that would detail the automatic spending cuts in the sequester and work on the 2013 defense department spending bill. the senate is in today at 2:00 eastern with work this afternoon on a federal judicial nomination for new jersey and a bill dealing with campaign finance disclosure rules known as the disclosed act. live up -- lies health coverage tomorrow on c-span and you can watch live senate coverage on c- span 2. after campaigning in virginia over the weekend, president obama is heading to ohio today. he will participate in a town hall meeting at the cincinnati mccaul today. the president was last in that stayed two weeks ago on a two day campaign bus tour and he will return to washington this evening and is scheduled to attend the olympic men's and women's exhibition basketball game against brazil at the verizon center. while the president is on the road, vice president joe biden will be meeting today with

seniors in the executive office building next to the white house and we will have live coverage of that at 11:45 eastern this morning. coming up live on c-span at noon, we will take you to the woodrow wilson center for a discussion examining the future of syria and the assad regime. as many as 300 people were killed in attacks last thursday. it is one of the bloodiest days in the nation's 17-month conflict at 2:00, more live coverage with a form on u.s. border security and ordered management strategies this afternoon right here on c-span. >> pandora personalize and that radio. >> panasonic has a wide range of products. >> you can think of it like a computer-controlled hot glue gun.

>> a look at the latest in technology from a consumer electronics association technology fair on capitol hill tonight at 8:00 eastern on "the communicators appear "on c-span 2. >> the nation's governors gathered in williamsburg, virginia over the weekend for the national governors' association annual meeting. on saturday, the health and human services committee held an hour and a half session focusing on innovative strategies to improve health systems and lower medicaid costs. the governor of all i was serves as the committee chair with the governor of illinois serving as the vice chair.

i believe every governor is interested in improving the service delivery which is providing ways to control the cost within the medicaid program. it is a program that has been demanding an increasing share of our overall state budgets are the last dozen years or so. the following four speakers will present today -- dr. jeffrey brenner, executive director of the canton coalition for health care providers, mr. david

velinga, president and ceo of mercy medical center in des moines, iowa, and jennifer decubellas, health director for the anapin to minnesota, and dan crippen./ we will dold questions until the end of the presentation but before we get onto our spriggs years, i want to yield to our committee vice chair, governor pat quinn of illinois for opening remarks. >> q very much. i think this is a timely discussion. this is a good concept of the divisions, cost reductions, improvements in our health-care system and all of us understand this is one of the challenges of our time in our state and country. a run state of illinois, we had to make some tough choices this year in restructuring our medicaid system. we had reduce liabilities by

$2.7 billion in a $15 billion system and reduce debt through efficiencies and reductions as well as some new revenues to repair the program's long-term deficit. we reduced the medicaid spending and reductions by $1.6 billion and then we raised our cigarette tax by $1 a pack that will allow us to match our cigarette money with more money from washington for medicaid. a part of our restructuring in an illinois involve the modernizing of our system through electronic medical records and innovative coordinated care remodels the focus traditionally on medical care but integrity and mental health and human care services as well. in the coming time, we're committed to enrolling at least 50% of our medicaid clients into some sort of coordinated care. the medical innovations project

goal is to redesign our health care delivery system to be more patient-centered with a focus on improving health outcomes. we want to dwell on the system. we want to enhance patient access and patient safety. we plan to achieve this goal by testing community interest and capacity, to provide alternative models of delivering care that we may not have today but we would like to see for tomorrow. erry lso joined with t where we have a statewide effort for wellness in washington. i've shown a good model by their leading health insurer and we are interested in trying to do similar things in illinois. i walked across illinois 12 years ago. i walked across our state from

the mississippi river all the way to lake michigan in chicago on behalf of decent health care for everybody. i am happy to say that since then, we have had some great reforms of the federal level to allow our state to carry out the mission of getting more people health coverage, decent health coverage. we intend to work from that. i think it is important that we are -- that we hear today from some experts that can help us reach that very important policy goal for everybody. i will yield back to you, terry, and we will take it from their. >> thank you very much. i am pleased to introduce our first speaker, dr. jeffrey brenner was a family physician who has worked in camden, new jersey for the past 12 years before establishing the camden coalition for health care providers. he owned and operated a solo practice bourbon family medicine practice and provide a full spectrum of family health

services to a largely hispanic medicaid population including delivering babies, caring for children and adults, and doing home visits. and recognizing the need for a new way for hospitals, providers, and residents to collaborate. he founded and has run the camden coalition for health-care providers since 2003. the camden coalition is a non- profit organization committed to providing quality capacity and accessibility to health care delivery within the city of camden. through the camden coalition, a local stakeholders are working to build an integrated health delivery model to better provide care for camden city residents. dr. brenner, the floor is yours and look forward to your comments. >> thank you. i am a family doctor and i am here today because i have spent

my career taking care of medicaid recipients and don't think we're getting our money's worth. i want to show you some evidence of that and talk about ways we can do better. about 10 years ago, as a medical student project, i had a young person work with me in the summer to collect patient data from three local hospitals. this is the billing data that they use at the state to bill insurance companies. we got rob patient data, the name, address, david -- date of birth and the date of that mission, insurance status, and diagnosis codes. the work for this is called an aupair database. we never get hold of this because this is usually locked behind walls. what i learned was stunning about how our health care system works. half the population in canada goes to an er hospital in one

year and one person when 325 years -- 325 times in five years. in the center of trenton, they found somebody who had been 450 times in one year. the total amount of money for camden residents per year is $100 million just for hospital and emergency room care. we spent $2.80 trillion as a country and i can i get my head around that amount but i know what $100 million buys and it could buy a lot more than what we're doing now. we spent probably twice as much on all health-care services. this is just for emergency room hospital care for a city of 79,000 people. it is nine square miles were the first, second, and third in the country. $100 million would buy a lot of health coaches and diabetic and primary care and different delivery systems. the most expensive patients at

$3.5 million in payment for their care and 30% of the cost to 1% of the patience of spending in health care is highly concentrated in smaller patients. 80% of the cost went to 13% of the patients. i have looked at employee data set and a labor union data set and looked at multiple states and that basic rule holds up everywhere you look in health care. a small sliver of people are driving much of the cost. we as a health care system ignored these patients for the most part. this system is not set up to do with their needs. we're good with the average patient but not really good with the very sick patients. we can do amazing things for them. we can transplant their hearts and lungs and we can put them in the icu and rescue them but beyond that, we deliver very non-coordinated care that is expensive. about 20% of medicare recipients are seniors and readmitted within 30 days to a hospital.

that is spending about $20,000 for that unit of service where it was essentially a defective service because i had to come back within 30 days and get another unit of service. it speaks volumes about the disorganized system we have created. the number-one reason to go to emergency room camden is head colds. there were 12,000 visits for head colds, 7000 visits for your infections, 7000 visits for byerly infections. -- for viral infections. these are problems are routinely delaware in my office. my office is a boarded up and close right now aren't as many permanent care offices in canada because my payment rates to medicate kept dropping on average. i have the billing data and i can tell you the hospital's bill and receive one of 53-$700 for these visits. in camden, we build new hospital

wings with expanded emergency rooms. offices like my continued to be boarded up and closed and have no value. the problem in health care is that we pay whole lot of money if you cut. scan, or hospitalize someone but we pay very little money. in my office, i make more money when a tree had calls that i do treating a really sick patient. i can bill slightly more for a complex patient but a run from room to room treating head colds, i can see more patients in an hour. if i talk to a complex patient with complex diabetes, that could take me half an hour-45 minutes. i may as well send the patient out the door with a $50 bill because i have just wasted a lot of time and money. that is wrong and does not make any sense. the other side of the delivery system, if they can amputate that person's foot and keep them in the hospital makes an enormous amount of money.

we have a distortion in the marketplace of health care in how we have set prices and how we pay for services. one of the segmentations' of the data we found useful is the geographic segmentation. this is a map of the city of camden, 5.5 years of data for three hospitals combined into one set with patients mapping out the payments to all three hospitals for their hospital and e.r. care. this is a small city, 9 sq miles. the red areas on the map or 6% of the census blocks, 10% of the land mass, 18% of the patients, but 20% of the visit to the hospital and 37% of the payments to hospitals. it turns out the way we as people in america as you get older and more disabled, you cannot live in the middle of nowhere. you get congregated into specific housing patterns. the two most expensive buildings in the city of camden are

beautiful buildings with great management. building at the top has senior dual-eligibles which are older disabled people, 600 patients in the building had $12 million in payments for hospital he are care over five years. that does not count all the other costs. the building at the bottom is a nursing-home, 300 patients have $15 million in results -- in receipts over five years. the stories we collector tragic and week at -- and i am deeply ashamed as a health-care provider how difficult our system is to use. your patience and we -- these are patients in wheelchairs' and maybe illiterate or blind or deaf. we have taken this basic primer and begun to explore data sets from other communities. we have a nonprofit that has been formed in trenton that does similar work that has outreach teams in the community and does primary-care reaches aren't and

we found that important to start conversations. this is a new work with a similar geographic pattern of specific buildings were high cost complex patients are being collected. we get data from the state of maine from governor and we want to find the of the basic premise held up in a rural state. we got three counties in maine for medicaid patients and found out that they collect in town centers. it is hard to live in the middle of nowhere as you get more disabled. you end up close to a town center and this makes the problem easier to deal with that an average team working with these patients that would need

to drive 50 miles. believe it or not, this data analysis, we have had very little funding to do this. i have 15 hospitals data, three counties in maine, and two employers sitting on hard drives with open source password encroachment, all the data analysis has been done on microsoft access and i've got a 23-year-old kid getting a master's degree at doing this. there is a $1,000 piece of software doing this. this is not that difficult to do. the problem is getting the data. our organization is a nonprofit. my board members are local permanent care providers like hospitals and behavior and health providers and i've got community residents on board as well. our goal is to make the city of canton the first city in the country to dramatically banned the cost curve and improve

quality. there is no city or state in the country that has ever managed to reduce the trend line in spending and health care dramatically. we think of the poorest city in the country does this, it makes a powerful statement to all of you that this is not a technical problem waiting for a vendor. this is a complex political, spiritual, and moral problem where we are wasting public dollars and need to spend them in different ways and we have misaligned incentives in this health care system where people are paid more for sickness then they are for taking good care of patients. our organization is trying to take basic ideas of business. the last one of the years, our country has become very wealthy because we have become very productive. health care does not innovate in the same way that other parts of our economy have innovated. we have invented new pals and devices that the basic process

has not changed 100 years. that is what needs to change. we have a gap that is in health care where we spend more and more money but we are not getting value for that money. our organization spends time in primary care of this is helping them redesign how they deliver services between hospitals and doctors. involved with patients, helping them to better manage their illnesses. i will go quickly through some slides but i want to make an essential point -- all of our care starts with data. we get real-time data every day from the local hospitals and this attempt to look at who has been submitted at the hospitals and go up to the bedside within 24 hours. this is not telephonic case management. there are no gizmos and gadgets and we're not looking people to remote devices. we visit them in the hospital and then go to their house within 24 hours, opening every

medicine cabinet to pull out all of the 50 different old medicines they have to sort them out and throw them away and organize their care and then we go with them to their primary care of us, sitting in the examination room, 60 minutes-90 minutes to see the doctor and sitting there and helping them learn how to talk to their doctor and how to advocate for themselves. this is very hard work. this is not something you consult with telephonic case management which is primarily the model being used around the country to deal with complex. -- with conflicts. we look to the top 1% of hiatal herni is. ias. one hospital cannot solve this problem, one held center cannot

solve it. this is a community-level problem. the community has got to get engaged and solve local stakeholders have to work together. we embodied the basic idea in a piece of legislation that had bipartisan support and was signed by governor christie back in october to create a medicaid- accountable demonstration project. the basic premise is if we save money in camden, and reduced cost for the state for medicaid, the state will share some of the savings back with us to create a virtuous cycle instead of costs going up all the time. this bill is better care at lower cost with no up-front funding my fear about acos which is an integrated delivery model. in camden, i would end up with competing acos fighting over poor people and trying to align

with a homeless shelter for it would not make sense. our model is a collaborative model in which working under the roof of one nonprofit in a collaborative way, three local hospitals, local church groups, health centers, primary-care providers can work together to improve care. that is what we have been working on for the last 10 years to figure out. we are slowly making progress in that. thank you for the chance to speak with you. >> thank you, dr. brenner. we will come back to you with questions. i am pleased to introduce dr. david velinga, president of the mercy mallet -- and mercy medical care center. it is situated in three campuses in the des moines, iowa metropolitan area. i've known him for many years and i have been a patient in the hospital.

when i was hit by a truck but that is another story. with more than 7000 employees at a medical staff of more than 1000 physicians and allied health providers including 380 employed physicians and 130 allied health professionals, mercy provides services and support to a network of critical access hospitals and health-care facilities in 18 central iowa communities and has 10 on subsidiaries. in addition, mr. velinga errors as vice-president for operations of diocese health care. a joint operating venture between catholic health initiatives headquartered in denver, colorado and trinity help headquartered in novi, michigan. the floor is yours. >> thank you very much.

i am reminded of doing this kind of talks and it is engaging everyone involved. i'm reminded of my daughter who went to the university of iowa but then went to the united university of southern california for a master's degree in social work. my mother was now 90 years old cannot figure out why my daughter is leave and don't settle back in iowa. last thanksgiving, my mother passed white they don't come back. orange city need social workers and i can take care of you. what of you come back? leave santa monica. >my daughter would say, grandma, i have this great little condominium that is close to the ocean.

which i pay for. i have this used car but it is nice and i can get around very well, which i pay for. i've got this graduate program i am in at usc, that i am paying for. she said i love being on my own [laughter] it is that idea that has starkly doctors and hospitals and systems and government comes to this issue of health care. we come together because we have are on issues. my message to you is that it is time to engage all of us. we are receptive to changes going on. we are tired of the fee-for- service system that has diminished our health-care system and we are ready for a new system. i will talk about mercy/it does moines and we are responsible for lots of other hospitals. we have about 13,000 employees. we have 650 employed physicians

across the state of iowa. there are multiple good systems in iowa but integration is crucial. the market is driving this already. our point is that patients, providers, payers, in this case the pair of medicaid is the government, and government will be engaged together to achieve the triple aim of better care, lower-cost, help your communities. we have to all be engaged. our governor is providing leadership in beijing all of us in the state of iowa as to how we address this issue as opposed to addressing just the patients or providers for the pacers. providers must demonstrate quality and efficiency and use the data. dr. brenner's, as are so pertinent.

we have not had the data to make good decisions. we have been driven by fee-for- service is and is trying to get rid of that. we have to make sure we pay for value, how we change our payment systems to add this to the right thing? we will do the right thing but we need to have the right incentives. patients must assume greater responsibility but they cannot do that on their on. they have to have the doctor brenners of the world working with them. government must be assured that the paper value. -- that they pay for value. the market is driving a stored value-based payment. it is happening and it is happening now. physicians and hospitals are

ready for this. they are tired for continuing feeling that we need to crank out more volume in order to meet the population's needs. what we need our payment systems that allow us to be reworded economically for the value we create. there is huge value to be created with the money we have. at the tool uses clinical integration. one is primary medical homes. we have been using this for 15 years. the second is patient-centered systems. this is not the gazillion- dollar i.t. systems we hear about. these can be very simple things. dave came home and said it would be great if i had a disease registry.

his teenage son developed in a weekend. it is not expensive and sophisticated. it is simple. it can provide enormous amounts of data to do great work. we have invested in health coaches. each of our primary care clinics have multiple health coaches. we have transition coaches in the hospital to make sure the transition goes quickly and easily. we have ambulatory care clinics. with a sick patient, they go to the ambulatory clinic to make sure they get the intensive care they need and maybe avoid hospitalization. the standard care processes. we have agreements between specialists and primary care doctors. we do this, you do that.

we avoid redundancy between primary and specialist physicians. data management -- we do not need to do everything. we need to do everything or a small segment of patients and focus on them. we will have dramatically reduced costs. the drivers of cost reductions are simple. they are intuitive to you. counter to how we have worked for 35 years where we have been paid on a fee-for-service business. the more we do, the more we get paid. we want to reverse the incentives so we can provide value instead of just volume. the second is the decrease in the episodic cost. we will give increased primary- care offices. we will improve primary care.

the decrease in the administrative cost structure with improved service capabilities. this is actual data we have. everything must change. we need to change the system. we do not have to change it for every patient. we need to focus on the highest cost chronic patients. you look at the triple multiple chronic diagnoses. there are only 399 patients, but it is over $2,000 per member per month. the multiple dominant is 14% at $955. you start to say, where can we make the most impact in the work we do? we now have the state. -- this data.

it is the first time ever where insurance companies are providing data. otherwise, this would be very isolated. i know my hospital data. jeff knows his physician data. this is not expensive stuff. we need to find a way to bring the data together to analyze it. the results are remarkable. patients with diabetic test, 24% compared to 30%. patients on coumadin, 65% from 75%. significant improvement. what we have before was patients with congestive heart failure were coming into the hospital. it would be big, expensive bill.

they would go back, get sick. doctors would say to do this and this. the reality is that would go home and nobody would follow up with them. they would get sick and come back. they would come back into our hospital. economically, they came back to the emergency room and hospital. we improved ourselves economically but worsened care of the patient and increased the cost. this is not high tech stuff. using case managers and telephones, we would call the patient and asked about their weight. if it was changing, the case manager would say to do this. what happened was an 85% reduction in admissions. in a fee-for-service world, that hampered our economic performance. but look at what the cost savings did. this was done through no additional payment or steps

other than it was the right thing to do. this shows you mercy incenting positions resulting in increased performance. the benefits are real. think of the one test. look at the results. 50% decrease in heart failure. a 12 point decrease in blood pressure over 10 years will prevent one death for every 11 patients treated. those tests results in real outcomes. mercy applied these same benefit design and incentives to our own employee health population. premium costs have increased less each year. you can see a decline in our

employee costs and an actual decline last year. we attribute it to basic benefit-design risk assessment, doing patient-centered medical homes for our own employees. it is not a sophisticated stuff. it is basic data, and getting it and using it. lessons learned are this. engage everybody. do not focus on one of the other. governor branstad is doing that in our state, bringing people together. physicians and hospitals are ready for the engagement. state governments should support i.t. systems, not the million dollar effort, the data warehouse. get patient information to the

providers. support clinical integration. remove the legal and regulatory barriers so doctors and hospitals can work together to provide better care. do not create barriers. take down the ones that exist. strength in primary care. that is the backbone of population health management. hospitals have resisted that. the message is they should be supporting it. the better they are at it, the better they will be at providing in patient care. ensure medicaid payment model rewards value not volume. reward value not volume. mercy is participating in three key initiatives. the home health program is a step in the right direction. we have to provide medical homes every site across the state and will participate in it.

there is a workgroup redesigning iowa's health care delivery system. i think it will be tremendously successful. then the healthy state initiative. we're proud of what we have done. we know we're 10% of the way. we have a long way to go. we're on track. my message to you is engaged positions in your state, hospitals in a collaborative fashion to say let's go in that direction. >> mr. vellinga, thank you for your fine presentation. in my previous position as president of des moines university, we worked closely with mercy and other providers in the chronic care coalition working on congestive heart and

diabetes patients. you have been working on this a long time. we appreciate your leadership. we will come back for questions. i will turn it over to governor quinn to introduce our next speaker. >> i am pleased to introduce jennifer decubellis. she is the director for hennepin county in minnesota. she is the area director in human services and public health with the responsibility for health care reform. before joining hennepin county in february of last year, she worked in houston, texas, as the assistant deputy director for the mental health and mental retardation office. she improved efficiencies between multiple agencies as a means to improve patient care and reduce costs. in hennepin county, she has

taken on a similar role. the county operated health plan, the county federally qualified health care center, and the social service arm of hennepin county. the idea is to make a streamlined model for health care reform. jennifer, the floor is yours. we look forward to your comments. >> i appreciate the opportunity to be here. hennepin has newly embarked on health care initiatives trying to look at things differently. imagine not knowing where you will sleep or where your next meal is coming from. often we find patients not taking medications or managing blood pressure. the biggest failure of health care is we are not paying attention to bringing together health care services with

social services and basic needs. that is the opportunity hennepin county is working to resolve. we identified we were in crisis. about two years back as the economy to turn for the worse, as a counter provider, we saw more people accessing services because of unemployment or under-employment. more people were coming to safety net providers. revenues were down. demands were up. the system was in crisis around health care. with every crisis is opportunity. that is what we're looking to maximize. we looked at where we were spending our greatest dollars. you have heard others mention the top 5% in hennepin county are utilizing 64% of our dollars. it was an approach to see what they were utilizing. we found was crisis-driven care. it is our most expensive venue. most of the dollars are going to crisis services, not

preventative care. we noticed system fragmentation. systems that were not working well together. systems provide specific services but do not look across the span of holistic needs the individual's need and ensure folks do not fall between the gaps. as a safety net provider, we were looking at cost shifting. we have an opportunity to look at what happens in the jails and shelters and other downstream costs where we were funneling a lot of dollars into deep end services instead of ensuring health and wellness up front. hennepin health is one initiative in the state of minnesota of many. the state of minnesota is working on integrating and coordinating across continuance of care.

withre working directly providers and counties on initiatives where they best know the needs of the populations they serve. they are encouraging multiple models. it is not a one-size-fits-all approach. i am sharing the hennepin health model that is one of many in the state of minnesota. we have our hospitals, federally qualified community clinics, social services arm, and our health plan working together to try and find a service system that works together well. we are talking to partners and providers in the community to say we have got to stop competing and start collaborating. when we compete and do not share our successes and failures, we do not maximize the opportunity to improve the system across the span of care. the premise is if we do not meet basic needs, we will not get their attention on health care. what we found looking at the

top 5% is individuals labeled non-compliant. the health care system felt they had done all they could to work with the population. in looking at the details of the individuals' lives, we found there were reasons for that. it was transportation, lack of resources, talking to patients about why they're going to emergency rooms in large volume. it is not because that is where they prefer to get care. we found transportation was a challenge. if they had a neighbor that could drive them, they needed to go today. they did not have funding for preventive service or did not know how to access them. they knew to call 911 and have an ambulance take them to the hospital. those are huge opportunities to reduce costs and change delivery. we're working with the medicaid expansion population. that is where we found in the

bulk of our dollars going to come of population typically not connected to care and services. we started january of 2012. we have great learnings i will share with you. we have only build about 30% of what we know needs to change to provide better outcomes. population statistics are telling. 68% of our population are a minority status. mental health needs make up 60% of the population having one or both conditions. chronic pain at 30%. and stable housing at 30%. 30% of these folks are very transient in shelters, corrections, the emergency department because they do not have another place to go. 30% have one or more chronic diseases. we have taken the opportunity to work with tier 3 members. it is the highest cost

individuals the system is working the least for. the system is not working. that is why they are in the deep end services. for every one individual we can turn care around for, we free up amazing dollars to get to the next tier and continue to recycle dollars through the service system. objectives are to improve the outcomes for patients. we have added in improving the experience or providers. if we do this on the backs of providers by reducing rates and opportunities, we're not going to have more providers coming into the system. that is what we need. we're watching for provider satisfaction. we have heard providers want this as much as the system and payers want it. providers got into the business to provide good it outcomes and health care. they need the tools to do so. core elements of hennepin

health, we have patients helping us design the system. we're utilizing the health care home approach to get as many people involved in preventive services as possible. integration across systems is critical. we have a unique opportunity because we operate several pieces of the system. this is replicable in any system where providers need to be incentivized to work together. the cost and duplication of services are incredible. i met with one individual in a shelter who was confused about what was happening. he said i have got a lot of people working hard to get me where i need to be, but i do not understand where i should be going. what i found looking into it was he had a case worker from

the health plan assigned to him because he was a high utilize it. he had a case worker at the clinic in the shelter where he was living. he had a social worker assigned from the hospital. they were trying to reduce admissions. he had a social services social worker trying to meet his needs. none of these social workers or caseworker's new the others existed. a huge failure in the system. folks were off and running in separate directions and sometimes in the same direction. a waste of resources in an individual who could not get the care he needed. he just knew he needed health. we have tried to solve that. we're looking at one core patient record. there are a lot of different systems. the one core patient record is the way to bring those together.

we have created a dashboard. if i am a provider, the last thing i want to do is wade through a lot of notes. i need a dashboard that tells me the key things i need to know. it bubbles up from the record to give them key indicators. the dash board for a social worker is different from the nurses. it is the ability to be able to flag that another worker has been assigned. we're pulling those folks into virtual teams. we do not all need to work for the same place. we do need to coordinate care and understand who is on point to get to the outcomes we want to have for individuals.

it is reducing admissions. it is reducing crisis services. it is working to increase getting people into preventive care. spending more dollars upstream to prevent higher cost downstream services. we're working to reduce churn. every eight months, individuals are falling off of medicaid benefits because of the renewal process and paperwork. it is not that they suddenly got a wonderful job and no longer need care. they are transient and moving from place to place. they do not always know they have a renewal date coming up or how to complete the paperwork. it is a system so you're able to meet their needs. -- it is a system figure to meet

their needs. -- system failure to meet their needs. hennepin is 100% at risk. they have given us a per member, per month amount goes to the insurance company. we do have an insurance company in the project that gives that. the difference is the gear shifting. we have the dollars. we have to provide medicaid benefits. we have the opportunities to spend dollars in other ways. an example is somebody who has diabetes and is in the hospital greater than six times a year for insulin issues. we are finding it is simple things like my refrigerator is not working. i do not have a place to keep my medicine. an $800 refrigerator being purchased by hennepin health can reduce hospitalization. huge cost savings and easy answers. we found the model for everyone we take care, we're able to fund social services for others. it is constantly releasing more

of the funding back into the system to take care of a larger population. the other interesting part about the approach is in the past when funds are not shared across systems, folks do not take care of each other. we have individuals who are stuck in a hospital bed, medically stable but high needs. traumatic brain injury, behavior issues. high needs and nobody wants to take them. at the point the system does not work together, a hospital is on the hook for that. they are medically stable. there is no reason to get payment at that point. in the past, some were not motivated. now we wave a red flag and social service is at the table. we have nursing homes saying we are willing to partner with you. nursing homes said now we are all in it together, the hospital is motivated to support the nursing homes. the nursing homes said we will take the difficult patients.

when the patient is difficult, we need your behavioral health team helping to manage them. if you are not there in the traditional model providing support, the tendency is to call 911. send an ambulance, send them to the hospital. as soon as they are hospitalized, the placement does not want them back. it is the opportunity to incentivized working together in the wellness of individuals. it has had great successes. early learning, dental, and emergency. on day three it was identified a high population were going to the e.d. for dental care. you get a visit and charge. they prescribed pain medications and refer you to a dentist. that population does not have a way to get to the dentist or the dentist is not available. they came back in for pain medication.

we have high chemical dependency in this population. we probably made that worse. we identified that through data. we made same day dental access. stop giving them the band-aid and making it worse. care get them into dental the same day, provide the care they need, and solve the problem. those are the constant opportunities we keep finding of we are systems can work together to make huge improvements. pharmacy consoles have been deployed. we found in the top tier it was not uncommon to have 11 different providers and 7 different pharmacies in 12 months. providers were duplicating services and tests that had been run somewhere else because the payments system does not

motivate them to go find out what happened. or the data and technology does not allow them to know the provider existed. we are looking to change that. our pharmacy consoles have been able to do outreach and medication management to bring costs down by 50%. medication delivery is another initiative. folks were not taking medication. with the low income population, the person was often not going to the pharmacy. we make sure they get the medication and understand how to take them so we can successfully deploy the resources. we're gradually working our way through the list to say where is the system failing, how do we change it for this individual, how do we expand across the entire population where we find issues not working well together?

those are some of the care initiatives we have. it is a small initiative of things moving as we learn more about what is broken in the system. typically health care plan and providers do not share information. we are taking our health plan and merging with providers. we're saying we do not want two nurse lines. duplication of costs. the health plan does not necessarily need the information. the providers are the ones that need to act on it. bringing those together is huge. the same with disease management and outreach calls. there is a volume of information that often does not get to the provider. the provider is the one that can impact care. we're looking at continual of

care lenghts, behavioral health care programs. they have improved lives and outcomes. the patient gets referred to another level of care, but there is not the linkage of having a system that works well between transitions. challenges to resolve. we have several challenges we're looking for solutions for. members lose benefits if we do not develop a system that let them state on benefits. what happens is they go to fill the prescription and are told they no longer have benefits and need to pay out a pocket. they cannot pay out of pocket. this is a population of less than $700 a month. if they cannot pay for it, they stop medication and in the back in the emergency department. we have cycled back through the system again.

we have got to find a way to keep folks engaged. you have heard all this talk about the power of having data. as we talk about bringing health care with public health and social services, one of the big fragmentations is our statutes do not support it. we have health care statutes that define what data can be shared. we have welfare statutes. we do not have statutes that clearly define how those worlds work together. that has been a real challenge for getting information into the right hands of the right time. informed consent is the ideal way to share information. there are folks jumping between crisis situations in dire situations where we need to be able to quickly deploy resources to get them better care. we need to figure out how to do that in a cost-effective way. thank you.

>> thank you, miss decubellis. we appreciate your presentation and the presentation and perspective of each of the speakers. now we would open it for questions. yes. >> thank you to everyone for their presentations. it was very informative. it gives us pause for thought on what we can do at the state level. dr. brenner, i was fascinated a the, you made that health care has not innovated. i was thinking about that in my own lifetime. in the last 50 years, it seems like we have seen a lot of innovation with newt surgeries and procedures, transplanted organs, knee replacements. it has been remarkable.

the advancement of drugs has given us a better quality of life and improve life in the surgery room with better outcomes and quicker recovery. it seems we have had significant innovation. in the united states, our health care is expensive. it looks like the quality is very good, particularly for problems that would be life threatening like cancer, heart problems. america is probably the best place in the world to have better outcomes for those diseases and problems. what do you mean by lack of innovation in health care? if there is a lack of innovation, why?

>> that is a wonderful question. thank you for picking up on a comment. >> we have seen incredible innovation. surgeries', medications. it would be as though we were apple and had invented an amazing iphone, but every time we did a redesign, it took 10 years to come out of the laboratory. what makes i.t. so innovative is just-in-time manufacturing. at the plant where they make the iphone, raw materials come

into the plant almost the same day the product comes out the other end. there is very little product on the shelves. every time they cycled through new version of the iphone, the just-in-time manufacturing system is finely attuned to make the product come out. that is a process for engineering. the cars that come off of assembly lines, anyone on the assembly line can hit the button and stop it if there is a flaw or error. as a result, it is not just the we have a new and different kind of car, but that the way we make the car has been reengineered. in health care, we do incredible things every day.

but the sum total of all parts is often a failure. a 70-year-old patient was flagged because he was frequently going to emergency rooms and hospitals. our team went to see him. he drew up air and went to inject into his arm. he was sight-impaired and could not see what he was doing. it was a process failure. the medication in the bottle is brilliant. we should be proud we are able to produce that. but there are so many failures built into what happened to the patient. many of us do not realize how broken is until we are sick or have a relative sick in a hospital bed and 20 different doctors come into the room every day. you slowly start to realize none of them are talking to one another and you know more about the care delivery process. we have incredible quality in certain areas and abysmal quality and others. we think probably 100,000 people died a year in hospital from preventable errors. we do amazing things. we transplant their hearts and then throw them into the

community. they are bewildered at home. they are lost. they called primary care offices. they get put on hold. they come in. i agree with what you are saying. the product is innovative. how the pieces of the system add up is often a failure. >> why is that? what is causing the stifling a better process. they find ways to do it or they do not survive. someone else comes along with a better product. what is it about medical processes that we are not finding innovative ways to streamline process commensurate with the products we are making? >> there is no financial incentive. if we get all parts to work together, you will close hospitals. there is a wonderful example of this in a close health care system in which the insured owns the hospital and employs the

doctors. they did a complete redesign of all the processes of care. for the average primary care office, they lower the number of patients. the average doctor has 2500 patients. that is why there are too many people in the waiting room. that is why when you call, it is busy. when you get in the room, you are waiting for an hour for the doctor to spend 10 minutes with you. they cut down a number of patients the average doctor has. they put nurses back in the office. they gave the doctor time to answer the phone. you could make a telephone appointment or e-mail the doctor to get things done. the reengineered care so every patient hospitalized got some tlc and special attention. they dropped emergency room and hospitals use by 30%. if we dropped the bed days for hospitals by 5%, you close the mall. -- them all. hospitals are in the same

business as hotels. it is about occupancy rates. every hotel looks at the occupancy rates per day. they are good at building service lines and marketing those because of how we pay for health care in private insurance models and medicare and medicaid. it is by and large a volume- based model. you will put yourself out of business. there are wonderful examples of innovation being shut down because it reduced volume of service. >> from a hospital person, we see tremendous innovation in the area doctor brenner mentioned. the more volume you do, the more you get paid. on the primary care side, it

does not mean hiring mid-level practitioners to do other work to keep patients out of your hospital or clinic. your state has done a great job. it is one of the states with lower costs than iowa. we are second or third. your systems in the state have taken is to integrate care and financing so they assume risk. now they have an economic advantage to say we're going to try to keep our population healthy. that is a fundamental shift

going on in health care. we're moving from fee-for- service or volume to value. where iowa is going has led many in those directions working together across the continuing. >> i would echo that. you have heard me talk about provider groups where we are duplicating. fee-for-service incentivizes a practitioner to do more. it does not pay me if i go look at what david did three weeks ago for the same patient. we have got to turn the incentives around. we are saying we are in this together. if we can bring costs down and

improve outcomes, we all gain. providers are starting to look at it differently. it is not about me doing more. it is about doing less but better with what i am doing. if not giving extra radiation to a patient is better for them and i can look at the radiology he did, we can turn the system around. it is merging the payment system to match it. >> i would like to follow-up and ask a big picture issue. i understand what all of your saying and the manner in which you think we can reduce costs. are you suggesting the current system has more than sufficient funding, we just do not use the money efficiently? >> we spend twice as much as any of the industrialized country in cover far fewer people. i do not think the french are a dying industry. i do not think the germans, swiss, canadians. i realize each system has good and bad points. ours does as well. we are a country that does not like to look around the world and take best practices from other places.

i think that is a shame. there is enough money in the system now. the problem is any business that has done change management, sometimes you have to spend money up front to reengineer things to make money on the back end. we're going to make investments in people, resources, human capital. states have an incredible role to play. states at the leading edge are places where the government. states at the leading edge are places where the governor or others have banged their hands on the table and brought people

together. >> we think there is enough money in the system if incentives are restructured. we're getting data and starting to realize how we are in effectively using the resources we have. i think the answer is yes. we are close to being able to say, i am close to being able to say yes we are. >> it is not pulling the rug out from under providers. it is the diagram we shared where you need to gradually improve systems and release funding that can be used. if the gradual process happens, that is what will keep providers whole and not shut them out of business. if someone says tomorrow there's been a reform happening and we are changing it, systems will not be ready to switch. we will lose quality providers.

i would take a cautious approach. i would take a cautious approach but agree. >> thank you for an outstanding panel. each of you is so insightful and have proven your theory. you are doing it every day and it works. i was reminded as i was listening to this great panel. about 20 years ago, many big city mayors thought we would never get a handle on violent crime.

it was going to go up. the costs were going to continue to go up. the arrests were going to continue to go up. then they applied comstat measuring performance where you have the opportunity to rest your most violent offenders. i have been following your work for many years. as my second health secretary will tell you, i bang my fists on the table often. my wrist is near broken over this issue. i see you are doing it. we need a common platform that takes a system that is uncoordinated and disconnected. it makes it better coordinated and connected.

the third thing you have to go through quickly was the notion of the patient dashboard, the ability for the patient to see that they are ordinance on the cost grid. i wondered if he might elaborate on that and the role a better- informed patient plays in helping us to reduce costs. i agree. i think there's plenty of money in the system. it is not being deployed properly. >> you caught on to an opportunity we have with public health. we cannot solve health care issues. take the obesity issue. we cannot solve that in 10 or 20 minutes with a physician visit. it needs to be getting word out to the general public with individuals owning their own health care. we can employ folks to do behavior changes that will

health. it is using all parts of the system. right now, public health often operates separate from social services and health care communities. we're pulling together a strategy to say we need front end education. we need food resources available for them to make health the terraces. it is taking a system approached saying we have to bring all resources to the table to give patients the tools they need to make healthy choices. >> what is the dashboard? is that something i.t. or the internet allows you to do? is it on the iphone?

what is the patient dashboard? >> it is a provider dashboard that bubbles up what people need to see to meet their specialization. there are models across the country where there is a patient dashboard where they can go in and see their own labs and recommendations. what is being encouraged is charting. there are a lot of tools individuals with computer access can be brought into. working with the low income population, we're finding we need to get them into public libraries to have some of those tools. using cell phones, and deploying cell phones the remind people to take medications and remind them they have not sent in their health or blood pressure. because of the payment mechanisms, physicians are bringing individuals in to check blood pressure. that is a huge waste in the system. there are a lot of patients

tools that can be deployed at low cost. >> we are running out of time. i want to give governor markell the chance to pass the last question. >> i agree. this is a terrific presentation. i want to drill into the issue you were talking about. you said if we reduced by 5% the admission rates to hospitals, all the hospitals would go out of business. i think this is probably the most complicated public policy challenge we have. it is a total of reorientation of an entire industry. it is easier for me to understand how we can start to make providers whole by rewarding quality as opposed to paying on the fee-for-service model. can you explain how it works? i can sort of see how you do it with doctors and health care providers. given your analogy to hotels, how do we get there with institutions? >> states have an important role to play. we have inflated the largest economic level in the history of mankind. health care is 18% of our

economy. hospitals are a significant portion of that as are the high-tech specialty portion as well. we have done that through bonds. we have a mountain of debt underlying. the states have guaranteed a lot of that. the big short is to sell short hospital bonds because if you look at the cost of what is in this, half of the costs are hospitals and doctors. the bulk of the federal debt going forward is health care. it will be larger than the entire rest of spending in government. it will be drawing a lot of money out of medicare and cutting payments and rearranging payments to doctors and hospitals. hospitals being the biggest

chunk of that. we're looking at a cataclysmic change in an industry. it is just like other industries. the underpinnings of what was going on in the economic system changed rapidly. the other analogy is psychiatric hospitals. at one point, they were 1/3 of your state budgets. in the 1970's, we de- institutionalized that care. the question is whether we're going to build a system on the other side. health care is 18% of the economy. housing is about 11%. finance is about 7%.

think about what it will do to the model of urban redevelopment, the major employment gains we've had in health. it is being built on a mountain of debt. we have a problem. all over the country, hospitals are closing down. private equity is buying them up. that will be propped up by unnecessary occupancy through paying for medicare. when you have a capacity problem, states have an important role of the during out the transition model so we do not have massive unemployment and other problems.

sequestration could be going off the cliff for a lot of hospitals. >> hospitals are rapidly becoming not just hospitals. doctors are rapidly becoming not just doctors. you see the rapid development of the integrated system. doctors, hospitals, appears coming together to provide a better product. it is rapidly changing. i support that. i think it makes sense. right now, we have a foot in two boats. it is a delicate dance. my lense says they are ready for this conversation. the market is driving this conversation. government needs to educate and support for the development of that and reward those for doing the right thing.

the reality is we have the system we designed. we pay on a fee-for-service basis. we get more volume. that is what we have. now we have to pay for and reword those that create value, not just micromanage everything, but create a system that values the value created. >> i would like to provide an update on the activities and opportunities in the health division of the nga. it provides governors and staff with information, technical assistance, policy analysis, and periodic meetings facilitating. strange. the health division will focus on medicaid cost containment, health system transformation, prescription drug abuse prevention, workforce planning. i would like to turn it over to the executive director to highlight some of the planned activities and new initiatives from the center for best practices. >> we are in the process of

launching an initiative that ties to the presentations today. we want to invite you to tell us what else we can be doing to health you with costs in general. most of you have met christa. she is driving much of this agenda. she lets me speak for her occasionally. we currently have an initiative to get states together to compare notes and best practices on the abuse of prescription drugs. it is something important to virtually every state. it is worse in some places than others. we will have six or seven states funded to do meetings for a year. it will run about $50,000 per state for your expenses.

we will be putting on leadership retreats for systems transformations. we will have technical assistance teams going to states as well to work on child health care and how we limit preterm births. a very important piece for medicaid. it is directly applicable to medicaid but all kids as well. we will be having a meeting next week with 41 states registered with representatives to talk about the implications of the supreme court decision last week and what options you have. we will launch a new web site about labor day. i think it will be the first of several virtual centers of best practices.

it will be aimed at health. it will have case studies from virtually every state. it will have listings of your scope of practice laws state- by-state. we are doing some things with the state of maryland on expanding dental services. many of the medicaid kids are not getting sufficient and services. more to the point for today's presentation, steve lieberman taught me the bank robber's rule of health care. you may recall willie sutton said he robbed banks because that is where the money is. the rule here is why do you look at the expense of patients? that is where the money is. that is where the need is. the other side of that is 80% of the population does not need much health care in any given year. focusing on expensive patients is an important piece of this. we sometimes bifurcate in ways

that do not make sense. we worry about unusual use of resources. excessive use of hospitalization, nursing homes, or emergency rooms. we have only begun talking about how to give these people better health. it will require less health care services. it is how we take care of these people. it takes more than just a doctor or hospital. increasingly, we are understanding that behavior help is a very important part in order to reduce physical health costs. this is when the fee it states that integrates the physical and behavioral -- few stats that

integrates physical and behavioral health. we have begun to solicit other foundations for health care analysis that will be available for all governors. one of the first things we do is software that we can give you that can replicate what jeff has done. most of you have the data said to do it at least for medicaid patients. some of you already do it so it is not new. we will have the identification as part of this initiative. separately and equally as important, it is one thing to identify the patients and characterized them in different ways reject most of these to have chronic disease. -- them in different ways, most of these do have chronic diseases. they're very much alive.

you can do something about their health. just by identifying the high- cost patients, how do you treat them? there is no simple straight answer. we have some sense of holistic treatments. one of the things we will be doing is putting in place some of these facts are already out there. they have not been tested across states. we can begin to look. what can we do to directly affect its? and at one solution fits every state. a lot of health care is still lynn local in nature.

upre going to try to set tests that will allow us to evaluate what would work. we understand that health care is a dominant issue for all of us. medicaid is not only driving par but state retirees and employees are costly. it is important that we address that say you can get back to the transportation as well as health care. we understand that. we are soliciting foundation funding and other things to help broaden and share what is going on. a gives you software and

technical support to do analysis if you need it. we are available for all of that. i really encourage you to tell us what we can do more in ways that can be useful to you, whether it is some aspect in your state or whether it is these more systemic kinds of activities. thank you for letting me tell you a little bit about what we're trying to do. tell us what else you do to be helpful. to correct our time has expired. i want to thank the audience and our panelists for your presentation. this is a huge issue that affects us all greatly. i think you gave us some really great insights. thank you. [applause] [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2012] >> in half an hour, the wilson center for discussion on the future of syria and the assaad regime. opposition forces said as many as 300 people were killed on thursday making it one of the deadly as days in the recent

months. this afternoon, also on c-span, border strategy. on c-span2, in 15 minutes, the vice president meeting with senior is inside the old executive office building. live coverage schedule for 11:45 eastern. the doctor known, on c-span3, washington state democratic senator talking about the so- called fiscal cliff, tax increases and the impact of the fiscal clip which could push the u.s. back into recession live at 2:00 p.m. eastern on c- span3. >> pandora is personalized internet radio.

it has a very wide array of products >> to take plastic and run it through a heater. then a layer by layer you can fill this out. >> a look at the latest in technology and tech devices from the consumer electronics association fair on capitol hill tonight at 8:00 p.m. eastern on "the communicators." >> there has been a hostility to poverty. lyndon johnson was the best president that look at poverty issues and spend money on it and talk about the social service program. lyndon johnson. i hate to say this, but richard nixon is the father of minority business development. they established the minority business development and let the small business administration.

>> she regularly writes and comments on african-american economic history. your questions, calls, emails, and it tweets for the author wrote, "surviving and thriving." "indepth" on "booktv.: >> until we take you live to the wilson center for an update on the violence in syria, a discussion from today's "washington journal" on the impact of tea party evangelicals on the election cycle. job is working for the news. how the party is taking back america. the inside story on how the evangelical than the tea party

are taking back. tell us a little bit about the teavangelicals as a term. how did you come up with that? caller: i noticed they were praying at the beginning of these rallies. in some there were some prayer circles. i said i should do some interviews. i did, and many of them were conservative christians. that bore that out. surveys say it is even higher. they're actually conservative christians. i needed a name for it. i thought maybe tea party christians, so that was boring. i went with the teavangelicals because they are breaking bread with these libertarians. host: the definition you put up there for them. a conservative christian who strongly supports the tea party agenda or is active in the tea party movement.

is this a relatively new phenomenon? guest: with libertarians, it is new. that is for sure. now, we are seeing fiscal issues take paramount importance here during this time in the country's history. clearly, this is a big part of why they are breaking bread with these libertarians. host: if it is the fiscal issues, does that mean social issues have taken a back seat? guest: not at all. that does not mean they want to stop the social issues. bake until just as strongly about the abortion issue, but there will take that ball and play elsewhere. they're not bringing it into the tea party rallies.

60% of tea parties are considered socially conservative. the of all of these conservative christians and social conservatives in the movement. the was the two-party done? they adhere to a very strict fiscal discipline, if you will. host: the tea party enjoyed strength in previous years. what does it give to the party as far as their ability to influence even more so in this coming election? guest: here is the bottom line and truth. libertarians can not make a difference by themselves. conversely, conservative christians cannot do it all by themselves as well. clearly, you take them out. if you rapture them out of the tea party, you are left with

less than half of a movement. host: as far as describing them as a group, how would you define evangelical? guest: there are well known for their influence in the community and a lot of their service. someone who believes in the bible and that every word is true that of this resource with the belief in jesus christ as your personal savior. there is some fine-tuning after that. host: david brody is our guest. if you want to ask him questions about his books or maybe religious voters and politics, to ask him questions, here is how you can do so. the number to call for our democrat line is 202-737-0001. the number to call for our republican line is 202-737-0002. the number to call for our independent line is 202-628-

0205. you can also send us a tweet or an e-mail. @cspanwj or journal@c-span.org. if you had to say, as far as teavangelical is concerned, who could to give as an example? guest: quite a few. a sara palin would definitely be one. -- sarah palin is one. the of their strengths and weaknesses, for sure. mike huckabee is out there. jim demint. allen west is one. there's also marco rubio as well. a lot of people say, marco rubio, his catholic. that is right. you can be won. rick santorum is one, but he is also a roman catholic. people sometimes get confused. we want to make sure we're talking about conservative christians. host: how are they looking at mitt romney?

guest: they're not that enamored with him. let's be honest here. having said that, this isn't some much about mitt romney at this point. it is all about president obama. how did they see mitt romney? they are somewhat skeptical, but realize this is their best shot and only realistic shot at taking this president out of office. host: part typically about his mormon ism? guest: about 50%. having said that, not the

stereotype folks around the country, but if you look to graphically, you'd think that more of the anti-mormon sentiment would be in that southern part of the united states. states that romney will win it anyhow. if you look at it within a swing state battle, it probably will not be that big of a battle. host: "the teavangelicals." first caller. good morning. you're on. caller: this teavangelical thing is constantly pushing to force their religion on me. it is my choice not to participate in religion, and yet you are trying to shed your series of abortion on me and creationism on me. i will not have that. everyone of those people you have mentioned lacks spiritual substance and are more interested in convincing me they are right rather than their spiritual salvation.

guest: and the sentiment out there. unfortunate, no disrespect, if you actually go to tea party rallies, it is not necessarily about making it this christian nation and everybody needs to just go under this one banner. look. they feel very strongly about their judeo-christian principles, but it does not mean it will start forcing their faith. the committee principled without being obnoxious. that is more of the sentiment that i experienced for sure. host: 10 you connect where someone would find a judeo- christian principle in tax

policy? guest: we talk about tax policy in the book. they will use bible versus to make their case. evangelicals will use bible versus, too. in the bible and in the psalms, it? but a person with their children's children. in lieu of the talks but if you -- in luk, it talks about if you build a tower, when you first estimate the cost of the tower in the first place? in the bible, they see a good tax policy as it relates. does not mean they do not want to pay their taxes. the lender is ceaser, for sure. they believe in that, for sure. at the same time, they believe that lower taxes means more

money that a family can choose to spend rather than the government. host: north carolina, jim. the republican line. go-ahead. caller: this sounds a little ragged. i hope you can hear me. the tea party deal, if i understand their primary concern, one of their founding principles was that government is much too big. well, let's stick to federal here. the talk about principle been principal without being obnoxious.

then i ally myself with the tea party movement and then i have to cut my medicare card and mail in my social security back every month. guest: well, i am somewhat following the argument there. i think he makes an important point about government getting too big. a lot of these teavangelicals things that god is getting smaller and the public arena. this is a big reason why teavangelicals have joined the tea party. this is not just about president obama. this really started under the big government programs under president bush. tarp, the bailout, all of that. they believe that this is part of a spiritual awakening in this country, kind of akin to the great awakening.

they believe this and see it manifesting itself in the tea party movement. host: currently, maverick off of twitter asks this. he cites the example that sarah palin claims to be a tea party patriot. can it be both? guest: i assume he is talking about the organization tea party patriots. what is interesting and we point out in the book is that she is very good friends with ralph reed who heads up the freedom coalition which is also its evangelical organization. they do events together. they do events together. amy kramer is in constant contact with concerned women for america.

the web is connected in all different ways. it does not mean it is organized specifically like that, but it is loosely organized from the relationship respective. host: alexandria, virginia. good morning to john on our independent line. caller: hi. i want to ask if his theory is the tea party is primarily evangelicals? why is it almost all the money from the tea party is going through grover norquist from the koch brothers and other wealthy investors? while they say christian kings, their focus is primarily on reducing taxes and limiting the effectiveness of government. they have to destroy an it in order to make government ineffective. how does that represent any type of christian values? guest: this is a bottom up movement. yes, there is tea party money floating around with the koch brothers. but this is a bottom-up movement. the movement is so organic in nature that the belief system of the tea party comes from not so much the koch brothers and the money and all that, it comes

from the ground up. you cannot stop that. if the koch brothers or anyone else tries to become a tea party master, it would not work. it's not so much about the money. the money is not what is driving the movement. the the people driving movement. many of them are evangelicals. they will have the final say on what is going on. host: donna on twitter says -- guest: talking about libertarians, they talk about a return to constitutionally limited government. teavangelicals call it something different, a return to judeo-christian principles, but it's the same thing.

people say what does that mean? it means district restriction as to view of the way the founding fathers intended this company to be -- a restructionist view. host: there is talk in the paper about the louisiana governor bobby jindal possibly becoming a vice presidential candidate for mitt romney. does bobby jindal captured things evangelicals light? guest: the would be a wonderful teavangelical pick. even among evangelical leaders. they love bobby jindal. but whether or not he is ready for prime time nationally, that is separate. but in terms of his public policy work and the idea that he converted to catholicism from

hinduism and has been a champio -- champion in the pro-life community, he is in the tier "a." tim pawlenty would be another choice that would excite some. he is a born-again christian who does not talk about it as much, but he is. that would play well. he has also developed street spread within the in the -- developed street credibility within the evangelical community. there is governor bob mcdonnell. and a couple others. marco rubio would be fine, but there are national readiness issues. they love mike huckabee, but that's maybe tier b. host: what about condoleezza

rice > guest: mitt romney has promised to make the vice-presidential choice a pro-life person. condoleezza rice is pro-choice. that would be a broken promise within the evangelical community. host: dallas tx, emma on the democratic line. caller: i am curious who they are talking about taking the country back from. they took it from the indians and brought the slaves over to build the country and brought in the mexicans for cheap labor. taking the country back from whom? guest: that's a great question. i was on a program with tavis smiley almost two years ago. i remember him asking me that same question. i said it's not about who they are trying to take it from. it's where they are trying to take it to.

they are trying to take it back to the founding of the country the way they interpret it, the way the founding fathers interpreted the founding of this country with a belief in the almighty god and return to lower or rather limited government. that it's what this is about. evangelicals are not out to make this a christian nation and they are not trying to convince everybody to be christian. there were so many teavangelical folks out there and i found the stories to be great. this book is littered with personal stories. one of them about a tea party libertarian who was the head of

the new york city tea party patriots. was a libertarian and wanted nothing with god and started to go to one of the tea party meetings with a lot of other tea party groups in florida. there was a big segregation of folks. some of those departed leaders started witnessing to him about the gospel at one of those tea party meetings. three months later he ended up introducing his wife to jesus christ. he became a teavangelical. it was interesting because he was witnessed to with the gospel of jesus christ within a

tea party setting with other tea party leaders, which i thought was interesting. there's a lot of stories like that. host: bob is on the republican line. you are on with david brody. caller: thank you. i very much appreciate your take on this. i have been a member of the tea party quite some time. not that i go to attend meetings, but i have it in my heart. i get on facebook and i share a lot with people. i believe in the foundation of our country. i believe in the founders and the way they believed. they were not takers. they were helpers'. they have strong moral character.

you would rarely see -- i talked to people in the tea party on facebook. you do not see the viciousness that i hear so much on c-span and the morning from different groups -- it is republicans, democrats, and independents. it makes me sad. we really want this country to get back to being on their own two feet and working together. your take in your book, i very much appreciate that. but i am not a religious person, so to speak. guest: he mentioned the idea about the viciousness and a lot of people thinking the tea party is vicious and a lot of other names. i brought on the upper west side of new york city. i read the new york times every day. i grew up in a liberal bastion of new york as a jewish guy. when you read the new york times every day and when you go and pretty much have a corridor that is new york and washington, you really get a much different perspective on a world than

when you actually travel around this country. that is exactly what i did for this book. when you travel around the country, you find out the tea party is not vicious at all. not not saying they're pockets in terms of certain knuckleheads so show up at rallies, but there are knuckleheads all across the country in all different movements. but the vast majority of the tea party is not vicious. they are god-fearing and got loving americans. host: how his money doing in reaching out to evangelical leaders? guest: i just saw an article within the last couple weeks.

there's his campaign in front of the camera and another behind the camera. there's been a lot of reaching out behind the camera as it relates to mitt romney and his team. one of his senior advisers is talking to all these type of leaders on a daily or weekly basis. we know that requiring and mitt romney have spoken a couple times in the last couple weeks. -- rick warren and mitt romney. in 2006 mitt romney was courting evangelical leaders. there's a fascinating story about how he had jerry falwell and a lot of others hosting & a which is in his living room in 2006. a month later they all got a package in the mail and it was a huge chair and on the back was a plaque that said you will always have exceeded my table. he's been doing that since 2006. there is a behind-the-scenes courting of evangelical leaders. in front of the camera, the romney campaign picks and chooses when they won him to show at family events. host: in spoke about romney before the naacp last weekend your reference to a certain section of the speech that he

talked about some potential problems when it comes to religious leaders. i want to play that section. [video clip] >> with 90% of african- americans who typically vote for democrats, some wonder why a republican would bother to campaign in the african-american community and to address the naacp. one reason is i hope to represent all americans of every race, creed, and sexual orientation. [applause] from the poorest to the richest and everyone in between. host: what did you find in that phrase? guest: he was about seven seconds too long in the teavangelical world, when he mentions sexual orientation. race and creed, he could've stopped there, but he went to sexual orientation. this has been a democrat and liberal playbook for some time, which is to include sexual orientation as a class. if that is what he did right there. he is using the language of the liberal playbook. that is something but does not go over well with teavangelicals because this is what they have been fighting

against for decades, the idea of classifying sexual orientation from the statutes and point within the federal government language. host: even as part of an oval -- overwhelming and desire by some to see president obama out of office in the religious community/ guest: when money used this language, it goes to a trust issuing and whether they can trust him on social issues. they trust him economically. most of them will vote for him for his economics. the question is, it's all about trust and social issues. if it is romney all the way there with evangelical voters? he is about 80% there. president obama did a great job in helping romney get there. host: arlington, texas, independent line, deon. caller: hi.

as someone who grew up in church, i often found this whole movement of trying to inject jesus christ and religion into politics, i have often found it disgusting. first of all, when it comes to god's word, both parties fall short. i think we should kill this whole notion that somehow if you vote republican, you are voting with god and all this kind of stuff. basically, what you all have done is create your own false religion. just vote for who you want to vote for, but quit -- and less jesus christ is running, you cannot vote your faith. le'