places, our own Coastal 
Medical.
  One Rhode Island practical example: When intensive care unit staff 
follow a checklist of basic instructions--washing their hands with 
soap, cleaning a patient's skin with antiseptic, placing

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sterile drapes over the patient and so forth--rates of infection 
plummet, and the costs of treating those infections disappear--no 
infection, no cost.
  These reforms have the triple benefit of protecting Medicare and 
Medicaid, improving patient outcomes, and dialing back health care 
spending for all Americans. How big is it? The President's Council of 
Economic Advisers has estimated that we could save approximately $700 
billion--that is billion with a ``b''--$700 billion every year--every 
year--in our health care system without compromising health outcomes. 
The Institute of Medicine took a look at the same question. They put 
the savings number at $750 billion.
  Other groups are even more optimistic. The New England Health Care 
Institute has reported that $850 billion could be saved annually. The 
Lewin Group and former Bush Treasury Secretary Paul O'Neill--who as the 
CEO of Alcoa is deeply involved in the reform efforts in Pennsylvania 
that have been very successful and knows a fair amount about this--they 
estimate an annual savings of a staggering $1 trillion.
  Whatever the exact number is, what is clear is there is huge 
potential for savings in our health care system while improving or 
maintaining the quality of care. Since the Federal Government does 40 
percent of America's health care spending, when we get that right, 
taxpayers as well as patients become big winners from these reforms.
  I will close with two points: First, many of us are asking the Obama 
administration to set a hard cost savings target for these delivery 
system reform efforts. It may be $750 billion. Pick a number that will 
be a target to be actually achieved. A target--a measurable goal--will 
focus and guide and spur the administration's reform efforts in a 
manner that vague intentions to ``bend the health care cost curve'' 
simply cannot.
  Second, we need to put the full force of American innovation and 
ingenuity into achieving that serious cost savings target for our 
Nation's health care system. It is hard to do that without that target 
to strive toward.
  This is an issue where our Republican colleagues should be able to 
join us to accelerate these reforms in our health care delivery system 
and to move forward beyond tired-out calls to repeal ObamaCare so we 
can deal with the ongoing reality of health care reform.
  Let's give American families the health care system they deserve. 
Instead of waste and inefficiency, poor outcomes and missed 
opportunities, let's give them a health care system that is the envy of 
the world.
  I yield for my colleague, Senator Baldwin.
  Ms. BALDWIN. Mr. President, I thank my colleague for convening us and 
for giving us an opportunity to discuss the important topic of delivery 
system reform and to highlight some of the innovations that are 
occurring in our own States.
  I heard Senator Whitehouse talking about moving forward. It is 
actually the motto of the State of Wisconsin. One simple word: 
``Forward.'' Throughout our State's history, that motto has well 
represented our leadership in extending high-quality and affordable 
health care.
  Our health care providers and payers have pioneered forward-looking 
reforms that improve the quality of care and lower costs for families 
and for businesses. We are home to world-class, highly integrated 
health care systems. We make quality and outcomes data widely 
accessible to providers so they can measure their success against their 
peers. We stand at the forefront of using and advancing health care 
information technology. All of this affords some of the highest quality 
care in the country at a competitive cost.
  Congress has a lot to learn from Wisconsin's health care delivery 
systems. A recent Institute of Medicine report reinforced what we have 
known for a long time: that geographic variation in health care 
spending and utilization is real and that variations in health care 
spending are not consistently related to health care quality. For every 
State such as Wisconsin with higher quality outcomes and lower costs, 
there are five other States faring worse. Even within States, the 
regional variation in health care spending and quality is troublesome.
  Unfortunately, instead of advancing and fostering forward-thinking 
innovations such as those working in Wisconsin, far too many of my 
fellow lawmakers are looking backward when it comes to health care. In 
the House of Representatives, the Republican leadership has scheduled 
votes to repeal or defund the Affordable Care Act almost 40 times. Some 
State governments--including, unfortunately, my own--have refused to 
move forward with America's new health care law and are undermining its 
effectiveness at every chance possible. Now some of my colleagues in 
the Senate are threatening to shut down the government if investments 
in our health care system are not stripped out of our budget entirely.
  Families and businesses in Wisconsin and across the country are tired 
of these political games. For as long as some of my colleagues and some 
of the Governors across this country remain glued to the past, waging 
political fights based on pure ideology, we lose golden opportunities 
to move health care reforms in our country forward. We should all be 
focused on building a smarter and more affordable health care system, 
not trying to tear down the law of the land.
  That is why I am so proud to stand on the floor with my colleagues 
tonight, committed to moving our Nation's health care system forward. 
By building on the best reforms to our health care delivery system that 
are embedded within the Affordable Care Act and making new improvements 
to how we deliver care in our country, we will lower health care costs, 
improve quality and strengthen our economic security and reduce the 
deficit. Better yet, we will have more States with health care systems 
such as Wisconsin's, and Wisconsin's system will be improved as well.
  The possibilities are exciting. I think one of the things Senator 
Whitehouse just mentioned bears repeating: There is widespread 
agreement that significant savings can be achieved in our health care 
system without compromising the quality of care. The figures he cited 
bear repeating: The Lewin Group and the former Treasury Secretary Paul 
O'Neill have estimated that we could save $1 trillion per year without 
affecting health care outcomes by enacting smart, targeted health care 
delivery reforms. The New England Health Care Institute pegged that 
number at $850 billion annually, the Institute of Medicine estimated 
this number to be $750 billion, and the President's Council of Economic 
Advisers foresees savings at $700 billion a year. No matter the exact 
figure, these are impressive savings that would strengthen our entire 
Nation.
  The Affordable Care Act has sparked this hard work of transforming 
health care delivery. The law provides health care practitioners with 
incentives to better integrate care, increase quality, and lower costs. 
These efforts are producing impressive results in Wisconsin. For 
example, the Pioneer Accountable Care Organization Program has offered 
financial incentives to meet quality and Medicare savings benchmarks. 
Bellin-ThedaCare Healthcare Partners in northeast Wisconsin has 
excelled with this program. In its first year of participation, Bellin-
ThedaCare earned $5.3 million in shared savings and lowered costs for 
its 20,000 Medicare patients by an average of 4.6 percent. While not 
every pioneer ACO has been as successful, the CMS Office of the Actuary 
believes this program could save Medicare up to $1.1 billion over 5 
years by simply better coordinating care.
  Wisconsin boasts six additional health care providers participating 
in the law's traditional Accountable Care Organization Program which 
the Department of Health and Human Services estimates could save up to 
$940 million over 4 years. Wisconsin health care providers are also 
taking part in the Affordable Care Act's Partnership for Patients to 
improve health care quality. This public-private partnership engages 
hospitals, businesses, and consumer groups with the goal of preventing 
injuries and complications in patient care--including hospital-acquired 
conditions. The administration

[[Page 12638]]

estimates that reducing medical errors and preventing conditions will 
save up to $35 billion in health care costs.
  Another public-private partnership--the Affordable Care Act's Million 
Hearts Initiative--is preventing heart attack and stroke. 
Cardiovascular disease costs this country $440 billion per year in 
medical costs and lost productivity. The initiative seeks to deliver 
better preventive care to stop 1 million strokes and heart attacks by 
the year 2017--in part by utilizing innovative technology. Wisconsin's 
own Marshfield Clinic designed a winning mobile application for the 
initiative. The app will encourage patients to get their blood pressure 
and cholesterol checked and to work with their health care providers to 
improve their heart health.
  Finally, the Affordable Care Act has empowered the CMS Innovation 
Center to develop new ideas to improve health care quality and lower 
costs for people enrolled in Medicare, Medicaid, and the Children's 
Health Insurance Program. A number of the center's projects are 
currently underway in Wisconsin. For example, the Children's Hospital 
of Wisconsin, Aurora HealthCare, and the Wheaton Franciscan Healthcare 
system have created a model to decrease emergency room visits for 
children. The estimated 3-year savings of that project is almost $3 
million. In addition, the Pharmacy Society of Wisconsin is utilizing a 
provision in the Affordable Care Act to better integrate pharmacists 
into clinical care teams. That initiative is set to save over $20 
million in 3 years.
  This represents a small sampling of the delivery innovations being 
promoted through the Affordable Care Act that are saving us money right 
now. These parts of the law are empowering Wisconsin health care 
providers to provide higher quality care at reduced costs. Public 
officials who advocate for repealing the Affordable Care Act would end 
these impressive initiatives as well. Instead, we must build on these 
delivery reforms, as so much more can be done.
  To name two priorities, Wisconsin cardiologists have developed an 
innovative integrated network called SMARTCare to deliver better more 
efficient care for a vulnerable patient population. The Department of 
Health and Human Services should encourage this coordinated care model 
by investing in it and measuring its results.
  We should improve the law to increase access to Medicare claims data. 
The Wisconsin Health Information Organization currently holds over 65 
percent of health insurance claims data in the State--from private 
insurers and from Medicaid. The organization shares that data with 
health care providers so doctors can compare their performance--in 
terms of quality and cost--against their peers. This data-sharing 
promotes competition and it lowers cost. But due to current law, the 
organization cannot access Medicare data. If we open Medicare claims 
data, we will further improve quality and we will lower costs.
  Lawmakers have a clear choice: Go backward and try for the 40th time 
to repeal the Affordable Care Act or put progress in our country ahead 
of politics. We welcome our colleagues to join us in moving our country 
and our health care delivery system forward.
  I now yield for Senator Murphy.
  Mr. MURPHY. Mr. President, I thank very much Senator Baldwin and 
thank the State of Wisconsin for, in a lot of ways, leading the way and 
showing us what is possible when it comes to delivery system reform.
  It is pretty amazing some of those statistics Senator Baldwin used 
when she talked about how much waste there is in the system today. The 
estimates are from the Council of Economic Advisers, $700 billion; from 
the New England Healthcare Institute, $850 billion. To put that in 
context, even if the median of the two is right--somewhere in the high 
$700 billion range--that is $100 billion more than we spend every year 
on the military. That is enough money to provide coverage for 150 
million more Americans. That is enough to pay the salaries of every 
single first responder personnel in the country, including 
firefighters, police officers, and EMTs for over a decade.
  It is an enormous amount of money that we are wasting today because 
we have a reimbursement system, as Senator Whitehouse said as well, 
that essentially rewards providers and hospitals and health care 
systems for providing volume rather than providing quality.
  We understand there is not a single health care provider in the 
country that does not get into this if not for their desire to provide 
quality health care. There is no malevolent motive involved here. But, 
ultimately, when you have to keep your doors open--as a medical 
practice, as a hospital, as a nursing home--and you get paid more the 
more medicine you practice and the more treatments you order and the 
more tests you have your patients undergo, then you are going to follow 
the money. It is time we reorient our reimbursement model under 
Medicare and Medicaid, and in partnership with our private insurers, so 
we are reimbursing based on the quality of medicine and the quality of 
the outcomes you provide rather than on how much stuff you order or 
prescribe.
  Let me talk about three examples of how we have succeeded already 
when it comes to changing the model of reimbursement.
  First, the issue of readmission rates. When you go into a hospital 
for a surgery, that hospital is going to get a set fee for the surgery 
and for the amount of time you spend in the hospital afterwards. It is 
called a bundle payment. Bundle payments are good because what it does 
is it encourages you to essentially use your resources wisely because 
you are not going to get paid more if you keep the person in the 
hospital for 10 days than if you keep the person in the hospital for 5 
days.
  But here is the problem when it comes to the care people were getting 
after a particular surgery. Because the hospital got a set payment for 
that period of time, they had an incentive to push the person out of 
the hospital as quickly as possible. That was an incentive not only 
because the payment itself did not get bigger the more amount of time 
you were in the hospital, but it also was incented that way because if 
the person went home too early and then they came back again to the 
hospital, the hospital got a second bundle payment when they came back. 
And if they came back a third time and a fourth time, they got another 
payment.
  So what was happening is there was an incentive to send people home 
before they were ready because not only would that save you money on 
the first bundled payment, but it actually made the hospital or the 
health system money in the long run because the person came back a 
second or a third or a fourth time.
  I do not think there was a single hospital in the Nation that was 
deliberately misaligning their care so they would have people coming 
back to the hospital a second or a third or a fourth time. I am not 
suggesting people were trying to game the system in that way. But what 
certainly was happening was that without an incentive that pulls you 
the other way--get the care right the first time--there was, 
unfortunately, insufficient care being provided.
  So the health care bill says: Listen, we will pay you for maybe the 
first readmission, maybe for really complicated procedures we will pay 
you for a second readmission, but at some point there has to be an end 
to this model. At some point it has to be up to you as the hospital or 
as the health care provider to get the care right the first or the 
second time so we are not on the hook for readmissions occurring times 
three or times four. That is a pretty simple change, but it can save 
hundreds of millions of dollars.
  The second example is accountable care organizations. We set up a 
bunch of Pioneer accountable care organizations. These are bigger 
systems of care, where you have primary care doctors networked with 
specialty care providers, working under one umbrella to coordinate the 
care of the sickest patients. There are different numbers, but they all 
tell the same thing, which is that the sickest 5 or 10 percent of 
patients in the country are taking up

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about 50 percent of annual medical expenditures. So if you do a better 
job of coordinating the care of that small percentage of the medical 
population, you are going to save a lot of money.
  Accountable care organizations can do that. Instead of having siloed 
care, where a co-morbid patient goes to a primary care doctor over 
here, then a specialist here, then a specialist there, if they are all 
under one roof and they are talking to each other, then you can save a 
lot of money just by coordination. That is the theory. So the health 
care reform act put that theory into practice. It set up a pilot 
program by which Pioneer accountable care organizations--essentially, a 
beginning set of accountable care organizations--would be set up under 
a model through which Medicare would say: If you save money, we are 
going to deliver back to you some of those savings so that, in fact, 
there is not a disincentive to practice less medicine because if you 
practice less medicine, Medicare will take some of the savings and it 
will share with you some of the savings.
  Well, we have only had a year or so of returns from this model, but 
the results are pretty stunning. The average increase in costs per 
beneficiary has been--in the Pioneer ACOs--less than 50 percent of that 
for non-Pioneer ACO models. That is a pretty significant savings.
  In addition, go back to this question of readmissions. In 25 of the 
32 Pioneer ACOs, there was a lower risk-adjusted readmission rate than 
in non-Pioneer ACOs. Coordinated care where you are reimbursing an 
organization as opposed to just the individual physicians actually 
saves you a lot of money.
  Then third, the issue of outliers. What you find when you look at the 
data--and it may be that Senator Whitehouse talked about this--is that 
sometimes 60, 70, 80 percent of the system is practicing good medicine 
at the right cost, and it is really only a small handful of providers 
that are way outside of the median and all you have to do, when it 
comes to some subsets of reimbursement, is bring those outliers back 
into the median.
  Home care was a great example. In the Accountable Care Act, we said 
that for home care providers that had utilization rates that were far 
outside the median, we were going to stop reimbursing for those 
episodes that were far outside the median. CBO was not sure how to 
score it because they did not really know that was going to change 
people's practice. But it did. And it is estimated that single change, 
in controlling for the handful of outliers when it comes to high 
utilization rates in the home care line item, is going to get us almost 
$1 billion in savings over a 10-year period of time.
  When you look at home care, actually it is only a handful of areas in 
which you have these outpaced utilization rates compared to the rest of 
the country. It is places in Texas, it is places in certain counties in 
Florida. Most of the country is right where you should be. So part of 
reforming our delivery system is also taking care of these outliers.
  We have seen savings, whether it be in controlling readmission rates, 
setting up accountable care organizations, or taking on outliers within 
our home care system.
  Now it is time to do more because, before I turn it over to my good 
friend Senator Blumenthal, here is where the rubber hits the road.
  In about 10 years, Medicare starts taking in less money than it sends 
out. It does not go bankrupt all of a sudden, but it starts to become 
fiscally insolvent. There are only a handful of ways to stop that 
reality from happening. You can either ask beneficiaries to pay more 
out of pocket; you can cut their benefits, give them less; you can ask 
people to pay more into the system while they are working or you can 
make the system more efficient.
  It may be that we have to do a mix of those. But clearly the first 
three are not that palatable: reducing benefits, increasing copays, or 
increasing taxes. This is not a partisan issue. Both sides agree that 
in 10 years we have an accounting problem in Medicare. Both sides agree 
that we have to make changes today in order to stop that crisis from 
occurring.
  It strikes me that if the most conservative Republican and the most 
liberal Democratic sat down at a table and looked at those four 
options--increased copays, reduced benefits, increased taxes, or 
increased efficiencies--we would all agree. The conservative Republican 
and the liberal Democrat would agree, along with probably every other 
Member of this body, that is the first place you should go is to reduce 
inefficiencies. That is what the delivery system provides. So we have 
set up a working group here in the Senate which is beginning its work 
this week, that Senator Baldwin, Senator Whitehouse, Senator 
Blumenthal, I, and others will be building over the course of the late 
summer and fall. We hope it will draw interest from both sides of the 
aisle so we can start to put some meat on the bones when it comes to 
the changes in our delivery system that can be made to increase 
efficiencies so as to forestall the need to balance the Medicare books 
on the backs of taxpayers, workers, or beneficiaries.
  With that, let me yield the floor to my great friend from 
Connecticut, someone who both as a Senator and our State's attorney 
general has been fighting for health care consumers for a long time, 
Senator Blumenthal.
  The PRESIDING OFFICER. The Senator from Connecticut.
  Mr. BLUMENTHAL. Mr. President, I want to thank my colleague, Chris 
Murphy. Senator Murphy has been a long-time champion on this issue. My 
colleagues may wonder why two Senators from Connecticut, both of our 
Senators, are here on the floor and part of this working group seeking 
to lead on this critically important issue of health care delivery.
  The answer is we come from a State where it is working. We have seen 
the future in Connecticut's health care delivery system. It is still a 
work in progress, a lot of work still to be done, but Connecticut 
hospitals and providers and insurers and patients know it has to be our 
future, that cutting cost is essential to preserving and enhancing 
quality. Let me emphasize how important that basic principle is, 
because a lot of our colleagues believe there is a choice here between 
cutting costs and quality, that quality cannot be enhanced if we cut 
costs.
  In fact, the opposite is true. Cutting the cost of health care is key 
to enhancing and improving quality. It is the way we will reduce 
premature discharges from hospitals, that we will diminish the number 
of discharges from hospitals without proper rehabilitation plans, and 
cut the number of hospital-acquired infections. It is not only possible 
to do but it is essential. It is a way we avoid the false choice--and 
it is a false choice--between preserving Medicare on the one hand and 
avoiding increasing copays, decreasing benefits, or increasing taxes, 
as my colleague from Connecticut has said.
  I reject every one of those options as necessary to preserving 
Medicare. Increasing copays, decreasing benefits, or increasing taxes 
is not the way. In fact, increasing efficiencies and avoiding 
unnecessary wasteful and indeed harmful costs are necessary to preserve 
Medicare.
  My mother taught me a number of things. She said, No. 1, if you don't 
have something nice to say about someone, don't say anything. So I am 
not here to say not-so-nice things about the folks who say we ought to 
cut Medicare benefits. But I would oppose those kinds of cuts as 
unnecessary and harmful.
  She also said an ounce of prevention is worth a pound of cure. In 
fact, that basic truth is what will help save our health care system. 
Prevention of costs, prevention of illness, prevention of obesity and 
smoking, and other kinds of diseases and conditions that lead to 
increased health care costs are essential to this effort.
  My mother said also listen to your younger brother. My brother, Dr. 
David Blumenthal, has been a pioneer and an expert in this area. As 
much as it pains me to acknowledge that my younger brother knows a lot 
more about this subject than I do, in fact, he has been able to 
enlighten me and many of our colleagues here on this point. I mention 
him and the others who are experts and pioneers in this effort. He is

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one of many who have advised and provided that kind of enlightenment.
  Because there is no more kind of guesswork as to whether advances can 
be made in this area by cutting costs and raising quality. It has been 
documented. There are projections. It can be costed out. It can be 
scored, in my view. It can be the basis for action by my colleagues 
here in seeking to cut costs that are skyrocketing out of control.
  I have seen these reforms at work throughout the State of 
Connecticut. This issue is of national importance, but it hits 
hospitals and providers in every one of our States. I have seen it and 
listened to folks who work at places such as St. Vincent's and 
Bridgeport Hospital, in Bridgeport; St. Mary's Hospital in Waterbury; 
Yale-New Haven and Greenwich Hospital, Middlesex Hospital. All around 
the State of Connecticut, I have seen the checklists at work, the 
protocols for hand washing, the increased attention to quality care 
that has helped reduce costs. They have helped improve patient care 
while reducing cost. They reject this false choice between quality and 
cost cutting. Both are possible. Both are essential.
  We hear so much rhetoric about the Affordable Care Act in Washington. 
But in Connecticut, we see tangible examples of how it is working and 
making a difference. The implementation of the Affordable Care Act is a 
historic opportunity for continuing this work and expanding it 
nationwide. We need to continue our dedication to health care reform.
  My colleagues and I have come to the floor today to call for smart 
reform that helps patients and avoids harm to them, and does not 
discourage providers from being a part of a Federal health care 
program. In fact, we need to identify areas of reforms within the 
health care system that we can address that will strengthen health care 
in this country and address the serious concerns about the skyrocketing 
costs of health care.
  We have seen a slowdown in the growth of national health care 
expenditures over the past year. But slow growth certainly does not 
mean a decrease in overall expenditures. Smart policy decisions require 
that we address the ongoing problem of health care spending in this 
country, and turn a corner for the good by reducing the current costs.
  I am concerned that there are shortsighted strategies, such as taking 
money from the Prevention and Public Health Care Fund established under 
the ACA, which has been a tactic unfortunately used by both parties in 
financing programs. That tactic will undermine our long-term efforts at 
reducing health care spending. The Prevention and Public Health Fund is 
used in Connecticut for programs such as mental health services and 
substance abuse prevention, as well as public health research and 
surveillance.
  These measures will ultimately result in lower health care spending 
through prevention and preventive health care. But we need to stay 
committed and stay the course. What we need to do now is to continue to 
work toward developing a sustainable health care system, through 
structural reforms such as the accountable care organizations, health 
maintenance organizations, patient-centered medical homes that have 
provided advances in this area, and have created provider organizations 
that lead to greater provider acceptance of responsibility for health 
care outcomes in their patients.
  Measuring the success of those organizations requires taking a closer 
look at whether the savings and outcome improvements actually 
materialize. We have to be hard-headed and clear-eyed about whether 
they are working. The metrics must be applied. We need to measure 
success. Measurements are possible; as I said at the outset, no longer 
a matter of guesswork. There are scientific-based measurements.
  The success of these organizations will have more to do with how they 
are run than with how they are structured. As sophisticated as many of 
our health systems are, the development of process goals has only 
recently become a consideration. The Association of American Medical 
Colleges recommends, for example, the use of surgery checklists through 
their best practices program.
  Peer-reviewed studies have shown that the use of comprehensive 
checklists is associated with reductions in complications and mortality 
during surgery. But they are most successful when health care 
organizations subscribe to a culture of safety. That culture of safety 
and prevention is essential.
  Some hospitals in Connecticut have been rewarded through the Medicare 
Program for their commitment to improving quality through the use of 
process measures: Bridgeport Hospital, St. Mary's Hospital in 
Waterbury, Middlesex Hospital have all seen increases in reimbursement 
rates through the Value Based Purchasing Program.
  Again, the Federal Government can provide incentives and encourage 
and support this effort. Manchester Memorial Hospital, Hartford 
Hospital, and Rockville General Hospital all have avoided Medicare 
penalties by lowering their readmission rates. While payment 
differences for these programs represent a small portion of the overall 
Medicare payment, hospitals should continue to be rewarded for 
addressing these issues.
  I want to conclude by drawing attention to some of the innovative 
work being done in my State of Connecticut around delivery reform and 
data collection. I have mentioned the importance of measurements and 
metrics. Much of the work is supported by grants that were made 
available through the Affordable Care Act. But it has been the State 
itself that has decided how exactly to use these funds. While 
Connecticut has established a working group around innovative reforms 
which continues to work on specific proposals and recommendations for 
reforming the health care system, one of the areas of focus has been to 
ensure integrated clinical data exchange between health care providers.
  Connecticut has invested in interoperable health information 
technology systems and developing an all payers claims data base to 
create comparable, transparent information that can be better used to 
understand utilization patterns and enhance care access.
  One of the most basic aspects of reforming any system should be a 
clear understanding of where the biggest problems lie, and yet we still 
lack the data necessary in many systems to truly understand where the 
unnecessary spending is taking place. It is like a diagnosis of any 
kind of medical condition. Facts are essential. Data is key, and I 
believe an investment in information technology and data collection 
activities will help inform payers and consumers about where our health 
care dollars are being spent, where they are being spent most 
effectively, and where we can reduce spending that will ultimately 
enhance health care outcomes.
  Connecticut is taking a considered and insightful approach to 
obtaining and utilizing data while considering the needs of consumers 
and looking toward developing stronger programs for telemedicine and 
provider coordination. Technology is advancing. Data collection can 
help implement technology where it does the most good.
  We need tangible goals for long-term reform, and that is part of the 
work that we have described and we are undertaking as part of our task 
force.
  I know my colleagues this evening all agree with me that we need to 
continue this work and take advantage of advancing technology, the 
metrics that are now being sampled, of good practices, leadership of 
providers, the medical community, and good ideas wherever they are and 
whoever is willing to offer them.
  I wish to thank my colleagues for joining in this effort, and I look 
forward to returning on this subject.

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