Dr. Farzad Mostashari, Brookings Institution

(Music)

Ma rk Masselli : This is Conversation on Health Care, I'm Mark Masselli.

Margaret Flinter : And I'm Margaret Flinter.

Mark Masselli : Well, Margaret , the growing pains continuing for the online insurance
market places Verizon who hosted the data hub was down, knocking the exchange side
down as well. They ’ve had a fair share of problems , Margaret, but they also have
brought in some technical experts to get this thing resolved.

Margaret Flinter: That’s right and even while it was happening, Mark, CMS
Administrator Marilyn Tavenner was on Capitol Hill apologizing to a Congressional
Committee about the problems with the exchange saying it wasn’t acceptable, taking
responsibility, vowing to see a fixed and setting a deadline by wh en it would be fix.

Mark Masselli: You know also they ’ve en counter to another problem in addition to the
website, people are saying that millions of Americans are being kicked off their
insurance, I think the Secretary Sebelius clearly laid out and m illi ons of Americans
annually prior to this have lost their insurance, they had insurances that were sold to
them that it didn’t cover anything, and anytime that they found themselves needing
health insurance, many times they we re dismissed from the plan, that ’s no longer
allowed and I think that’s good news.

Margaret Flinter: I agree with you and speaking of Health a n d Human Service
Secretary Kathleen Sebelius well s he ’s been on the hot seat taken a bit of a drumming
from some members of Congress over this problems with the launch of the Federal
Exchange .

Mark Masselli: Meanwhile the President chose a different venue to bring this case to
the people, he travelled to Massachusetts which has h ad a very robust health insurance
plan, but we didn’t started out , it also face these similar problems, those who are in
distinct memories and now people enjoy a robust plan from Massachusetts as well as
the Federal Plan .

Margaret Flinter: But you know t he administration I think did make a reason and
appropriate decision to extend the deadline for the individual mandate to purchase
st
insurance by March 31 , they’ve extended that deadline for opening (2:01 inaudible )
th
and other six weeks out to April 1 5 , I think that was a good recognition that people had
been inconvenienced and who knows if ultimately that made the difference but
appropriate decisions to make.

Mark Masselli: Margaret I think you're absolutely right on that, and some good news
came out r ecently for those Americans who rely on Medicare Part B Premiums , their
rates won't be going up in 2014, remaining flat. Medicare Part D had save seniors over

$8 billion in drug cost as well, so a positive bit of news for seniors relying on this
program.

Margaret Flinter: Well our guest today knows quite a bit about change in the Health
Care A rena, Dr. Farzad Mostashari recently left his post as the National Coordinator for
Health IT at the Department of Health a n d Human Services . He is now at the Brooking s
Institution where he is going to continue to promote the expansion of Health Information
Technology across the country to improve Health Care . H e’ll be taking a look back and
also talking about his new endeavors.

Mark Masselli: We’ll also be h earing from Lori Robertson, Mana ging Editor of
FactCheck.org who would be stopping by to shine a spotlight on the statements made
about health policy in the public domain.

Margaret Flinter: But no matter what the topic you can hear all of our shows by
Googling CHC Radio.

Mark Masselli: And a s always if you have comments please contact us at chcradio.com
or find us on Facebook or Tw it ter, we’d love to hear from you.

Margaret Flinter: Now we’ll get to our interview with Dr. Farzad Mostashari in just a
moment.

Mark Masselli: But f irst here’s our producer Marianne O’Hare with this week ’ s Headline
News.

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Marianne O’Hare : I’m Marianne O’Hare with this Health Care Headlines . The Obama
Administration on the offensive. President Obama using last week ’s Anniversary of his
Reelection , to trumpet a campaign and making sure the onlin e health insurance
marketplace is work, saying he’s got one more campaigning and President Obama
vowed continue the work on the issues plaguing Health Care .gov until the system runs
smoothly. Plagued with merrier problems and setbacks on the Federal Exc hange or
cowdrey of handpick top of the line coders from across the internet spectrum are
working a round the clock to fix the system, some of the top folks from Google, Ama zon
and more. They're still shooting for an end of November deadline , they have the worst
to the problems sort it out. However around of criticism against the law continue to
mount with each passing day, to allow this course resonating from the right of the isle
but the increase number of d emocrat and support ers of the Health Care Law are calling
for recalibration of the timeline as it is the deadline sign up for health coverage has been
th
extend six weeks to April 15 . And though the state based insurance exchanges are
generally being run more efficiently, they are still problems being reported there as well
especially a juncture s where the state exchanges interface with the Federal
Government website. Well tens of thousands of customers have gained coverage and
exchanges across the country and states like New York, Connecticut , and California, as

of last week not one customer in Oregon had been able to sign up due the problems
with their website.

And what about those policies being cancel ed by insurance companies across the
country, millions of self - insured residents have gotten cancellation notices on policies
but there is somewhat of a back story, most of those plans are expensive with high
deductable and don’t cover the essential benefits required by the Health Care Law,
some insurance companies then urging them to get it more expensive plan in that
insurance company stirring them away from the exchanges as the number of this poli cy
holders look into the Federal or State Exchanges for an alternative their finding those
policies are cheaper, cover more and relevant to capitalize on government subsidies, to
defray the cost of health insurance. N umber those insurance companies are already
been fine d for misleading their customers. And with all of the hullabaloo over the Health
Care Law especially in Congress, there is one bright spot in the horizon bipartisan
support for a fixed to the SGR the Medicare Reimbursement Formula that’s been
plaguing the Health Care industry for years as a major under consideration that would
freeze current reimbursement for 10 years and fixed the formula to reward value and
outcomes, without a fixed Congress hold s to the Health Care industry in each grip every
year while votin g on the last minute so called do c fix. I’m Marianne O’Hare, with this
Health Care Headlines .

(Music)

Mark Masselli: We’re speaking today with Dr. Farzad Mostashari a visiting fellow with
the Engelberg Center for Health Care Reform at the Brookings Institution, Dr.
Mostashari was recently the National Coordinator for Health IT at the US Department of
Health and Human Services where he led a national initiative to promote widespread
adoption of Health Information Technology. D r. Mostashari has served at the Center for
Disease Control and Prevention; also serve as Assistant Commissioner at the New York
City Department of Health and Mental Hygiene with initiative and serves as Chair of the
International Society for Disease Survei llance. Dr. Mostashari , welcome back actually
do Conversations in Health Care .

Dr. Farzad Mostashari: Thank you for having me back.

Mark Masselli: Well, we’re in that hopefully the final stage is the rollout of the Affordable
Care Act and there has been 7x24 on the troubles of healthcare .gov the Federal Portal
to the online insurance marketplace and we’re sure they're going to get that fixed but
sort of lost in this larger focus has been the work that you’ve been doi ng on meaningful
adoption of electronic, health records across the country to improve health care delivery
through better health and management. So tell us a little bit if you will about your
thoughts on the current crisis, but also the bigger Health IT i ssues that are not part of
the current debate that’s going on in the Congress.

Dr. Farzad Mostashari: Absolutely. So, I mean the one thing is the Affordable Care Act
has taken some big steps for ward in terms of getting people covered, whether it’s

throu gh the Medicaid expansion, whether is through children under the age of 26 being
able to stay on their parents insurance with pre - existing conditions and this is the last
piece of that puzzle fitting together to get the 15% of US population , it doesn’t hav e
access the health insurance, access to health insurance which is a good thin g , and you
know I think all the discussions we can't forget about -- yeah almost the moral
imperative of having people be able to access health insurance which they never could
d o before. The website is not the Affordable Care Act and at the end of the day there
are better options for people today than we had before to be able to have access to
Affordable and Health Insurance . And I think that the website issues will be resolved ,
but at the end of the day it’s going to come down not the discussion of health policies ,
it’s going to come down to individual consumer thing. Do I have accessed to better
health insurance and less expensive premiums and including with the subsidies the n I
have before and I think for the vast majority of Americans answers are going to be yes
for those who didn’t have insurance or who are transitioning as I am, I -- for me to be
able to keep the insurance, the family plan that I had with my family and my federal job
after I left my federal role last month would have cost our family $25,000 a year, if I
were purchasing it as an individual. On the Maryland Exchange yesterday I went on,
and I went all the way through and it work.

Margaret Flinter: Yes.

Mark Masselli: Isn’t that great.

Dr. Farzad Mostashari : I could get that same family plan for $10,000 a year , that is
outstanding and it’s you know , it ’ s better.

Margaret Flinter: Well Dr. Mostashari thank you so much for putting in that perspective
y ou ’ve obviously just left a very high profile job as the National Coordinator for Health
Care Information at the Department of Health and Human Services, you also had
another goal which was not just to implement them but to liberate the data that came
from them to accelerate the pace of research which ultimately improves Health Care
and improves health outcomes. Perhaps you could give us an assessment, how far
have we come in the United States since the time that you join the ONC about four
years ago?

Dr. Farzad Mostashari : The short answer is about half we done trough the basic
process, the first step of bringing the age of data to health care , digitizing health care .
So, when we started at 8.8% hospitals , about 17% physician practices did and within
th th
just a few short years that number went up 5/4 for hospitals and 3/4 for physician
practices. S omething that was you know pretty unusual just a few short years ago is
now the norm, using electronic health records to take care a patient not just to billing,
but as you point out that just the first step and what are we using them for and how are
the meaningful use requirements around population health management around being
give n to examined disparities and the care you're providing and being able to share
information with patients, and with each other. Those are just tactical capabilities; those
are competencies in delivering health and new ways which I think we’re only about five

to 10% of the way through figuring out how to use the technology in t hese new ways,
but a whole lot of work yet to be done.

Mark Masselli: You started to talk about the information share with patients and I was
thinking about the next 10 years really being about consumer engagement and thinking
about the sort of the three A’s Access, Action and Attitude. So talk to us about what you
see this sort of shared decision making with patient at the center of this, how are we
going to engage the consumer, what’s the paradigm shift?

Dr. Farzad Mostashari : There’ s a whole series of behaviors that flow down from how
we pay for health care , and it really runs counter to what people went to medical school
to do with their lives. But there is a couple of big trends here that are changing that
equation, the first is changing in paymen t that does two things, one increasingly the
patient perspective and patient experiences are one of several factors that are going to
play into physician reimbursement. And you know like it or not but there is going to be
more attention and money behind t hose , b ut more substantially I think is going to be
those measures and metrics relating to outcomes that the patient get readmitted. Well,
so me of that, a lot of that is going to be what happens to patient and how well they know
how to take care themselves after the y leave the hospital. So there is a lot more
attention now all of a sudden because of the reimbursement changed to making sure
the patient understand s by golly, yes, let’s bring the family member in too, so they can
understand, so ther e is a better passage and they can help take better care of
themselves. And then the other massive megatrend is the fact that that hardware and
software, and platform is now ubiquities in more and more pockets we have this
smartphones that are really goin g to be able to be equitably powerful tools if an
ecosystem emerges to help turn that data into useful actions for people, and that is I
think one of the most exciting things happening now is this vast ecosystem that starting
to get rolling that is around health and wellness, and I think it’s very exciting.

Margaret Flinter: It is very exciting, and do you know I have to draw an analogy here
between the excitement about engaging patients, engaging them in decision making,
giving them tools to change and t o make progress. And what the office of the National
Coordinator did with the creation of the regional extension centers for the adoption and
implementation and meaningful use of the electronic health records and I think the
question might be does that st ructure live on passed years of the meaningful use dollars
and the High Tech Act should become something of a cornerstone or a building block
that we can use when we need large scale change improvement and advancement, and
the health care system but we nee d on the ground, we need to enroll communities and
urban communities. We needed across America, I’d be so curious in your thought s on
that.

Dr. Farzad Mostashari : Gosh, I can't say it more beautifully than you just did, it’s really
been an incredible success story, there is nothing I'm more proud then the work that the
62 Local and Regional Health IT Extension Centers did i n reaching out to in their own
communiti es, reaching out to those most difficult implementation effect, not taking the
easy , right ? The Extension Centers went to the hardest, they went to the small

practices and so the practitioners in the community health centers, and the rural health
clinic, and the critical access hospitals, and they got 143,000 primary care providers to
help them get to this really very difficult process of changing what we’ve been doing for
5 , 000 years writing with pen and paper into electronic age. Now you're asking well now
what, are we done? No, we’re no done. How to use that in the process change and
how to get quality improvement and how to do the patient engagement piece of this and
how to succeed ed Accountable Care, don’t we need boots on the ground to help with
th at too ? More than ever I would say, more than ever. And it is the -- it is really the
largest force that we do have for practice transformation in this country. And yeah, you
know I don’t know if it’s going to be the State that step up, there are many S tates who
have now enable to leverage 9 to one f ederal funding actually to help those Extension
Centers , extend their work to special ist on the Medicaid si d e, but the fundamental
problem I think here is that they have been seen as something that should be free or
almost free. And making that mental switch to think, I'm not going to compare it to free,
I'm not going to compare it to the 50 or 100,000 dollars that’s going to cost me to bring
in a private sector consultant to those half of what these guys do, that I think is the
challenge that we’re facing.

Mark Masselli: We’re speaking to day with Dr. Farzad Mostashari visiting fellow with the
Engelberg Center for Health Care Reform at the Bookings Institution . Dr. Mostas hari
was recently the National Coordinator for Health IT at the US Department of Health and
Human Service s, where had led as National Initiative to promote widespread Adoption
of Health Information Technology. And we've talked to -- and you ’ve talked abou t the
transforming the health care landscape is we really need to take an American approach
to payment reform and there has been a lot of focus about the Accountable Care
Organizations being a big factor in this new payment models. You know wondering if i t
really is going to come from those areas I think they seem to be out there but in name
only and I wonder what your thought s are about Medicare and Medicaid really leading --
leading this drive because I think you have to ask yourself the question what do we
pay ing for , we’re paying for people to get healthy, right ?

Dr. Farzad Mostashari: Absolutely.

Mark Masselli: So or we ’re paying to save money, short - term savings, and I wonder if
Accountable Care Organizations without the f ederal leadership here really going to --
really come into to their own right now, and so tell us what y ou're thinking about what
you see the future to be about new payment approach to really shift this landscape and
absolutely been a cross curve but to cl early get away from this terrible model that we
have now which requires the body to comment, you know and sort of , so lot I -- just is in
focus on the patient or outcomes.

Dr. Farzad Mostashari: I am a big believer in the concept of the Health Care
Organ izations and I think it is the single best hope we have for primary care in this
country. I think it’s a huge opportunity and it’s really the primary care physicians in all
this and that hold the keys to the kingdom and they don’t even know they're holdin g it.
And with the Accountable Care Organization which is a national program that’s

available to any primary care provider that a group of primary care providers, they have
more than 5000 Medicare beneficiaries. The core concept there is if you improve
q uality, if you improve chronic disease management, care coordination, and you keep
people healthy and out of the hospital and then you get to share in the savings that from
that and that is just an enormous opportunities for primary care because primary ca re
providers don’t account for more than a few tiny percent age point to the total health care
cost , so by investing more and this is what we've been saying all alon g but now here’s
an opportunity to walk the talk, right ? If you deliver more and better pri mary care and
keep people healthy, you will be able to recoup those cost to be able to reinvest in the
kind of improvement and the kind of care that you’ve always wanted to provide.

Now the challenges here is knowing how to do that is not easy, we have a lot of the
information tools but we don’t have I think as you pointed out the widespread
understanding of how to use the tools to meet those payment models. How to be able
to reduce those admissions that are enabled to care sensitive , how to be accountable
and to be able to account all my patients and I'm anticipate who is going to be the one
to get in trouble and to reach out to them affirmatively instead of waiting for them to
make an appointment with me. And those are fundamentally new skills and we have
Accountable Care Organization learning network here at Brookings that I'm really
working to invigorate the physician ACO part of the process. And I really invite anybody
who is a physician ACO, if you're a primary care practice and you're not thinking about
it, by god you're missing the opportunity and I’d love to have you engaged with me here
at Brookings on that activity.

Margaret Flinter: You know it’s -- in many ways you're describing a phenomena I think
of recent years which is the all health care people have understood every responsibility
to be lifetime learners, lifelong learners.

Dr. Farzad Mostashari: Yes.

Margaret Flinter: Staying current with the developments in science, but now that’s been
a new focus put on people to be life time learners of practice transformation of lifetime
learners of quality improvement and of new techniques and yeah we -- you know we
just had this conversation with a team of our colleagues this morning , has this gone to
the level of the schools of the health professions, about the undergraduate schools and
certainly the graduate professional schools from your purge, w hat are the
transformations happening in the education and preparation of the next generation that
are going to make this a smoother, easier platform for everybody ?

Dr. Farzad Mostashari: That’s a great question . I have long regretted that when I was
going through my medical training there really wasn’t much of a focus at all on
improvement science, on m anaging population it was 100% focus.

Margaret Flinter: Right.

Dr. Farzad Mostashari: You have a person in front of you who have an illness, and
almost to the exclusion of even understanding the context, the community that that
person comes from. The time and where are we and when are we, and what ’s
happening of which the population with that person is merely one example, and how
they improve a cohort of patient s . Those are skills that are still not being taught, and
the electronic health record, I kn ow that there are in many schools -- the students don’t
even have the right to touch the record, because they don’t -- they haven’t figure out the
policies of how to make sure that the counter signing in a medical aspect or liability
issues or addressed. But those are solvable problems and absolutely I think the
medical students, nursing students and others can be huge assets, and part of their
training must be how to use information systems to improve population health, as well
as individual health. The wonder array of light that I'm seeing, we’re doing a pilot –
ONC is doing a pilot study now, with the experiment with the curriculum with educators
and tough medical school but I had recently heard from someone that some of the
newer medical school s are actually incorporating these themes into includ ing the one I
heard in Connecticut. So and maybe again some of the disruptors, some of the new
comers that for which – are the most interesting things occurred.

Mark Masselli: You know I want to harkin g back to the days that you and Tom Farley
were working in New York City’s Department of Health and Mental Hygiene.

Dr. Farzad Mostashari : Yes.

Mark Masselli: First of all a shout out to Marry Bloomberg for how did he assemble the
two of you it’s sort of a great end others -- and others who were there but you know for
this learning the public health folks who are also listening, talk about sort of passion that
brought there you all were thinking about really radical transformations of the muni cipal
environment, and they had national, international implications , what we need back in
our communities at the governmental level, what type of leadership do we need to
continue that because there are really the place for real transformations in our cou ntry.
Certainly the national work that you’ve done has been exciting but I still harking back to
those days and the excitement that you brought into the national arena.

Dr. Farzad Mostashari : You know Tom -- Tom and I wrote a paper and it was about
Near City Smoking experience and then how smoking in teens was drop ped by half and
adult and after years of beings dime and it came down because of the combination of
things that we did, driven by data, driven by evidence, but really hard policies but you
know whether it’s smoke free or whether it’s cigarette attacks, whether it’s coming down
on more enforcement, whether it’s education, whether it’s marketing and so forth. But
at the end of the article we said you know in order to have sustain improvement as
f ederal action is needed which is kind of a standard thing that people that local to the
state level, they always write in the end of their articles right like we need federal action .

(Multiple Speakers)

Dr. Farzad Mostashari : And the editor made one change, they cross out that line and
said our evidence shows that local action can't have a major impact. And I think that’s I
guess the lesson that I take away from that is that everyone of us can be leaders in our
community, and to paraphrase the wa rning that I heard this today you know, doing,
saving lives is simple, it just hard .

Margaret Flinter: Great.

Dr. Farzad Mostashari: We know what to do, we know what to do saving live s is sim ple,
there are few simple thing, right, the ABC ’ s right focus on the blood pressure control
and the cholesterol, and smoking and there are public programs that we know work, it
just hard to do them but let’s do them, and we will see the results. And that I guess is
what I will give real praise to Marry Bl oo mberg , h e was never afraid of doing the simple
but hard thing that would save lives.

Margaret Flinter: Well thank you for that shout out to personal to local and to national
leadership, all of which you embody. W e’ve been speaking today with Dr. Farzad
Mostasha ri, visiting fellow with the Engelberg Center for Health Care Reform at the
Brookings Institution, and recently National Coordinator for Health IT at the US
Department of Health and Human Services. You can learn more about his work by
going to brookings.edu; also follow him on Tweeter @farzad_md, Dr . Mostashari thank
you so much for joining us on Conversations on Health Care .

Dr. Farzad Mostashari: Thank you.

(Music)

Mark Masselli: Conversations on Health Care we want our audience to be tru ly in the
know when it comes to the facts about Health Care Reform and Policy , Lori Robertson
is an award winning journalist and Managing Editor of FactCheck.org, a nonpartisan,
non - profit consumer advocate for voters that aim to reduce the level of decept ion in US
politics. Lori , what have you got for this week?

Lori Robertson: We've seen true and false claims about the Health Care Navigators ,
these are the Federal Workers funded by the Affordable Care Act that educate the
uninsured about their option s on exchange s , and help them enroll for coverage. Let’s
start with the false. House Republican claim ed on the energy and commerce
committees website that a Fox News reports makes clear that navigators were going
door to door to enroll American s , after the Obama Administration said that they would
not be going door to door, but the Fox News report was mistaken, the workers that
showed weren’t navigators, they we re representative of the United Way of Florida, and
a group called Enroll America. Ne ither group receive federal funding under the
Navigator Program , we spoke with both groups and centers for Medicare and Medicaid
Services to confirm that. Now for the tru e, Senator John Barrasso claims that
navigators don’t have to go through criminal bac kground checks that’s right . There is
nothing in federal statute that requires such checks. A handful of states five of them to

be exact have added that requirements, and there are other safeguard and protecting
against identity theft which was Barrasso’ s concern . A nd that’s my FactCheck for this
week, I am Lori Robertson, Managing Editor of FactCheck.org.

Margaret Flinter: FactCheck.org is committed to factual accuracy from the country’s
major political players, and is a project of the Annenberg Publi c Policy Center at the
University of Pennsylvania . If you have a fact that you ’d like check email us at
chcradio.com, we ’ll have FactCheck.org ’s Lori Robertson check it out for you here on
Conversations on Health Care .

(Music)

Margaret Flinter: Each week, Conversations highlight s a bright idea about how to make
wellness a part of our communities and everyday life, when Derreck Kayongo was a
young refugee living in Africa; he learned the true meaning of survival.

Derreck Kayongo : He tell the wor ld can you simply describe as a kid (28:11 inaudible )
hut place, it’s finding all your pieces and trying to put them back together.

Margaret Flinter: Rescued by an aid organization and brought to the United States, he
knew he had to do something to make a difference in the lives of those many children
left behind. Children displaced by war, orphan by disease, living in extreme poverty, 2.4
million chil dren died each from lack of access to basic sanitation.

Derreck Kayongo : We have about two million people kids die of sanitation issues,
mainly because they don’t wash their hands.

Margaret Flinter: And when Kayongo learn the hotels around the United S tates
disposed of 800 million bars of soap every year, he knew that was a resource to tap
into.

Derreck Kayongo : 800 million bars of soap in the hotels throw away in the US alone
every year.

Margaret Flinter: He fou nd that the Global Soap Project , the discarded soaps are
gathered and processed to the plant to sanities , i t’ s melt and reform s new bars of soap
that will be distributed around the world to children and families living in poverty or in
disasters zones like Haiti and with that the children were give n lessons and basic
hygiene, some learning for the first time, how to thoroughly wash their hands and why.
The Global Soap Project earned Kayongo the distinction of one at CNN’s hero finalist,
and he was also winner in the Annual Classy Awards . We support philanthropic work
that improve s health and wellness around the globe. A simple idea repurposing the
waste of soap and providing one of the most simple tools of hygiene to those in need
around the world, now that’s the bright idea.

(Music)

Ma rgaret Flinter: This is Conversations on Health Care , I'm Margaret Flinter .
Mark Masselli : And I am Mark Masselli , peace and health.
Conversations on Health Care broadcast from the campus of WESU at Wesleyan
University , streaming live at wesufm.org and brought to you by the Community Health
Center .