Summit on Aging in America

Note: This is an unedited transcript. For direct quotes, please see video here: http://allh.us/u4Dr Sarah Dash:  Morning everybody. Oh, wow. Good morning, you guys are awake. This is fantastic. Thank you so much for joining us here today for our summit on Aging in America. My name is Sarah Dash, and I am the President and CEO of the Alliance for Health policy. Welcome. For those not familiar with the Alliance, we’re a non-partisan organization dedicated to advancing knowledge and understanding of health policy issues. Sarah Dash:  We’ll be live tweeting during this event. You can join the conversation if you like using the hashtag all health live. And for those in the audience, we’ll be taking some questions at various times during the program as well. This is the second to last event in our 2018 opportunities for progress signature series. We created this series to highlight progress on persistent health policy issues, and examine prospects for moving forward. Sarah Dash:  Earlier this year, we examined healthcare costs, and you can find those materials on our website. Today, we start our conversation on aging in America with this summit, and then the final event in this series will take place on December 7th, on Capital Hill, and we hope you’ll save the date for that and join us. I want to thank our 2018 opportunities for progress signature series sponsors, and you’re gonna have an opportunity to hear from some of them throughout this morning as well. Sarah Dash:  We’d like to thank our visionary level of sponsors, Health Is Primary, and Pharma. Our champion level sponsors, ETNA, Anthem, Ascension, Blue Cross, Blue Shield Association, Cambia Foundation, Glaxo Smith Kline, and InnovAge. Our signature sponsor for the aging series is The Catholic Health Association of the United States. Sarah Dash:  Very important note in your packet of handouts, you’ll find an evaluation from, so please fill that out throughout the event, and we really value your feedback, and we use it to help plan our future programming. Finally, we’re planning already for next year’s signature series. I appreciate your thoughts on the topics that we should cover. We have an annual audience assessment, and that is gonna help ensure that our events continue to provide thoughtful, balanced, and useful content for each of you. Sarah Dash:  It’s an online survey, should take no longer than 10 minutes. I’ll probably give a pitch for it again at the end, but we hope that you will all participate. Okay, so finally, with those housekeeping notes out of way, I would like to invite the Alliance’s board Vice Chair and Secretary Tom Scully. We are thrilled to have him here. Tom, thanks for coming to give some opening remarks. Tom Scully:   Brief. Sarah Dash:  Brief. Tom Scully:   Brief opening remarks, hopefully. Anyway, thanks for coming. I’m Tom Scully, and I’m just proud to be the Vice Chair of the Alliance. I’ve been on the board for a couple of years, and it’s been a great organization for a long time. For some, I’m an old guy, but I think I first got involved in 1982. Senator Rockefeller is a great friend, and he did the world a great service in healthcare by creating this thing a long time ago. Tom Scully:   Back then I was the bush one healthcare guy. So, you can imagine Senator Rockefeller and I didn’t always agree on everything, but we became great friends because he actually likes to talk about issues on both sides. Republican, Democrat, Conservative, Moderate. And in Washington, there’s way too little of that going on now. It was a little better 25 years ago, but Senator Rockefeller, but I always found the Alliance is really one of the very few places in Washington where you can actually talk about serious policy discussions, and have very little politics and lots of substance, and I think it’s been a great source of briefings for staff, and members, and staff at HHCS, and other people for many years. Tom Scully:   So, I’ve been very proud to be involved in it. Senator Rockefeller’s an old … I see John down there who’s been involved for about 100 years as well. Rather, he’s younger than I am. But it’s just been a great organization for a long time. They’ve done a great job for a long time, and when people ask me why do you support the Alliance? Because if you wanna be in the middle of fair policy debate in Washington, you should support the Alliance. Tom Scully:   So, my firm, I’m a partner in a private equity firm in New York. We’ve been a supporter for a number of years, because we’re just proud to be involved. And actually also the next speaker here, briefly at InnovAge, I happen to be a Chairman on the Board of InnovAge. I’m a zealot on improving longterm care, especially for poor, frail, elderly folks. PAIC, if you don’t know, there’s a program for all inclusive care for the elderly, but you’ve got a lot of folks up here that are senior care options program Massachusetts. Tom Scully:   All of your panel are talking about innovative and creative ways to do a better job of taking care of seniors, particularly frail elderly seniors. And that’s the kinda thing people should be talking more about, instead of throwing bombs back and forth about very vague issues of what you should do with Medicaid work requirements. Not that that’s important, when nobody really gets in the details, the Alliance gets into the weeds on lots of issues and talks about things that matter. And that doesn’t happen enough anymore, on either side. Tom Scully:   And finding a creative policy middle without politics is a critical thing, and they do a great job. So, I’m very proud to be the Vice Chairman. Also proud to be the Chairman of the Board of … and I’ll introduce Sylvia. Where’s Sylvia in here? So, I’m also the Chairman of the Board at InnovAge, which the other board members include Marilyn , so there’s a bipartisan group for you. I was the CMS administrator to Bush. She was under Obama. She’s a good friend. Tom Scully:   Ted Kennedy Junior. Peter Thomas. So, I mean, it was the lawyer in town. But we’re all fired up about trying to find the right way to take care of frail elderly seniors, and there’s a lot of ways to do it. I happen to think PAIC is one of the more massively unutilized programs in that area, but there are lots of them. And how often do you go to a conference where somebody’s talking about taking care of frail elderly seniors outside of the Alliance? Not a lot, and that’s a sad thing. Tom Scully:   So, I’m very proud to be Chair of the Board of PAIC. Proud to have Sylvia. We just acquired four big systems in Philadelphia. Sylvia’s run, so she’s now are running the East coast operations of our company and she’s been with us for a few months. And we love her. Hopefully she loves us back. But anyway, we’re happy to have Sylvia here this morning to talk quickly about InnovAge. But I’m proud to be involved in the Alliance. Proud that they’re having these kind of forums, proud that at the end of every one of them that I go to, you can find that they’re fair, balanced, and factual. And that’s a rare thing these days in Washington. It’s something the Alliance should be very proud of. Tom Scully:   Sylvia, you wanna come up? Thanks. Sylvia:           Thank you, Tom. I am definitely in love with InnovAge, just to clarify. So, InnovAge is proud to be a partner with Alliance and the summit. The topic of aging in this country continues to be a really important topic, one that deserves our attention because our seniors deserve our best efforts. Alliance’s focus on having non-partisan policy discussions is right in line with InnovAge’s approach to helping serve more seniors. Sylvia:           As the largest provider for PAIC, the Program of All-Inclusive Care, as Tom mentioned, InnovAge is committed to bringing personalized comprehensive models of care to seniors. That’s neither a blue or red issue, because as each and every one of us continue to age, the opportunity to serve more people in PAIC is staggering. Since the US government launched PAIC in the 1970s, the program has grown to serve 45 000 seniors in 31 states. Sylvia:           Today, there are 12 million seniors who are duly eligible for Medicare and Medicaid, and 1.7 million of them are candidates of PAIC, meaning that they are at least 55 years of age or older, they can live independently in the community with some support, and they live in a area that is served by a PAIC program. For those of you who don’t know, PAIC is an alternative to institutionalizing seniors. Sylvia:           PAIC provides a customized healthcare and social engagement to frail seniors to help them age in place in their own home, and their own community as long and as safely as possible. Participants have personalized care plans, and they receive most of their healthcare and social support within a local center. Sylvia:           PAIC is really a different way to think about aging. And InnovAge is a different way to think about PAIC. So, my colleagues and I look forward to continuing the conversation about aging in America, and we encourage you to consider PAIC as one of the viable options in this ongoing discussion. Thank you so very much for this opportunity. Jennifer Fuller:   Good morning, I’m Jennifer Fuller from Cambia Health Foundation in Portland, Oregon. Cambia Health Foundation is the corporate foundation for Cambia Health Solutions, which is a total health solutions company dedicated to transforming the way people experience healthcare. We were founded in 2007, and we’ve invested over 58 million dollars to advance patient and family centered care. Jennifer Fuller:   We strategically invest in philanthropy to change the way people experience healthcare from birth to the natural completion of life. On behalf of the foundation board of directors and staff, we’re very pleased to help sponsor today’s summit and be an active participant in the conversation around reframing aging in America, and ways to improve health outcomes for older adults. Jennifer Fuller:   Since it’s inception, the foundation has made purposeful philanthropic investments totaling more than 30 million dollars to advance the field of palliative care nationally. We invest in emerging leaders in the field in support of workforce, we invest in consumer awareness, and we invest in systems innovation and change in order to ensure that palliative care is everywhere. Jennifer Fuller:   Palliative care is an extra layer of support for people with serious illness. It’s about designing solutions that enhance quality of life for both the caregiver, and the person they’re caring for. It means starting with the person receiving the services, or the person providing the care, listening to their needs and hopes, and asking what matters to them in deciding their course of treatment, rather than what’s the matter with them. Jennifer Fuller:   It’s my pleasure and honor to introduce our keynote speaker this morning, Doctor Preeti Malani, Chief Health Officer and Professor at University of Michigan, who will address perspectives of older adults and caregivers. Thanks. Speaker 1:     Thank you. So, thank you for being here this morning, and thank you to the Alliance for inviting me to share a little bit about our journey with the national poll on healthy aging. Before that, I wanna take a step back and really talk about aging in America, and why we’re all here today at the summit on aging in America, and for that matter, why healthy aging matters at all, or doesn’t matter. Speaker 1:     Does it matter to people? Does it matter to their families? How about to healthcare systems? Health provides? And certainly to policy makers. And again, overwhelmingly, is yes. But why? Well, Americans are living longer than they ever have. They’re living longer and working longer, and today on average, people are living to 79 years, which is three decades longer than a century ago. Speaker 1:     So, it’s a remarkable change in a relatively short period of time. And living well, really being productive in their older years is a priority for older adults, as well as their family members. This is a picture actually taken from in Portland, Oregon, where Jennifer is from. Where I did my geriatrics fellowship. And this is Mister Mark . I took this picture with him a few days after his 103rd birthday. Speaker 1:     And he went on to die peacefully a few years later. And although he required full care at 103, he was really robust and active, and independent, into his late 90s. He was pretty active volunteering in the community. I don’t think he was driving at that point, but he was quite active. And although the overall number of people that make it to 105 is small, the absolute number of Americans who are living into their late 90s and beyond is growing exponentially. Speaker 1:     Over the next decade, we will see continued growth in the population that’s 50 and above. And as you see in this slide, the 50 and above group is gonna grow by about 15 million in the next decade. It’s about a 13% increase, and in comparison, the younger adults 18 to 49 will only grow by 8.6 million. So, we need to think about not just the extremes of age, but also about people who are aging in. So, even the 50 year olds who are sort of pre aging. Speaker 1:     So, I wanna bring this back to a health policy lens. So, why does healthy aging matter? Well, this group of individuals who are 50 and above, they require a disproportionate number of resources. The amount of care they receive, the cost, the expenditures are all gonna be a lot higher in this group, so it’s very important from a money standpoint as well as a social standpoint. And just to give you a sense of what that means, about 110 million individuals fit this US 50 plus population. About 85% of them have filled a prescription in the past month. Speaker 1:     And as you look at the older portion of this group, it’s much higher. It’s six medications on average. About a third have been to the emergency department in the past three years, and more than half have gone to the dentist. When we think about healthy aging, we really should ask those who are aging what’s important to them, and these are data that were taken from the ARP member survey from a couple years ago, and they asked members 50 and over, what’s important to you? Speaker 1:     And the percentages shown here are people who responded that they were either extremely concerned or very concerned. And again, this list shouldn’t really be surprising to the folks in this room, but it’s worth looking at. So, staying mentally sharp, 84%. Having Medicare in the future, 83%. Living a healthy lifestyle, 79%. Having health insurance, 77%. And declining physical health, 69%. Speaker 1:     I wanna put some of these numbers into a little more personalized context, and to do that I’m going to show you a picture and share a story. And this is my grandmother. We call her Dotty. Although, my brother and I kinda refer to her behind her back as The General, because she’s a pretty tough lady. And she is 95 years young. She lives in Michigan with my parents, and she’s actually an avid watcher of Days of Our Lives. She’s watched Days of Our Lives for almost 40 years, and it’s kind of interesting. Speaker 1:     But she’s learned a lot of English from Days of Our Lives. Although, Hindi is her primary language, and she has a number of these interesting idiomatic expressions, and one of my favorite is, in Hindi it’s , which roughly translated means as long as my hands and feet work, everything’s good. But if they don’t, it’s not so good. And I brang that up because in geriatrics we talk a lot about this concept of functional status. You know, activities of daily living. Can you get to the bathroom? Can you feed yourself? Can you bathe yourself? Speaker 1:     My grandmother is not afraid of dying. She is terrified of losing her independence. And she is not alone. I think this is really a very real fear for many people. I wanna shift gears and talk a little bit about academics. So, I’m an academic, from the University of Michigan, and the academic timeline for getting things done is a little different. It’s a little bit slow. We might have an idea, we might write a grant, we might get the grant funded. A few years later you do a study, you write it up, and if you’re lucky, if you’re really, really on point, something you’ve done might actually impact health policy. Speaker 1:     Now, the timeline for health policy is actually very, very different. So, at the University of Michigan, we have the Institute for Healthcare Policy and Innovation, and this is a very multidisciplinary group. More than 500 faculty across our campus, 18 schools and colleges, people all working together on various aspects of health policy. Some of the current work that we are doing include opioid misuse in Michigan, and some of that work has actually changed laws around prescribing. Speaker 1:     Also, the Medicaid expansion in Michigan evaluation. About four years ago, the leadership at IHPI said, “You know what? What topics are gonna be really important in the coming years? Where should we be putting our resources? What should we be thinking about to position IHPI to really be very impactful?? And aging rose to the top of that list. And one thing lead to another, and this really lead to the institute for healthcare policy and innovation’s national poll on healthy aging. Speaker 1:     And when we think about aging, we’re not thinking about just the frail elderly, or extremes of age, we’re really thinking about 50 to 80 year olds. So, people who are aging, and people who are getting ready to age, and people who are actually caregivers for older adults. And we’re also thinking not just about health, like traditional medical issues. We’re talking about health, health policy, healthcare, and really expanding that vision to think about all the things that are really important to people. Speaker 1:     So, there are a lot of questions that are just difficult to answer with traditional research methods. The randomized control trial is really good for certain things, it’s not so good for really understanding behavior change, and what people are thinking in their everyday lives. What are their experiences? And one of the big goals with the national poll on healthy aging was really trying to capture that voice, that experience, the perspective of older adults and their families. Speaker 1:     What is it that they do on a every day basis? And with that in mind, our overall goal was to develop, implement, and sustain a reoccurring nationally representative household survey of US adults, and again, I mention 50 to 80 year olds. And all aspects of health, health policy, and healthcare. And we’ve been able to really sort of go beyond the usual medical issues with this. Speaker 1:     Also, dissemination of the results was really a big part of our initial goals. And again, academic dissemination tends to be sort of stagnant, and slow. Writing papers, making posters, we really wanted to have an impact immediately. And so, with that in mind, thinking about things like media, communications, and also who our partners were. Speaker 1:     We thank about three broad audiences for our poll, which is consumers, or patients, people who provide care, health systems, and clinicians, and then finally policy makers, and people like you. Really happy to report that we have succeeded, at least in terms of putting out reports, we have had 13 reports. The first one came out 15 months ago, so we’re really, really pleased, and these are just some examples of reports. And I have actually brought some with me, which I can leave in case anyone would like some copies, and they’re also available on our website, healthy aging poll dot org. Speaker 1:     One of the things that’s really made us successful is a really unique and special partnership and collaboration with AARP, and I’m really pleased that some of my AARP family is here today. This is something, this is a very non-traditional partnership. It’s a discussion that began maybe in a space like today’s space where it was sort of an academic group, a foundation, a consumer organization, sort of coming together to think about how they could find some common ground. Speaker 1:     AARP provides financial support for the poll, but the poll is independent. It’s at the University of Michigan, it is our product, but they also, AARP provides so much more. They have incredible depth of research experience. They have a team that’s very, very committed to the care of older adults. Also maintaining health, and sort of disrupting aging, all the things that we’re thinking about today. And not only have they helped us make the poll better, and really get the poll out to their 38 million members, and help us with everything like what topics, what questions, but they’ve also come to visit us in Ann Arbor, and our entire IHIP community has benefited. Speaker 1:     And you can see on the right, they had a chance to meet with our investigators who are interested in aging, and to really think about making academic work much more meaningful and really powerful in terms of getting into that policy space. This was our first report, and this was one on drug costs. A really common topic. But instead of just talking about how much people were spending, and how many drugs they were taking, we really were interested in how people go about getting their medications. Do they go to multiple pharmacies? Do they ever ask the pharmacist about cheaper alternatives? Do they ever talk to their doctor about how much they’re spending on medications? Speaker 1:     And one of the things we identified was an interesting relationship in that there was this assumption for a lot of patients that my doctor knows how much I spend on medications, but yet they had never had a conversation about it. Those individuals who had a conversation about drug costs, they said, “Yeah, you know, I had this conversation, and by the way, my doctor gave me some advice or prescribed a cheaper drug.” Speaker 1:     So, it was kind of an interesting thing that we found. We also found that with pharmacists, that a little bit of conversation might actually go a long way, and please don’t assume that your doctor knows how much you spend on medications because as a doctor I’ll tell you, I don’t always know that. Speaker 1:     And this is an example of a graphic that was in the AARP bulletin. So, the editors of the bulletin independently took the data we had, recrafted it, made it into something that was important for their membership, for their readers, and really helped us disseminate these results more broadly, and it’s a little hard to see but on the far right side it was sort of the portion of folks had actually got a cheaper alternative by talking. Speaker 1:     And it’s a sizable number. So, again, pretty simple message that you can … it won’t solve every drug cost issue, but it’s just something simple that people can do. We had another report on dental care, and this time we focused on 50 to 64 year olds. And again, interesting findings. Different patterns of use, where some people were prevention focused, some people only went when they had a problem. There was not, surprisingly, a very close correlation in terms of people being embarrassed about their teeth, which is such an important thing socially if they weren’t getting good care. Speaker 1:     One of the interesting policy points we found was that a large portion of people didn’t know where they were gonna get dental care when they were older, and many of them thought that Medicare would cover them, which clearly it doesn’t. Many people in that 50 to 80 year old group are also caregivers for loved ones with dementia. And in this report, we wanted to look at what are some of the health effects on the caregiver. And we found that many people who were caregivers had their own challenges, health wise. Speaker 1:     27% were delaying their care, or they weren’t getting the care. Two thirds said that caregiving interferes with their ability to really take care of themselves and their everyday activities. And again, to folks in this room, this doesn’t really sound that surprising because many of you work in this space, but I don’t know that all clinicians really stop and think about it. Pediatricians, people who take care of children, probably stop and think, and they know that the parents of their patients are caregivers, but we don’t always think about it with some of the ones that we’re seeing, particularly in that 50 to 80 year old range. Speaker 1:     So, one of the take-home messages to our healthcare providers was ask. Ask people are you a caregiver? Because it has an important impact on people’s health. One other partnership that we have forged in recent years is with health affairs, and not so much the print journal, and the academic journal, but with the blog. We wanted to take a deeper dive into some of the policy aspects of a few of the reports, and so far we’ve had two. In June, our report on patient portals, and how people are using or not using patient electronic portals was something that we were able to write about in health affairs. Speaker 1:     And again, different audience, we were able to engage some people like all of you, and we also did this with our overuse of low value care services, how to engage over adults. So, this gave us a chance to really take a deep dive into the policy aspect, something that wouldn’t really be as appropriate for consumers, or even clinicians. And I wanna just stop with my last slide, and thank my team. I don’t know if there are any college football fans here, or any Michigan fans. But legendary football coach at Michigan, Bo Schembechler, talked about the team, the team, the team. Speaker 1:     And my team back home in Michigan, we worked together to really put this out. Although I’m the one here representing them, it’s such a team effort. We also have important team members in DC with our government affairs office, and then of course, AARP who has been a partner from day one for us. So, I would like to thank you for your attention. Sarah Dash:  Thank you so much, Doctor Malani. That was really, really informative. So, before our first panel, I’d like to invite Andrew Barnhill, who’s director of federal policy at Glaxo Smith Kline, to briefly make some remarks, and introduce our next moderator. Thank you. Andrew Barnhill:           Thanks so much, Sarah. It’s a pleasure to open today’s panels for the summit on such an important topic. On behalf of Glaxo Smith Kline, and our nearly 100 000 employees all around the world, we wanna thank the Alliance for recognizing the importance of aging, and the larger discussions about healthcare in America. Andrew Barnhill:           I have a pleasure of leading federal policy for GSK, a global manufacturer in pharmaceuticals, vaccines, and consumer health. And GSK’s mission is to help people do more, feel better, and live longer. Over the past several years at GSK, we have developed a concentrated effort to support the goal of healthy aging for all of our customers. And as one of the world’s largest adult vaccine manufacturers, we believe that as the US population ages at an unprecedented rate, it’s essential to improve awareness of vaccine preventable diseases, and increase access for older adults. Andrew Barnhill:           Vaccines have the potential for significant economic and social returns for public health overall, as many of us know, and GSK is proud to be a leader in that space. In addition, we at GSK recognize that as our industry’s innovation continues to grow and develop through time, Americans are continuing to live longer and healthier lives. GSK, now through our partner Vive Healthcare, has helped people all around the world living with HIV live longer and healthier lives. Andrew Barnhill:           Through new and innovative anti-retroviral therapies that continue to improve with the latest research and development and technology. So, GSK and the whole bio-pharmaceutical industry is committed to being leaders in this conversation about how best to prepare for an aging population here in the US, in the decades to come. Andrew Barnhill:           And so with that, I would like to introduce our first panel, with the focus on the drivers of health for older adults, and the moderator for this panel, Stewart Butler, senior fellow of economic studies, at the Brookings Institution. Welcome, Stewart. Thank you. Stewart Butler:   Have a panel coming up, right? Great, thank you. And I just wanna echo first of all, something Scully said at the beginning about the importance of the Alliance. And really how its been in the forefront of engaging in these kinds of conversations on these very important topics, and the topic of aging in America, of course, is one of the most important that faces us. The older I get, the more I feel that’s the case. Stewart Butler:   And I was telling my daughter, who’s 30, the weekend that I was doing this, I was gonna be here on this panel, and she said, “Well, I really hope it’s very successful because I don’t wanna spend my life paying for you.” So, this is a good example of family love, as you can tell. But anyway, in my role at Brookings, one of the things I do is actually convene a monthly meeting of people, of researchers, policy makers, and practitioners from … PART 1 OF 5 ENDS Stuart:           For researchers, policy makers and practitioners from different sectors, housing, education, healthcare, social services, and we look at these issues where the road to better health, whether it be for children with mental health issues or for the elderly is not simply a medical path but looking at these other issues that a play a really important part in that. So it’s very important, I think, to begin with the panel looking at these drivers of health for older Americans because the nonmedical factors are so important in reaching a healthy and happy life. And so we’re going to look at some of these drivers, with a distinguished panel that comes from different perspectives, some of these drivers, how they play and what some of the policy issues and other issues are associated with them. I’m going to introduce the panel very, very briefly, that you’ve got their bios in your packages. Stuart:           And then we’ve got strict instructions to keep opening comments very short so we can have some time for a discussion and including from you from the floor. So let me begin first by we’ll hear from Dr. Yael Harris, who’s vice president of health research at the American Institutes for Research and has been very focused the last 20 years on looking at data driven efforts in the healthcare system to redesign access. Melanie, Melanie Bella is the chief of new business and policy at Cityblock Health, in which is a care delivery system built for low income people in urban populations and so on. The ground sees these issues every day. Jason Barker is the regional market president of GENMED in South Florida and for many years has been, involved it says on these notes with the dysfunctional nature of how the system typically functions and trying to feel how to deal with that issue. Stuart:           And then last, by no means least, we’ll have Lucy Thalhimer who is chief strategy and impact officer of Meals on Wheels. I talked about one of the services that is so crucial for aging in this country and she spent a lot of time at ARP looking at these sorts of issues. So let me start by handing over to Yael. Dr. Yael H.:  Thank you so much and I want to thank the Alliance for this really wonderful opportunity and to all of you for putting up with hearing from me. This is a really exciting opportunity for me. This is a field I’ve been in since I first left Grad school and I actually was at Michigan studying with … There was an institute on aging at the time, so I don’t know if it still exists, but I was there under . Dr. Yael H.:  Kimberley. Don’t tell them how old I am. So, anyways, it’s been a real pleasure. Right after that I went and worked at CMS and specifically worked on aging and long-term care and quality of care. And since then my career has mov