senator casey looking a chronic disease for young people and said under isakson teaming up and a lot of senators who care about this issue. what i am struck by is that the outset how valuable to me in the kind of seat of my pants it would be to have one individual, one single individual, whether it is a nurse, a physician, another individual from the health care system who basically would be the go to person for coordinating the appointments and keeping track of multiple doctors and making sure that one individual.or communicate with another. i was the whole point of the electronic medical record. you didn't want dr. three have to repeat all this stuff.or two and one did. but we are still trying to make

sure the interconnection is fair hearing what start with you, ms. dempsey in you, mrs. lehmann to get non-record how valuable it would be. we know the debate of who would to be, but one single individual be that go to person to coordinate the array of benefits and services and the like. let's start with you, miss tennessee. >> would be life-changing. it would be absolutely wonderful to be able to i guess free up some of my time and maybe even relax enough to know that i don't have to follow a step behind out there want to make sure things are done and make sure my care is at the top of the list. if i had one person that is the go to person that would make

sure that everything was done correctly and everything was scored dated between everyone else, it is just invaluable. >> in you, mrs. lehmann. >> not only would it be life-changing, it would be life-giving. because most of my time is spent feeling overwhelmed. do i call for this? where do i call for that quiet now looking at long-term care. how are we going to do that? this is a very huge issue. i want to keep 10 at home with me. i want to be his caregiver, but i am going to need no. he considerably weighs more than i and i am going to need help. i find this very, very

overwhelming. if i had one person to whom i could call and say, how can we do this? how can you help me? i would so appreciate that. >> well, thank you, both. i will forgive other questions after a mixture of my colleagues get a turn. but that literally, since those great panther days struck me as a prerequisite to turning this around. you all have called up life-changing, you know, life-giving. i would just like to take some of that folder off your shoulders. you know, when you deal with the conditions you have described this morning and you've got to figure out how to navigate -- i saw with my mother. i said to myself at one point, so here i am a united states senator. that's a pretty important decision. everyone in the health care system do about it. my mother got a masters degree from yale and we were in her

hometown where i play basketball. and i said to myself, if it is this hard for somebody like me in a family, what is that like for everybody else who's not starting with that? that so we've got to turn around. let me allow my friends to have added. next is senator stabenow and you should know she's done extraordinary work on alzheimer's. i don't think a month goes by without senator stabenow talking to me about what we have to do in this community about alzheimer's. >> thank you, mr. chairman. and thank you to each of you will you play in the important work you are doing. this is lehmann, thank you and before i asked for questions regarding alzheimer's, i do want to start by saying further. that while a lot of things that

folks want to talk negatively about in the affordable care act, because we have the affordable care act, there's no more preexisting conditions. ms. dempsey, at least you're not having to worry about finding insurance with all the challenges you have. there are no annual or lifetime limit on the number of treatments that you can receive input and also not having to battle all of that. we are in a situation where there is more affordable options for people and while we are not doing everything we can on cost savings, at least we are having a conversation on coronation and accountable care. in michigan received several savings i'm not. so there's more to do faster. at least we are talking about quality of care and what needs to be done. in my judgment, we've got talk

about case management, mr. chairman in a much more real way. first of may save for the record, number one cause of death of women in this country is hard he is. people don't realize that. one out of three -- one of the three death of women, mr. chairman, are because of heart disease. we need to remind ourselves as not her's don't understand, unfortunately, women have different systems. they are diagnosed differently. oftentimes it is set to be stressed when it's actually something happening in terms of hard ease. we have a very important report coming out from the fda in amendment offered in the safety innovation not that we passed that is going to require an action plan for more participation of women in drug clinical trials because women are different than men and have

different reactions. we at least want to make sure, ms. dempsey, do what you are carrying around is the best for you to have is a woman. so very important fda action plan, mr. chairman. let me just say your story just emphasizes and re-energizes me to pass something that senator collins and i have introduced called the hope for alzheimer's facts. we have got to get this done. as you know, this would require comprehensive clinical diagnosis of valuation for alzheimer's disease, caregiving plan for newly diagnosed individual and caregivers about all the options and things are talking about to make that available as well as documentation on the planning going into the medical records and so on. back on top of critical research we have to continue to do because there is hope what we should be doubling down on the

research. i'm wondering if you could just speak to it 15 years earlier you had been able to have the tools to diagnose your husband has alzheimer's symptoms and so on, what difference would that is made to both of you in your lives if you had really known earlier and been able to get the care he could've had had at that time? >> it would've been -- it would've been tremendous been tremendous, just absolutely tremendous. by the grace of god i am still standing. that's how i feel. this last 15 years has been very, very difficult. it is the love that we have for each other that is truly sustained us. it is our faith and our family. without those elements, i can't

imagine having been through this. just go into the marriott about there is a neurologist whom we expect it would know or be knowledgeable about alzheimer's. both were not. i was hoping that the time when i was looking for the second neurologist if there is just a guide in the yellow pages that would say specializes in alzheimer's in the alzheimer's association was able to get the last of doctors who did specialize. but it was later in the process. it shouldn't be that hard. >> it should not have been not hard. >> one of the very first doctors we had seen had referred us to the alzheimer's association. it was actually a friend in california who called and said how are you doing and when she heard how i was not doing some

issues that call the alzheimer's association. my dad had alzheimer's and they were such a help to me. abb will be a help to you. so here is another instance of the caregiver helpline, which i now refer to as my caregiver lifeline. i was the beginning of the change. >> is a wonderful group. mr. chairman, i know you know this, but for the record when not in five medicare dollars goes to the treatment of alzheimer's. one out of five medicare dollars. this is a huge issue predominately of quality of life and life. but it's also a huge issue for us in tackling costs. i very much appreciate your doing this and also ms. dempsey, thank you for being here. i am listening to you. it is overwhelming just listening to you and just

unbelievable what your challenge was. thank you for taking the extra effort to come and share your story. >> thank you for your dedication. >> thank you, senator stabenow. in addition, mrs. lehmann, you should know senator to me has spoken to live about alzheimer's as has senator warner and there will be strong support in this committee on both sides of the aisle for reform some alzheimer. before i recognized another isakson, senator klobuchar and franken would like to submit statements for the record. i ask unanimous consent the records be submitted for the record. we very much appreciate the good work that senator isakson has done in this area. he has been my partner now for many, many months and when you work for senator isakson on health reform, you are running with the right crowd. senator isakson come your questions. >> thank you, mr. chairman.

dr. bornstein, thank you for coming out on the coordinated care. your testimony was compelling on one point. you are medicare, care according a nurse or nurse is coming back right away you are not reimbursed are you quick >> correct. >> but she do then to coordinate care for patients to coordinate care of your patients come which lessens the number of visits on a fee-for-service basis for which are reimbursed. another word they cost more to do less and less to do more. so for denmark airport nation would be in better shape financially as a country unless another health care and improve quality, is that correct quiet >> correct. >> of ms. dempsey was your patient and you had an embedded quark coordinator in the process, with a misdiagnosis -- not misdiagnoses, the improper

drug for rheumatology procedures had been cut by health information technology? >> well, the care coordinator can play a role in that. our information system would help alert us to die. 's i also believe the important role of primary care. in the earlier discussion, the fact we need somebody looking at all of those pieces. i think there's another element in the dependency on third parties coordinating care, we need to have that built-in, but we also need to have all the individual specialist thinking about care coordination through the process of care. to give you an example similar to what ms. dempsey taught about, that i use as a litmus test for how our system is performing. when i take every patient with diabetes who might be seen another specialist and not specialist considers starting a patient on with a a

quarter-point, an anti-inflammatory drug that raises blood sugar, the best thing is for the individual to coordinate with me plan around the effects of the medication similar to the medication that might increase the risk of seizures. the question is how often does that happen? the answer in my experience is almost never. occasionally the specialist will ask the patient to that they know about this, putting the burden on the patient to coordinate care. so i think we know most of these individuals are hard-working, well intended and care about the entire patient care that the burden of our fee-for-service structure is such that there is relentless pressure to see patients face-to-face and no real provision are the type that to the sydney to go on with patients aren't there. the conversation specialist be back together that complements

having care coordinators in primary care providers as well. >> your testimony affirms that the chairman i have been talking about tonight is you can lower the cost of improving the quality at the same time by coordinating care for people with multiple chronic illnesses. on alzheimer's, my mother passed away from alzheimer's and i was her caregiver for the first three years after my father's death. one of the things i remember the aggravated alzheimer's was when we would have to take her to a physician or a medical appointment and not of her surroundings where she was staying. do you experience that? >> ken is ill early stage, but i definitely know that that is something that is very common with persons who have alzheimer's. it can be very difficult and it can result in behaviors that we don't see on a day-to-day basis necessarily. >> care court nader can help avoid the number of visits you have to make to citizens which

aggravate alzheimer's tremendously. i remember my mother situation she would go a docile individual to an agitated individual because she was asked at the surrounding she was so familiar with when she was in the home. >> mr. chairman, and the testimony certifies what you said all along and not is if we can do a better job of incentivizing coordination among the best is better care, but also less cost. testimony we heard today verifies those analogy think our witnesses are being here today. welcome to georgia. we are glad to have you here. i've got a house two counties over for me when it's god's country were glad to have you there. >> my mother called to god's country, too. >> thank you, mr. chairman. i would tell our guys that you often see senators in age in this bouquet tossing contest saying nice things about each

other. but on the bipartisan bill here in the senate and house, the better care at lower cost at the senator isakson who from the get-go saw that as the frame around which to build. we think senator isakson for his leadership. senator bennett is next and i'll tell you senator bennett has been running in and out of this room trying to figure out how to juggle meetings and still be here to tackle these issues. senator bennett. >> thank you, mr. chairman. the nice thing i'd like to say about my colleague is that never happens around this place. they should build a statue to you. [laughter] mr. chairman, things continue not offer this testimony. it's very consistent with what i've heard from patients and others in colorado delighted with the important topics. dr. bornstein, couple questions for you. senator grassley and i as well

as others on the committee have been focusing recently on how to improve better care port nation for children with chronic conditions who are often overlooked and suffer tremendously as a result of that. i'm sure you encountered this figure hospital and the children was medically complex conditions. i wonder if you can talk about the challenges they face in the improvements you have put in place to deal with their kids. >> well, care of children at emory as a separate endeavor, but i know that the same principles apply, whether a kid or an adult, when you've multiple medical conditions from our numerous conditions in medical specialist, coordination is not going to occur spontaneously. it requires extra energy and matter. it requires in particular the allocation of time to do that. i think as we have discussed earlier, there's been lots of

hope placed on information technology and i think given the complexity of the care we now render, information technologies absolute crucial. but it's necessary but not sufficient. by itself it won't solve these problems. >> beyond just the institution of a hospital, they could figure out how to create a set of conditions for the children's hospitals across this country for able to work in closer. >> is true for adult care as well. while we have burrowed integrated medical records and not accomplish is quite a bit, as soon as they see a provider outside of our knotwork, most of the information is invisible to last. >> you had mentioned in the discussion with senator isakson but problematic result that we face because we are enslaved in the fee-for-service system. i wonder if you could talk about other ways in which the federal

government and private insurers create incentives that are not only not helpful to you, but drag you in a completely different direction from where you would like to go. i realize it's a big question, but since you are here and we've got the folks that are in theory going to be making decisions, think big. don't think small. if you were in the senate, but her handful of things you would do to make your life less of a misery? >> let me actually try to address that from two alto twos. it is a good question. >> i'm not implying your life is a misery, but to the extent that we caused these problems. >> at me say at the outside, the fact we are having these conversations is really important and i have great hope for the future and what is possible. as i said in my testimony, they should be a wonderful time for patients and caregivers, given

all the wonderful things we have to offer and if we can just break through the barriers and improve the structures, we can deliver on that promise. at the granular level, one big concern i have relates to how quality measures are used. so if every quality measure in every implementation, there's always unintended consequences be as bad as justin h. or the universe more or less. i think what is particularly important when we think about quality measures is what are the unintended consequences and how can we continually improve them. for example, when ms. demars was talking about profiling, which i support, we need to make sure the severity adjustment is built into that. so if i'm an endocrinologist at emory taking care of the most complex patients with diabetes whose measures of cocos control may not be as good as some

patients with less complex diabetes, high do we account for that? if we don't, what would you is undermined the important efforts that are devoted to those patient groups in need of the most complex types of care. at the other end of the spectrum if you asked me for thoughts on how we change all of that, you know again, the payment structure is a tissue. we desperately need a system in which we have time to put energy and effort into coordination of care and use all of these tools we are now developing. so for patients with diabetes, more and more care can be delivered when a patient is not there. it needs to be continuous care. sublet sugars can be transmitted to me if they choose to have that happen and i cannot be more continuous relationship. in our current structure come if

i spend my time doing that, i will go out of business and honestly no margin, no mission. i also think there is a way to think about how we develop quality measures that reflect coordination of care. this may get me in trouble with some of my colleague, but it is a concept i have thought about that in a way has several liabilities of the patient has a group of medical problems, my thought is each of the providers taking care of the patient not be responsible for all the measures of the quality that patient needs. so if you're seeing me for diabetes and orthopedist for back pain, or to have accountability for back pain in the orthopedist ought to have accountability for the diabetes control because after all each of us does have an impact on the whole patient. >> thank you, senator bennet and

thank you for your efforts on this over the years. we look forward to working with you. senator warner is another alzheimer's and chronic disease and long-standing interest. let us recognize him. >> thank you, mr. chairman. thank you holding this hearing and i know it's the beginning of a series of hearings on the subject. i know you've raised the issue after ms. lehmann talks. all of us have a personal story. my mom had alzheimer's for 11 years in the nine of which he didn't speak there my father was the primary caregiver along with my sister come a journey much harder than anything i've ever done and have an honest or site for both of them for what they did. that has driven me from my tenure as governor now a senator and they keep giving shadows to johnny isakson, the johnny isakson and i've taken another piece of this journey. i know senator bennet is talked about children and senator isakson talked about chronic disease. senator isakson and i have got legislation focused on advanced illness and the component of

life's journey. where i want to start with anyone else and i think dr. bornstein raised some interesting cons that come interesting ideas. i'm sure some of your colleagues heads exploded when you just said that. prior to that kind of pale and responsibility, one of the things at the front end is how you set up a care plan. i would like in a view to address this notion of first of all how we can do a better job of setting up these care plan that make sure all of the not only medical providers, but other stakeholders in the individual's life are engaged, whether that is social workers, hospice, others number one and number two would either comment on what we from the legislative side, kind of a mirror image of

time on one end of life of what we in congress can do to advance the goal of having care plans carry some of the things senator isakson and i have looked at if you have that kind of the ants direct it virtual that it would be recognized across state lines. we hear from our first witness from south carolina to georgia. advance directives if you have them would be honored in many states across the line. if you want to start another members on what we can do from a stakeholder standpoint and then from the congress standpoint. >> i have to say that this is a new concept for me. i have been as i mentioned the operations manager. i have been a care plan or an i haven't gone as far as made a wish list for what could be because i am dealing with the

day-to-day. >> you are still living it. >> i am indeed living it. but i think it would be so very helpful just is, to even have someone to coordinate with, and even i wouldn't mind making a call to someone with tommy or shall i call, who should i call? whom should i call? it is a myriad of lots and lots of resources. and i have access to them. i have loads of booklet and from the senior linkage line in minnesota i have so much wonderful information and i look at it and i am overwhelmed. >> one thing i mention that we started a decade ago was based upon my own interest is senior

navigator.com that provided those questions but also provided the resources drilled down to by zip code level because so many caregivers or others don't know where to turn. do you want to address those? >> yes, sir. you put your finger on some very important opportunities. from the standpoint of care plans, while we are making good progress on his care plans for diseases. for patients with multiple diseases will have a diabetes care plan in a coronary artery disease care plan. what we need is care plans for all those users. integrated care plan designed for the individual patient that takes into account all of their illnesses. again, that won't happen without a payment structure that does not solely reword visits.

it requires one that will reward those for producing better care. >> someone with repeated tests refuse to compensate them talk through this stage of life. >> we have a very successful program at emory, but the conversation thingy tab take a long time and even under the reimbursement code, they are not able to sustain themselves. other opportunities i personally think that there is a great need for these conversations to occur outside of health care facilities. you are probably familiar with alan goodman's conversation. these are hard conversations come even very sophisticated

amylase will often do everything they can to avoid the conversation. there are tools out there and we can do a better job of promulgating those tools. this goes way beyond the health care systems. if the public health opportunity. >> one thing i would mention. i know time has expired, but often times the doctor may be as uncomfortable having a conversation at the family. >> absolutely. the different different specialist may be on different pages and they need to have those conversations together as well. >> thank you, mr. chairman. >> thank you, senator warner. our guess should note that senator warner in addition to raising these important issues, what he has described dovetails very well a large demonstration project that is beginning shortly ran through cms called medicare care choices in the first time this would allow

those to have an option between curative care and hospice care, which in the past has not been permitted in all the applications are in making decisions so this is about to be rolled out shortly and dovetails well with the important work senator warner is talking about. senator casey. >> mr. chairman, thank you for the hearing i want to thank you as well for sharing your own personal story about your mom. unless you're a couple moments ago and had a meeting but a whole set of topics of foreign policy and the person the meeting when i told him were escorted back to setting up a 944 euros mother choose the equivalent of a concert pianist. she is 94 and has alzheimer's, but she can still play very well in yet other parts of her life are more complicated. so it affects so many families, senator warner and others have spoken to this over many years.

i will direct my questions not to ms. dempsey and mistry and eight and i don't do that for any other reason than that i have limited time. but i'm especially grateful you are here to provide your own personal testimony. it not easy to talk about your own life in a public setting like that, especially something as challenging as this so we are grateful for your presence and testimony in the information we derive from it. will start with ms. demars. i want to start with the question of anna in particular. we know this is known to medical professionals, but we know that en masse is a serious debilitating disease in which a patient's immune system patient's immune system eats away at the protective covering on the nerves. we know that the treatment for ms is highly individualized and

not is why ask the question because at the same time it is complicated and difficult to deal that, we know proper management can yield great results, reducing symptoms, slowing disease progression and improving quality of life. the basic question i have for you is when you look at what plans and employers are doing, how do they select plan and ensure patients with ms and other chronic conditions of access to a full range of available therapies? could you speak to that? >> sure, thank you, senator casey. our members are self funded employer so i will speak from my head. we understand that the help of our work force is directly related to our business results. so share an interest in ensuring our employees and family members get the right care. increasingly, employers are

looking to this science, looking to research to help them unders and that they should be covering and i thought of those to ensure optimal health. iu-based benefit design is the nomenclature being used to refer to the practice of providing clinically sensitive, clinically nuanced coverage for employees. so this science related to ms would be something that would factor into a self funded employer's design of their benefits plan to ensure adequate coverage for that condition. >> is there anything you would hope we would do to be there further incentivize or facilitate this kind of approach to en masse or do you think were on the right track? >> maybe i could speak more broadly than specific to en masse. i think that the quarry research

has great promise to understand the relative value of testing treatments that we can begin to factor into how we provide coverage. >> thank you very much. i want to turn to dr. bornstein and the question of socioeconomic status of beneficiaries, which like everything has an acronym, ses. there has been a lot of recent research on the economic -- socioeconomic status can affect both outcomes and house. you know from the work of the committee and from your involvement with these issues that delivery system reform is a huge priority for us in a major topic. sometimes what is less often discusses what i'm sure you and others have seen is a growing daddy of research and evidence

that racial and ethnic feyenoord is in people with lower average incomes receive often lower quality of care than folks in other and come or racial categories. can you speak to that in the context of a guess the basic question is do you think there is a utility and a need to include these kinds of what might be called socioeconomic status factors when determining health care policy. i know that's a broad question. >> yes, sir. it's a critical element in improving health is addressing the socioeconomic disparities. right now there is a big going on as we speak about race and socioeconomic status and i think that illustrates the case very well. from a hospital standpoint, the hospitals that serve the

disadvantaged populations typically have higher readmission rate and as you know, much of what happens -- >> it could be penalized because the rates go up even though they have a more difficult challenge. >> much of what happens reoccurs after the patient leaves the hospital. so their home situation and access to care and support structures have a significant impact on not. to penalized those hospitals for things that are very much out of their control would have unintended consequences of a further deterioration of their economic viability in terms of providing eye care. by the same token, that needs not to cost the country's radar screen because this is a problem and the fact the disadvantaged have higher readmission rates and worse outcomes needs to be addressed. but the question is, does that need to be addressed by the individual hospital at which they were being researched from

or some other element of society? is a critical consideration and we need to never forget about it. >> thank you very much. >> thank you, senator keith e. i know you've talked about these issues and kids a number of times over the years and i very much appreciate your advocacy. we are joined by pennsylvania's other senators, senator to me. thank you, mr. chairman. i want to thank all the witnesses for being here today. direct my question to ms. lehmann. your story is painfully familiar to so many americans who are suffering through some very haitian en masse. i wonder if you could just give it some more thought from your perspective on how health care providers might approach care differently in the importance of coordinated care, the importance of whether that's a team or an

individual, whether you think which position your husband sees multiple sessions, who should have their fun filled day. any thoughts on how the focus of the care could be different and could be helpful to the patient and caregiver? >> i think among ken stott yours is our most important person. alzheimer's is our primary concern. it is fortunate that his atrial flutter is somewhat under control, medicated so he is able to thrive with it. but i still think in terms of when someone not to is your primary doctor, i always say the new urologist decodes in order to live well with alzheimer's, it begins with him.

it begins with how he begins to coordinate the health plan, which he has to a degree. i think it comes in different portions are different compartments. the way he's looking at in particular is making ken's life as rich and as powerful as they can be on a day to day basis. and so, he is a very important part of a program that ken is then entitled living well. it is run by the alzheimer's association, by the wilder foundation of st. paul, minnesota and by the jewish community center who has opened its doors to welcome my on their campus every week. and with that living well program is associated a

caregiver café so that ken and i ago together. and this is very, very important. it's not a day program where i drop him off to do my own thing, which once in a while happens because they taste that we have some free time and we say we want to calm. we want to be together. we want to have this time together. though we come together. we are a couple. we are supporting each other in this. he goes to his program where he learns about good diet, where they exercise and where they do a lot of creative expression, which is turning out to be a very, very important part of living well with alzheimer's. dr. rosenblum has been very much a part of that. in fact, he comes to the living well program. he is a part as well as speaking to the caregivers misspeaking to the persons with the disease.

also the neuropsychologist from arson are constantly insert question about the disease for the caregivers as well as persons with the disease. so that is an aspect which is very, very important in dealing with our daily living. for me, dealing with finances is another ratio and that is where the system for further help down the line. that is where a lot of triangle, another piece of the pie that i need assist in the period but i am so appreciative of the care plan that we have with our neurologist. .. some point ken is less able to communicate a discomfort or a problem that would be an indication of some other problem, and so is he the point person for making sure that there are, they're keeping up

with what needs to be monitored? >> he is. >> okay. >> he is. in fact, last, our last appointment he addressed that very issue. just knowing that the disease is progressive -- >> right. >> -- and we will be looking at different living situations and so forth. so he has been the point person for that for which i'm very grateful. >> great. well, thank you very much. thank you for coming and testifying today. appreciate it. >> thank you. >> thank you, mr. chairman. >> thank you, smoother toomey. -- senator toomey. we have talked about this issue a number of times, and i look forward to working very closely with you. >> thank you. >> let me go to the next question. this will involve you, ms. demars, as one of the payers and employers. we've talked a lot about medicare, for example, which i've put a special focus on. but chronic disease is often diagnosed well before a patient becomes medicare eligible.

in your view, what strategies can the committee in your view, what strategies can the committee pursue again in a bipartisan kind of fashion so that when individuals aged into the medicare program, they are going to be healthier than they would have been otherwise? >> well, i think the transition to medicare and the health status of people coming into medicare of course is contingent upon the health care and the lifestyles that they are living prior to medicare age so i'm thinking about an answer to your question that, how could congress help promote better health pre-medicare for people

with chronic conditions? for employers, for employers we focus on early detection. as i said earlier we have a vested interest in the health of our workforce and so focus on things like health risk appraisals with biometric screenings which oftentimes detect. >> you you all off for those biometric screenings? >> many of our member companies do annual biometric screenings at work for a couple of reasons. the first is as an employer they want to understand the aggregate help their employee population and use that baseline data as a way to monitor the impact impact of worth -- workplace-based wellness and health promotion. conducting those biometric screenings provide individual

confidential information to each of the participants and unfortunately or fortunately oftentimes people are learning that they have a chronic condition for the first time through that biometric screening. so early detection is key and then optimal management. once people are diagnosed. one of the things that the alliance is doing is realigning how we pay physicians based on optimal care of diabetes, a measure that we are using. so that address addresses early detection and begins, only begins to address the need to realign financial incentives. then there's the whole how do we help people live healthier lifestyles? and that is a complicated question. employers work on that because

they have people there during the workday but it's a much bigger issue than one that employers could tackle alone. >> i very much would like to follow up with you and i'm glad you are on the program because we clearly want to see if we can come up with some fresh creative ways to involve employers in this and i think we all understand that many of the underlying challenges patients face when interacting with the health care system are present for both the medicare and the nonmedicare population and to the extent that we can find a way as i describe it, take age into medicare with having played offense to the greatest extent possible as you talk about with biometric screenings and the treatment approaches, that makes a lot of sense. we are interested in working with all of you, the employers.

>> that's excellent. i think there are great opportunities for alignment between public sector and commercial employers who share the same interest in promoting health and optimal health care at an affordable cost. >> let's turn to another topic that is really not targeted that we have to figure out make additional progress and that is how we ought to go about using this array of health information technology. i call it the treasure trove that we now have of all this technology and electronic medical records and ideally this would be good for patients because patients would have this information. it would be good for providers because it's going to help do a better job of coordinating care.

also ms. demars made a point and i'm interested about the medicare planes data and how you use that, so why don't we just see if we can bring the four of you into this discussion about the health information technology and start with you ms. dempsey and you miss a lehmann. with respect to your ability to access all this medical information from the various doctors, how is that working out? is it a useful tool? is it being shared? is it hard to figure out where to go to for why? tell me your thoughts on that ms. dempsey. >> i don't know that it's hard to figure out who to go to once you call the doctor's office and explain to them what you want. then you may wait on hold while they try to figure out who they need to get you to and in what

hands but no match for me i have been found that that's a problem or a difficulty. >> you are able to get your hands on the information you need? >> not right at the time but you know, there are process, yes. >> and it's fairly useful? >> i'm sorry? >> and is fairly useful to you? >> yes. sometimes i don't get exactly what i need to be useful but i will eventually. >> and you miss a lehmann? tell me about your experience. i call it the treasure trove of data. sometimes you almost wonder if there's too much and tell me about how your experiences with respect to accessing all this information from the various doctors doctors are and possibly if there are any suggestions you have on how the information

could be more useful to patients like yourself and ms. dempsey and others. >> we have a binder at home. each one of us has a binder and after the appointments with the neurologist, we take it home and get the three hole punch out and put it in the binder. but that's the only medical report that we received. we did not receive any from the cardiologist tonight don't go with him i have no idea of what has transpired other than his relating to me what has transpired, nor do we get any record from the internist who just makes a follow-up appointment but never gives any specific information from that appointment. i so appreciate when i do get that information from the neurologist.

i'm always there but i also can review what has transpired and any referral that he may give us he puts down the phone number so everything that i need is right on those sheets. so that's wonderful. >> so you are doing well with the neurologist and the cardiologist front in the internist front things are coming up a little short. >> exactly. >> okay. let's get our providers and our prayers into this whole question of the health i.t.. i know dr. bornstein being aware of your good work that you all have put a lot of effort into trying to make health information technology work. what do you think the big challenge is in terms of how we tackle this and mrs. lehmann and

ms. dempsey. ms. dempsey said she thought it was okay and she said it was hard to pry it out and mrs. lehmann had some that work and some that didn't work. would he think the next steps are in terms of health i.t. as opposed to chronic conditions. >> as i said is not for the faint of heart and it's a big topic in what you heard from ms. lehmann and dempsey providers are at different points in that transition. add memory we are all connected. we have a patient portal so patients can see their lab results. we can communicate with patients about those lab results and that's a beginning. our goal is to get for the whole record to be available to patients but it has to be done carefully because sometimes not

everybody wants to read everything that's in there and that involves some additional research that needs to be done. it's how best to use these these tools with them when they start moving across systems there are all kinds of barriers and while we can see everything that we are doing frequently we will see a patient outside of the system and the patient may or may not be getting information from a specialist in the may or may not be able to get that information so that's a major barrier. meaningful use will help move people toward sharing of information but it's a slow process and it's had its own unintended consequences. i think more than anything we need more research to understand how best to use this health information technology. like everything else we have been talking about there are unintended consequences and we need to learn how to be smart about it but i think it's an important tool. >> thank you and i'm struck that you characterize it as a patient

portal. mrs. lehmann described it as her binder. obviously we are going to have to try to figure out ways to make this tool user-friendly or both the patient and the providers and i continue to hear from providers describe this kind of water torture kind of routine where they are up until 2:00 in the morning trying to fill out various records. you just have this picture in your head. what's this all about? we have providers in the middle of the night trying to work on their charting. we need them ready to go at the crack of dawn to get the kind of quality health care services that are so important to our patients and their caregivers. we are going to ask you some more questions dr. bornstein on this and i was interested, for

you ms. demars on this medicare claims data -- you know senator grassley and i are very involved in the initial efforts to make a significant amount of data available but what you are interested in doing is also extremely important because you want to really get down to the patient level and we will have to figure out a way to make that doable so protects the patient's privacy and the like. tell us if you could wave your wand as an employer, trying to deal with medicare claims data down at the individual level, what would he be trying to do? >> senator we are one of the founding members of the wisconsin health information organization which is in all claims database to which peers across wisconsin and self-funded coalitions like the alliance contribute data.

we are fortunate in that it represents 70% of the care for wisconsin patients. the big hole is medicare data and as dr. bornstein commented earlier that task of doing physician specific information is tricky and sensitive and critically important and the more data we have to work with the better we will be able to do. in addition not just claims data but through health information our significant investment as a country in health information technology and health information exchange. we look forward to the day when clinically important indicators can be fed into the administrative claims data to allow us to do a much more sophisticated job of risk adjusting performance measurement to take into consideration some of the things that dr. bornstein said.

>> you all have been a terrific panel and given us a whole host of valuable ideas. i have been scribbling away as you can see an two hours and let me kind of give you my take with respect to where we are and i think your testimony has been so valuable. you can see senators on both sides of the aisle. nobody talked about what the democratic approach to deal with chronic disease and what's the republican approach to deal with chronic disease. you had senators on both sides of the aisle so let's talk about what's practical and what's fair and how is it going to be user-friendly for patient's? i will tell you my own judgment is that chronic disease has really gotten short shrift in the debate with respect to health care in america. it's gotten short shrift in the big debates and i don't think it

happened deliberately. i see absolutely no evidence that the senator got up in the morning instead i want to be rotten to those chronic disease or i do want to pay any attention to this. i think what happens in congress is you get up and there are a whole host of issues on your plate and off you go for 12 or 14 hours trying to tackle the and a lot gets lost. i think what you heard today from senators again on both sides of the aisle is those days are over. those days are over when chronic disease gets short shrift. you saw determination among senators to look at both the under 65 population and the over 65 population. i came to this initially in terms of the over 65 population

for a variety of reasons. my background working with the gray panthers and also senator portman and i have introduced something called the medicare better health rewards program to create incentives for those on medicare to lower blood pressure, lower cholesterol and smoking cessation and the like. that is where i started that way you heard today from senators is that they very much understand that link between the under 65 population in the over 65 population and trying to put in place what amounts to a seamless web of services so in effect you touched on in medicare you will have already begun to heavy lifting. i could go right down the row with each one of you and thank you for the specific contributions that you have made

and because i have worked primarily with patients over these years and since before i got elected to congress, i'm leaving with that picture ms. dempsey about those trays and trying to imagine what it is like every single day, day in and day out, to make your way through this and dealing with it for a long time and to you mrs. lehmann thank goodness we have caregivers for alzheimer's patients. my mom got to go to a wonderful, wonderful facility shenon house in palo alto california. this is the area i specialize in and my goodness so many patients don't have what your husband has so thank goodness for you and dr. bornstein you have been even with senator isakson and by census journey began and we very much appreciate the good counsel you have given us and to you

ms. demars you account well for the panel. i'm sure glad that he did so the days when chronic disease got short shrift in the debates about health care in america and in congress are now with this panel, they are officially over and you all have been present to get this launch often the right direction. i thank you, god bless and the hearing is adjourned.

next a political outfit -- outlook for 2016. >> host: it's time for our regular wednesday feature spotlight on magazines. this time we turn not only to "national journal" because of the redesign of the public -- publication is public -- publication is going to put the content that looks at 2016 and joining us for that discussion richard just of "national journal." he is their editor. welcome. you write looking at 2016 on the opening pages the rattu 2016 you write this sometimes it's worth paying attention to the hidden heir to the forgotten idea or the overlooked character. what do you mean by that?

>> guest: with the magazine we are trying to get beyond the daily news cycle. we have a journal that tells people it's going on on a daily basis and with the current media climate it's easy to get wrapped up in what's going on in a minute by minute hourly basis. we feel a print magazine is for that environment is to step back and tell the hidden stories to look at the characters in the underlying themes and some other things that are as apparent in the daily news cycle. what we want to do with this issue issue is do a deeper dive into the character shaping 2016 a deeper dive into the candidates who might run and do their advisers are in some of their histories to look at where they come down on the issues and what their historical patterns have been as a up in a world of politics. >> host: you start one of the major features looks at hillary clinton a unified theory. you didn't write it peter beinart did. >> guest: peter's thesis is that hillary's greatest strengths and weakness are the same thing. she has an incredible capacity for putting her head down and executing a well-defined plan. she's incredibly hard-working and incredibly smart and when she knows what she's doing she

is very hard to beat and is incredibly talented and moving ahead and executing a plan. peter also identifies in her past and inability to always realize where the political world is headed and to adjust accordingly. he draws on two examples to make this case. as the first is the debacle in 94 with the health care plan where it was really clear well into that process that's what the clintons were proposing when she was overseeing a process that it wasn't working in folks in the white house were telling hillary and bill they need to adjust and maybe settle for half a loaf. she was just very dug in on what she wanted to do with them was able to read the writing on the wall. the other example that is more compelling as her stance on foreign policy with iraq leading up to 2008. she just didn't grasp the center of the democratic party had moved to the left that it