dr. holtz-eakin? >> so i think the important thing to echo are there are models and examples that appear promising at the moment for in particular doing the coordination in many cases across what ever are traditionally separated long-term care and health services. my experience at cvo is successful small scale models don't always scale successfully. what i would urge you to do is think hard about scaling things up. in particular if you're going to good past something that looks like a demo pilot. focusing on the states as a demo for scaling makes a lot of sense because they have the capability of running large scale programs like medicaid. they have flexibility in how they implement things, and you can learn from the different states' experiences. so i think a focus on the state level makes a lot of sense from that point of view. we also know that many states have been very successful in the health area using managed medicaid approaches with adequate quality controls for outcomes to the extent that we

dr. holtz-eakin? >> chairman kohl and ranking member corker, thank you for the privilege of being here today. let me pick up on some points made by the panelists before me, and then i'll be happy to answer your questions. the first is obviously this is a very difficult problem whose scale will grow rapidly in the years and decades to come. and there are really two separate aspects to it. the first is going to be the nuts and bolts costs of long-term care services driven by a greater number of individuals who will require those services and an increasing cost per person. and there are really two things that the committee can think about on dealing with that fundamental problem, which is the cost. one is those kinds of preventative actions that could be taken to either defer or eliminate the need for long-term care services. and they're the things that stand out are the increasing prevalence of alzheimer's and dementias, which lead to extremely costly cases. and to the extent that research and other pro

dr. holtz-eakin's point that flexibility is really important. how we are going to meet the needs of families and delivery systems is very locally based on assets on the ground and a resources. so the solution to your three points reside in organized, accountable systems of care that have flexibility to meet the needs of families and are responsive to the assets that are available. i would offer that those flexible accountable systems have four the characteristics. the first is they begin by focusing on the quality and coordination of care. the notion of targeting the right services is incredibly important and how you get the efficiency to look forward. the second point would be that they have rebalancing at their core which means we will focus on helping folks stay in the communities of their choice. we will work against the tyranny of the bricks and mortar. i grew up in hospitals and cared for people in nursing homes. bricks and mortar drive so much financing of health care. what we're talking about is a system that begins and reside in the com

dr. holtz-eakin? >> there are models. our experience at sea be all was that successful models cannot scale successfully. dold that when i was at the cbo -- at cbo, i learned that successful models to not always scale successfully. you can learn from the different states experiences. to the extent that we wanted to try some more coronation, that would be a sensible first step in this area. we can see what we get in larger populations. >> senator bob corker? >> thank all of you for your testimony. look at overall financing for health care in general. a major train wreck is on the horizon. i was visiting a couple of neighbors in a long-term care facility. it is incredible. many of us have friends or neighbors who have had alzheimer's. we see more and that -- more and more of that coming. the financing problem is incredible difficult and a national issue moving to a national crisis. how r&d institutions you work with doing? how are they acting warily -- actuarily doing? their are larger concentrations of alzheimer's. how are

dr. holtz-eakin is president of the american action form. was chief economist with the council economic advisers from 2001 to 2002 and he served as the director of the congressional budget office from 2003 to 2005. professor judy feder is a little long and distinguished academic career, serving as dean of the georgetown public policy institute in washington d.c. from 1999 to 2008. today she is a professor at georgetown university, a fellow at the urban institute and an elected member of the institute for medicine. we also have dr. bruce chernof with us, the president and ceo of a foundation based in long beach california. an organization dedicated both to research and dissemination of knowledge that improves the health of older adults. dr. chernof also serves as director and chief medical officer for the los angeles county department of health services. we thank you for being here and before we go to your testimony, we will hear from the distinguished ranking member of this committee, senator corcoran. >> mr. chairman thank you. i know you h