Congressional Briefing on Aging in America

12:00 p.m. – 12:10 p.m.    Welcome and Introductions

• Sarah J. Dash, MPH, president and chief executive officer, Alliance for Health Policy
  @AllHealthPolicy

12:10 p.m. – 12:40 p.m.    Perspectives from the Administration

• Lance Robertson, MPA, U.S. Assistant Secretary for Aging;
  Administrator, Administration for Community Living, U.S. Department of Health and Human Services
  @ACLgov

12:40 p.m. – 1:30 p.m.      Age-Friendly Innovators

• Tom Cornwell, M.D., founder and chief executive officer, Home Centered Care Institute, @HCCInstitute
• Lindsay Goldman, LMSW, director, Healthy Aging, The New York Academy of Medicine, @AgefriendlyNYC
• Whitney Austin Gray, Ph.D., LEED AP, WELL AP, senior vice president, Delos, @DelosLiving
  
• Sabrina Smith, DrHA, chief operations officer, American Telemedicine Association
  @SabrinaTelemed

Please note: This is an unedited transcript. Note: This is an unedited transcript.

For direct quotes, please see video at  http://allh.us/gwBA

SARAH DASH:  Good afternoon, everybody.  Go ahead and get us started.  Hi, I’m Sarah Dash; I am President and CEO of the Alliance for Health Policy, and we are delighted to have everybody here today.   For those of you who are not familiar with the Alliance, we are a non-partisan organization that is dedicated to advancing knowledge and understanding of health policy issues.  We serve the public servants, and the healthcare leaders who really hold the future of healthcare in their hands, and I want to acknowledge public service today. We are happy to have today with us Assistant Secretary of Aging, Lance Robertson, who is — it’s very exciting to have a public servant here.  And I just want to acknowledge, of course, our country lost a very important public servant in President George HW Bush.  So I just want to acknowledge that today, and if we could just have a brief moment of silence.  Thank you.   So we are here today to talk about aging in America.  This is the third and final installment in our signature series on opportunities for progress, and it is the final public event of the year for the Alliance. So we created this series to really highlight progress on persistent health policy issues and examine progress — ideas for progress for moving forward.  Earlier this year, we examined health care costs, and you can find everything archived on our website.   I want to add that we’re going to talk about services that are likely to help people from needing expensive healthcare services, and as we talk about costs, you know, this conversation on aging really follows along with that.  So we’re going to do things a little bit differently today, for those of you who have been to some of our briefings.  We are pleased, as I said, to have Assistant Secretary for Aging, Lance Robertson, who is going to share some of his perspectives on aging in America.  Then we will follow that with an expert panel of age friendly innovators who will spend the remainder of their time discussing their successes and challenges working in this space.   I want to thank first some of our sponsors who have supported this series and we would not be here today without them.  Health is Primary and Pharma.  Our champion sponsor is Aetna, Anthem, Ascension, Blue Cross/Blue Shield Association, Cambia Health Foundation, GlaxoSmithKline and InnovAge, and our signature sponsor for aging, the Catholic Health Association of the United States.  So we have a few of our sponsors here to make some brief opening remarks to highlight this issue.  I’m going to introduce them all right now, they will come up here and speak, and then we will turn to our program.   So first we will hear from Dr. Chamain Labird , who is Vice President of Medicare Clinical Operations at Anthem. Next, we’ll hear from Fran Sossaman, Executive Vice President, and President of Government Services at Aetna, who will say a few words.  And finally, we’re happy that we will hear from Ann Sebold who is campaign director for Health is Primary.  So with that, let me know turn the podium over to Dr. Labird, thank you.   SPEAKER:   Good afternoon, thank you, Sarah. So first and foremost, as a physician, it behooves me to remind everyone with the holiday season coming up, with family gatherings, make sure you gather family history and document that, as well as make sure you see your primary care doctor, and get those screenings done. As a physician, I feel with a captive audience, I must do that.   So I represent Anthem, and from a clinical standpoint, Anthem serves 1.8 million Medicare members.  We comprise Medicare Advantage, Part D, Medigap, and a group retiree.  And today, you’re going to hear from a panel that will attest to the importance of really addressing the needs of the whole person and not just the medical portion of the member, or the patient. And I think it’s really important today to take note of that, and be able to bring this back to wherever you are in your day-to-day work life, and family life, to be able to understand that the whole person is really important. And Anthem actually does this in a few ways. We have a couple of innovative products as well as programs that we’re doing, and I just want to highlight a few of  them today. We do have a new product offering as of 2019 that looks at helping our members get transportation to where they need to go, or have access to meals. And that’s thanks to CMS’s ability for a Medicare Advantage Program to do that, and we have that in select areas. We also have — CareMore is a subsidiary of Anthem, and what CareMore has done with the togetherness program, is we’ve taken some of our employees and linked them with our members who may be — seniors who may be isolated and lonely. And we found that by engaging our employees — we have about 800 CareMore members, or seniors, who get phone calls from our employees. And in looking at the some of the stories, what you’ll hear is that sometimes this is the only phone call that they get all day. And the member, our patients, are so engaged, that they — we found that they are more active, and so 53% of them are going to exercise classes. We’ve noticed a decrease in ER usage. And so by not going to the ER and having someone to talk to, or help to manage what they need, is really making a significant difference as well as decreasing inpatient admissions, which can be sometimes significant. Additionally, we have case managers who are nurses and social workers, who actually work with care coordination. And clearly, by connecting our members and our seniors with those services that they need, let’s say on discharge, they maybe need to get a wheelchair, or they need to make sure that their primary care appointments are set. Those are key things that we find that have been helpful.   And finally, we also have a Silver Sneakers program which works with health clubs, and that helps to engage our members and get them active. Where we find that, you know, as we age, and as time passes, our bones and joints just don’t work as well. And by being more active, it actually decreases fractures, falls, all that is really important in keeping our members healthy and safe.   Lastly, Anthem clearly can do more, and we are striving to do more in 2019 and going forward. But hopefully with having the insights of the panel today, I will be able to bring that back to anthem, and you all will be able to take those insights as well back to respective areas, and be able to influence change for our seniors.   Lastly, I really want us to consider how the social and physical environments affect how our healthcare is delivered. By influencing policy, we’re able to make a difference, and I think it’s very, very important to remember that the social determinants of health really are important in making sure that the entire — the whole person, remains health and stays healthy. Thank you.     SPEAKER:   Clock’s running. Good afternoon. I’m Fran Sossaman from Aetna, and it’s a pleasure to be here. I want to thank Sarah and thank the Alliance for organizing this series on aging in America.   It’s been an extraordinary series to surface the challenges, which may be for some are the obvious, but for others, it’s been enlightening. And it’s very timely, because the reality is that every day, 11,000 Americans are aging into Medicare eligibility, and that continues out for the next three decades. So America is getting older, and we can’t stop that. That is something that we are facing in terms of what’s happened with the acceleration of the Baby Boomers aging into Medicare eligibility. So it’s beyond the statistic. The reality is that not only are we aging into Medicare eligibility faster, unfortunately those who are aging in, are coming in with more chronic conditions. So the challenges that we face are even greater. So more co-morbidities, more chronic illness, and as a country, you know that means we have even more costly events that we have to deal with when the Medicare trust fund may not be sufficient longer term.   So what are we doing about it? Well, Medicare Advantage has been a good alternative to original Medicare, to drive better outcomes at lower cost. But that still has to evolve. So at Aetna, we have been, and will continue to focus on the challenges holistically. We have been approaching this from an integrated perspective in terms of the physical, behavioral, social, and pharmacological components of healthcare. And the social determinants have become even more of a focal point, because we realize that it’s the basics of life that oftentimes lead to the medical challenges that present in the ER. And whether it’s a Medicare patient or a Medicaid eligible patient, and we have to solve those. So we have to tackle this at each end of the spectrum, each end of the continuum.   And Aetna’s world has changed recently. As of last week, we are now owned by CVS Health. And that presents an incredible opportunity to accelerate transformation. CVS Health has nearly 10,000 retail locations across the United States, within three miles of 85% of the U.S. population. Getting us closer to consumers. The reality is, with the growing of the Medicare eligible population, we are not going to have the infrastructure as a nation to deal with the population growth of Medicare eligible not having enough beds in the right locations. So more care is going to be delivered in the home. So this is important to us, to allow us to have greater access to our members, to patients in the home. And that’s not a bad thing, that’s actually a good thing, because most people would rather be in their homes; certainly would rather be in their homes, than in the nursing home. So we are approaching this in a multidimensional fashion — telemedicine, working with home and community based providers, telemonitoring. Every available technology, every available community resource and asset, is how we’re approaching this. There is no simple solutions, no one size fits all. And we are approaching this in a manner that reflects the diversity of our American society, meaning a multicultural competency.   So the challenge is daunting, we are up for it, and I think we can tackle this. So thank you for this opportunity. Thanks, Sarah.     SPEAKER:  Hi, I’m Ann Sebold, and I’m a co-director of the Health is Primary campaign, which is a campaign run by American Academy of Family Physicians, and seven other family medicine organizations. Basically to promote the value of primary care within the context of healthcare. We have been a sponsor of the Alliance series for two years, because we believe primary care needs to be a part of every conversation about healthcare. Because the foundation of primary care, we know for a fact, having a strong foundation of primary care delivers better outcomes, better patient satisfaction, at lower cost. And this especially true and important for the aging population. Our campaign has been about the good news of healthcare, and we have spent the last four years telling the stories of primary care and innovation and transformation that are happening at the practice level, and at the state level, where investment in primary care is happening. And you’re going to hear one of our best case studies today from Dr. Tom Cornwell. But our goal really is that in policy moving forward, that these case studies and sort of microcosms, have the opportunity to be taken to scale, to serve the aging population, and frankly all of population. Thank you.     SARAH DASH:  Thank you all. It is now my pleasure to introduce to you the United States Assistant Secretary for Aging, and the Administrator of the Administration for Community Living, Lance Robertson.     You have his full bio in your packet, but I will say that Assistant Secretary Robertson hails from the great state of Oklahoma, where he served for ten years as Director of Aging Services within the state’s Department of Human Services. Prior to that, he spent 12 years at Oklahoma State University where he co-founded the Gerontology Institute, and served as executive director of the nation’s largest regional gerontology association, Mr. Assistant Secretary, thank you so much for joining us today.     LANCE ROBERTSON:  All right, hello everyone. Do you not realize it’s Friday afternoon? You are on cruise control to the weekend. It’s an honor to be here. Thank you, Sarah, so much, and I’m delighted to be here to kind of honor and help kick off this Aging in America briefing. I think the timing, of course, of today’s briefing is well placed, given the upcoming reauthorization of the Older American’s Act.  Since 1965, the bipartisan legislation certain has placed and helped provide critical services that have better enabled millions of older Americans to live independently, and with dignity in their homes and communities. Never before has this law been so relevant, and so timely. As has already been referenced, some of the data I think we all know across the United States, 10,000 people turn 65 each day. And by the year 2030, we are talking about basically 20% of the population being 65 and older.   So it’s my distinct privilege as the Assistant Secretary for Aging, to head the Administration for Community Living, which is the federal agency tasked with implementing the Older Americans Act, as well as several other very critical pieces of legislation and programs.   You’ve got an impressive cadre of speakers that are going to no doubt reaffirm that we all have an imperative to respond to the rising aging demographics with smart, cost effective, and person centered strategies. I know we all look forward to hearing from this panel of innovators on what they are doing as we usher in this new era of age friendly communities. I’ve had a chance to look at their power points, and it’s going to be a wonderful conversation.   To set the stage for their remarks, I am pleased to share with you just a slice of what we’re doing at the Administration for Community Living. Through partnerships across the federal government, and with state and local leaders, to promote the following simple, but profound goals:  First, that all people, regardless of age or disability, should have the right to live independently and participate fully in their communities. Secondly, that every person should have the right to make choices, and to control the decisions in and about their lives. And finally, that this right to self-determination includes decisions about where to work, where to live, and other daily choices that most of us simply take for granted. So by funding services and supports provided by networks of community based organizations and with the investments in research and innovation, ACL helps make this principal a reality for millions of Americans. We are proud pioneers in transforming communities to become age friendly, and doing so long before the term was really ever coined. And we do this by advocating across the federal government for older adults, people with disabilities, their families and caregivers; by investing and training in education, from workforce training to helping families learn to support a loved one with a lifelong disability, and also training to help the aging and disability networks improve their abilities to partner. And finally by funding research and innovation, that includes everything from new business models to improving the long-term sustainability of community programs, to high tech research and development of assistive technology tools.   I would like to emphasize the value of each of these goals that I just referenced, through the different pillars that I created when I was going through Senate confirmation last fall, and something we continue to champion at ACL. So our five pillars:  Connecting people to resources, protecting rights and preventing abuse, supporting families and caregivers, strengthening the networks, and expanding employment opportunities.  The majority of the work that we do at ACL is administering programs that provide services and supports in the community.  They are provided primarily by a network of community-based organizations, and that also includes universities, faith-based organizations, and various other non-profits. Collectively, we refer to them as the Aging and Disability Networks. The Aging and Disability Services Networks, honestly, is like the glue. It holds together all of the pieces of the community, and really helps provide what that individual needs to remain functional. It is the nation’s home and community-based long term services and supports, infrastructure, and system, and enables people to reside in their homes and in their communities. Our programs meet the goals established by Congress, providing assistance to help people maintain their health, independence, dignity, and to avoid institutionalization. They are effective in targeting the poor, the near-poor, and those who are frail, and certainly those who are at risk of institutionalization.   That last point:  The effective prevention role that our programs play through the provision of critical services and supports, to often vulnerable adults, is pivotal to one of Secretary Azar’s top priorities. As the Secretary of Health and Human Services, he’s identified as one of his four key priorities — transforming healthcare to a value-based system, which has again, direct applicability to today’s conversation. By that, he means creating a healthcare system that pays providers for outcomes rather than simply procedures. The value-based transformation has multiple components. One key element of quality assessment for post-acute care facilities, is cutting down of course, on re-admissions.  And as Secretary Azar also has said, “A system that pays for value, will aim to move patients into the lowest cost, and most appropriate setting.” That means avoiding hospitalization, avoids nursing home admissions, shortening durations of stay, and preventing re-admissions where possible. Considering the depth and breadth of services and supports that ACL provides millions of Americans through programs that target the social determinants of health, Secretary Azar has pointed out when he has spoken to healthcare organizations recently, that we need to do a better job of engaging and involving aging disability networks if we are going to achieve the goal of that value-based healthcare system. So I’m pleased to be working closely with the secretary and his team to realize that goal. As the secretary recently remarked, and I quote, “Social determinants of health is an abstract term, but for millions of Americans, it is a very tangible, frightening challenge. How can someone manage, as an example, their diabetes if they are not sure how they are going to pay for their meals?” So thanks in large part to the Older Americans Act, ACL administers programs that strive to alleviate those types of worries. For example our nutrition programs support 5,000 community based organizations serving more than 900,000 meals a day all across the country, through both congregate meal settings and home delivered meals, Older Americans Act nutrition programs provide of course more than just food. They also address other health disparities. The program’s goals of course include decreasing hunger, decreasing food insecurity, decreasing isolation, and to offer other health promotion activities. And this is done every day across 20,000 different meal sites in every corner of our great country.   Increasingly, the issue of social isolation among older adults has been gaining traction in the field of public health. As one of the earliest programs authorized by Congress under the Older Americans Act, our nutrition programs have been at the forefront of tackling social isolation. In fact, the recent evaluation of our Older Americans Act nutrition program indicated that older adults living alone who receive meals, showed reductions in feelings of social isolation. Social isolation is an especially important topic for us at ACL, because as one ages, there are many changes that occur which can often trigger this issue. It’s estimated that nearly 20% of older adults 65 and older are socially isolated. Opportunities to identify and address social isolation are present throughout the work that we do at ACL. We know that persons with comprised health and disability are at high risk of loneliness and social isolation. These individuals may not engage with families, friends, neighbors or peers due to barriers when it comes to speech or hearing impairments, inadequate transportation, and settings that are just simply not accessible. We also know that social isolation and loneliness have a detrimental impact on one’s health and well-being. Researchers have suggested the health risks associated with social isolation can be compared in magnitude the well-known dangers of cigarette smoking and obesity.   According to a report by the AARP public policy institute, and Stanford University, social isolation among people with Medicare is associated with an estimated 6.7 billion dollars in additional Medicare spending each year. That’s comparable to additional program spending for people with chronic conditions like high blood pressure. Several studies have found reductions in loneliness and improved social well-being with programs funded through the Older Americans Act. For example, one report shows 93% of congregate meal participants were socially active, and were satisfied with their opportunities to spend time with other people. We’ve also learned the typical congregate meal participant does not experience loneliness. Only 7% of congregate meal participants screened positively for depression, and 81% of home delivered meal participants reported satisfaction with their opportunities to spend time with other people.   So social connection is also enormously important for our veteran population, pivoting slightly. A population that we know is at a high risk of suicide. To bring the expertise of the aging and disability networks to the service of those who have served our country, ACL and the Veteran’s Health Administration, VHA, have partnered to build a veteran directed care program. Since 2008, this collaboration has helped veterans with disabilities of all ages, and their families receive needed social supports and services in their own homes and communities. The ultimate goal of course is a nationwide home and community based long-term services and supports program that allows veterans more access, choices, and control over the care that they receive. We have combined the hands on experience and skills of ACLs, networks with a commitment and resources of VHA, to provide veterans with an unprecedented additional opportunity to avoid nursing home placement and remain independent in the community. As of August, the program is serving 2,133 veterans across 35 states and the District of Columbia and Puerto Rico. At the same time, 79 Veterans Affairs Medical Centers or VAMCs have partnered with aging and disability networks.   Another where ACL, through our core mission of promoting community and connection, continues to lead, is in the application of research and technology to promote the quality of life of older adults and people of disabilities. We have a research division at ACL, very proud to say. The National Institute on Disability, Independent Living, and Rehabilitation Research, or NIDILRR.  NIDILRR currently invests $20 million annually in technology research and development for individuals across the lifespan, with functional, sensory, and mobility issues. Since 1999, NIDILRR has a proud history of funding technological innovation that has led to increased social participation and community integration, including ensuring that the development of web browsers include accessibility features. Developing the principles of universal design that are now widely used nationally and internationally when making age-friendly spaces. And also developing clinical and medical interventions for us in the real world, such as portable dialysis machines. We regularly talk with industry on issues like data and service standards, accessibility, and usability, and the particular needs of older adults, and people with disabilities. More recently, NIDILRR has been funding efforts to develop mobile telehealth tools for use by people with disabilities and their healthcare providers. For example, we are supporting grants to researchers at the University of Pittsburg who are developing two new telehealth and telerehabilitation tools. One is a mobile health software platform to support wellness and self-management among people with disabilities called iMHere 2.0. The second is an interactive telehealth platform designed to support various telehealth, and the telerehabilitation services to rural clinics or directly to people with disabilities at home, or in our communities, and that one is called Visitor 2.0.   So as you can see, ACL is a leader in advancing a spectrum of community and technology-based solutions to major challenges to the health and welfare of older adults, persons with disabilities, or families and caregivers. As healthcare in the United States is undergoing rapid change, and as a population of older adults and persons with disabilities continues to grow, so to will the demand for resources from community based aging and disability organizations. ACL is committed to working with public and private partners to help the aging and disability networks we support, meet this challenge. It is going to not only require continued investments from Congress and programs that we deliver, such as the Older Americans Act, but it’s also going to require the commitment from the private sector and healthcare industry. We need their commitment to work with community-based organizations, to fill the gaps in prevention and care when it’s clear that a clinical intervention won’t deliver the best results for the patient, and certainly will not be the most cost-effective.   So the fundamental idea is this:  When services from community-based providers and healthcare entities are well integrated, consumers win. Thanks again for convening this briefing, and for your series on Aging in America. I look forward learning more of the suggestions, as well as the practical policy and programmatic solutions that your participants propose. ACL is willing, ready and able to provide public/private partnerships, support for the great work that we do in sharing our common goals. Thank you.     SARAH DASH:   Thank you so much, Mr. Assistant Secretary. So again, in the sort of switching up the Alliance format, we have time for just a few questions. Kind of noon fireside chat, if you will. And — to get into a little bit more depth on your remarks, and then we’ll get to our panel. So thank you so much.   In your remarks, you really made it clear the importance of the linkages between the community services and supports, the clinical setting. You talked about a number of kind of initiatives that you have with other agencies. Can you talk a little bit more about those? How does the Administration for Community Living work with the other agencies in the federal government? And if you want to talk about the state level too, that’s fantastic.   LANCE ROBERTSON:  Very good. Quite a complex question there with lots of opportunity to kind of unwrap that. Again, thanks so much to everybody for being here. Now it’s an opportunity to go off script from the lawyer approved talking points, and really kind of share with you, I think, from my perspective, some exciting things that are happening, and I will say to Sarah’s question, really what just inspires me each and every day, is the opportunity to better partner across federal government. That opportunity, of course, has always been there, but as many of my colleagues in the room, and others that work every day with me know, I believe that’s where the secret sauce is at. I think it’s more about, how can we work together more effectively to produce an outcome that is better for America. And  you know, when I think about the $1.3 trillion federal agency that is the Department of Health and Human Services, there’s a lot of opportunity just within HHS. So at ACL, we have really put emphasis on how do we create stronger relationships with fellow sister operating divisions like CMS, and FDA and HERSA and Sampson and Indian Health Services, and really appreciate their mission, their goals, where their resources are directed, and how we at ACL can help support that, but in return knowing that it’s going to ultimately help us achieve our mission. So one question we often get is — and maybe it’s around reauthorization, or maybe it’s just around how do we serve this growing number of people who are older and living with a disability? You know, the reality is it’s not an answer that is, fix simply with more money. While I think appropriations is always a part of every valuable conversation, to me it’s about how do we leverage the existing resources and how do we make sure that we are partnering within HHS and across the federal government? And if time allowed, I would love to talk more about some of those partnerships, because they are exciting. Whether it’s with the Veteran’s Administration, which we referenced. The VA work is phenomenal, and is really gaining a lot of momentum. To some of the things that we’re doing, say for instance in the elder justice space. We have, for instance, the honor to chair the Elder Justice Coordinating Council, which really is a federal body consisting of 14 different federal agencies, all committed to moving the needle, and positively addressing elder justice. And again, that’s just one example, Sarah, of a lot of what we do. But suffice it to say, in my role as administrator, I really make sure that that remains a priority. It’s about building those relationships, and moving effectively toward common goals, and leveraging existing resources where we can.   SARAH DASH:  You mentioned your partnership with the VA; I understand you’re a veteran yourself? Is that correct?   LANCE ROBERTSON:  I am.   SARAH DASH:   The United States Army.   LANCE ROBERTSON:  Yep, go Army. Beat Navy tomorrow!   SARAH DASH:  If you could wave your magic wand, besides winning the game, what would you hope to accomplish even further in terms of that partnership with the VA?   LANCE ROBERTSON:  Great question. So really, I think in just being honest with you, you know, both as a veteran, but also as somebody that’s worked in social service space all of his career more or less. What really has been both exciting, but a bit puzzling to me is, as I think in the last 10 years, as the Veteran’s Administration has gotten very serious about serving veterans in a setting of their choice, and wrapping good services around them, we all naturally understand that’s sort of our mission in charge each and every day, and has been. So I think in conversations we’ve been having with the VA and helping them build their veteran directed care program, it’s just such a natural fit for us. So I think as we try to — I’ll just say, bring up to speed the Veteran’s Administration on how we take care of people in a home and community-based setting, they can then turn to us, rely on us, because of our track record, because of our expertise, because of the networks that are already in place. So it’s an example, I think, of a real win-win that is happening quickly, and it’s because of, again, both the experience and the bandwidth we bring to the conversation, and coupling that with their desire and resources, again, I think it’s going to continue to prove to be a very valuable thing, specifically for veterans. But again, as we all know, when it comes to those need