second, the accountable care organization 0 approach proposed by the new affordable care act locate care for the sickest patients at centralized hospitals such as van ness and geary. rather than locating food service on an interior court yard its location on van ness energizes the street scape while still providing a modicum of privacy to diners. additionally, as san francisco's second largest employer it lies on one of the best served transit corners, making it an ideal site. increased birthing services are provided in a community friendly environment. they will have the sime -- same private patient room size as van ness and geary. these two hospitals are vital to san francisco's future. a great city needs the finest in health care and i ask for their approval. thank you. president olague: thank you. >> good evening, president olague and commissioners. my name is lance bayer and i'm a san francisco resident and i am speaking on behalf of the concordia argonaut board of directors. the concordia argonaut club is located on van ness and post directly across from the proposed hospital site

second, the accountable care organization 0 approach proposed by the new affordable care act locate care for the sickest patients at centralized hospitals such as van ness and geary. rather than locating food service on an interior court yard its location on van ness energizes the street scape while still providing a modicum of privacy to diners. additionally, as san francisco's second largest employer it lies on one of the best served transit corners, making it an ideal site. increased birthing services are provided in a community friendly environment. they will have the sime -- same private patient room size as van ness and geary.

eliminate unnecessary care, and that is why, when we were beginning to do our request for proposal this year, we heard about the model of creating an accountable care organization and said, you know, we put that in as a requirement. we wanted that increased transparency and the increased cooperation. blue shield was the only vendor who included an accountable care organization in their response, and at accountable care organization will hopefully create financial rewards for the doctors and hospitals and insurers collecting the data. to increase efficiencies, to provide better data transparency as well as cost transparency, and improve the coordination and quality of patient care. i was sitting there thinking and wanted to end by saying that as we look at consolidation, i heard on the radio yesterday as i was driving home that starbucks is now the second- largest vendor in the country in terms of the stock market. it comes in right behind wal- mart. i was thinking san francisco has had lots of hearings on starbucks moving into neighborhoods, but what happens is the one vendor, whether it is a coffee vendor or a hospital, sets the high mark of how much can be ch

the affordable care act of the direct the innovation center to develop new approaches to payment and delivery. it's not clear they're going to work. the poster child is the accountable care organization. we've seen that the major health plans everybody points to as the models, don sinner, mayo clinic, cleveland clinic etc., they have written a letter in the past week basically saying they are not interested in becoming the accountable care organizations. what it boils down to is the government has specified conditions that make it a bad business deal. and so it is not just about whether you can deliver health care efficiently. it's whether you can actually make a business out of it and we shouldn't forget that that is an issue something i think is often overlooked when washington people talk about health policy. you want us again this is the sixth consecutive year of excess general revenue funding. i have written down what that means. it's easy to understand. you might take a few minutes to study it. it's just intuitive with that term means. and then of course if you have two consecutive years of excess general revenue funding i have to look at my notes to make sure i get the words r

here you have a leader of one of the nation's top accountable care organizations saying that essentiallyhe house republicans medicare forums do a better job of promoting quality, coordinated care, which reduces costs, and in the administration's proposal for accountable -- for an account care organization. host: questionable whether he will stay beyond this year. guest: there is a lot of opposition to him in the senate for their risk -- that is one of the reasons why he is a recess appointments. he has made a lot controversial statements about the government rationing decisions for seniors, deciding when they will and will not -- and a lot of people see this accountable care organization program as an effort toward that rationing. host: donald berwyck joined us yesterday. all of our program, part of c- span's growing video library. check it out at c-span.org. unions saying they do not have to pay or have obamacare info on them, why should we the people? let's get your phone calls. next is oakland, california. good morning. caller: good morning. please do not cut me off. i have quite a fe

here you have a leader of one of the nation's top accountable care organizations saying that essentiallyouse republicans medicare forums do a better job of promoting quality, coordinated care, which reduces costs, and in the administration's proposal for accountable -- for an account care organization. host: questionable whether he will stay beyond this year. guest: there is a lot of opposition to him in the senate for their risk -- that is one of the reasons why he is a recess appointments. he has made a lot controversial statements about the government rationing decisions for seniors, deciding when they will and will not -- and a lot of people see this accountable care organization program as an effort toward that rationing. host: donald berwyck joined us yesterday. all of our program, part of c- span's growing video library. check it out at c-span.org. unions saying they do not have to pay or have obamacare info on them, why should we the people? let's get your phone calls. next is oakland, california. good morning. caller: good morning. please do not cut me off. i have quite a few co

the accountable care organization structure, the new partnership for patients which i just mentioned which has some cost savings. we have new tools for going after fraud, waste and abuse last year alone produced about $4 billion back into the trust fund. we produced a report yesterday that is available in more detail which, analyzes about $120 billion worth of savings over the next five years, which are part of the early implementation of the aca and that can give you considerably more detail. >> in the back. >> could you explain the distinction between social security ing in deficit and the trust funds being exhausted? is it slightly deceptive to talk about social security running a deficit currently considering it takes in less than it pays out until 2036? >> [inaudible]. can you hear me? good. i'm glad you asked that question. actually in last year's press conference stressed the importance of the media unrstanding the term exhaustion which means something different to the actuaries than it does to the average person and that what exhaustion in 2036 this year means that we'll have

the accountable care organization structure, the new partnership for patients which i just mentionedas some cost savings. we have new tools for going after fraud, waste and abuse last year alone produced about $4 billion back into the trust fund. we produced a report yesterday that is available in more detail which, analyzes about $120 billion worth of savings over the next five years, which are part of the early implementation of the aca and that can give you considerably more detail. >> in the back. >> could you explain the distinction between social security being in deficit and the trust funds being exhausted? is it slightly deceptive to talk about social security running a deficit currently considering it takes in less than it pays out until 2036? >> [inaudible]. can you hear me? good. i'm ad you aed that question. actually in last year's press conference stressed the importance of the media understanding the term exhaustion which means something different tohe actuaries than it does to the average person and that what exhaustion in 2036 this year means that we'll have money to

here you have a leader of one of the nation's top accountable care organizations saying that essentially the house republicans medicare forums do a better job of promoting quality, coordinated care, which reduces costs, and in the administration's proposal for accountable -- for an account care organization. host: questionable whether he will stay beyond this year. guest: there is a lot of opposition to him in the senate for their risk -- that is one of the reasons why he is a recess appointments. he has made a lot controversial statements about the government rationing decisions for seniors, deciding when they will and will not -- and a lot of people see this accountable care organization program as an effort toward that rationing. host: donald berwyck joined us yesterday. all of our program, part of c- span's growing video library. check it out at c-span.org. unions saying they do not have to pay or have obamacare info on them, why should we the people? let's get your phone calls. next is oakland, california. good morning. caller: good morning. please do not cut me off. i have quite a

the accountable care organization structure, the new partnership fo patients which i just mentioned which has some cost savings. we have new tools for going after fraud, waste and abuse last year alone produced about $4 billion back into the trust fund. we produced a repo yesterday that is available in more detail which, analyzes about $120 billion worth of savings over the next five years, which are part of the early implementation of the aca and that can give you considerably more detail. >> in the back. >> could you explain the distinction between social security being in deficit and the trust funds being exhausted? is it slightly deptive to talk about social security running a deficit currently considering it takes in less than it pays out until 2036? >> [inaudible]. can you hear me? good. i'm glad you asked that question. actually in last year's press conference stressed the importance of the media understanding the term exhaustion which means something different to the actuaries than it does to the average person and that what exhaustion in 2036 this year means that we'll have money

the accountable care organization structure, the new partnership for patients which i just mentioned which has some cost savings. we have new tools for going after fraud, waste and abuse last year alone produced about $4 billion back into the trust fund. we produced a report yesterday that is available in more detail which, analyzes about $120 billion worth of savings over the next five years, which are part of the early implementation of the aca and that can give you considerably more detail. >> in the back. >> could you explain the distinction between social security being in deficit and the trust funds being exhausted? is it slightly deceptive to talk about social security running a deficit currently considering it takes in less than it pays out until 2036? >> [inaudible]. can you hear me? good. i'm glad you asked that question. actually in last year's press conference stressed the importance of the media understanding the term exhaustion which means something different to the actuaries than it does to the average person and that what exhaustion in 2036 this year means that we'll

the accountable care organization structure, the new partnership for patients which i just mentionedme cost savings. weave new tools for going after fraud, waste and abuse last year alone produced about $4 billion back into the trust fund. we produced a report yesterday that is available in more detail which, analyzes about $120 billion worth of savings over the next five years, which are part of the early implementation of the aca and that can give you considerably more detail. >> in the back. >> could you explain the distinction between social security being in deficit and the trust funds being exhausted? is it slightly deceptive to talk about social security running a deficit currently considering it takes in less than it pays out until 2036? >> [inaudible]. can you hear me? good. i'm glad you asked that question. actually in last year's press conference stressed the importance of the media understanding the term exhaustion which means something different to the actuaries than it does to the average person and that what exhaustion in 2036 this year means that we'll have money to p

the hospital and physicians as well as better coordinated care, and we are going to continue to watch that model as it unfolds, both for our members as well as any future accountable care organizations that blue shield will be developing in other parts of the state. i want to point out something i think you need to pay attention to because we are starting to pay attention to it. that is that cost management of the implantable medical devices -- we worry that we will see a proliferation in the market of multi-competing companies with multiple models and direct to consumer advertising similar to what happened to the pharmacy industry. we're trying to get ahead of that curve as part of our strategies for managing our markets moving forward. finally, we were -- we actively sponsored the patient safety initiative. we will be doing more work in patient safety as it relates to not just improving quality, but releasing costs. we have been working closely with health and human services to demonstrate our commitment and our efforts and to coordinate as they roll out patient safety in their health care reform. i did not mention health care reform, but we implemented a number of provisions that

accountable care organization has been announced for san francisco. i hope that you will get some details about that and ask more questions. the point is that the way care is paid for now in general rewards doing more and everybody doing everything. everybody knows this cannot be sustained. so from the federal government on down, there are policy prescriptions to change that. how quickly these descriptions will be effective and whether they will actually reduce the cost of care we all are waiting breathlessly to see. >> following up on that point -- what can government do -- you know, right now, there are incentives for one hospital when we get a patient to run all the tests that they could possibly run without thinking -- or maybe they do think -- i do not know, but maybe you could say that -- you know, have these tests been done by another provider and whether they can get access to those results so there is no duplication of the costs. what can government do to make sure that duplication is avoided? >> government, as a purchaser, can think about how and when it is going to pay for services. knowing that some care is ineffec

the next idea is piloting a new payment models. you have per preference to be accountable care organization, you will hear more about this from our calf speaker from calpers. this is where you take a disparate parts of the system and put them together

care of families all across the cowboy state -- visiting a hospital in cody, wyoming, and they said we're trying to figure out this one aspect of the health care law, accountable health care organizations, it's six pages of the law -- that health care law passed through in the middle of the night -- the people doing the regulations, they took six pages of the law and came up with over 400 pages of regulations. they just came out about a month ago, and the hospital administrator said we're having to take money away from patient care, from helping with nurses and therapists to pay for consultants to try to explain these rules and regulations to us so we can abide by them. those are the kind of regulations and rules on steroids that i continue to hear about as i traveled in the last week or so at home visiting with people, visiting in communities, listening to what people have to say. and the concern and the uncertainty because of what's coming out of washington is a drag on our economy. it is preventing us from making it easier and cheaper for the private sector to create more jobs. people all across the country are concerned, madam president, and that's why i'm so happy to be here with

the world. so, yes, there are ways we can better deliver health care. not only for less cost but also for better results. medicare must continue to institute further reforms, including the creation of accountable care organizations, reductions if there are high readmission rates, bundled payments, a focus on fraud. these reforms are meant to incentivize our doctors and hospitals to provide high-quality efficient care. the radical changes to medicare that are proposed in the ryan budget are not solutions to our long-term debt. there is a way to get the country on a better fiscal path. one where you're not doing it on the backs of seniors. now, you would think if you were going to take such a drastic step as ending medicare as we know it, you would put most of your savings towards deficit reduction. instead, mr. president, the ryan budget uses its $4.3 trillion in savings for $4.2 trillion in tax breaks that disproportionately go to the wealthiest americans. instead of putting that money into deficit savings, it disproportionately puts the money in the pockets of the wealthiest americans. at the same time, the house budget is disproportionately targeting seniors and the middle class, it leaves the pentagon that ma

you have per preference to be accountable care organization, you will hear more about this from our calf speaker from calpers. this is where you take a disparate parts of the system and put them together and have a team responsible for total cost of care, hospital, ambulatory, tests, and so forth, for a given population. calpers has been doing this for a year its insurer, blue shield hmo, and in the northern part of san francisco, with 41,000 members, and already they have seen $51 million in savings. just by having things work more like a system. i assume this relates partly to the question about health care information technology. if you can make in interoperable, you can make it better. i think you have an opportunity to do this, and i believe you may be to some planning for that. finally, we just need more transparency. as you were suggesting, mr. chairman, we need to know more about quality and in terms of what we want to know. is there harm in going to its hospital -- this hospital because it's infection rates are too high? are people having trouble after their hip surgery? i am sorry you cannot read this, but if you live in pennsylvania, you can go

care period. there is occasionally affected organizations established that take up a piece of it, but there is no over all maintenance of accountability. and that is part of the problem that you will have an opportunity to address, add this planning review unfolds. one result of that has been, efforts have been started up in several places around the country to identify waste, reduced the rates of error, and develop systems of accountability. one of those systems of accountability is known as potentially avoidable complications analysis. it is a software system developed in the public demand by a nonprofit research and development organization. it was developed with philanthropic support from robert johnson, and the commonwealth fund, and is within the public domain. it is fully transparent and was developed from the court did efforts of a very highly skilled team of clinicians and researchers around the country. what it does is take claims and sort them out in a way that you can see, for every individual patient, for groups of patients, you can see what services they got that conformed to the protocol of care. that is the evidence-based standard of care for