Keynote Sessions at the 6th Annual WHCC



Well, it’s hard to do any “real-time” blogging with no plug for my laptop and no Internet access. I’m glad I actually began to try Twitter the other day. Here were the quick Twitter updates that I threw out there. To see all the “tweets” about the conference, you can go here (#whcc09).

  1. Information transparency is a waste of time if you don’t have choices. #whcc0927 minutes ago from txt
  2. Audience smiled less, gets less sleep, and less happy via gallup well-being survey done before event. #whcc0931 minutes ago from txt
  3. India $14 pmpy hc costs. #whcc09about 1 hour ago from txt
  4. Consumer reports rolling out safety and effectiveness comparisons to site tonight. Could be big deal and big first step. #whcc09 about 1 hour ago from txt
  5. #whcc09 highest selection on data to disclose is providing information on comparing mds (via audience poll). about 1 hour ago from txt
  6. Are consumers really willing to trade convenience for savings and broader coverage? Not real til it affects me. about 1 hour ago from txt
  7. #whcc09 healthcare is either engine for growth or anchor about 2 hours ago from txt
  8. #whcc09 ceo of kelly svcs says surveys show that greatest issue to starting company is access to hc about 2 hours ago from txt
  9. #whcc09 – ceo of wpt just said they sold nextrx to esrx as a way to lower costs. True in economy of scale perspective. What about coor about 2 hours ago from txt
  10. #whcc09 only 10% of audience believe costs will be managed with legislation in 10 years. About 50% skeptical. about 2 hours ago from txt
  11. #whcc09 – reform w/o public plan an option if meet admin’s 8 objectives. about 3 hours ago from txt
  12. #whcc09 – MA connector has 80% of purchases online in under 25 minutes. Will broker model die? about 3 hours ago from txt
  13. #whcc09 person from MA connector – waste is someone else’s income – one challenge. Their trend is only 5%. Not bad. about 3 hours ago from txt
  14. #whcc09 bs of ca ceo – hc is a right. Can’t achieve coverage w/o controlling costs. Involve constituents more often. about 3 hours ago from txt
  15. #whcc09 good speaker from administration…laid out principles…no secret sauce…costs, quality, coverage about 3 hours ago from txt


These are my notes from the sessions. As time allows, I will work on some “stories”, but I thought I would share this.

Dr. Hughes from the Obama administration:

  • HC costs are “crushing the budgets” of families and government
  • Businesses finding it difficult to maintain coverage and be competitive internationally
  • HC reform not just a moral imperative but an economic imperative (Obama says)
  • Not whether every American deserves coverage but how we get there
  • How we get there
    • Expand coverage
    • Prevention and expansion of public health
  • Hosting of localized healthcare session – 9,000 volunteers; 30,000 participants; 4,000 reports
    • Very similar findings
    • Affordable, high-quality coverage
  • CHIP plan
  • American Recovery and XXX Act
    • Billions for research and other health priorities
      • $19B to modernize system w/ HIT
      • $1.1B comparative effectiveness
      • $1B Prevention
      • $2B Community Health Centers
      • $500M for health workforce training and education
    • $87B to states for Medicaid and CHIP
      • Protect 20M Americans
    • HC tax cut of 65% for COBRA
      • 7M Americans
  • $630B healthcare reserve fund for next 10 years
    • 50/50 by increasing revenue and cutting costs
      • Tax the rich
    • Reduce overpayments to MA
    • Reduce drug prices
      • Expanding access to generics
      • Follow-on biologics
    • Medicare / Medicaid payment accuracy
    • Improving care for those that have been hospitalized
      • 1/5 Medicaid rehospitalized w/I 30 days
    • Align incentives for quality not just quantity of services
    • LT investment
  • No written plan…approaching with open mind to collaboration
  • President has endorsed 8 principles
    • Protect family health
    • Affordable
    • Prevention
    • Quality and safety
    • Portability
    • Choice of MDs
    • No pre-existing conditions
    • End LT health cost growth for business

Bruce Bodaken – CEO of BS California

  • Lessons learned from failed CA experiment
  • Principles:
    • Healthcare is a right (can’t turn a blind eye)
    • Can’t achieve coverage w/o controlling costs
  • Been working on CA legislation since 2002
  • Need to touch base w/ constituents more often
  • Need unions and business in lock-step
  • May not want to take this all on at once [big bang vs. incrementalism]
  • Can’t be globally competitive w/o addressing cost issue
  • The right time to see this happen…”capture the moment”
  • Change happens when things are up in the air

John Kingsdale – MA Health Connector

  • Moral challenge that the country has to win
  • Passed 198-2 in MA (across both houses)
  • Bit of genius to how they did it
    • Bit off what they could chew
    • Almost universal (2.6% uninsured)
    • Universal insurance in Europe is closer to 1% uninsured
  • Costs no more worse than CA and other places
  • Didn’t worsen costs (5% annual trend)
  • Didn’t do radical attack on costs…health care reform 2
  • Pay ~600% more than industrialized countries for administration of health
  • Pay ~300% more per day in hospital than other countries
  • “Waste is someone else’s income”
  • Moving away from fee for service model
  • How does the federal government do it in depth of recession?
    • Premium increases still going up 10% while in recession / depression…how is that possible.
  • Connector
    • Educate and inform buyer
    • Put forth high value option
    • Facilitate comparison for “shopping”
  • Connector can create a modern way to distribute health insurance…but this will threaten some of the existing players [i.e., brokers]
    • Should be all online
  • 80% of their purchases are online in 20-25 minutes



  • Need for bi-partisan support. What’s president’s perspective – important or will he ram it through?
    • Wants bi-partisan support.
    • President will do what he has to do to get it passed.
  • One of the big elements of discussion is having a big public plan. Does it drive private plans out of business? Don’t take away from what people have. How does administration think it will play out?
    • There are lots of good plans out there. Administration open to change / discussion. Plan doesn’t have to have public plan if it meets his 8 objectives.
    • Having regulation w/ teeth important. Risk pool vs. head-to-head competition.
    • Proposals for single payor in CA has failed multiple times.
    • Need to do something other than putting ½ T business out of business


Audience Polls:

  • Believe legislation will be passed
  • 50% believe we will make marginal progress in next 10 years
  • ~ 50% feel that cost mgmt unlikely
  • 40/40/20 audience split btwn republican/democrat/independent



Second Session – Facilitated by Vanessa Fuhrmans (WSJ)

Health and Money

Angela Braly (WPT), Carl Camden (CEO of Kelly Services), and Mark McClellan (Brookings Institute)


Audience Poll: 42% believe individuals should pay the most for HC



  • Jeopardy question ” what does WPT provide to 1 in 9 americans?” answer was life insurance which was wrong
  • Needs to be a game-changer.
    • Need solution for uninsured
    • Don’t think gov’t plan is the right answer
    • Think need to make changes in individual market
    • Enforceable
    • Reward healthy behavior
    • Guaranteed issue
    • Focus on cost and quality
  • Sold PBM since it’s a way to drive to lower cost


Poll – what % of 17M adults going to MD will receive recommended course of care – 55%


CEO of Kelly Svcs

  • 26% of workforce is “free agent”
  • Expected to grow dramatically
  • The group that produces the most new business start-ups
  • US falling behind others in start-ups per 1,000
  • Greatest impediment to starting business in US survey is access to HC
  • Total costs of employment in US is driving move to offshore
  • Question should we where jobs are growing vs. whether companies moving offshore


Mark McClellan:

  • HC can be engine for growth or anchor
    • Is spending getting more or due to inefficiencies?
      • Life expectancy goes up 1 year per decade
  • Have to change the system not just buy more people into the current system
  • Lots of examples of getting much more with less
    • Cleveland Clinic
    • Geisinger
  • Key steps:
    • Major emphasis on measuring quality and cost
      • Consistent, meaningful, patient level, outcome based
    • Create accountability in payment systems and benefit systems


Audience Poll – Do you support reforms to the current payment system – 82% support major reform.


Audience Poll – Do you support reforms to the current delivery system – 84% support major reform.


Audience Poll – Would you still support if it affected access to your md, policies and cost – 67% yes. [this is a major variance from public response]


Angela – Private insurers will take proactive role in driving healthcare payment reform. Aligning reimbursement w/ outcomes may be the result. Compensating for prevention is important.


Mark – Lots of worry about comparative effectiveness being over simplified and mis-applied.

Mark – Need to focus on value in HC.

Angela was asked the “tough” question on why hasn’t healthcare reformed itself. I thought she had a great answer…”because people want convenience”. Members don’t want to have smaller networks or restricted access. They want everything, but at a lower cost. [Not a likely scenario.]

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