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Program - By Health Track:

Sunday, April 26, 2009

  11:45 AM - 1:45 PM

Government and Health: A Dialogue for Accelerating Medical Solutions With Anna Barker and Andrew von Eschenbach
By invitation only

Anna Barker , Deputy Director, Advanced Technologies and Strategy, National Cancer Institute
Jonathan Simons , President and CEO, Prostate Cancer Foundation
Andrew von Eschenbach , Former Commissioner, U.S. Food and Drug Administration

  3:00 PM - 5:00 PM

Prostate Cancer Foundation Board Meeting
By invitation only

Monday, April 27, 2009

  8:00 AM - 9:15 AM

The Future of Health

Susan Hockfield , President, Massachusetts Institute of Technology
John Lechleiter , Chairman, President and CEO, Eli Lilly and Company
Henry Waxman , U.S. Congressman (D-California)
Elias Zerhouni , Senior Fellow, Global Health Program, Bill & Melinda Gates Foundation; former Director, National Institutes of Health

Greg Simon , President, FasterCures / The Center for Accelerating Medical Solutions

The future of health lies in proactive prevention and personalized medicine versus the reactive treatment of symptoms, according to this panel of experts. They believe this shift will require innovation, translation of basic research, multidisciplinary collaboration, investment in infrastructure and a culture shift.

Elias Zerhouni of the Bill & Melinda Gates Foundation identified two current barriers: the current focus on acute care and the unanticipated complexity of biology. There is a disconnect between advancements such as completion of the human genome project and translation to care. He believes that a societal shift to a concept of "embedded health" will be required to truly change the face of health. A commitment to change and healthy living is needed at the societal, economic and political levels.

Rep. Henry Waxman spoke to the role of government in this metamorphosis, specifically in promoting prevention, creating and sustaining public health infrastructure, addressing access inequity and funding basic research. He believes that government needs to create greater access to healthcare but also needs to look at health beyond just treatment of symptoms (for example, promoting behavior or environmental changes that can positively affect health). Waxman stated that the government needs to take a harder look at public health policy and make provisions for the unanticipated. He also spoke to the need for a sustained and increasing commitment to funding basic research rather than fluctuating with shifts in power.

Susan Hockfield of MIT and John Lechleiter from Eli Lilly also called for sustained funding as well as investment in human capital. Hochfield believes the future of health, prevention and treatment lies in innovations stemming from the collaboration between life and physical scientists as well as engineers. These partnerships can give rise to new technology and delivery systems but require basic research funding and crossing of disciplinary divides. Additionally, investment in both K-12 and higher education is required to nurture the talent leading this innovation.

Lechleiter had a similar stance and referred to this nurturing as part of an "ecosystem for innovation," which also requires investment and regulation. To create and sustain this ecosystem, government, public institutions and private sector need to work together more efficiently.

According to panelists, our future will bring personalized medicine with an emphasis on prevention and targeted, cost-effective and high-tech treatments. Achieving this future will require not only investment in human capital and basic research but also a culture shift among researchers, politicians, philanthropists and the general public.

  9:30 AM - 10:45 AM

How Nonprofits Can Sustain Their Mission in a Down Economy

Sherry Lansing , CEO, Sherry Lansing Foundation
Carl Schramm , President and CEO, Ewing Marion Kauffman Foundation
Jonathan Simons , President and CEO, Prostate Cancer Foundation
John Walsh , Co-Founder, President and CEO, Alpha-1 Foundation

Greg Simon , President, FasterCures / The Center for Accelerating Medical Solutions

In this economic downturn, nonprofits are seeing a decrease in institutional giving, but a spike in donations from individuals. Panelists said charities′ coffers would benefit greatly from innovative models of funding and research, more transparency and collaboration in medical research, and increased accountability on the part of nonprofits.

Asked by moderator Greg Simon why nonprofits exist, Carl Schramm said charitable giving and nonprofit activity is really a function of capitalism. For Schramm, the "nonprofit sector exists in some regard to make up for market failure" because the dynamic market conditions of a capitalist society will necessarily fail to provide what society needs, and nonprofits will spring up to fill the void.

However, Schramm said government can have a negative effect on the level of charitable giving in the United States because charitable giving declines as the state takes more of the gross domestic product. Schramm said governmental action is premised on the flawed idea that the state can better dispose of income than individual charitable impulses. As an example of such flawed government spending, Schramm pointed to the federal stimulus program, which he said will subsidize many unworthy nonprofits that would otherwise cease to exist.

Schramm said business is not the enemy of nonprofits because "all entrepreneurs are social entrepreneurs" in that they create jobs and the wealth that sustains an individual′s charitable impulses.

Sherry Lansing said when a cause "strikes someone′s heart, that′s when you really get [individuals] to give." But being motivated to donate is not the end of the decision-making process, she said. In a market downturn, donors are inspecting nonprofits and calling for greater accountability. Lansing encouraged all donors to follow the money to evaluate how much goes to overhead and to make decisions about worthy causes based on how effective their donations will be in furthering the cause. In this environment, Lansing said, nonprofits need to adopt better practices and higher standards to withstand the scrutiny of the donor market.

Jonathan Simons predicted that institutional giving will be negatively affected for the next three to four years but agrees with Lansing that more individuals will donate to charitable causes. Simons said medical philanthropy is different from other charitable causes in that medical philanthropists "want to wake up one day and turn out the lights" by finding a cure for a specific disease.

The difference between philanthropy and charity, he said, is that philanthropy is finding a way to solve a problem and charity is giving money to the solution. Simons would like to see more demands made of the government, as the nation′s largest medical philanthropy investor, to examine best practices of medical research.

John Walsh has used innovative funding to sustain his charitable organization despite the market downturn. Walsh figured out how to fund medical research in a meaningful way by recycling insurance dollars into research. One such innovative funding method was when he persuaded a pharmaceutical company to make a legacy gift of $1 million dollars that would be restricted to research, even though the company was being acquired by another pharmaceutical company. This type of innovative funding is more important during down economic times, he said.

  11:00 AM - 12:15 PM

Wellness in the Workplace: Obesity and Other Bottom-Line Issues

Steven Burd , Chairman, President and CEO, Safeway Inc.
Delos Cosgrove , President and CEO, Cleveland Clinic
Mark Mastrov , Founder, 24 Hour Fitness
Indra Nooyi , Chairman and CEO, PepsiCo Inc.

Andrew von Eschenbach , Former Commissioner, U.S. Food and Drug Administration

The solution to the nation's obesity epidemic is mostly in the mirror, but food manufacturers, retailers and the government can play an important role in encouraging healthy living, panelists said.

The choices people make about diet and exercise ultimately determine the balance between calories in and calories out. Behavioral factors are responsible for a large number of deaths every year, and there is a limit to what medicine, employers and policymakers can do, speakers said.

But some businesses have taken the initiative in improving the health of employees and the consumers they serve. Employer-based programs require an initial financial outlay, but they have secured short-term returns. For example, Steven Burd said Safeway recently introduced a Healthy Measures program that adjusts employees' insurance premiums based on tobacco use, weight, blood pressure, and cholesterol; employees are refunded the difference at year's end if they improve in those categories.

"You have to measure so you know where you stand, then you have to make progress on that," Burd said. By shifting financial responsibility onto individuals, employees bear the consequences of their choices.

The Cleveland Clinic also has been successful at making the workplace healthier, promoting better food choices and reducing smoking — all without increasing employer costs, Delos Cosgrove said.

The Cleveland Clinic improved on-site food options; labeled cafeteria portions and calories; and provided free access to Weight Watchers, Curves and exercise classes. Although the changes cost the clinic $5 million in the first year, the 80,000 pounds lost by its employees in the first six months were estimated to save $6 million in health-care costs, Cosgrove said.

Manufacturers share the responsibility. "Food and beverage companies have to actively agree to reformulate their products," Indra Nooyi said. If healthy products end up costing more, or tasting worse, then they have failed. Industrywide standards for nutrition labeling and consumer education are also needed, Nooyi said.

"We're putting wiser, healthier options up front without serious trade-offs in quality, taste and price," moderator Andrew von Eschenbach said.

In addition to the "calories in" component, more exercise is required to affect the "calories out" part of the equation, panelists said. Physical education is disappearing from schools and from children's daily lives, which Nooyi called a serious threat. For adults, building fitness centers near workplaces improves exercise opportunities, Mark Mastrov said.

However, widespread promotion of health programs faces a number of challenges. Businesses that are self-insured focus more on administration solutions than on health promotion, and they are unaware that premiums can be adjusted to incentivize behavioral change. Policymakers in Washington, D.C., are increasingly aware of the societal costs of obesity, but they need to support the development and expansion of effective programs. The law around obesity is part of the problem.

"Obesity is protected by the Americans with Disabilities Act, which seems to me to send the wrong message from the government about what obesity is and what it represents," Cosgrove said.

  11:00 AM - 12:15 PM

Encore Careers and Volunteerism: Civic Engagement After Age 50

Jennie Chin Hansen , President, AARP
Sherry Lansing , CEO, Sherry Lansing Foundation

Nancy Aossey , President and CEO, International Medical Corps

Whether it's using one's skills and experience, working on a cause that's affected someone close, or learning new skills, increasingly people over the age of 50 are choosing to be philanthropically and civically engaged. That was certainly true for Sherry Lansing, founder and CEO of the namesake foundation she started when she turned 60. As Jennie Chin Hansen, president of AARP stated, "People want to participate and shape their destiny for this country and for their grandchildren."

With a membership of close to 40 million, the AARP and individuals like Lansing are helping to reframe what it means to be retired. Citing the fact that today's AARP encompasses three generations of members — in which grandma, mom and daughter are all active and over the age of 50 — Hansen said that there were demographic imperatives demolishing old stereotypes: "This is not just your grandmother's AARP." In fact, as moderator Nancy Aossey, president and CEO of International Medical Corps pointed out, the AARP cast off its old name, the "American Association of Retired People," and went with just the acronym in response to the reality that half of AARP's members work either full or half time.

Part of the need to rethink our notions comes from the fact that ageism is still prevalent in our society. Experience is devalued in a society where youth culture dominates. As Lansing mentioned, perhaps ageism is the "last area of discrimination." Seizing Jeri Sedlar's spirit of "Don't Retire, Rewire!" both Hansen and Lansing encouraged a semantic sea change in order to harness the movement to redefine aging. "Call AARP the American Association of Rewired Persons!" Lansing exclaimed. If 50 and up is to be seen as the prime of someone's life, the language should reflect their relevance to the times. Rather than talking about "volunteers," Lansing preferred the term "social entrepreneurs." She also made the pointed distinction between charity and philanthropy: "Charity in the past meant that you gave money. Philanthropy means you want to affect a change with the money you give, and that's very empowering."

It is imperative, then, for baby boomers and the generations that came before, to harness a movement. Hansen spoke to the importance of harnessing public-private partnerships and agreeing on core principles surrounding societal issues like health care. In today's economy, these partnerships are especially crucial.

The panel served up a powerful reminder that people over the age of 50 are equipped today, more than ever before, with the health and the wealth to make a difference.

  2:30 PM - 3:45 PM

Life After 80: Always Looking Forward

Norman Lear , Producer
Jim Pattison , Chairman and CEO, The Jim Pattison Group
John Sperling , Founder and Executive Chairman, Apollo Group Inc.
Deborah Szekely , Owner and Director, Rancho La Puerta and Golden Door

Marty Kaplan , Research Professor and Director of the Norman Lear Center, USC's Annenberg School for Communication

"Eighty is the new 60," proclaimed moderator Marty Kaplan of USC's Annenberg School for Communication. But judging from the stamina and recent accomplishments of the panelists, it may have been more appropriate to say 80 is the new 30. Jim Pattison of The Jim Pattison Group captured it best when he said, "Retirement is not in the cards."

The four panelists hail from across the U.S. and Canada, though all grew up in modest households and lived through the Depression. John Sperling of Apollo Group recalled his mother saying, "The Depression doesn't mean anything to us. We've been poor all our lives."

Deborah Szekely of Rancho La Puerta and Golden Door speculated that living in that troubled era had been an advantage because they had nowhere to go but up. "Risk-taking and challenges are the vitamins and minerals of life," she said. Growing up poor hardened her resolve and perseverance, two qualities she believes are crucial to attaining success in life.

Producer Norman Lear "does not enjoy or look for conflict," though with twin 14-year-old girls at home he has plenty of excitement. He does, however, look ahead at all times. In his words, he is "always on to next."

Another similarity among the panelists was their dedication to philanthropic endeavors. Each has specific and unique causes — Lear is a benefactor of People for the American Way, Pattison has tithed 10 percent to his church his entire life, Sperling contributes to an array of scientific endeavors and Szekely helps new immigrants — and all believe in the power of giving.

Not surprisingly, each of the panelists also makes diet and exercise a priority. Szekely has eaten well her entire life, though just recently she acknowledged her lack of discipline in "the exercise area" and hired a trainer three times a week. Lear chimed in saying, "I want to talk about my body, too. My legs have been carrying me around for 86 years." Then he kissed his knees.

Kaplan asked the panelists about a recent New York Times article documenting a recent study that showed people with more friends — even distant friends — seem to live longer, healthier lives. Three of the panelists echoed the sentiment to varying degrees. But Sperling countered, "I love humanity but they are not my friends."

Lear recounted that his son-in-law once asked him to reconsider his desire to be cremated. "I want to take my kids to your headstone and have them see 'Even This I Got to Experience.'"

  2:30 PM - 3:45 PM

What Are the Real Economics of Quality Health Care?

Juan Davila , Senior Vice President, Network Management, Blue Shield of California
Marc Hoffing , Medical Director, Desert Medical Group and Oasis IPA
Paul McBride , Vice President, Health Care Management and Services, Wellpoint Inc./Anthem Blue Cross & Blue Shield
David Schmidt , CEO, SCAN Health Plan

Richard Merkin , CEO and Founder, Heritage Provider Network; FasterCures Board Member

Health-care reform will require society to make hard choices about what it values, according to this panel of experts. David Schmidt of SCAN Health Plan explained that society is not willing to confront issues that drive health-care costs, and doctors are not willing to have conversations about what procedures are worth doing.

Marc Hoffing of Desert Oasis Healthcare put it even more bluntly: "Supply and demand is completely upside down in health care."

In locales with lower supply, Schmidt observed, patients are more satisfied with access because physicians are more willing to have discussions about values. Juan Davila of Blue Shield of California pointed out that facilities don't always have your best interests at heart; there is a lack of interest and a lack of communication. The moderator, Richard Merkin of Heritage Provider Network, added that many patients are hospitalized who don't need to be.

Washington has a key role to play in this debate, but Hoffing claimed there is little discussion of incentives or rationing there. Schmidt pointed out, though, that the American Recovery and Reinvestment Act (ARRA) has allocated $1.1 billion for comparative effectiveness research, which is in effect rationing.

Many of the panelists pointed to health care labor as part of the problem. According to Merkin, 60 percent of hospital expenses are labor, with the majority of that being nursing expenses. Paul McBride of Wellpoint Inc. said that in some countries with comparable or better outcomes, health-care labor costs are lower than in the United States.

Hoffing further argued that nurses and physicians are being used incorrectly. Physicians are incentivized to order more tests, leading to higher costs. This means better-qualified doctors get paid less, Merkin explained, and an integrated model with revised payment incentives could help ameliorate this problem. Physicians must also be incentivized to become primary-care providers; the noted the average age of primary care providers in California is 57.

McBride stated that patient incentives are also skewed. Patients are uninvolved in their own care because the marketplace is designed around the delivery system, not the consumer. This lack of responsibility leads to overutilization and higher spending, Davila agreed. These costs will continue to grow as baby boomers age and qualify for Medicare and as obese youth acquire adult-onset diabetes. Nevertheless, many patients have financial barriers to even accessing the health-care system; others have the means but choose not to get insurance, raising costs for everyone else.

Davila summed it up by noting that the U.S. health-care system is extraordinarily complicated, and multiple pieces need to be re-conceptualized.

  4:00 PM - 5:15 PM

Living Longer and Better Through Science, Nutrition and Lifestyle Choices

Scott Berns , Co-Founder, Progeria Research Foundation Inc.; Senior Vice President of Chapter Programs, March of Dimes
Pinchas Cohen , Pediatric Endocrinology Specialist, UCLA Children's Health Center
Luigi Fontana , Research Associate Professor of Medicine and Associate Director of the Longevity Research Program, Washington University in St. Louis School of Medicine

Howard Soule , Executive Vice President and Chief Science Officer, Prostate Cancer Foundation; Senior Fellow, Milken Institute

Scott Berns′ passion is finding a cure for progeria, a rare childhood genetic disease causing premature aging. Pinchas Cohen studies growth hormones and their role in increasing the human lifespan. And Luigi Fontana is using animals to discover how restricting calories improves long-term health and longevity.

To listen to them, it′s an exciting era for age-related research.

Cohen emphasized the distinction between health span — the length of disease-free living — and life span — the length of life. Life span is a result of genes and environmental factors, while health span is related to genes, environment and behavioral factors affecting preventable maladies, such as cardiovascular disease or cancer. Cohen said longevity studies demonstrate that size, i.e. height and gender, are important determinants of life expectancy and longevity. Moreover, high levels of growth hormones or testosterone correlate with higher risk of oxidative stress and prostate cancer.

Berns gave an overview of the Progeria Research Foundation, a 10-year-old organization that was funded to find a cure for progeria, a premature aging disease often leading to death by age 13. The foundation has supported research leading to the discovery of a single gene mutation associated with the disease. The foundation has sponsored a clinical trial to test the effectiveness of farnesyltransferase inhibitors to reverse the dramatic nuclear structure abnormalities that are the hallmark of cells from children with progeria. Finding a cure may create lead treatments for other aging-related diseases such as cardiovascular disease and cancer, Berns said.

A highlight of the panel was the research on calorie-restricted diets presented by Fontana. Fontana′s research has found that restricting rats′ diets leads to a 30 percent to 50 percent increase in life and health spans. Fontana′s research suggests that aging and chronic diseases are not linked, at least in small animals. A study is underway to test the effects of calorie restriction and find the optimal nutrition for human lifespan. Patients are fed low-fat dairy, whole grains, vegetables and other energy-intensive foods. Preliminary data have shown that the study diets improve all biomarkers for cardiovascular disease compared to a typical American diet. Fontana stressed that calorie-restricted diets must be carefully administered to assure that they are nutritious and meet daily requirements for vitamins and minerals.

Tuesday, April 28, 2009

  8:00 AM - 9:15 AM

Health Information Technology and the Health-Care Revolution

Margaret Anderson , Chief Operating Officer, FasterCures / The Center for Accelerating Medical Solutions
David Levy , Global Healthcare Sector Leader, PricewaterhouseCoopers
Stephen Lieber , President and CEO, Healthcare Information and Management Systems Society (HIMSS)
Frank Moss , Director, Media Lab, Massachusetts Institute of Technology
Yitzhak Peterburg , Senior Visiting Fellow, Milken Institute; Former CEO, Clalit Health Services; Former President and CEO, Cellcom Israel Ltd.

George Blumenthal , President and CEO, Park Avenue Medical Data Systems

Creation and implementation of a health information technology superhighway can increase quality, decrease costs, enable research and accelerate cures, according to panelists.

Despite these incentives, just 20 percent of hospitals and fewer physician practices use electronic health records, according to Stephen Leiber.

The Recovery and Reinvestment Act of 2009 allocates $35 billion to increase the use of electronic health records. The four major components include funding incentives; setting standards for health information technology, or HIT; linking incentives to HIT certification; and demonstrated use and establishing minimum requirements for functionality and interoperability. Leiber predicts that outcomes of HIT implementation will be eliminating unnecessary medical procedures, reducing errors and increasing efficiency.

David Levy said health-care costs are rising faster than economic growth, and global leaders in health-care delivery are concerned about sustainability. Integrated systems can lower cost and improve care, Yitzhak Peterburg said. Take-away messages from Peterburg′s experience implementing HIT in the world's second-largest HMO were increased patient satisfaction, improved quality indicators and an improved budget.

"Health IT is a stepping-stone for expense control and better medicine," Peterburg said, but to be successful it needs to be integrated; you need to do the research and get the right system; you need to get user buy-in; and you need to recognize that it's a culture shift that will take time and likely be met with some resistance.

"HIT is not only a stepping-stone for increased quality and decreased cost but also for clinical research," Margaret Anderson said. Anderson strongly encouraged HIT adoptees to integrate clinical research components prospectively rather than trying to build in post-implementation. A research-inclusive HIT will allow for quicker identification of patients eligible for clinical trials, enhanced monitoring of adverse drug reactions, and access to a broader, more diverse patient population, Anderson said.

Another means for faster cures and improved care via technology was proposed by Frank Moss. "Ordinary people, empowered by technology, are transforming every facet of society" and will affect health-care delivery and decision making as well, he said. For example, he said, orphan disease studies have found that electronic social networks provide a means of connecting patients and empowering them to track their disease, pose research questions and attract researchers. Moss highlighted the role of low-cost technology in distance medicine both for developing nations with limited access to providers and for developed nations as a means of addressing staggering health-care costs.

Recommendations and projections from the diverse group of panelists all spoke to the same theme: Technology provides solutions to many dilemmas health care is facing by improving outcomes, accelerating cures, increasing access and lowering costs.

  11:00 AM - 12:15 PM

The State of Stem Cell Research

R. Alta Charo , Warren P. Knowles Professor of Law and Bioethics, University of Wisconsin, Madison
John McNeish , Executive Director, Pfizer Regenerative Medicine
Brock Reeve , Executive Director, Harvard Stem Cell Institute
Alan Trounson , President, California Institute for Regenerative Medicine

Margaret Anderson , Chief Operating Officer, FasterCures / The Center for Accelerating Medical Solutions

Stem cells have enormous potential to shape the future of medicine but may not live up to the hype, according to a panel of experts.

"Tremendous work is going on right now at the speed it should be going on," John McNeish said. However, the hype is more than is warranted at the moment, according to Brock Reeve.

He said patients are seeking out scientists to participate in their clinical trials, even when such trials are many years and millions of dollars away. Alan Trounson agreed, saying the public does not understand the long gap between creative science and drugs that are ready for clinical trials.

"In my opinion, there′s almost been a conspiracy of hype," R. Alta Charo said. The controversial nature of federally funded stem cell research led patient groups to over-promote the potential of stem cells to press their case for funding, she said. Sympathetic politicians did the same to their constituents, setting off a chain reaction that has slightly distorted the scientific reality.

At the same time, it's important to remember the huge potential that stem cells hold, McNeish said, particularly in pre-clinical drug testing. Animal testing is a vital part of drug research, but translating a drug's effectiveness from animals to humans is extremely unpredictable.

McNeish said it generally takes at least $100 million to get a drug into clinical testing. It is exactly for that reason, Reeve said, that the ability of stem cells to better replicate real human conditions in laboratory settings is so crucial. Stem cells could save billions of dollars and years of research by catching problems before clinical testing, benefiting both pharmaceutical companies and consumers.

This potential has become much easier to pursue since President Obama eased federal restrictions on embryonic stem cell research, the panelists agreed. "We are entering a massive growth phase, where there will be terrific opportunities for people to engage," Trounson said, citing both venture capitalists and pharmaceutical companies.

Reeve said much of the progress is because of the simplification of the current patchwork of research laws across different states. "If you′re trying to move significant research forward, having that sort of variation just gets in the way," Reeves said, mentioning the crucial need for collaboration among researchers.

Soon, Charo said, it will become clear whether the limit on progress was the lack of funds and scientists to move forward, or the science itself.

  11:00 AM - 12:15 PM

The X-Prize Model: Driving Innovation in Health Care

Samuel Nussbaum , Executive Vice President, Clinical Health Policy, and Chief Medical Officer, WellPoint Inc.
Patrick Soon-Shiong , Chairman and CEO, Abraxis Bioscience; Founder and Co-Chair, Chan Soon-Shiong Family Foundation
Billy Tauzin , President and CEO, Pharmaceutical Research and Manufacturers of America

Peter Diamandis , Chairman and CEO, X PRIZE Foundation

The X Prize Foundation and Wellpoint recently announced a $10 million award for radical innovations in healthcare. Peter Diamandis, X Prize CEO, illustrated the potential inherent in this move by describing how past X Prize awards have created incentives to devise and drive brand-new industries and forced paradigm shifts and breakthroughs in sectors where governments, academia and industry have lagged behind.

According to Diamandis, humans are "genetically bred to compete" and "fundamentally, you get what you incentivize for." To date the foundation has launched one prize per year focusing on core areas: life science, energy and environment, exploration, and educational and global development. Teams don't compete solely for the prize, but also for the revenue and publicity generated by the competition. Diamandis emphasized that the U.S. has become increasingly risk adverse, and the X Prizes are a response to encourage risk-taking.

Samuel Nussbaum of Wellpoint commented that we are currently living both in the best and worst of times for health care. Sequencing of the human genome will enable personalized medicine to become a reality, yet there are more than 46 million uninsured Americans. The U.S. health-care system is largely uncoordinated and inefficient, he maintained, noting that over half of the care delivered does not actually advance medical outcomes, and there is large variability in the standards of care, locally, regionally and nationally. Meanwhile the health of Americans continues to deteriorate as obesity rates soar.

Nussbaum concluded his remarks with staggering metrics on the U.S. health-care system, declaring that 5 percent of Americans account for almost 50 percent of health-care costs. Wellpoint's partnership with the X Prize Foundation is meant to find solutions to address the unsustainable state of American — and global — heath care.

The Grand Challenge for the Healthcare X PRIZE is designed "to create an optimal health paradigm that empowers and engages individuals and communities in a way that dramatically improves health value." The guidelines challenge participants to improve health value by more than 50 percent in a 10,000-person community during a three-year trial. In order to effectively compete for this prize, teams will need to fundamentally change health financing and care delivery, while creating new incentives and better outcomes for both individuals and the community.

  2:30 PM - 3:45 PM

Global Health: New Business Models

Larry Brilliant , President, Skoll Urgent Threats Fund; Philanthropic Advisor to Jeff Skoll and Google
Janice Culpepper , Senior Program Officer, Infectious Disease Development, Global Health, Bill & Melinda Gates Foundation
Myrtle Potter , President and CEO, Myrtle Potter & Company LLC
Kari Stoever , Managing Director, Global Network for Neglected Tropical Diseases, Albert B. Sabin Vaccine Institute

Seth Berkley , President and CEO, International AIDS Vaccine Initiative

"There are enough dying kids for all of us," declared Myrtle Potter by way of opening. The rest of the panel agreed that there is no dearth of global health problems — from blindness to neglected tropical diseases to AIDS — but the solutions are often hampered by significant market failures.

Kari Stoever observed that in many cases, such as with neglected tropical diseases, easy fixes exist, but delivery is the big problem. Health philanthropies know where the need is and pharmaceutical companies have donated the medicine, yet they cannot actually deliver the medicine to the communities that need it.

Stoever suggested that one of the reasons for this failure is the need for a regional financing structure that allows communities and regional governments to focus their resources on the particular set of diseases most relevant to the area. Janice Culpepper noted that the Gates Foundation uses grants to encourage pharmaceutical companies to enter into product development that they wouldn't normally touch, such as developing new mosquito pesticides, which do not have a compelling market driver. Culpepper added that this works in part because of public opinion, with pharmaceutical companies desiring to be seen as good global citizens.

Larry Brilliant added that another very specific method of funding global health in underserved markets is to have the rich subsidize care for the poor. According to the Seva model, wealthier clients needing eye care pay for a private room, subsidizing the poor, who cannot otherwise afford care. Seva found that one paying customer subsidizes three unpaid ones (getting the same quality care). Via this model, one of their centers in Nepal has seen enormous revenue surpluses despite treating 80 percent of their patients for free. Alternately, in Bangladesh, Seva convinced Muhammad Yunus to give microloans to individuals needing eye surgery, requiring the loans to be repaid when the person can work again.

In all of this, panelists emphasized the need to listen to communities and practitioners regarding local needs. Stoever also put emphasis on the need for greater efficiency in health spending. She recommended rewarding efficiency, for instance, by having a carry-over, rather than a "use it or lose it" system.

Creative solutions like this are required to address the issues of health funding generally. Much of the financing for diseases is forced into silos such that, even though schistosomiasis appears to be strongly correlated with the higher prevalence of AIDS in young women in Mozambique, practitioners in that country cannot use to $700 million in AIDS treatment funding to help address schistosomiasis.

Culpepper stated that one way around this would be to get people not traditionally from the health field to weigh in on health issues to get new information and new thought into the system. She suggested that agencies are underutilizing human capital because they think only researchers in America and Europe can solve these problems.

Panelists concluded that global health agencies should be looking to everyone they can for answers, even if they are outside the methods traditionally embraced by the public health community, and look for a new way to work in the poorest parts of the world. Potter agreed: "This is where all of us as leaders have to step up and challenge the companies with which we have affiliations."

  4:00 PM - 5:15 PM

Alternative Medicine Joins the Mainstream

Deepak Chopra , Co-Founder and President, Alliance for a New Humanity
William Nelson , Marion I. Knott Director and Professor of Oncology, Johns Hopkins School of Medicine; Director, Sidney Kimmel Comprehensive Cancer Center
Dean Ornish , Founder and President, Preventive Medicine Research Institute; Clinical Professor of Medicine, University of California, San Francisco

Michael Milken , Chairman, Milken Institute

The way we view the human body is all wrong. It's the reason why we get sick in the first place, and why health care has so much trouble healing us properly. Panelists discussed the concept that Western medicine treats symptoms rather than causes and does not adequately embrace the notion that a healthy body can heal itself — sometimes even more effectively than surgery or drugs.

That healing process, panelists insisted, requires a lifestyle that promotes the health of the mind and the body. Better health for the wider population will require a shift in the paradigm of thinking by individuals, their health-care providers and the broader health-care system.

What's wrong with the way that we think about health starts with the individual. There is too much credit given to the role of genetics, said Dean Ornish of the Preventive Medicine Research Institute. "Our genes are not our fate," he said. Research about the impact of behavior on health outcomes overwhelmingly supports the notion that lifestyle is more important than genetics. Heart disease could be prevented in 95 percent of cases through better living, Ornish maintained. He presented evidence showing that gene signals that turn on cancer can, in fact, be turned off by healthy living. On the flip side, Bill Nelson of Johns Hopkins noted that the deleterious effects of maternal malnutrition during pregnancy can be passed down to a woman's child and even grandchild in the form of adult-onset diabetes.

People undervalue the importance of mental and spiritual connections to the functioning of the physical body. Stress and fear shorten longevity, said Deepak Chopra, which implies that negative approaches to induce behavioral change — such as restrictive dieting or scare tactics — are counterproductive to health. Careful reflection and awareness about our dietary choices will not only increase enjoyment of food, but also motivate individuals to eat better and eliminate unhealthy behaviors. Chopra shared the story that his success with quitting smoking came from focusing on his desire for the cigarette, rather than mindlessly consuming it.

The panelists agreed that health-care providers are actually part of the problem. They are trained as technicians to look at the body as a machine, and to treat disease rather than to promote health.

Today, however, medicine is undergoing a revolution, said Nelson. Where it was once reactive, it is increasingly proactive, and will evolve with a greater preventive emphasis in the future. Providers who do not believe that patients will change their lifestyles fail to understand how to approach the process in a positive and health-promoting way. We must reframe the reasons for healthy living, said Ornish. It's not about fear of dying and risk-factor reduction but the joy of living.

But health-care reimbursement policies must follow suit. Ornish has been successful in getting Medicare to cover lifestyle changes that may be even more effective than expensive, invasive and risky cardiovascular procedures. "It's not really evidence-driven medicine. It's reimbursement-driven medicine," Ornish said. "If we change reimbursement, we can change medical practice and medical education."

  4:00 PM - 5:15 PM

Global Aid Workers: Heroes on the Front Lines

Nancy Aossey , President and CEO, International Medical Corps
Larry Brilliant , President, Skoll Urgent Threats Fund; Philanthropic Advisor to Jeff Skoll and Google
Caryl Stern , President, U.S. Fund for UNICEF
Thomas Tighe , President and CEO, Direct Relief International

Cinny Kennard , Senior Fellow, USC Annenberg School for Communication's Center on Communication Leadership and Policy

The climate for global aid workers has changed dramatically in the past few years. Once untouchable, many now fall victim to targeted attacks in volatile regions around the world. In 2008, more than 100 aid workers were killed — and that number rises above 200 when taking kidnappings and other violent attacks into account, according to Nancy Aossey of International Medical Corps.

"We used to be able to go out with a big red cross on our jeep or a U.N. sign on our car and it was a cone of immunity. That has changed," recounted Larry Brilliant of the Skoll Urgent Threats Fund and Google. According to the panel, this dramatic shift from aid workers being immune to becoming targets is due in large part to deeply held misconceptions about intentions of aid workers. "Part of the problem we face with violence toward aid workers is misconceptions about the role of foreigners," Brilliant observed.

Caryl Stern of the U.S. Fund for UNICEF agreed, noting some of the practical reasons aid workers face increased violence. "Attackers know aid organizations have good jeeps, so they steal ours. They also know that whatever violence they cause, they get a chance to get their message to the press," she remarked. These security concerns not only create a sense of danger in some regions, but have significantly increased the cost of delivering supplies.

Despite the growing safety concerns, aid organizations are still operating thanks to a committed and courageous group of individuals who feel a calling to humanitarian work despite the personal risks. Aossey stated, "Most of our volunteers do it in large part because they really want to help the communities, and because doing the work provides a lot of meaning and impact in their lives." The panel agreed that these individuals doing incredible work in tough regions are the true unsung heroes. The best way to prepare these workers and support them in the field is with appropriate training.

The panelists also discussed the down economy and its effect on the work of NGOs and aid workers. According to Brilliant, many organizations are already suffering because some foundations just don′t exist anymore. Stern noted the effect that the economy was having on the U.S. Fund for UNICEF, sharing that some big donors have disappeared, but individuals and families that give small donations remain consistent in their giving. She shared, "The people that give us small, consistent donations tell us they have decisions they can make with their money, but the children UNICEF serves never had a choice to begin with." This continued support helps make it possible for NGOs and global aid workers to address some of the world′s most challenging problems.

Wednesday, April 29, 2009

  9:30 AM - 10:45 AM

Health-Care Reform: Once More Into the Breach

Marian Mulkey , Senior Program Officer, California Healthcare Foundation
Samuel Nussbaum , Executive Vice President, Clinical Health Policy, and Chief Medical Officer, WellPoint Inc.
Chris Singer , Executive Vice President and President International of the Pharmaceutical Research and Manufacturers of America
Kenneth Thorpe , Executive Director, Partnership to Fight Chronic Disease; Robert W. Woodruff Professor and Chair of the Department of Health Policy & Management, Rollins School of Public Health, Emory University

Margaret Anderson , Chief Operating Officer, FasterCures / The Center for Accelerating Medical Solutions

Panelists from across the health-care industry favor universal access to care for all Americans, and decreasing costs will be big part of the equation.

The experts discussed the current and future impact of universal coverage and decreasing health-care costs by changing the delivery and prevention systems for chronic care. All panelists — representing insurance companies, advocacy groups and academics — supported universal coverage for the currently 46 million uninsured Americans.

Kenneth Thorpe of the Partnership to Fight Chronic Disease said the average cost of coverage for a family is about $12,000. The fundamental challenge of requiring everyone to have health insurance is affordability, he said. The estimated cost of covering the uninsured for the next 10 years is $1.5 trillion to $1.8 trillion.

Private insurance companies generally are not in favor of a public plan for the uninsured. Samuel Nussbaum of Wellpoint Inc. said such a plan likely would be based on current Medicare reimbursement rates, which are 20 percent less than those of private insurance. Today, the cost of Medicare's underpayments is passed on through private insurance.

Nussbaum, who leads one of the largest insurance companies at more than 35 million members, said 5 percent of Wellpoint′s members are responsible for 55 percent of reimbursement costs, so addressing those high-risk members is key to lowering costs. Nussbaum said the focus should be on prevention and wellness, better management of chronic care and promoting evidence-based medicine.

Wellpoint has achieved cost reductions by actively engaging consumers at home and working to prevent chronic illnesses, Nussbaum said. This includes encouraging inexpensive or free access to preventive measures such as blood pressure drugs and glucose testing for diabetes.

Commenting on high readmission rates of Medicare patients and the inefficiencies of the health-care system, Nussbaum said, "(Currently) someone′s inefficiencies are someone else's revenues." Addressing those issues requires aligning payments with outcome and changing the incentives of the health-care system, he said.

Chris Singer of the Pharmaceutical Research and Manufacturers of America said employers — large ones especially — should get behind the effort to reduce chronic diseases, which account for the bulk of health-care costs. The indirect costs of chronic illnesses to employers dwarf the direct costs to the health-care system, Singer said. These savings flow directly to the bottom line of the company, which benefits from increased worker productivity.

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