Community Leadership Health Care Forum Report

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    T H U R S D AY , A U G U S T 2 8 , 2 0 1 4 | 9 : 0 0 A M - 3 : 3 0 P M Elg in Communi ty Col lege : Se ig le Audi to r ium Bui ld ing E

    Community LeadershipHealth Care Forum Report

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    C ONGRESSMAN R ANDY H ULTGREN (IL-14)

    1 | Community Leadership Health Care Forum

    T ABLE OF C ONTENTS

    EXECUTIVE SUMMARY ..................................................................................... 3

    First Panel: The Affordable Care Act (ACA) & the Consumer: 2015 and

    Beyond ........................................................................................................... 5

    Second Panel: Health Care Innovations: Technology in Medicine ............. 5

    Third Panel: Health Care Innovations: Access to Health Care .................... 6

    I. REDUCING HEALTH CARE COSTS AND IMPROVING QUALITY ....... 8

    Our health care system must operate more like a free market. ....................... 8

    II. EXPANDING ACCESS TO HEALTH CARE ..............................................10

    Small employer health insurance faces significant challenges. ....................10

    Policymakers must take active steps to maintain consumer access to a wide

    range of health care options, especially as the program transitions from a

    fee-for-service model to a value for service model. ......................................10

    Retail-based health care can meet the health care needs of the

    underprivileged. .............................................................................................11

    Policymakers must study how health insurance co-ops have impacted the

    health insurance market. ................................................................................12

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    III. ENCOURAGING HEALTH CARE INNOVATION ..................................13

    Health care technology, both biotechnology and health care IT, is becoming

    an increasingly important part of our health care system. .............................13

    Startup companies need help to survive the valley of death. .....................14

    We must encourage the development of new health care ideas through our

    research and education system. .....................................................................15

    Policymakers must improve the FDA approval process. ..............................16

    MATERIALS DISTRIBUTED AT FORUM ......................................................17

    10 Key Policy Issues Facing Health Care .....................................................18

    FORUM PROGRAMS & PARTICIPANT BIOGRAPHIES ...........................24

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    C ONGRESSMAN R ANDY H ULTGREN (IL-14)

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    E XECUTIVE SUMMARY Our healthcare system in America has two faces: it provides state-of-the-art care, but is oftencomplex and frustrating. In fact, our system is so frustrating and unpredictable that Americansrepeatedly put their own and their family's health care near the top of their list of what mostconcerns them. Americans are simply not fully in control of their healthcare decisions toomuch of it is decided by insurers and the federal government.

    Last year, I was confused with no one to turn to for clarity when I had to do what millions ofAmericans have done: choose a family insurance plan under the Affordable Care Act. It was asdifficult to sign up as my constituents had told me. Like many Americans, I never trusted myfinal decision because I had limited information and I had a hard time learning if I was actuallyenrolled. I had to relearn the differences between deductibles, copayments and coinsurance onmy own. I had to gamble with making a plan choice based on my family's current healthsituation, not on what could happen with their health in the following year. There should be a big"buyer beware" sign required for consumers having to make serious choices based on thoseterms.

    Americans have every right to feel frustrated with the Affordable Care Act today its far fromwhat they were promised. Consumers cant plan or predict whats up ahead for the ACA andadministrators and providers grapple with implementing it. Americans are increasingly worriedabout rising health insurance costs, less coverage, lower quality of care, and their jobs beingturned into part-time employees. They worry their employers will no longer provide health careinsurance coverage and that they will fall into the gap where they aren't eligible for ACA taxsubsidies and can't afford to buy health insurance. They search for long-term economic security

    but find unsustainable costs. Possibly most of all, Americans are concerned they will lose thehealth insurance coverage they have now altogether.

    These problems and more are why I organized this forum.

    Like my previous Community Leadership Forums on Illinois' curriculum standards and heroinand painkiller abuse and prevention, I convened this event to bring stakeholders together to shareinformation and work together to tackle Illinois health care challenges.

    We heard from a broad spectrum of health care participants, including doctors, professors,hospitals and other health providers, health insurance companies, health technology companies,local government health officials, health trade associations, and those who represent and servethe elderly. They discussed what works, and helped spot problems and devise strategies toimprove health care delivery in Illinois.

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    This report is just the beginning of a collaborative engagement and requires input and revisionfrom the participants, as well as the community as a whole. However, I trust you will find thisreport offers valuable insight on the issues confronting our healthcare system today. Itsummarizes the main takeaways from the forum, including potential improvements to ourhealthcare system.

    Thank you,

    Randy HultgrenMember of Congress

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    How can consumers adapt to these changing health care technologies? (3) What are the best policy, economic, and industry conditions for improving research and development in the healthcare technology area?

    Our moderator was Brian Lemon, President of Central DuPage Hospital and Executive VicePresident of Cadence Health. Our panelists included (1) Jeff Coney, Director of EconomicDevelopment at Northwestern University, (2) David Miller, CEO and President at IllinoisBiotechnology Industry Organization, (3) Dr. Harry Rowland, CEO at Endotronix, and (4) DanYunker, CEO at Land of Lincoln Health.

    Recent events, such as the Ebola outbreak, have put this topic on the front burner. Is the drugapproval process working? Can consumers obtain potentially life-saving treatments on time?What about repealing the medical device tax, which hurts innovation in medical technology? Or,should we improve other policies that impact the speedy delivery of innovative technologies to

    the consumer marketplace? Medical innovations are vital to strengthening treatments andreducing costs in the health care system.

    Congress can and should act to promote medical innovation. For example, H.R. 3116, theMODDERN Cures Act, speeds up the development of innovative treatments for patients withchronic diseases and disabilities. Consumers need access to drugs that address conditions withfew or no medical options for treatment. More must be done to help consumers access vital drugsand technologies, and quickly and safely get the drugs to market. Our second panel explored thisfurther.

    T HIRD P ANEL : H EALTH C ARE I NNOVATIONS : ACCESS TO H EALTHC ARE

    The third panel focused on recent developments in consumer access to health care. Majorquestions discussed during the panel asked: What services are transforming and have the

    potential to transform consumers access to health care? How can consumers best utilize thesechanging means of access to care? What are the best policy, economic, and industry conditionsfor improving this access?

    Our moderator was Dr. Vikram Patel, President and Medical Director at ACMI Pain Care and

    Board Member at McHenry County Medical Society. Our panelists featured were (1) Dr. OpellaErnest, Vice President and Chief Medical Officer at Blue Cross and Blue Shield of Illinois, (2)Mike Randall, Vice President of Clinical Innovation at Advocate Health Care, (3) DeniseScarpelli, Market Pharmacy Director Chicago at Walgreens, and (4) the Hon. A.J. Wilhelmi,Chief Government Relations Officer at Illinois Hospital Association.

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    Our struggling economy has made it difficult for Americans to access health care. Health careneeds often take a back seat to putting food on the table and paying rent. We should gain a betterunderstanding of retail health care like that provided by Walmart and urgent care facilities. Canthey effectively fill the gap for those without primary physicians?

    Improving access means managing costs, and we should applaud such efforts to do so. Forexample, Affordable Care Organizations (ACOs), under which health providers contract tooversee a patients total course of care, can play a key role in improving health outcomes.Twenty million Americans are currently covered by ACOs. Illinois is in the midst of theadoption of a statewide program to assign all Medicaid enrollees to an ACO provider. Withdoctors overseeing billions of dollars in health spending under these arrangements, we shouldexplore transparency procedures, while allowing for innovation and consumer choice.

    What follows are the best insights from these three panels, along with the keynote address from

    Scott Becker, Partner at McGuire Woods in Chicago, IL, who spoke on the 10 Key Trends inHealth Care Reform he sees industry -wide.

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    I. REDUCING HEALTH CARE COSTS AND IMPROVING QUALITY

    O UR HEALTH CARE SYSTEM MUST OPERATE MORE LIKE A FREEMARKET .

    Panelists throughout the day noted that the health care system often operates counter to the freemarket.

    Instead of relying upon the market to lower health care costs, the ACA largely trusts in federal programs and government bureaucrats. Mr. Craig Rodrigue, an Independent Insurance Advisorrepresenting the Association of Mature American Citizens, believed that federal regulations will

    never truly succeed at driving down health care costs. After all, relying upon central planning tocut health care costs is difficult and costly. For example, as Mr. Steven Tucker, the Founder ofHealthInsuranceMentors.com and Small Business Insurance Services Inc., argued, the medicalloss ratio has driven insurance companies out of business, and forced other companies to canceltheir insurance plans. This is because it tries to lower health care costs by arbitrarily preventingadministrative costs from exceeding an arbitrary threshold 20 percent for most insurancecompanies. This either requires companies to meet a standard that they already meet, or forcesthem to lower costs past what they can sustain.

    While federal regulations and mandates will not drive down costs, the market can. As Mr.

    Rodrigue explained, costs decrease while quality increases in the elective surgery market. Thisoccurs because consumers must pay directly for elective surgery, instead of depending uponinsurance. Thus, they pay attention to health care costs, negotiate with their doctors, and forcetheir doctors to justify their claims. Numerous panelists throughout the day noted thiscorrelation.

    Mr. Tucker floated two broad solutions that could help the health care system function more likea market.

    First is Avik Roys Universal Exchange Plan, which gradually moves health care consumersonto an improved version of Obamacares health care exchanges. This repeals the individualmandate and the employer mandate, and deregulates the federal health care exchanges.

    Second is Rep. Paul Ryan and Senato r Ron Wydens bipartisan Medicare plan, which maintainsMedicares current structure, and gives recipients an option of a government-provided voucher touse toward private plans that offer a baseline level of benefits. As companies compete with each

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    other to offer the best plan, costs are reduced and consumers can choose Medicare if they do notlike their private plan.

    Mr. Tucker encouraged policymakers to explore Indianas successful Healthy Indiana Program,

    including their health care savings accounts. Health care savings accounts mimic the free market by making consumers pay attention to price, because costly services deplete their savingsaccount.

    Mr. Tucker also bemoaned that the ACAs rules and regulations created extensive healthinsurance cancellations, a violation of a promise made by President Obama. Mr. Tucker believedthat buying insurance across state lines could address that problem. Mr. Rodrigue was skepticalof this, because it undermines federalism. State health care insurance regulations reflect whatstates believe are best for their residents.

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    II. EXPANDING ACCESS TO HEALTH CARE

    S MALL EMPLOYER HEALTH INSURANCE FACES SIGNIFICANTCHALLENGES .

    Mr. Tucker, Mr. Rodrigue, and Mr. Todd Page, the Senior Vice President of Sales and Marketingat AHIX.com, a division of JLBG Health, recognized that the ACA poses significant challengesto small group insurance, the means by which small employers often provide health insurance fortheir employees. Mr. Rodrigue, in particular, believed that in ten years, small group insurancecoverage will not exist.

    As Mr. Tucker argued, the ACA encourages some employers to cancel their health insurance plans so that their employees can buy their own plans, such as on the health insurance exchanges.

    Mr. Rodrigue elaborated that companies historically offered health insurance because it wascompassionate and was an incentive for employees to fully invest themselves in the culture of acompany. Now, many companies find it more compassionate to terminate their health care

    benefits. They find that it is a greater economic benefit to the company for the employees to seeksubsidies under the ACA. For example, under current law, employer provided health care can

    preclude eligibility for other health care subsidies. Mr. Page agreed that companies are often better off canceling their small group insurance plans than continuing to provide health insurancefor their employees.

    Mr. Jason Montrie, the Executive Vice President at Land of Lincoln Health, also expressed

    concern that some small businesses will soon be unable to offer health insurance. Insurancecompanies should address this problem by giving small business representatives a voice in theoperation of their company, as some insurance companies do.

    P OLI CYM AKERS M UST TAKE ACTI VE STEPS TO MA I NTAI N CONSUM ERACCESS TO A WID E RANGE OF H EAL TH CARE OPTI ONS , ESPECIA L L Y ASTH E PROGRAM TRANSI TI ONS FROM A FEE - F OR - SERVI CE TO A VALU E - F OR - SERVI CE MODEL .

    Mr. Page said that the biggest health care challenge for 2015 is ensuring that consumers especially those that use a preferred provider organization have access to a sufficient numberof doctors and hospitals. The ACA has made the problem of consumer choice especiallyrelevant, because consumers cannot change their coverage until the next open enrollment perioda year later. Many upcoming health care exchange insurance plans restrict consumer choice byoffering access to few providers.

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    This choice problem is especially relevant in Illinois because, as many panelist s brought up,Illinois health insurance exchange was marked by little competition. While there were only 6insurance carriers on Illinois exchange last year, there will be 10 this year. Mr. Montrie believedthat the health insurance companies, especially those without the dominant market share, have asignificant responsibility to increase competition by offering a superior product.

    Our health care systems transition from fee -for- service, which compensates doctors for theirindividual transactions, to ward value -based care," a compensation model that takes into accountthe value a doctor provides for their patient, could also impact consumer choice.

    This change could be transformative for the health care industry. Mr. Brian Lemon, the Presidentof Central DuPage Hospital and Executive Vice President of Cadence Health, held that oursystem will eventually transition to a system where providers are motivated and rewarded forkeeping people at home and healthy, instead of our current fee-for-service model.

    Blue Cross Blue Shield of Illinois (BCBS - IL) is transitioning toward value-based care, as Dr.Opella Ernest, their Chief Medical Officer and Vice President explained. Dr. Ernest argued thatthis reflects BCBS - ILs mission to provide consumers quality and cost-effective health care.BCBS recognizes that the best health care is by a physician and argues that coordinated,

    physician directed care such as with an HMO receives consistently high marks from patients.

    Mr. Rodrigue worries that the value-for-service model transforms the health care system from acooperative model where the doctors and patients collaborate, to a hostile one where the doctordecides a patients coverage for them. The ACA has especially encouraged this model .

    R ETAIL - BASED H EALTH CARE CAN MEET TH E H EALTH CARE NEEDSOF THE UNDERPRIVI LEGED .

    Ms. Denise Scarpelli, the Market Pharmacy Director Chicago at Walgreens, explained howWalgreens is expanding access to health care in Illinois. Walgreens has 600 stores in Illinois,and 56 in Chicago. Walgreens takes a preventative care mindset to their stores and providesaccess to acute care when no other care is available. And, in last year alone Walgreens provided435,000 flu shots to customers, and donated 40,000 shots to people who could not afford it.

    This access innovation can be a great service to the underprivileged, but it must be usedresponsibly to complement (not replace) the efforts of doctors and hospitals.

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    P OLI CYM AKERS M UST STUD Y H OW HEAL TH I NSURANCE CO - OPS H AVEI M PACTED THE H EALTH I NSURANCE MARKET .

    The 2010 Affordable Care Act provided $3 billion of seed funding for states to create healthinsurance co-ops, which are member-driven non- profit insurance companies. Illinois co -op isLand of Lincoln Health. Mr. Montrie represented the co- ops perspective. He was optimistic thatthe co-op model would be competitive with other insurance provider because in other states, theyhave successfully captured a significant portion of the marketplace.

    However, it was stated that there has been evidence in other states that the co-op model isunsustainable. It was advised that Congressional policymakers should continue to examineresults from the health insurance co-ops.

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    III. ENCOURAGING HEALTH CARE INNOVATION

    H EALTH CARE TECHNOLOGY IS BECOMING AN INCREASINGLYI M PORTANT PART OF OUR H EAL TH CARE SYSTEM .

    Health care technology, including biotechnology and information technology (IT), isdramatically transforming how our health care system diagnoses and treats diseases, and caresfor patients.

    Mr. David Miller, CEO and President of Illinois Biotechnology Industry Organization persuasively championed biotechnology during his panel appearance. He held that the biotechfield will continue to produce cures for previously incurable diseases. He also agreed with thelate Steve Jobs that within the next 100 years, biotechnology will permeate all of society. Mr.

    Millers organization, iBio, exists to keep Chicago at the center of this burgeoning field. Oureconomy is at stake: every new biotechnology job produces 2.8 to 5.6 other jobs.

    Dramatic improvements in health care IT can greatly improve and are already improving thedelivery of health care throughout the state.

    Mr. Dan Yunker, Senior Vice President of the Metropolitan Chicago Health Care Council,elaborated on how health IT improvements have already transformed many aspects of the healthcare system.

    While the banking and financial system is generally a connected eco-system, the health caresystem has traditionally been far from it. We live in the 21st Century, but our health care systemis stuck in the 20th Century. Mr. Yunker held that the Health Information Exchange (HIE),www.healthit.gov, will push the health care system toward this century. This initiative, accordingto the governme nts website, makes it possible for health care providers to better manage

    patient care through secure use and sharing of health information. Health IT includes the use ofelectronic health records (EHRs) instead of paper medical records to maintain people's healthinformation. Mr. Yunker said that these efforts will improve, and already have improved,quality care, patient safety and care coordination. They have reduced medication errors andduplication and avoided duplicate testing and unnecessary hospital admissions. MCHC operates

    the Chicago HIE.While this expansion of health care IT relies upon big data, Chicagos HIE is taking significantsteps to secure the health care data and limit its application to appropriate uses. They are alsodeveloping ways to help different electronic medical health record systems maintaincompatibility with each other. Efforts are being made to also make the states interconnected.

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    Panelists all agreed that health technology is transforming how patients access health care.

    The first example of this is telemedicine, which allows patients to visit their doctor online. Dr.Harry Rowland, the CEO at Endotronix, argued that telemedicine would be especially helpful for

    rural patients, because they may not have the time or resources to travel a long distance to visit ahospital. Mike Randall, the Vice President of Clinical Innovation at Advocate Health Care,explained that Kaiser Permanente is a leader in virtual health care visits, as it had around 10million virtual visits last year, including by using secure email messaging. Mr. Randall believedthat virtual visits will eclipse health care visits within the next 10-15 years. The Hon. A.J.Wilhelmi, the Chief Government Relations Officer at Illinois Hospital Association, agreed thattelemedicine has the potential to transform health care access in rural and underserved areas.

    Dr. Rowland held that transitioning from a fee-for-serve model, where hospitals are reimbursedon a transaction basis, to a value-based model, where hospitals are reimbursed for the overall

    service they provide to their customer, will help make the telemedicine model more sustainable.

    For example Pager, a mobile application developed by an Uber creator, allows users to visiton-call physicians, either remotely or in person, and receive services such as a prescription. Thisservice was launched in Chicago this August.

    A significant barrier to the increased utilization of mobile health care technologies is developinga fair and accurate compensation model for services such as virtual visits, which still accuratelyaccounts for its value.

    These technological changes can be driven by government policy, but Mr. Lemon held thatgovernment cannot drive all of these improvements; health care stakeholders must take asignificant lead in driving innovations.

    S TARTUP COMPANIES NEED HELP TO SURVIVE THE VALLEY OFDEATH .

    Startup companies, a backbone of our economy and job creation, can transform the best ideas inhealth care from a concept, to a concrete product. Unfortunately, challenges facing startupcompanies often make even the best ideas fail, as Mr. Jeff Coney, the Director of EconomicDevelopment at Northwestern University, explained.

    The biggest challenge is the valley of death: the time between a drugs invention and when it becomes profitable. Before a drug reaches profitability, companies must patent their idea,transform it into a tangible product, study its safety and efficacy, work toward final FDAapproval, and develop a successful marketing plan. Each task requires access to capital that isdifficult for startup companies to access. Without this, the best ideas may never see the light of

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    day, and consumers will lack access to drugs and medical technologies that could radicallytransform their life.

    Dr. Rowland and Mr. Miller singled out governme nt policies that impact this valley.

    Federal, state, and local policymakers must be aware of the broad impact that their economic policies have upon these startup companies, including the rate, distribution, and efficiency of ourtax system, and the impact of government spending on an economy. For Mr. Miller, one exampleof a poor economic policy is the 2.3 percent sales tax on medical devices, costing our economyanywhere from 30,000 to 40,000 jobs.

    Dr. Rowland also supported institutional research, development incubators and supportincubators, such as iBios program, Propel. As Mr. Miller explained, Propel provides early stagelife science companies with coaching, professional services, educational programs and

    networking, mentors, and other grants and awards. They also provide these companies withtechnical assistance for applying for various federal grants.

    Angel investments can also help startup companies. Dr. Rowland pointed out that Illinois had anAngel Investment program, which helps place investment dollars and up to $10 million annualworking capital into newly formed, innovative companies in Illinois. The program providesangel investors with a tax credit worth 25 percent of their overall investment. Mr. Millersupported a federal angel tax credit as well.

    Finally, Mr. Coney believed that H.R. 2981, the TRANSFER Act, would help the companiessurvive the valley of death, by helping the best ideas move from the laboratory or researchfacility to the marketplace.

    W E M UST ENCOURAGE TH E DEVELOPM ENT OF NEW H EALTH CAREI DEAS THROUGH OUR RESEARCH AND EDUCATI ON SYSTEM .

    The foundation of health care innovation comes from the development of new ideas. Our panelists discussed extensively how to design an education system to encourage these new ideas.

    First, Mr. Miller argued that health care innovation in our country depends upon ensuring thatAmerica has the best scientific research facilities and education system in the world. Researchcan be a primary leverage point for improving Americas economic edge . Unfortunately, ourcountry has fallen behind the rest of the world in math and science. Mr. Miller supportedexpanding federal funding for scientific research, and improving how our system handles mathand science at every stage of a students education.

    Second, Mr. Coney supported S. 2658, the Accelerate Biomedical Research Act, which reversessequestration for the National Institute of Health and allows Congress to increase funding for the

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    agency. He believed this would help the NIH discover treatments, cures, and lead the country inmedical innovation.

    Third, Mr. Coney supported S. 2115, the American Cures Act, which would establish a

    Biomedical Research Fund and steadily increase funding for biomedical research.

    Fourth, Mr. Coney supported preserving the Bayh-Dole Act. This act first allowed university,small-business, and non-profit inventors to keep their intellectual property even if they inventedthe product while using federal research dollars. Previously they had to assign the relatedintellectual property to the federal government. Mr. Coney held this incentivizes thedevelopment of innovative health care products, because inventors may personally profit fromtheir creations.

    Finally, Mr. Miller believed that policymakers must be aware of abuses of the 340B Public

    Health Service Act, which allows health care organizations that care for the underserved to purchase discounted outpatient drugs. Companies that abuse their program privileges drive down profits for producers of outpatient drugs, which discourages the development of new, innovativedrugs because drug companies may not be able to cover their costs.

    P OLI CYM AKERS M UST I M PROVE THE F DA APPROVAL PROCESS .

    The FDAs drug and medical device approval process is a significant hindrance to health careinnovations.

    As Dr. Rowland argued, medical devices often take a long time to move onto the market becausethe FDAs regulatory approval process is too unwieldy. As a result, the United States health caresystem relies on much older technology than should be expected in our country. The same is trueof our drug approval process.

    This relative dysfunction stands in stark contrast to the European medical product approval process. Many companies in Europe are on the market three to five years earlier than in theUnited States because drug companies need only demonstrate their drugs effectiveness beforegoing onto the market. Companies answer questions about the produ cts effectiveness while the

    product is on the market.

    Panelists mentioned two main policies that can improve the FDA. First, Mr. Miller persuasivelyargued that the FDA, which has a domain that encompasses 25 percent of American GDP, must

    be adequately funded.

    Second, Dr. Rowland persuasively argued that the FDA must explore ways to improve its stagesof product approval, and consider whether it should let certain drugs go to market before theireffectiveness has been conclusively proven.

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    M ATERIALS D ISTRIBUTED AT F ORUM

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    10 K EY P OLICY I SSUES F ACING H EALTH C ARE

    By Scott Becker, JD, CPA, Lindsey Dunn and Molly Gamble

    The last few years have been nothing short of fascinating to watch in terms of health care policy change and implementation. The passing and now (somewhat troubled) passage of thePatient Protection and Affordable Care Act is the most significant, but certainly not the only,

    policy issue to gain national attention, from the industry and public at large. Following is a listof, in our view, 10 of the top key policy issues facing the industry as well as some of the issuessurrounding each.

    1. Is the Impact of the PPACA Worth the Cost? A July 2014 study from theCommonwealth Fund found 20 million people now have health insurance due to the PPACA.

    Approximately 8 million people signed up for health care through federal or state health careexchanges between October 2013 and April 2014. Of these, 57 percent, or approximately 4million to 5 million individuals, were previously uninsured (with the others previously havingindividual coverage). Another 12 million people gained coverage through other PPACA

    provisions, such as Medicaid expansion (in 27 states, including Washington, D.C.), allowancefor young adults to remain on their parents' health insurance until age 26 and bans on healthinsurers' denial of coverage because of age or preexisting conditions, according to The Hill. (See"Study: 20M have insurance under O-Care," The Hill, July 2014)

    In contrast, the PPACA created literally billions of dollars in new taxes. These include a

    Medicare tax increase of .9 percent for individuals earning over $200,000 or married couplesearning $250,000; a net investment income tax of 3.8 percent tax on individuals, estates, andtrusts worth more $200,000 or $250,000 for joint filers; and an increase in the threshold foritemized deductions for medical expenses from 7.5 percent to 10 percent of gross income, not tomention the additional costs to providers and health care companies to comply with the law. (See"Full List of Obama Tax Hikes" at atr.org)

    In 2012, the Congressional Budget Office and Joint Committee on Taxation estimatedthat the insurance coverage provisions of the PPACA will have a net cost of just under $1.1trillion over the 2012-2021 period. A great question remains: Is the cost worth the gain?

    It will be interesting to see when or whether the societal benefits of having 20 millionnewly insured outweigh the billions spent for improvements in societal health care costs overtime. Will the law's unintended consequences lessen its ROI? Will the approximate $1.1 trillioncurtail health care spending in the United States? National health care spending grew at anannual rate of 4 percent during the first 11 months of 2013, just above the revised all-time low

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    rate of 3.6 percent for 2011, according to the Altarum Institute's Center for Sustainable HealthSpending and CMS. However, health care spending growth slowdown occurred in otherindustrialized countries as well, suggesting it is not solely attributable to the PPACA. The WhiteHouse has said it anticipates an uptick in health care spending as newly insured utilize health

    care services, but it will be interesting to see whether or how long that persists, and if health carecosts will start trending down for good.

    2. Should Federal or State Governments Control Health care Policy? A greatquestion exists as to whether states should be able to be laboratories of democracy, or whetherthe federal government should develop top-down solutions for health care. Seventeen states(including Washington, D.C.) decided to build their own Obamacare exchanges, while the rest ofstates chose a partnership model with the government or the federally-facilitated marketplace. Ofthose 16 governed states, 12 are led by governors who are Democrats, while the remaining areled by Republicans and one Independent governor (Rhode Island).

    Generally, state-based exchanges enrolled a higher percent of the eligible population thanstates using the federal marketplace, Health care.gov. But just as there were problems withHealth care.gov, some states experienced setbacks of their own. In April, after undergoingmonths of technical problems and putting applications on hold due to processing difficulties,Oregon decided to shut down its troubled Cover Oregon marketplace and transition to the federalmarketplace. In May, Nevada did the same, scrapping its state exchange to join the federalmarketplace for at least one year. Massachusetts is still trying to save its exchange, but alsolaying the groundwork to join Health care.gov. Some states have seen success, however.

    Connecticut's exchange portal has performed remarkably well - so well that Maryland wants to buy it and use it as a model for its own. Kentucky also hit its stride: more than 413,000Kentuckians (or one in 10) signed up for coverage through the state's kynect system.

    A Politico report last month suggested the federal exchange option - which was supposedto be a temporary fallback for states - may become a longterm solution for the majority of states.This was not the intent of the health care law. " But a shift to a bigger, more permanentWashington-controlled system is instead underway - without preparation, funding or even publicdiscussion about what a national exchange covering millions of Americans means for the futureof U.S. health care," according to Politico. "It's coming about because intransigent Republicans

    shunned state exchanges, and ambitious Democrats bungled them." (See "GOP's Obamacarefears come true," Politico , June 2014)

    3. Are High-Deductible Plans and High Out-of-Pocket Costs a Necessary Evil?High-deductible health plans and out-of-pocket plans have long been a Republican tenet ofhealth care reform due to arguments around choice and free-market ideals. Interestingly,

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    Democrats, who haven't as closely supported these plans in the past, intentionally orunintentionally did so through the passing of the PPACA, which created marketplace planstructures that include high deductibles and up to 40 percent cost sharing.

    Republicans oppose the law for a number of reasons, but some have pointed out that theirrecent attack on high-deductible plans departs from the party's previously held views. Lastwinter, Ezra Klein wrote a column for the Washington Post 's Wonkblog in which he noted hisconfusion about Republicans' criticism of high-deductible plans. "What's confusing about thisline of attack is that high-deductible health care plans - more commonly known as 'health savingsaccounts' - were, before Obamacare, a core tenet of Republican health care policy thinking. Infact, one of the major criticisms of Obamacare was that it would somehow kill those plans off,"wrote Mr. Klein. In that column, Mr. Klein wondered if some of Republicans' pushback stemsfrom the health care law giving a bad name to a policy they like. (See "Obamacare exposesRepublican hypocrisy on health care," Wonkblog, December 2013)

    Some political debates around high-deductible plans and out-of-network paymentsremind one of President Bill Clinton's passage of welfare reform in 1996. There, Bill Clinton

    broadly put into place a Republication tenet much to the chagrin of some Republicans.

    4. What Policies are Generally Supported by Both Parties? Notwithstanding thegeneral concerns about health care reform, the ban on insurers' discrimination against preexistingconditions, limits on age discrimination and the elimination of lifetime caps are popular conceptsamongst constituents who are Republicans or Democrats. In a November 2013 Gallup poll, those

    who approved of the PPACA said the top reasons they support the law is because it makes healthcare accessible to more people, they find it fair that everyone have health insurance, it providesmore health insurance options and it covers people with preexisting conditions.

    5. Who should be required, if anyone, to cover contraception? In Burwell v. Hobby Lobby, the Supreme Court ruled in a 5-4 decision that a health plan offered by a private employerthat is a closely-held, for-profit corporation need not include contraception coverage. Here, itreasoned that the concept of being forced to offer contraception violates the freedom of religionof the owner of the company. Based on this ruling, a federal judge estimated that a third ofAmericans are not subject to the requirement that their employers provide coverage for

    contraceptives: Small employers are not required to offer health coverage at all, religiousemployers like churches are exempt, religiously affiliated groups may claim an exemption andsome insurance plans that had not previously offered the coverage are grandfathered in,according to the New York Times. (See "Supreme Court Rejects Contraceptives Mandate forSome Corporations," NYT, June 2013)

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    you don't set up an exchange, that means your citizens don't get their tax credits." He added, "Ihope that that's a blatant enough political reality that states will get their act together and realizethere are billions of dollars at stake here in setting up these exchanges." Mr. Gruber made similarremarks to another group, as well.

    8. Is the Explosive Increase and Expansion in the False Claims Act Warranted orOverreaching? Previously, the False Claims Act only covered true false claims. Ten years ago, itwas relatively easy to identify a bad intent or bad actor in an FCA case, many of which wereegregious and severe. Now the FCA covers any claim that derives out of a violation of the StarkLaw or Anti-Kickback Statute. This has led to a tremendous growth in health care FCA cases.

    Under the False Claims Act, plaintiffs file civil actions on the government's behalf calledqui tam suits, from a Latin phrase loosely meaning "who brings the action for the king as well ashimself." The Justice Department can join a suit it deems worthy, taking over the case. It usually

    prevails: Among cases it joined from 1987 through 2010 that had outcomes, 95 percent producedsettlements or judgments by 2010, according to a Wall Street Journal report. (See "InvokingAnti-Fraud Law, Louisiana Doctor Gets Rich," WSJ, July 2014)

    Two-thirds of the 753 qui tam suits filed in fiscal 2013 were in health care. Such suitswere behind 87 percent of the government's $12.3 billion in civil recoveries from the industryover the five years through fiscal 2013. Some of the largest settlements involved allegations thatdrugmakers overcharged or illegally promoted medicines in ways that led to improper billings togovernment programs. But some say the FCA's provisions have given rise to plaintiffs who,

    more interested in profits than fraud, often file cases with thin premises.

    9. Has Lack of Antitrust Enforcement led to too Much Hospital Power? A growing body of literature demonstrates that providers with a higher market power can negotiate higherthan competitive rates. For example, an ongoing project from Robert Wood Johnson Foundation,launched in 2006, is examining hospital consolidation and its effect on consumer prices and carequality. In 2012, the researchers found when hospitals merge in concentrated markets, healthcare costs increased sharply, often more than 20 percent. Further, those increases are passed onto consumers in the form of higher insurance premiums. (The research does not distinguish

    between for- and nonprofit hospital mergers.)

    There has also been research on vertical consolidation, as hospitals acquire physiciangroups and practices. This spring, a study published in Health Affairs found prices were mostlikely to increase when hospitals bought physician groups rather than establishing a loosercontractual relationship with practices. (See "Vertical Integration: Hospital Ownership OfPhysician Practices Is Associated With Higher Prices And Spending," Health Affairs, May 2014)

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    When the FTC does choose to challenge a merger, it has proved successful: Since 2007,the FTC has successfully challenged three hospital mergers, and a number of transactions have

    been abandoned after the FTC threatened a challenge. But the aforementioned study findings

    raise questions about whether FTC challenges are too few and far between, and whether thecommission only pursues case that are low-hanging fruit in an industry ripe with consolidation.

    10. Should Hospitals get Paid More Than Physicians and Surgery Centers forProviding the Same Services? On average, ASCs are paid about 50 percent of what hospitals are

    paid for the same procedure. Hospitals argue that this extra payment is in exchange for all theother things that hospitals do (e.g., trauma and specialized care, uncompensated care, etc.) and isnecessary for hospital financial survival. Physicians and providers assert that these subsidies areunfairly beneficial to hospitals and subsidize hospitals' ability to employ physicians and move

    business to hospitals.

    This spring, The Office of Inspector General recommended CMS seek legislation tomake it possible to reduce hospital outpatient department rates. CMS disagreed with the OIGrecommendations, which may be in part due to the financial stress already facing hospitals. Also,CMS may be more subject to politics than the OIG.

    Conclusion. Some of these 10 policy issues were to be expected in the rollout of thePPACA, whereas others - not so much. We are keeping an eye on a broad mix of issues,including how the government handles growing reliance on the federal exchanges, whether thecosts of the newly insured will reduce health care costs and spending in the long term, whetherantitrust enforcement will respond to studies linking consolidation and price increases, and getmore aggressive in a more noticeable way, and whether high-deductible plans are a necessaryevil to attain low health care costs. It will be most interesting to see how these, among manyother issues, pan out. Regardless of the outcomes, we know this to be true: It's a fascinating timeto work in (and write about) the health care industry.

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    F ORUM P ROGRAM & P ARTICIPANT B IOGRAPHIES

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    Thank you for joining me today for my Community Leadership Health Care Forum. Iam looking forward to a productive day addressing todays challenges to our healthcaresystem. We are joined by high caliber experts to tackle the top issues facing 14thDistrict consumers, including the Affordable Care Act, medical technology innovationand improving access to healthcare.

    Our healthcare system today is extremely complex and few Americans have the abilityto make sound and affordable decisions for themselves and their families. Consumersare facing rising costs and fewer options, and cant predict with any certainty howupcoming changes in the Affordable Care Act will affect them. My goal is to give myconstituents the most relevant and up-to-date information to make informed decisionsas they engage the healthcare system and for everyone to walk away with new ideasfor solutions to improve healthcare delivery, access, and care.

    I am thrilled you could join us today. Thank you for all of the work you do for ourcommunity.

    Randy Hultgren, U.S. House of Representatives

    W E L C O M E :

    Scott Becker, Partner, McGuireWoodsScott has served as a Partner at McGuireWoods since 2008 and is the chairman of thefrms healthcare department. He practices exclusively in the healthcare regulatory andtransactional area.

    He provides counsel on healthcare transactional and regulatory matters to hospitals,health systems, hospital chains, ambulatory surgery centers, ambulatory surgery centerchains, private equity funds and lenders, and healthcare industry entrepreneurs.

    During the past several years, Mr. Becker has devoted a majority of his time and effortsto ambulatory surgery centers and ASC chains, hospitals and health systems, privateequity funds and healthcare industry entrepreneurs. He provides advice and counselon a broad range of business and legal issues. Scott is a Harvard Law graduate and acertifed public accountant in Illinois.

    K E Y N O T E A D D R E S S :

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    A G E N D A :8:30 am 9:00 am Registration in Seigle Auditorium Atrium, Building E

    9:00 am 9:30 am Meet & Greet Coffee Reception with all Attendees

    9:30 am 9:35 am Elgin Community College Welcome, Dr. Wendy Miller, Dean of Health Profession s

    9:35 am 9:50 am Welcome Remarks, Congressman Randy Hultgren, (IL-14)

    9:50 am 11:05 am The Affordable Care Act (ACA) & the Consumer: 2015 and Beyond

    How is the ACA affecting the health care system on key metrics of access to, affordability of, and quality of healthcare? What challenges are on the horizon?

    Mark Grant, IL Assistant State Director, National Federation of Independent Businesses, Moderator

    Jason Montrie, Executive Vice President, Land of Lincoln Health

    Todd Page, Senior Vice President of Sales and Marketing, AHIX.com, a division of JLBG Health

    Craig Rodrigue, Independent Insurance Advisor, Association of Mature American Citizens Steven Tucker, Founder, HealthInsuranceMentors.com & Small Business Insurance Services Inc.

    11:05 am 11:20 amBreak

    11:20 am 12:35 pm Health Care Innovations: Technology In Medicine

    What technologies are transforming and have the potential to transform the everyday health care experience ofconsumers, and how can these technologies be improved? How can consumers adapt to these changing health caretechnologies? What are the best policy, economic, and industry conditions for improving research and developmentin the health care technology area?

    Brian Lemon, President of Central DuPage Hospital, Moderator

    Jeff Coney, Director of Economic Development, Northwestern University David Miller, CEO and President, Illinois Biotechnology Industry Organization

    Dr. Harry Rowland, CEO, Endotronix

    Dan Yunker, CEO, Land of Lincoln Health

    12:35 pm 2:00 pm Lunch in Dining Room, Building E

    Keynote Address: 10 Key Trends in Health Care Reform, Scott Becker, Partner, McGuireWoods

    2:00 pm 3:15 pm Health Care Innovations: Access to Health Care

    What services are transforming and have the potential to transform consumers access to health care? How canconsumers best utilize these changing means of access to care? What are the best policy, economic, and industryconditions for improving this access?

    Dr. Vikram Patel, President and Medical Director, ACMI Pain Care and Board Member, McHenry County Medical Society Moderator

    Dr. Opella Ernest, Vice President & Chief Medical Of cer, Blue Cross and Blue Shield of Ill inois

    Mike Randall, Vice President of Clinical Innovation, Advocate Health Care

    Denise Scarpelli, Market Pharmacy Director Chicago, Walgreens

    Hon. A.J. Wilhelmi, Chief Government Relations Of cer, Illinois Hospital Association

    3:15 pm 3:30 pm Wrap Up and Next Steps, Congressman Randy Hultgren, (IL-14)

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    Todd Page, Senior Vice President of Sales and Market ing, AHIX.com, a divis ion

    of JLBG Heal thTodd Page is currently the Senior Vice President of Sales and Marketin at AHIX.com. He began his career with Aon Corp. For the past25 years he has been at JLBG Health, where he designed health care plans for over 300 associations and franchise groups includingthe American Medical Association (AMA), the American Bar Association (ABA), the American Dental Association (ADA), as wellas the National Federation of Independent Business (NFIB). JLBG Health is the largest provider of private labeled Health Insurance

    Exchanges in the US for Associations, Trade Groups, and Franchise organizations. AHIX.com, a division of JLBG Health, is an online marketplace tolearn and shop for health insurance plans.

    Craig Rodrigue, Independent I nsurance Advisor, Association of Mature American Citize nsCraig Rodrigue has been helping business clients formulate and implement their plans for life insurance, healthcare coverage anddisability protection for over 16 years. Craig Rodrigue has been helping business clients formulate and implement their plans for lifeinsurance, healthcare coverage and disability protection. As the environment for healthcare coverage has changed, he has been at the

    forefront in keeping business owners strategically informed and in compliance with federal regulations.

    Mr. Rodrigue appears as a guest on various Florida radio shows and news programs to discuss insurance, financial planning,government and business issues. He has testified for the Florida Department of Insurance, serves on the Advisory Council for AvMed Health Plans andas Committee Chair for National Association of Insurance and Financial Advisors (NAIFA) and is regularly recognized as a top contributing agent bymajor Insurance Carriers for meeting client needs.

    Mr. Rodrigue graduated from the University of Central Florida and has operated his own businesses for 25 years, giving him an expertise regarding theneeds and retirement plans of business owners. He lives in Southeast Orlando with his wife and three sons.

    Steven Tucker, Founder, HealthInsuranceMentors.com & Small Business Insurance Services Inc.Steven Tucker has been a multi-state licensed Independent insurance broker since 1995. Representing clients in commercial businessand individual consumer-driven Health & Life insurance in over 15 states, he has garnered a notable reputation in informing andnavigating through the far-reaching complexities of comprehensive insurance coverage on behalf of families and small business.

    With an arsenal of insurance reform knowledge and real-world expertise, Mr. Tucker actively engages as a regularly featured speakerdelivering a unique insight and perspective to business employers, associations and advocacy groups and brings into context the new

    laws ramifications and impact on business and consumers. With acumen and recognition under his belt, his pointed-delivery encompasses all aspects ofwhat ails the health insurance system in America while dissecting the changes and looming challenges of the Affordable Care Acts provisions.

    Considered one of the leading authorities on small group market reforms, high-risk pools, HIPAA compliance, Medicare reform, and the AffordableCare Acts new mandated taxes and regulatory measures, Mr. Tucker, an advocate for the family and small business, is not afraid to charter new waterin exposing the never-ending challenge of a demanding global insurance marketplace, bringing to bear the relative significance of cost shifting, andthe prevalent problems and re-examination of how health care insurance is delivered.

    Founder of HealthInsuranceMentors.com and Small Business Insurance Services Inc. an independent agency for the last two decades, Mr. Tuckercontinues to actively specialize in meeting the health insurance needs of the self-employed and small business owner.

    Moderator: Mark Grant, IL Assis tant State Director, Nat ional Federation of Independent BusinessMark Grant is currently the Assistant State Director for NFIB in the state of Illinois. Direct grassroots efforts with NFIBs 11,000Illinois members by providing guidance on legislative and political activism. Mr. Grant advocates for small-business-friendly lawsand regulations on behalf of NFIB small business members. Mark Grant has a B.A. of Fine Arts from the Southern Illinois Universityin Carbondale.

    Jason Montrie, Execut ive Vice President, Land of Lincoln Heal thJason Montrie comes to Land of Lincoln Health with more than a decade of experience in insurance sales and health networkdevelopment. He has a proven track record of leading the development and execution of business strategies in the health care andhealth insurance industry. Prior to joining Land of Lincoln Health, Mr. Montrie was an executive at Humana Insurance and anAssistant Vice President at Euclid Insurance Company.

    THE AFFORDABLE CARE ACT (ACA) & T HE CONSUMER : 2015 AND BEYOND

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    H EALTH CARE I NNOVATIONS : TECHNOLOGY I N M EDICINE

    David Miller, CEO and President, Il linois Biotechnology Industry Organizat ionDavid Miller is president and CEO of the Illinois Biotechnology Industry Organization (iBIO), a life sciences trade organizationthat comprises leaders from the private, public and educational sectors. In this position, he also serves as the president and CEOof the iBIO Institute, which orchestrates business leadership in delivery of world-class educational programs and job-creating newtechnology ventures.

    Prior to joining iBIO, he served in executive positions for technology start-ups: Vice President of Corporate Development forAppsPoint Corporation in Silicon Valley; Vice President of Business Development and Vice President of Sales & Marketing for Clear Communicationsin Chicago; and President of Joiner Associates, in Madison, Wisconsin.

    Before that, David Miller served as business aide for the Mayor of Madison, Wisconsin, where he initiated a world-first, quality-productivity effort based on Deming/Japanese practices; he also drove the citys efforts to establish the heralded University of Wisconsin Research Park. He served asManaging Partner of New Age Housing, a developer of solar housing, and as a General Partner of Wyndemere Partners, a developer of energy-efficientconventional housing, both in Wisconsin.

    David Miller also initiated successful projects for divisions of Fortune 500 companies: as Regional Counsel for the Hartford Insurance Group subsidiaryof ITT, and as Real Estate Attorney for the Richman Brothers division of Woolworth Corporation. He earned his B.A. from Tufts University and his

    J.D. from Case Western Reserve School of Law.

    Dr. Harry Rowland, CEO, EndotronixDr. Harry Rowland has directed the Endotronixs operations, strategy, and technology development since inception. He received hisPhD in mechanical engineering from the Georgia Institute of Technology and a BS in mechanical engineering and MA in economicsfrom the University of California, Santa Barbara. Dr. Rowlands professional interests are at the intersection of transformativetechnologies and emerging business opportunities. He has been active in research and development of micro and nanotechnologyfabrication methods for more than a decade. His projects have led to invited research at Sandia National Laboratories, New Mexico

    and Trinity College, Ireland. Dr. Rowland has authored or presented over 15 conference and journal papers in internationally recognized peer-reviewed publications such as Science and Nano, with his work referenced in more than 200 scholarly articles. He is an inventor on several issued

    patents and pending applications.

    Moderator: Brian Lemon, President of Central DuPage Hospital Brian Lemon is President of Central DuPage Hospital and Executive Vice President of Cadence Health. Mr. Lemon is responsiblefor all CDH operations. He joined the organization in 2012, bringing with him more than 30 years of health services managementexperience.

    Mr. Lemons background includes strategic planning, quality and safety management, performance improvement, and healthcareorganization governance. Prior to joining Cadence, Mr. Lemon served as chief executive officer of Vanguard MacNeal Hospital in

    Berwyn, Illinois, the 427-bed Chicagoland flagship hospital of investor-owned Vanguard Health Systems. During this and a prior tenure at MacNeal,Mr. Lemon contributed to the hospitals growth by serving in several progressively responsible management capacities, including vice president, chiefoperating officer, and president and CEO. Between his tenures at MacNeal, Mr. Lemon was president and CEO of Holy Cross Hospital in Chicago.

    Mr. Lemon serves on the board of directors and is a member of the finance committee for the Illinois Hospital Association. He also has held positionson the boards of directors for the Metropolitan Chicago Healthcare Council and the Chicago Hospital Risk Pooling Program; on the Arthur Andersen& Co. regional advisory board; as chairman of the American Health Walk, Near West Suburbs; and on the board of directors for the Berwyn YMCA.

    Mr. Lemon earned his bachelors degree in biology from the University of Notre Dame, Indiana, and his MBA from the University of Detroit.

    Jeff Coney, Direc tor of Economic Deve lopment, Northweste rn Universi tyJeff Coney serves as Director of Economic Development at Northwestern University, a position he was appointed to in September,2007. He is also a member of the management team of the Innovation and New Ventures Office (INVO). His responsibilitiesinclude selected intellectual property and license management, marketing and business development for INVO. Mr. Coney joined

    Northwestern in 2000 as Director of New Business Initiat ives.

    Prior to joining the University, Mr. Coney spent 14 years as a software entrepreneur. He co-founded Facility Management Systems,Inc., a local software company, which was sold to a publicly traded company. He has also had prior employment with Arthur Andersen, MetropolitanStructures and The City of Chicago. Mr. Coney holds BA and MBA degrees from Northwestern and is a CPA.

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    Dan Yunker, CEO, Land of Lincoln Health

    Daniel Yunker Dan serves as the CEO of Land of Lincoln Health, Inc., the first and only consumer operated and oriented plan inIllinois. He also serves as Senior Vice President and Chief Financial Officer of the Metropolitan Chicago Healthcare Council, a

    position hes held since 2005. Through this role, Mr. Yunker provides strategic executive oversight for MCHCs MetroChicago HealthInformation Exchange, Business Resource Solutions, Human Capital Services and Employee Benefit Trust.

    A thought-leader in health care finance, he is a professor of finance in the University of Illinois at Chicagos master of healthcareadministration program, educating the next generation of health care leaders. Earlier in his career, he served as a vice president at Aon Corporationand director of Business Development at the Healthcare Financial Management Association where he was responsible for designing and implementing

    programs and strategies designed to contribute to the success of members and their organizat ions. He was intimately involved with special projects,educational programs and other HFMA thought leadership and resource offerings. In addition, Mr. Yunker held various leadership roles at CadenceHealth System, and is a founder of both IPS, a Chicago-based physician-practice management company and Air Angels, Inc. an aero medical flightcompany.

    Dan Yunker received his masters degree in business administration from the Keller Graduate School of Management and his bachelors degree fromthe University of Illinois at Chicago.

    H EALTH CARE I NNOVATIONS : A CCESS TO H EALTH CARE Moderator : Dr. Vikram Pate l ,Pre s ident and Medical Di re ctor, ACMI Pain Care , LLC and Board Member, McHenry County Medical Socie ty

    Dr. Patel began his career at B.J. Medical College in India, one of the countrys premier institutions where he also completed hisAnesthesia residency and Board certification. He later completed a residency in Anesthesiology at the University of Toledo MedicalCenter, where he also earned his Chief Resident status. University of Toledo Medical Center then awarded him a fellowship in painmedicine and regional anesthesia. Dr. Patel has led a vital career in pain medicine.

    Dr. Patel is board-certified in anesthesiology and also fellowship trained and board certified in pain management by the American Board of Anesthesiology.He is also a certified Fellow in Interventional Pain Practice. A highly active author, editor, and pain management specialist, Dr. Patel has managed and

    practiced at medical centers throughout Illinois, including Loyola University Medical Center near Chicago where he served as Program Director forthe Pain Management Fellowship program and as an associate professor of the pain management section in the Department of Anesthesiology. He hashelped publish Guidelines for Interventional Pain Management procedures under the auspices of American society of Interventional Pain Physicians.

    Currently, Dr. Patel is the president and medical director of ACMI Pain Care in Algonquin, Illinois.

    Dr. Opella Ernest, Vice President and Chief Medical Officer, Blue Cross and Blue Shieldof Illinois

    Opella F.Ernest MD, serves as the Chief Medical Officer for Blue Cross Blue Shield of Illinois. In this role, she is responsiblefor assuring the delivery of quality, accessible, cost effective care consistent with the mission and vision of Health Care ServiceCorporation (HCSC). Dr.Ernest is committed to health and wellness and has over 17 years of clinical leadership experience.

    Dr. Ernest joined HCSC in 2012 as a Senior Medical Director for HCSC Government Programs division. Prior to joining HCSC she

    was responsible for the clinical model of care for dual eligible members as Senior Vice President, Medical Management, for HealthSpring, Inc. Duringher tenure as a Medical Director for HealthSpring, she contributed to utilization management, quality and pharmacy programs. She has held physicianleadership roles with the Visiting Nurse Association, Advocate Health Care, and the Henry Ford Medical Group.

    Dr. Ernest, a board certified family physician, earned her undergraduate degree from the University of Michigan and medical degree from the Ohio StateUniversity College of Medicine. She interned at St. Joseph Hospital, Chicago, Illinois and completed her residency in family medicine at ProvidenceHospital, Southfield Michigan. Professional affiliations include the American Academy of Family Physicians, Illinois Academy of Family Physicians,the American College of Physician Executives and she is a Fellow of the Institute of Medicine (IOM), Chicago.

    She is committed to the community and is actively involved with the American Heart Association, Chicagoland Chamber Workplace Well Being andPrevention Practice Committee and serves as an advisor for the Healthcare Business Womens Association.

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