i'm dealing with a lower payment rate per service by increasing volume are seeing more patients and stuff that doesn't improve health care. another way for a to get to those achievable savings that many things are inventing the curve on health care cost and it is very important part of this make sure the consumers can get involved and have very diverse health-care systems to work with a wide range of practice settings and you heard about from patrick practitioners working on their role america and talk about different way of putting these different payment reform proposals together. working on this not only our best to put a whole range of different kinds of ideas all of which seem to have the same goal of getting better quality and avoiding unnecessary cost.

i want to highlight getting to accountability as a key part of this so there are some proposals out there that really are about supporting better performance and probably will have an impact. things i ping for reporting -- something that senator does and many private payers do and give better information and give spreaders better information on opportunities to improve care and can lead to improvements in at least specific aspects of care. piven for better coordination and things we don't pay for now to help people stay healthier and get better care like medical homes where we don't have payments now for an answering e-mail's were using records to track of patient and filling prescriptions and providing those medical services. two actually pay for better performance in some dimensions the so-called pay for performance elements that have been demonstrated in the private

sector to show impact. they pay more when it gets better compliance with diabetes medication or better results and other specific aspects. the challenge is there are some dimensions of important quality of care that even if you get improvements in some specific areas and can be hard to have an impact on overall cost and our overall health outcomes for a population so and many of these demonstrations when we have seen is an impact on specific aspect but may be less of an impact on overall cost because additional payments offset savings that might occur because you've got improved performance. more of an emphasis on trying to bring cost and reducing unnecessary cost directly into the performance incentives. a lot of effort is underway to implement the episode based payment when there is a payment based on a particular procedure

like bypass operation and the hospital care, the physicians' services and may be a case based piven for diabetes and these might be adjusted for the illness for the patient but the idea is you get paid the same amount or more if you deliver better quality care and those payments can be right important in getting better quality and the challenge is one way of improving health and reducing costs is to avoid many episodes in the first place and by avoiding the bipods or reducing level might be a better way to get the lower cost and to focus on episodes you won't incorporate in that important element of getting to higher value in health care and so some errors are focusing directly on payment for higher value. i'm going to talk about

accountable care and accountability forgetting this goal met. getting better outcome for a population of patients at a lower overall cost and that can be done through shared savings so this can be added into current payments systems without radical change. give providers in an opportunity to share in the savings they create and they take steps that are immersed enough for exactly the right patients. what ever it takes to get better outcomes and reduce average cost of the patients treating should provide better support and channels and to better support for the providers and even further is moving in that direction of an astonishing from traditional kind of capitated payment and the importance is there but the idea is putting more weight on an overall goal of meeting a cost target while improving quality and putting less wit on the traditional ways

of paying such as fee-for-service and the extreme you put no weight on a fee-for-service adjusted for quality and severity of ellis of the patient. far along the stream that definitely where a lot of organization reforms and accountable care organizations concept of working on to explain the hatters on this line mrs. trying to work by us at health care reform at brookings and the dartmouth instituted for clinical services for health policy in clinical practice. a collaborative effort and any anaheim accountable care rescission is we want to support providers organize and away the can manage continuum of care. the whole set of care for patients. maybe not too formal organization been having accountability and focusing

payments on the results for a population of patients. not for specific episode but for a population of patients. this requires the care organization to be large enough to support comprehensive measurement of performance and provide a critical mass with the kinds of targeted support services benefit for particular patients and also needs to be enough organization in these accountable care organizations to be able to plan ahead and take steps that are going to improve care and reduce cost. lots of different ways and a co conform and a lot of being considered in legislation now apparent wish of the requirements be a my own view is in his best to provide some flexibility given their a different practice settings in these accountable care stops may occur. you might have organization that is integrated between primary-care providers and hospitals. on the other hand, these kind of support for better results for a population of patients at our

cost could occur at original level and with a looser virtual relationship or informal relationship between providers that might be spread out more geographically and maybe including house out explicitly maybe not. its importance to consider there are other elements that brought in and think about changing payments that focus on better outcomes and lower-cost. mental health services, home health services and other elements of the overall delivery of care. even things that are in traditional health care like community-based services and well as programs that may be the most cost-effective way for some people to get better health outcomes at lower-cost outside of traditional medical care and only by having payments that focus on that goal and support better health outcomes and lower-cost provide incentives and financial support for bringing those together collectively as well. the basic idea in accountable care is sharing savings from

getting better outcomes and lower-cost so this is a graph illustrates it is possible to project forward at what cost might have been in the absence of implementing these reforms and the better statistical methods we can do this and then aim for a benchmark target below what spending would have been over all and the extent that benchmark is exceeded has the initial payment to the providers that get better outcomes and bring costs down at the same time. this provides a little more detail on how accountable care can be implemented and provides paris change the way they are fee-for-service approach. accountable care providers working together identify who that are and a pair can identify who is getting care from those providers and patients

accountable for based on actual patterns. doesn't require active enrollment, not taking benefits away from medicare beneficiaries and those providers responsible for the overall cost of the patients both services they deliver and others they receive a so there is a real connection between and the other providers in delivering care. the benchmark can be calculated about future spending and enter into a contract that provides potential savings for opportunity of sharon savings and accountable care organization now has a mechanism to make ends meet of still taking steps like answering e-mail's in using help i.t. attractively, using nurse practitioners and well as programs whenever it takes for their beneficiaries to get better health outcomes of our

cost. this is part of a most of the health care reform proposals being considered right now and focuses on accountability for the evers practice organizational and market settings and assign to be compatible with other reforms, and things like pay for health it and on all payments can help move in this direction of getting to what we really want accountability and payment on better outcomes a lower-cost and this can be done through multi stakeholder collaboration's as well. there are in number of is going on around the country and i'll mention those briefly but the idea is as bad triclosan there are some things to collaborate on to compete on to the extent possible to get multiple stakeholders to commit to the same kinds of quality measures that providers believe in and patience can believe and and can

help them get better value for their spending. multistate colder collaboration can support these accountable care activities. having consistent quality measures can also mean more accurate performance measurements because more patients are involved in the caribbean delivered by providers can be developed. that also means areas of the can be competition so if blue cross plans are participating in this african all implement payment reforms that would reinforce each other rather than pushing providers and lots of different directions as they each have their own quality initiatives as it adds up to a lot of noise and confusion from the standpoint of health-care providers. some of these can be regionally based as well and how to make progress on these kinds of issues. we have been working with a number of these around the

country not by any means all of them and important things happening as you heard about and it doesn't mean it is not critical but just to give an example in north carolina its starting with medical home concept in the medicaid program and spending to the state employee program that was north carolina as participating in exploring ways to get medicare participation in this program as well. the quality measures for the seven populations on the same but the goal is to get improvement in outcomes for payments will get a reduction in overall cost of care. these are not implemented and radical and seven way is moving away from the fee-for-service payment and providers, there are being implemented through incremental steps line providing up-front payments for medical homes and care coronations but

transition intended to move payment toward paying for better results in making sure these are leading to outcomes for payments an overall cost of care. a number of these around the country. there's a lot of discussion earlier about the importance of medicare and participate in these efforts. while i was sad cms we started a program started on this firm primarily integrated group practices were a number of physicians integrated groups and ipa participate in a deal like this where they still not paid the for service payments by in addition to that they started reporting on a meaningful quality performance measures for the patient population and the holes that were touched by their care including preventive measures and evidence based process and outcomes and experience measures for the common chronic diseases that

account for most medicare cost and medicare started tracking the overall spending for patients in these programs. the deal was the document improvement in the number of these dimensions of the important patient's quality of care and medicare saw a slowdown in the growth trend while they get back some of the savings. at this point the latest results are about all have significantly improved quality and half have been able to get cost spending down by more than two percentage points per year. that is significant adding up overtime as the savings interim get larger insubstantial as time goes on and more steps along these lines reinforced by the payments. key elements are getting multiple stakeholders' involved in a trust and process that brings key players and providers and public sector to the table.

having capacity to measure performance in terms of quality and cost of care and are trying to help i.t. and the definition of meaningful use being discussed now but puts an emphasis on demonstrated impact on performance measures an ad on quality of care. having some ability to compare these benchmark trends to impact over time having a control group our benchmark prediction track and against actual performance of this account a bowl care corporation, a savings one and then having a quality and efficiency component as also the steps are being done now. they are considered in legislation related to medicare that when given a much-needed ability to get import quality cost measures for their beneficiaries so that the impact

can be evaluated much more quickly and it potentially important part of achieving meaningful health-care reform. thank you all very much.

remarks on the financial markets from the chairman of the financial accounting standard board here from the national press club this is about an hour.

>> i am a reporter with usa today and i am president of the national press club. the leading professional organization for journalists and are committed to the future of journalism by providing innovative programming in journalism education and fostering a free press worldwide. for more information about the national press club please visit us on our website at www.press the.org appear in on behalf of our 3,500 members worldwide and a like to welcome our spirits and our guest in the audience today. i like to welcome those of you who are watching us on c-span. we are looking forward to today's speech and afterwards al asked many questions from the audience as time permits. please hold your applause during the speech so we have time for as many questions as possible. for our broadcast audience and i to explain that if you hear applause and maybe from the guests and members of the

general public and not necessarily from the working press. i would now like to introduce our head table guests and ask them to stand briefly the other names are called -- from your right keith hill of an bna, treasurer of the national press club, peter stemware, field reporter, ron of a market watch, russell goldman, fasb and a guest of our speaker, kerry, financial accounting foundation and customer speaker, skipping over myself at the podium here, angela kean, bloomberg news reporter and sherrif of the club's speakers' committee, i will skip over speaker for a moment, bob carden of cornyn communications, the speakers' committee member who range today's launch. thank you very much, bob. allen wildmon of the fasb and test of our speaker.

and finally night camping gear up to planters. [applause] the financial accounting standards board is on of those because i it government agencies that sense the business rules specifically fasb as it is known developed generally accepted accounting principles that businesses must adhere to reporting their results. this is done so businesses can in theory cookbooks to make themselves and their stock prices look better than they really are. good enough but if you picked up a newspaper in the last year you probably noticed that more than a few companies aren't doing very well. think your sam pointed everywhere and shortsighted ceos, sleeping or negligent regulators, overspending consumers and the sleazy lenders. fasb has been spent much of that

criticism. and companies did generally follow standard accounting rules. these days fasb is a bill like the most popular girl at that dance and companies particularly banks want a modification of accounting rules that might make their balance sheets look a little bit more appetizing. our guest today is head of fasb and has been so since 2002 and is one of many experts time to figure out the best way to get out of the economic home to make sure it doesn't happen again. he is a certified public accountant and less at price waterhouse coopers prior two excepting his current position. president obama recently announced a broad set of new regulatory measures in that stabilizing the economy. we look for to hearing our guests take on this and other economic issues facing the country. please try me in welcoming mr. robert hurts to the national press club.

[applause] >> thank you for that very generous introduction. it is a real pleasure to be here and a great honor. i have been on panels at the national press club here and i have been in the audience a number of times in march many of the speakers on c-span and had watched with great having not only because this is entering beginning to speak at but also because you get awarded the coveted coffee mug at the end of the. now i have an incentive. before i start my remarks and i do need to say that the views i will express today are my own

and not official positions of the this be one. but what i can assure you is any opinions i do today to reflect the opinions of our chairman. [laughter] by most measures the past two years have been a very difficult and challenging time for virtually everyone. as we continue to examine the causes of the global lead into a crisis then the emperor and lessons are emerging. lessons for all of us in that capital markets, lessons that challenge some of our core beliefs and a core operating principles. history does not repeat itself, people repeat history so hopefully the lessons learned will help us build a stronger solvent financial system going foreign. i think it is a general consensus that the excess leverage at many levels and lax lending practices fuel the

creation of complex and risky stretchers' securities and derivatives that would then spread across a pig in unregulated markets around the world. when the risks became evident the lack of basic supporting infrastructures in terms of timing and accurate information flows clearing mechanisms and price discovery compound the problems. leading to freezing credit markets plummeting at the markets and significant downward pressure on economic growth. however, one very welcome development arising from the financial crisis i believe is that a much broader constituency is common for a greater transparency as necessary ingredient for recovery and rebuilding of investor and public confidence. included in this has been the need to improve and strengthen certain accounting and reporting standards. while accounting to not cause the prices and accounting will

not indent it did reveal the number of areas requiring attention and so over the past 18 months we have responded vigorously but the number of new standards and enhance disclosure requirements relating to this to transitions and credit defaults slops and credit exposures. unfortunately there have been certain major companies including some of them subsequently fell and had to be rescued by the government and industry trade groups that have sought intervention into canting setting. while that certain is their right and while welcome active dialogue with lawmakers politicizing standard setting by special interest does risk undermining public confidence in the whole financial reporting system. the investing public expense and

deserves unbiased and transparent financial information that is not skewed the favor particular transactions or particular industries. we work hard to me that expectation trying to be very open, thorough, objective and timely in responding to reporting issues that arise and a very challenging environment. transparency is not just a buzz word or a cliche, it is a fundamental and absolutely essential and should be of sound financial markets. relevant trustworthy and timely information is the oxygen of financial markets. depriving americans of such information are putting the information can have adverse consequences in some additional systemic actions are needed by others i believe particularly in areas related to the complexity inherent in complex financial

products and information systems are on the americas restricted securities and derivatives. transparency to the american public around taxpayer financial support a major u.s. companies is also essential. last week the administration issued their plan or a financial and oratory reform. the gop has also released a proposal on regulatory reform. various private sector groups have issued a lengthy studies with in detail the recommendations on changes to our financial berated resistance. congress has begun discussing these and other proposals for change. while i may not be the best position to offer overall blueprint for regulatory reform or a particular elements of it i do have some strong views on the subject. formed from observing and purges abating in the events of the

past two years in a career dedicated to improving the functioning of capital markets to the enhanced provided to investors. so i would like to provide my thoughts on some of the key principles that should guide the reforms. a kind of outcomes based approach to it. what would be desirable outcomes from regulatory reform. i do so without any pretense these of the only were most critical matters that need to be addressed but i hope my thoughts will be useful in evaluating the many detailed proposals emerging and i will comment also on relationship between these matters and our role and activities as the nation's accounting standards. as we address and evaluate potential reforms i think we need to strike the right bounce between regulation that is respected and if i did we recognizes manages risk that

fosters sound economic growth and competitiveness and lets those who fail whale. i'm believe the primary objectives of any redesign of our regulatory systems should not only made to avoid a repeat of the financial crises of the past 20 years but more over to create a solid and durable platform for a sound and stable and economic growth to a ineffectively a functioning financial system that deserves and maintains public trust and confidence in our capitalist system in our way of life. while that may sound rather grandiose and someone take isn't that what financial institutions capital markets and financial regulation of all about? to promote and protect our economic well-being and of future generations of a sustaining public