Health Care Transformation Task Force Chair Dr. Richard Gilfillan on Value-Based Care Policies Trump and Congress Must Consider

Dr. Richard Gilfillan

(Music)

Mark Masselli: This is Conversations on Health Care. I am Mark Masselli.

Margaret Flinter: And I am Margaret Flinter.

Mark Masselli: Well Margaret, we're seeing more momentum towards repeal of
the Affordable Care Act . The House has followed the Senate’s lead and passed
its own resolution leading to dismantling of the Health Law and a number of
provisions they are putting forward are eliminating everything from protections for
those with pre - existing conditions and also protections from lifet ime caps o n
insurance payouts.

Margaret Flinter: There has been really quite a bit of effort to initiate repeal of the
ACA or at least many aspects of it which are quite popular with consumers.

Mark Masselli: But still a lot of unanswered questions fro m the health care
industry as we look forward.

Margaret Flinter: And that’s something our guest today has unique insight into
Mark, Dr. Richard Gilfillan is CEO of one of the nation ’ s largest not - for - profit
health system Trinity Health

Mark Masselli: H e served as the nation ’ s first director for the Center of Medicare
and Medicaid Innovation in the Obama Administration and before that he was the
top executive at Geisinger Health System .

Margaret Flinter: Dr. Gilfillan is also the chair of the Health Ca re Transformation
Task Force . That’s a consortium of stakeholders across the country all of whom
have recalibrated their business models in recent years to a lign with the
directives of the ACA to incentivize ways for the industry to trim costs and
improve care.

Mark Masselli: Lori Robertson always stops by , the Managing Editor of
FactCheck.org , but no matter what the topic you can hear all of our shows by
going to www.chcradio.com .

Margaret Flinter: And as alway s , if you have comments please email us at
[email protected] or find us on Facebook or Twitter, we love to hear from you .
We will get to our interview with Dr. Richard Gilfillan in just a moment.

Mark Masselli: But first, here is our producer Marianne O'Hare with this week’s
Headline News

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Dr. Richard Gilfillan

Marianne O'Hare : I’m Marianne O'Hare with these Health Care Headlines .
Showdown in the Senate , in the confirmation hearings for Georgia Congressman
Tom Price to beco me secretary of the Department of Health and Human
Services , all Democrats serving on the Finance Committee boycotted the
meeting that would have sealed his nomination. Senate rules require at least
one member of the minority part y to participate in the c onfirmation vote .
Democrats demand ed the chance to ask more questions of Price who had
already taken significant grilling over his investment portfolio which included a
number of pharmaceutical companies who allegedly benefited from his past
legislative a ctions. A day later the majority of Republicans on the Finance
Committee overrode the Democratic boycott confirming him anyway.

Meanwhile , a delay of another kind, President Trump’s Muslim travel ban is
impacting health care already . 25% of the nation’s physicians hail from other
countries and a number have been held up already in the wake of the ban . The
90 - day ban is the first wave but there are concerns among hospital and other
health administrators that the announced extreme vetting of all attemptin g to
come in from certain Muslim countries could prove an additional barrier.
President Trump also met with leaders from the pharmaceutical industry, that
industry he has publicly vowed to crack down on for exorbitant drug pricing . The
President urged th em to not only lower their prices but do more to manufacture
drugs in the US. Trump also vowed he would streamline the Food and Drug
Administration making it easier for drugs to gain approval and access to the
marketplace. Trump also sent a warning to fo reign countries that benefit from
drug manufacturing business that they will “have to pay their fair share . ” Trump ’s
saying he was putting an end to what he called global freeloading .

A nd if you don't use it you could lose it. According to a recent stud y conducted at
the Mayo Clinic in Arizona engaging in brain games for older adults actually does
delay the onset of mental decline. The study looked at 70 - year - olds who had not
begun to exhibit mental decline , those who engaged in game play saw a 22%
redu ction in the onset of decline , but other activities had significant benefits as
well . Those who made crafts saw a 30% reduction in mental decline. The
study’s author s say learning a complex new task like quilting or photography
showed a significant benef it for older participants , so want to keep your wits
about you get creative , stay busy and get in the game.

I’m Marianne O'Hare with these Health Care Headlines .

Mark Masselli: We're speaking today with Dr. Richard Gilfillan , CEO of Trinity
Health one o f the nation ’ s largest not - for - profit health systems serving
communities in 22 states . Dr. Gilfillan served as the first director of the Centers
for Medicare and Medicaid Innovation . Prior to that Dr. Gilfillan served as Chief
Executive Officer of Geisin ger Health Plan . He also serves as chair of the Health
Care Transformation Task Force and ha s twice top ped Modern Healthcare’s list
of Most Influential Physician Executive s. Dr. Gilfillan received his undergraduate

Dr. Richard Gilfillan

medical degrees from Georgetown Univers ity and an MBA from the Wharton
School . Dr. Gilfillan , welcome back to Conversations on Health Care .

Dr. Richard Gilfillan: Thanks very much Mark , it’s great to be back with you.

Mark Masselli: We ha ve you back and so much has happened . Now you run
o ne of the largest not - for - profit health systems , Trinity Health . You are , as we all
are , welcoming the new Trump Administration . Many are expecting significant
changes to health policy . What do you think the changes will be, and what are
the challenges for an organization like yourself to address what looks like a pretty
dramatic shift in policy?

Dr. Richard Gilfillan: I think first the conditions that we a re trying to address with
improving our health care system continued to be ensuring that people h ave
access to care and making sure that we have a delivery system that is capable of
delivering high quality care. I think those two realities will continue to drive efforts
in Washington to improve health care . We always knew that there would be a
secon d act in transforming our health care system and now that act is being
written . I am hopeful that we will find a way to continue to have access for
people to real coverage and have them be covered with great insurance plans
and I am hopeful that we will c ontinue on the work that has been done across the
entire country transforming the way we deliver care . And I believe that that issue
of transforming the delivery system has always been b i partisan and that gives
me comfort . That’s a course we’ve been movi ng on towards changing our
system into a people - centric health system focused on delivering better health ,
better care and lower cost for as many people as possible will continue to be the
right strategy.

Margaret Flinter: Well Dr. Gilfillan you we a r an o ther very important ha t at this
moment in time as the Chair of the Health Care Transformation Task Force .
That’s a coalition of more than 40 stakeholders really across the top tier of
providers, payers, patient groups , all of whom I think we can say have been very
focused on the importance of shifting to this value - base d system of care delivery .
So can you talk a little bit about the goals of the Health Care Transformation
Workforce , who some of the key players are, but really what are the driving
initiat ives of the task force at this time?

Dr. Richard Gilfillan: Many of us in the private sector felt that it would be
advantageous to develop a center of gravity and momentum to encourage and
move forward on changing our delivery system , and so individuals from and
leaders of other health systems, private insurers, employer groups and patient
advocacy groups came together to build this task force . The first goal we
established was to have 75% of our respective business for the payers and the
insurers and th e employers operating through alternative payment models that
reward providing the triple aim for the people we serve. So we felt we could do
that by being out front and establishing a goal , finding new ways of delivering

Dr. Richard Gilfillan

care and paying for care sharing those across the industry , encouraging public ,
government programs, state and national programs to align with these private
sector initiatives because the path to really achieving a sustainable value - based
payment system is by aligning private sector and p ublic sector efforts.

Mark Masselli: Your group just wrote a letter to the incoming Trump
Administration as well as leading members of Congress to approach such
reforms cautiously . just thinking about what you had said earlier about the
dynamic being di fferent and the hope for bipartisanship , the real problem with the
first round of the Affordable Care Act was it didn’t have bipartisan support . Is
your group worried about that it may be déjà vu all over again to give the health
care industry some assuri ty that this is not going to find itself turned over again in
the future?

Dr. Richard Gilfillan: Actually over the last seven years it’s safe to say that the
notion that people deserve coverage I think has actually become settled , exactly .
I think that’ s true . But I believe that we have seen in our country that it makes
sense for people with pre - existing conditions to have access, it makes sense for
young people up to age 26 to have access to coverage through their parents ’
plans . So exact mechanisms , clearly there will be debate and disagreement. On
the other hand with regard to delivery system reform , I believe there has been
bipartisan support . The most obvious evidence of that of course is MACRA ; it’s a
bipartisan bill that encouraged the movement towards alternative payment
models . Every time I went to the Hill and talked with people on both sides of the
aisle there was support for this notion of delivery system transformation , and so
from our standpoint as a health system we want our people to h ave access to
coverage and our members of our task force want to continue down this path to
change in the way we deliver care and change in the way we pay for care .
That’s why we wrote the letter that we wrote . It was specifically asking them to
give sig ns of their continued support for that approach and I think we a re actually
hearing that that there is support for delivery system transformation.

Margaret Flinter: Well Dr. Gilfillan , it’s great to hear your perspective that maybe
this is now hardwired into the consciousness of the American people that there is
the need and the right for coverage and the need and the right to access . You at
some point in your early training had sometime as a family practitioner in a
community health center model of care spent considerable time at Geisinger so
you so clearly understand the importance of policies and practices that support
population health management . For our listeners talk about that care model a
little bit and why it drives the results that you think i t can drive for us.

Dr. Richard Gilfillan: I think that the most critical element of these models that
we're trying to build is that the providers of care are conscious of the need for
and accountable for delivering coordination in the care that people r eceive , in
some ways that’s the most real absence of service that we feel in health care . If
you talk to someone who is taking care of their parent or a child who had

Dr. Richard Gilfillan

complicated medical problems and said to them who coordinates your care to
make sure tha t each one knows what’s going on with you, the cardiology looks at
the heart and the pulmonologist looks at the lungs and who coordinates across
all those , and the answer today is the patients or the family coordinates that care .
So the hallmark of accoun table care in my mind is coordinating care and keeping
track of a patient as they move across the system. Imagine a system where
th ere is a coordinator where as soon as you touch that system of care you can
rest assured that the care providers will unders tand you in all your dimensions ,
making sure that that movement from hospital to a nursing home to a home is
actually a smooth movement . That to me is probably the hallmark of the new
systems of care that we a re trying to build , and while Geisinger had el ements of
that the truth was we didn’t have that for every patient in every care episode , so
it’s moving towards a system where that is the reality that we a re all working
towards.

Mark Masselli: We a re speaking today with Dr. Richard Gilfillan , CEO of T rinity
Health one of the nation ’ s largest not - for - profit health systems . Dr. Gilfillan
served as the first director of the Center for Medicare and Medicaid Innovation.
You know there is general confusion in the public ’ s mind about lots of things that
hav e happened under the Affordable Care Act and certainly the innovations that
were launched . I a m wondering if you could talk a little bit about the initiatives
and the impact that they are having today?

Dr. Richard Gilfillan: Yeah . There was already tal k about the idea of
accountable care organizations, groups of physicians and hospitals that came
together to build the capability to coordinate care a s I just described , also
medical homes in building care coordination into primary care. We needed to
test those models out , and so the work that we did early on we constructed a
series of models to test how well those different payment models would support
delivery models that coordinated care better and produced better outcomes, and
then of course it expande d to the state innovation model and then we also a re
interested in encouraging other kinds of innovation, encouraging people to try
different care model . So the innovation grants programs that we did, that was all
about incenting the development of new ki nds of care models all focused on
delivering better health, better care and low er costs.

Margaret Flinter: Dr. Gilfillan I woul d like to take a look for a moment at what you
are trying to achieve now at Trinity Health which I believe is the second larges t
not - for - profit health system in the county . You are obviously a staunch
proponent of coordination of care , the accountable care organizations . Tell us a
little bit about your experience as you are finding in such a large health system
trying to impleme nt these changes and what are you learning that you think might
help inform Congress and the administration?

Dr. Richard Gilfillan: Certainly Margaret . Let me just also go back and answer a
question I didn’t answer before which was what kind of folks ar e on the task

Dr. Richard Gilfillan

force, people like the advocate health system, Essentia which of course is the
largest not - for - profit health care organization , Beth Israel Deaconess care in
Boston, Catholic Health Initiatives , Greenville Health System a very progressive
sys tem in South Carolina , so all these are folks that have done great work , and of
course [inaudible 14:38] and partners in Boston . Payers, we have had Aetna ,
we’ve had Blue Cross Blue Shield of Michigan and Massachusetts, Blue Cross
Blue Shield that were le aders in alternat iv e payment models and Health Care
Services Corporation of Chicago. We’ve had the Pacific Business Group on
Health which of course have been leaders nationally for a long time , and the
National Partnership for Women & Families and Communit y Catalyst , so folks
that are working together all of whom have that commitment to deliver 75% of
their care, of their services under these alternative payment models .

And we’ve been at this now for about three years . Our goal is that 75% by 2020 .
That’ s our specific goal in our strategic plan that our board has approved . We
have built accountable care organizations in each of our markets . We’ve built a
large episode - base d payment model working closely with CMS Medicare on
about $500 million worth of s ervices that are paid for under that episode - based
approach, and we’ve had many of our primary care sites operating as medical
homes within the context of our ACOs and we're actively redefining the way we
deliver care in our hospitals , in our networks of o utpatient caregivers and even in
our community wherein our community health and wellness group we're working
closely to address and improve the underlying determinants of health . We
capture all this in our strategic objective which is to build a people - ce ntered
health system together that addresses acute care , population health
management and community health and wellness .

So we’ve invested about $140 million over the last four years and what we’ve
learned is people love this work . We have about 120,000 employees now across
our system and they are excited about being able to do this work , particularly the
care coordination approach. It’s hard work to transform the way you operate and
you know people say well you're building the airplane and flying it , we ll you know
we're flying a plane and in fact we're delivering care that people need when they
are sick . We touch six million people a year and we provide probably about 1.5%
of all the hospital care in America . Then we say oh we would like you to
coordin ate care and build these new care capabilities , right . So we're rebuilding
the airplane as we're flying it, w ell how about you change the rules of gravity? So
we're changing the payment rules in addition to rebuilding and frankly it takes
longer than I’d hoped when I came here . I think that’s the lesson nationally , but I
believe we're clearly making progress, payers are learning, CMS is learning
because when they’ve changed the payment mechanisms that’s something they
need to adjust on constantly and I th ink CMS is doing an excellent job of learning
as they go.

Mark Masselli: You are a CEO of a very large health system and I wonder what
your advice is both to other leaders and to your staff because we’ve been flying

Dr. Richard Gilfillan

that plane , changing the engine , we ma y land the plane now, you know that’s
enormous psychological issue . We only have 1100 employees but we hear from
our own folks all the time about what’s going to happen and how do you keep
people focused , and there is real anxiety . People are grappling w ith the change ,
the ACA is still the straw that stirs the drink and it’s going to be altered ; w e're
going to see some form of replacement . As a CEO what are you telling your own
people about how to stay focused?

Dr. Richard Gilfillan: Well we believe th at the fundamental dynamics are not
different . We're strong advocates for ensuring that people have coverage and so
we will continue to be strong advocates in every form we can find to ensure
people have coverage . Because health care is increasing in cos t there is no way
health care is not going to continue to be driven from a cost standpoint because
of all the advances that are being made , therefore , everything we can do to make
the system more efficient , more effective and to deliver better outcomes is going
to be valued . Learning how to deliver more value is a no - regret strategy
regardless of what the world looks like in the future and so we are focused, we
stay focused on that. The reality is there is plenty of care to be delivered , the
need for care is increasing . Health care by all projections is going to be a growth
industry and so that’s the reality . If we focus on advocating for access , delivering
great care for the people we're serving and finding ways to deliver more value ,
those will be posi tive in any future we can imagine.

Margaret Flinter: We're speaking today with Dr. Richard Gilfillan , CEO of Trinity
Health and Chair of the Health Care Transformation Task Force . You can learn
more about his work by going to www.trinity - health.org/richard - j - gilfillan - md and you
can follow the work of the Health Care Transformation Task f orce by going to
www. hcttf.org. Dr. Gilfillan , thank you so much for your work and for joining us
o n Conversations on Health Care today.

Dr. Richard Gilfillan: Thanks very much Margaret and Mark , I’ve enjoyed it.

(Music)

Mark Masselli: At Conversations on Health Care we want our audience to be
truly in the know when it comes to the facts about heal th care reform and policy.
Lori Robertson is an award - winning journalist and managing editor of
FactCheck.org, a nonpartisan, nonprofit consumer advocate for voters that aim to
reduce the level of deception in US politics. Lori, what have you got for us this
week?

Lori Robertson : In a p ress conference about a week before he was sworn in as
President, Donald Trump touched on the Affordable Care Act claiming that some
states had seen health insurance premiums on the ACA exchanges increase by
100% . Only A rizona has an average increase that high and 84% of those with
marketplace coverage in 2016 received ta x credits to purchase insurance .

Dr. Richard Gilfillan

Premiums on the ACA exchanges for individuals who buy their own insurance
have jumped up substantially from 2016 to 201 7 , an average 25% increase
among the 38 health care .gov states . The increase the year above was only
7.2% on average . Trump cherry - picks the high end of the increases . Arizona
had 116% average increase . Indiana at the other end of the extreme had an
av erage 3% decrease . At least one county had a nearly 100% increase , in
Medina County , Texas the average increase was 99% . Texas overall however ,
had an 18% average increase . The vast majority of Americans who buy
coverage through the exchanges get tax cr edits which shelter them from these
premium increases . Based on income , the HHS report says 84% of the 10.4
million Americans with marketplace coverage in the first half of 2016 received tax
credits. Trump said at the news conference “ We're going to have a health care
that is far less expensive and far better . ” He promised to provide a replacement
plan shortly after the Senate confirms his choice for Secretary of Health and
Human Services. And that’s my fact check for this week . I a m Lori Robertson ,
Ma naging 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 Public Policy
Center at the University of Pennsylvania. If you have a fact that you would like
checked, e - mail us at www.chcradio.com . We will have FactCheck.org's Lori
Robertson check it out for you here on Conversations on Health Care.

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Mark Masselli: Each week Conversations highl ights a bright idea about how to
make wellness a part of our communities and everyday lives. For all the people
in the world without limbs , acquiring prosthetics can be costly and out of reach .
It’s especially challenging to make prosthetics for children since they are in
constant state of growth . Rochester Institute of Technology Scientist Dr. Jon
Schull stumbled upon a clever and affordable solution , provided online open
source templates to anyone anywhere in the world who has access to a 3 - D
printer a nd provide prosthetic hands for next to nothing.

Dr. Jon Schull : I’ve made th is Google Maps mashup . If you have a 3 - D printer
and you would like to help put yourself on this map and if you know someone
who needs a hand put yourself on this map.

Mark Ma sselli: He found ed the e - NABLE Network which has massed thousands
of volunteer makers in up wards of 40 countries around the world providing cheap
but functional prosthetics for children in need.

Dr. Jon Schull : I think we a re currently pushing 5800 iden tified members in our
Google Plus community and we have the followings in the thousands more . We
know that we have deliver ed about 800 hands devices and we suspect that this

Dr. Richard Gilfillan

comparable number ha ve been downloaded by people we can’t track because
we put al l of our design on the Internet .

Mark Masselli: The simple limb designs have become more sophisticated as
recipients of the prosthetic devices provide feedback for designers to make more
efficient devices.

Dr. Jon Schull : We're still working on opposab le thumb s . These things grip or
un - grip that’s all they do , so they are much less functional than our biological
hand and they are also less functional than a fancy Myoelectric hand , but for kids
it’s huge because those expensive devices are typically out of reach for children
who would outgrow them so it doesn’t make sense for them to get a $5000 or
$10,000 hand . And our hands don't even pretend to look like regular hands they
look like super hero Iron Man hands and for that very reason they’re very popu lar
with kids .

Mark Masselli: e - NABLE , a global collaborative network of open source designs
linking to makers with 3 - D printers to provide low cost prosthetic limbs to children
and adults around the world , now that’s a bright idea.

(Music)

Margaret Fl inter: This is Conversations on Health Care, I’m Margaret Flinter .

Mark Masselli : And I’m Mark Masselli , peace and health

Conversations on Health Care, broadcast from the campus of WESU at
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