passing that on both levels and they brought in a health policy analyst and it looks as if vermont may be on the way. the problem is before they can move they need waivers and they say you can't get a waiver until 2017 and what bernye sanders tries to urge is to move it to 2014 because on the ground are the members of the commercial insurance industry as they spread the propaganda -- more the wind is taken out of the sails. maybe vermond can do what the will of the people wants.

and we can say, 'as vermont goes, so goes the nation." >> i am encouraged when i look to vermont, about everything. it's just dreamy. >> a question over here. >> i read a cbo report that said employers would start simply paying the fee under obamacare and drop people. and you'd see as a result a lot of people moving to medicaid. is there the potential this could create that -- vested interest in medicaid to improve the program.

>> what is amazing is you read a cbo report. >> wonderful student. >> i am in awe. >> we are not sure what will happen. we have a lot of rhetoric and many employers said they would drop coverage. the public rose up and they said they won't go there. employee-urance is expected. i run a business and people want to know the benefit package. people make employment decisions based on that.

it remains to be seen. the moving target -- the cbo projected there may be some leakage out of the employee coverage system. with that, give our colleagues a round of applause. and i turn it over to judigth. thank you for being here. rooseveldt house. the books are upstairs. we will sign them upstairs. [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2013] >> president obama talks about the significance of the celebration of easter. congressman lee terry did the

republican address and calls for the approval of the keystone xl pipeline, saying it will make america more energy independent and create jobs. everybody. for millions of americans, this is a sacred time of year. this week, jewish families gather around the table commemorating exodus from egypt. this weekend, michelle, malia, sasha and i will join christians around the world to celebrate the resurrection of jesus christ. these holy days of four of the precious opportunity to slow down and spend quiet moments a developer and reflection. -- these holy days afford us the precious opportunity to slow down and spend quiet moments. savior, ourord and

neighbors and seeing everyone as a child of god. those values are at the heart of not just the christian faith but all faiths from judea's and to islam, hinduism. there is a powerful call to serve our brothers and sisters, to keep it until our hearts and compassion for all and to treat others as we wish to be treated ourselves. thatis the common humanity binds us together. as americans, we are united by faith in the ideals that lie at the heart of our fan -- of our founding. we have a shared responsibility to look out for fellow citizens. i hope we are able to pause and reflect and embrace our loved ones, to give thanks for our blessings and rededicate ourselves to interest larger than our own. blaste and i wish you a -- blessed and joyful easter.

may god bless you and continue to bless the united states of america. >> hello, i'm congressmen lee terry from the state of nebraska's second district. line againstthe tax increases and passed the balanced budget, and forced the democratic run senate to improve its first budget in four years. there is something else meet to do, take on the high energy bills many families of small businesses are up against. this is especially important at this time of year when the pain at the complex and even bigger toll on commuters and truckers. i have led the efforts in the house to support the keystone xl pipeline, a product that would bring more north american energy to the marketplace and put thousands to work. it will create roughly 20,000 new jobs related to the

construction of a pipeline and create another 118,000 jobs downstream. labor leaders in omaha, it will create 2000 jobs here. eystone is primed to give our economy a shot in the arm and make energy more affordable. it will not cost taxpayers a dime. despite that, the obama administration continues to block keystone using every bureaucratic trick an excuse in the book. it has been more than 1600 days since the initial oermits were filed -- permits were filed for building the pipeline. it took united states more than 3000 days to win world war ii. is ahe's done xl pipeline no-brainer. several environmental reviews and has picked up this -- support from a broad

coalition of unions and supporters. public backing has risen to 70% term last week, the democratic run senate endorsed keystone with a filibuster proof of 62 votes. the congress have spoken. to build the keystone pipe line. no more delays, nor more politics. if the president continues to drag his feet, congress is prepared to act. there is much more we can and should do is to support our nation of builders and nunlock our domestic resources as a way to create jobs, lower the cost of living and put us on a path to energy security. doing all of this is not just about the dollars and since,

it's about coming together to solve longstanding problems to ensure our children will have the same chances, hope and freedoms we had. these are the blessings we easter andduring passover. it is a time to unite in prayer and celebration, to renew traditions, lift up our spirits and tell old stories that remind us how trials and suffering can be overcome with courage and resolve. it is time for a perspective. if we look for opportunities to work together and seized on them, if we choose to build on and not squander past sacrifices, we can get much closer to realizing the promise of a more perfect union and peace for one and all. yourbless you and families and thank you for listening. >> next, a discussion about

changes in the method of paying for health services. then hispanic leaders talk about immigration. after that, retired general john allen talks about the u.s. mission. this week on news makers, the afl cio president who will talk about visa programs for workers for other countries, minimum wage proposals and the union federation talks with u.s. chamber of commerce. watch sunday at 10:00 a.m. and 6:00 p.m. eastern here on c- span. s year, we've received record amounts of entries from students. top 27 winning videos with their message to the president beginning monday

morning at 6:50 eastern and see all the winning documentary's online. >> on tuesday, the senior government official in charge of health care innovation says he is seeing a reduction in spending for health services. he is with the centers for medicaid and medicare services. he was a speaker at a forum hosted by catalyst for payment reform. this is just over an hour. >> welcome. i'm the executive director of catalyst for payment reform. thank you for coming to hear about our national scorecard on payment reform. while everyone is dialing in to join by webinar, i will show the agenda on the screen. all of you have folders and in front of you and those on line can see the agenda on your screen.

it's just a variety of specter's -- of perspectives we will hear today. before we get started, i want to go over a few housekeeping issues. those who are joining via webinar anre in listen only mode. if you have questions you want to pose, put them into the chat box and will monitor that an answer as many as time permits. those of you in the room who have questions, take note and we will have time for q&a at and. agenda and want .o hear a each speaker those on line can gain access to material that will be reviewed today on the catalyst for payment reform website.

you can go to our home page and find links to those materials as well. webinar.ocrding the if you want to forward the link, lides will be shown . let me tell you about who catalyst for payment reform is. then i will introduce each of the speakers and we will get started. the catalyst for payment reform works on behalf of large, private employers and state medicaid employee and retiree agencies to have a shared goal of changing the way we pay doctors in the hospital so we can get better value for health care spending. on the screen, we have a wide variety of members, including

private employers as well as state agencies buying on behalf of medicaid beneficiaries and others. together we have a shared strategy. we want to see changes to how we pay for care to get better value. there are two ways we work. we helped organize these dent and the others, i try to highlight the importance of tim reform and the urgency of action. we can love with the goal of by the year 2020 wanting a least 20% of payments to be a value came up carry it -- we with a local of by the year 2020 and one thing at least 20% of payments to be value oriented.

ant to thank our partner, the national business coalition on health,an care. and norc. i want to think those brave enough to share their data with us. and all the speakers who i will .ntroduce and the cpr staff thanks to all of you for your interest. heto myself and andrea, would hear from some of the leading experts in the country on health care reform and payment reform. dr. bhumibol from -- dr. blumenthal. of janet boyd, a director

government benefits for dow chemical company. curren, of aetna. \ gilfillan tord share the public sector perspective. he was sure his perspective on how providers are rising to the challenge. thank you for your attention and ranches. without any further ado, we will dr. blumenthal. can you all hear me? great. . am pleased to be here

my congratulations to catalyst repayment reform and folks who led the creation of this organization and project. it is very important work. part of my brief remarks will be to say what may be quite apparent to many of the. this is a unique time in the history of our health care system. the future has arrived. for decades, we have been that the pattern of expenditure was unsustainable and that lack of stability has become apparent in the debate about the federal deficit and

in role of health care causing the deficit which will not be tolerated for much longer. we are at a fork in the road and are facing tough tresses. this is continue to mount and deficits continue to mount. choice wee face - the face is between rationing and re-engineering. that is not ultimately is solution because it leads to a different kind of on sustainability. that is inadequate health care benefits for most americans. the other option is to re-

engineer health care. payment reform is fundamental to that. to do thepossible right thing. , if you will,way through the forest that enables .reativity to thrive the affordable care act has made major progress in that regard. the tool kit of reform is full. master of many of these tools. this it on his desk for the most part. they are numerous, maybe even too numerous and it is his job to sort through them and figure which words of which doesn't carry him reform will be more than critical elements of in this tool box.

fund took a crack at thinking about the cost problem. and issued a report a few weeks ago called confronting costs. the idea was that we could do , and affordable system and a better system at the same time. three major strategies figured attend to the recommendations of the report. over $1 trillion over a 10 year period. we are associate with him a forum-we are associated with payment reform. thate of the trends catalyst is trying to document and to stimulate. the question is how to get there? how to move forward?

it is clear that we can do some of the working through the public sector but the public sector is only half the bill. the other half of the bill is paid for by the private sector. that is where a catalyst is playing its role. i look forward to hearing the presentation of these results .nd continuing >> to share with you the results of the national scorecard on page every form, i will provide some context and then pass it to my colleague who will share the results with it. i apologize, we will take you at a tour at breakneck speed so we have a chance to get the results and hear from the other speakers in the time we have today.

the product california health care foundation and commonwealth fund supported was called tracking the nation's progress and payment reform. has two components. one of them is a scorecard. there's also an national compendium on reform. it is an accurate view of how dollars are being paid to doctors and hospitals through different him of mack it. .t is based on data it is not designed to be academically rigorous. the national compendium on payment reform will be a searchable database of different payment form

initiatives across the country. if you go to the web site today, you will see it just started to .e populated all of this work was guided by a multistate advisory committee. the that those members for providing us a lot of guidance. obviously we will talk about tim reform. we have to be clear on what that means. we defined it as payments and promotes our leverage is greater value for patients, payers, providers and purchasers. what is not him reform is in the tim a model independent of quality for ballet. value oriented payments reflect the performance, especially of the quality and safety. payment methods are designed for an efficiency and reduce unnecessary spending. if the payment method only addresses sufficiency, we do not

consider it to be value oriented. and we found the scope and the magic's we used in the scorecard. be partnered with the coalition on health. data collection and did over a month ago - ended over a month ago. those kohl plans represent 67% of the market. plant'll see, not every and to every question. so we provide the total number of each lance -- of each plan. let me be clear. the scorecard is a voluntary survey.

as you will see from the results, it is a quiet -- call to action for all stakeholders to make progress. an scorecard is not to be academically rigorous portion. i will turn it over to andrea who will take you on a tour of the scorecard. >> take it. i'm very excited to be here to share these results with you. the front cover of the scorecard will help the answer three questions to. how much of commercial payments are value oriented? andhat is the breakdown what proportion of payments to hospitals, specialists a primary-care physicians in volume oriented. if you look at the target in the upper left, the results show

that about 11% this @ today are of value oriented which means they are tied to performance and quality and design to cut waste. each drop on the right hand side of the page represents a payment reform program that exists in the private market today. the 10.9%.up the crops represent a wide range appeared to reform currently being used -- performance in various other reforms. each method is color coded. the light blue offers a carrot approach.

incentive --inical there is an incntive. entive. representlue drops .rograms that offer programs are considered at risk. an example of this is fundamental payment. at the center of the page, there are two transparent bubbles. these numbers tell us how much of the value oriented payment is at financial risk or not. within the 11% of payment saleh oriented, we found the other 42% offer is an

approach where there's just a financial incentive or added payments to providers. in the lower left hand, you will see three bars. what we wanted to do is understand what is the experience. on the total payment made to -- ital today, a 11% is -- [indiscernible] now the inside of the scorecard. we have identified by magic that provide benchmarks wanted to determine how far

reaching the impact is to help plan members. the best way to determine the split find out what proportion -- was to find out of proportion is attributed to a physician involved in the program but accountable care or patients and medical holmes? today, 2% a commercial in moment is contributed to providers. item in the middle, when figuring what overtime, in the course to plymouth to go to specialist versus primary-care physician. we found that of the total outpatient payments made, the scorecard found that 75% of his opposition payments to a specialist said. on the bottom of the left-hand

pages. gawdy oriented him to conclude two componen waste and coste but it as paymen methods to notdo not include quality, they are missing the mark. the right hand side of the page, you will see five transparent to metrics. i will not walk to each metric but i want to itwo for you. the first is that 98% of health plans offer a cost calculator which allows health care plan numbers to determine their out- of-pocket costs for care.

however, the last magic shows only 2% of total enrollment actually use those tools. so clearly we have a gap between the present and the use. we selected it as an indicator that can be tracked over time. asure. the re-admision me withfinding is consistent the benchmark in the commercial market. think that failed to go through all of these slides on an individual basis. but now we are at the last slide. ed it hasention

gone live. first of creating an on-line catalog of around the country. we encourage all those of all to add to this, website and catalog. back to suzanne. while we paz, i will provide some concluding remarks -- while provide some will concluding remarks. our estimate was somewhere

between 3% being tied to performance. we commend all the stakeholders to amend the progress. together, this is a call for action. these results give us very important insight into state -- we did notpayments have before. there is no doubt in my mind this would keep the conversation moving. we are looking forward to putting out regional scorecard of will help us see there is not regional variation in the payment methods being used. with no further ado, i look forward to hearing from all the speakers to address today and i will turn it over to dr. galvin. >> thank you.

you have a place probably never heard of. it buys health care for 39 companies. 1 billionnt about dollars. if i can put see .his into context let me focus on what i think it's a positive of the health care system. that as a triumph of transparency. is simply good to know. .f you look at the slide 15 years ago, we said what can

we do, what we know in the private sector. what can we do with our greater flexibility to help reform the system? we can love with this task. it had three couples. .e have to measure everything had to be transparent. that is why i think today it is such an important day in terms of