California Healthcare Policy Forum Spotlight: Assemblyman Nathan Fletcher

Nathan Fletcher is the State Assemblyman representing California's 75th District and will be addressing attendees of CHI’s California Healthcare Policy Forum in San Francisco at the Mark Hopkins InterContinental on Nov. 5. Assemblyman Fletcher serves as vice chair of the Assembly Health Committee and the Select Committee on Biotechnology. He is a member of the Accountability & Administrative Review, Water, Parks, & Wildlife and Utilities and Commerce Standing Committees. In addition, he sits on the Select Committees on Foster Care, Child/Adolescent Health and Safety, Healthcare Workforce Access, Safety and Protection of At-Risk California Communities and Government Reform.

Q: As a freshman lawmaker, you are vice-chair of both the Assembly Health Committee and the Select Committee on Biotechnology. What sparked your interest in healthcare policy and the biotechnology sector in particular?
A: If you look at my district, I have one of the world’s largest concentrations of biotech, including UCSD, Burnham, Scripps, Salk, all these various institutes and groups like CHI that help to bridge that and the 500 biotech companies that reside here. Also, if you look at the changing dynamics of economics, these are the jobs of the future. Information technology, biotech, clean tech, high tech, agricultural biotech—these are the industries and jobs of the future. If we don’t figure out in America and in California how to innovate and create new ideas, we’re not going to compete in the global marketplace. Whoever figures out how to cure diabetes, Alzheimer’s, cancer from a medical perspective; or to grow drought resistant crops; whoever makes a faster, smaller computer processor or figures out how to transport people faster with less of an impact on the environment; whoever figures out how to create sustainable power. Not only do they get to make the world a better place, but they also will get to sell that to the 95 percent of the world population that lives outside America and I want that place to be California. I’m very interested in this cluster effect and creating centers of innovation and working to get the brightest minds to come here and be part of it.

Q: What do you believe is the state’s role in healthcare reform?
A: The states play a tremendous role in healthcare. So much is administered by the states, even federal programs are run by states and counties, but aside from administering programs and making them work better, the states can be great incubators of new ideas. California is known for being at the cutting edge. It’s a great way to see what works and what doesn’t and California itself provides a very challenging environment. I believe in universal healthcare coverage—I think everyone should have healthcare and that we can design a system where everyone can participate, it’s just a question of how we get there. I also think California should lead on utilizing new technologies like electronic medical records.

Q:You have said that you believe healthcare begins with healthy living and that we should find constructive and creative ways to promote health and wellness. Can you tell me what some of your ideas are for the promotion of health and wellness in California?
A: I think when we talk about healthcare, we skip to the idea of healthcare for sick people and bypass the fact that healthcare should start with healthy living. I’m interested in incentivizing healthy living. I think financial motivators are great. There’s a remarkable difference in the healthcare costs of a healthy non-smoker who exercises and maintains healthy weight and at a certain point, people need to be held accountable.

I think people should be able to buy their own insurance, rather than relying on an employer-based system like we have now. It just doesn’t make sense anymore, now that people switch jobs and healthcare plans so often. We could then give individuals the tax breaks that employers now get and the consumer would get to choose and keep the plan that makes the most sense for them.

Immunizations are another area I’m interested in. I’ve lived in Africa, Asia, third world countries, and one of the saddest things I’ve ever seen is people dying of diseases like polio, which is now preventable. We’re seeing rates of unimmunized children jump in the U.S. and I’m worried about that. I respect parents’ rights but I think there’s a lot of awareness and education we can do. And we have to look at reimbursement and how physicians are paid for vaccinations. If physicians aren’t reimbursed for immunizing patients, then parents will have to go elsewhere and adding another hurdle to a busy parent’s schedule is one more hurdle that hurts all our kids.
Q: You’ve also acknowledged the need for technology and innovation to transform our current healthcare system, which is a topic that we’ll be exploring at the California Healthcare Policy Forum, where you’ll be addressing attendees on Nov. 5 at the Mark Hopkins InterContinental in San Francisco. How do you think technology and innovation can contribute meaningfully to reforming the delivery of care in the U.S?
A: Forty years ago we put a man on the moon and we talked to him. I was at Apple recently and they told me the computing power of the iPhone is equivalent to the entire Apollo project. Thinking about how we now use this technology, I can take photos, trade stocks, get information, watch news programs. Yet, I go to my doctor and he writes down information in my medical record and writes a prescription on a pad of paper that I take to my pharmacist. And I think, what are we doing? So, one application is in the medical record keeping area. I do realize the challenges with confidentiality, but certainly we can overcome this to have a system that allows my physician to see, from cradle to grave, what tests have been performed, any known allergies or chemical reactions, etc, there simply has to be a way.

I think it has a role to play in fraud prevention. I think a real-time stream of data and analysis could elucidate patterns of fraud. And the third way is empowering the individuals to make decisions as far as information. If you’re going to have a knee surgery, you should know how many your physician has done, how many of his operations led to infection, etc. The more information you can provide to people in an easy to use format, the more they’ll be empowered to make decisions about their own healthcare. In short, I see a lot of applications for technology and I don’t believe it has to be a cost center. Of course there would be some initial capital investment, but we really need to make that leap.

Q: You mention education as an important issue for you and your constituents. The biomedical industry in California is vested in improving math, science, technology and engineering education to secure a well-educated and prepared future workforce and has funded many programs to educate teachers and students and expose them to new research and technology. What are some of your ideas for improving STEM education in California?
A: The Hart-Rudman Commission did a pre-Sept. 11th study on the top threats to America and one of their top two or three, including foreign terrorism, was our declining prominence in the fields of science, technology, engineering and math. We really need to have a focus in these areas in education and incentivize students to study these topics. In Florida, high school kids can choose a major like we do in college, so having programs where students can specialize in these study areas could help. We need to adequately prepare students for schools like UCSD early on and incentivize them and invest in them.

The UC system used to be 7% of the general fund and is now down to 3%. I certainly understand of how programs get funded, but if we want to maintain our status as innovators, we have to invest in our universities. We also need to change our mindset with K-12 education. We should fast track college-bound kids. Right now, 80% of 9th graders will not go to collage. We need to offer career and technical education, with some math and algebra and other skills to prepare them to enter the workforce where they can get a good job that is high paying, such as in biotech manufacturing and these other high tech and biotech jobs of the future.

I’m looking forward to attending the California Healthcare Policy Forum on Nov. 5 and meeting the folks who are actually innovating new drugs and therapies and employing people and teaching California’s future workforce. I have a lot to learn from the speakers and from the attendees so it should be a great opportunity.

CHI-Advancing California biomedical research and innovation

California Healthcare Policy Forum Spotlight: Dr. Mark Smith

Dr. Mark Smith is president and chief executive officer of the California HealthCare Foundation and will be a part of CHI’s upcoming California Healthcare Policy Forum, to be held in San Francisco at the Mark Hopkins InterContinental, from 11:30 a.m. to 6 p.m. The Foundation is an independent philanthropy with assets of more than $700 million, headquartered in Oakland, Calif., and dedicated to improving the health of the people of California through its three program areas: Better Chronic Disease Care, Innovations for the Underserved, and Market and Policy Monitor.

A board-certified internist, Smith is a member of the clinical faculty at the University of California, San Francisco, and an attending physician at the Positive Health Program for AIDS care at San Francisco General Hospital. He is a member of the Institute of Medicine and serves on the board of the National Business Group on Health.

Prior to joining the California HealthCare Foundation, Smith was executive vice president at the Henry J. Kaiser Family Foundation. He previously served as associate director of the AIDS Services and assistant professor of medicine and of health policy and management at Johns Hopkins University. He has served on the Performance Measurement Committee of the National Committee for Quality Assurance and the editorial board of the Annals of Internal Medicine.

Smith received a bachelor's degree in Afro-American studies from Harvard College, a medical doctorate from the University of North Carolina at Chapel Hill, and an MBA, with a concentration in health care administration, from the Wharton School at the University of Pennsylvania.

Q: What have you witnessed in your interactions in DC with congressional aides, administration officials, policy analysts, and others as the healthcare reform debate continues?

A: The first thing that’s notable is that the terms of the debate have changed subtly from health care reform to health insurance reform. The good news is that realistically, it’s probably all that one can expect to happen at this point in the debate. The bad news is that the fundamental condition of American healthcare, which is that it costs too much, is unlikely to be dramatically changed by any of the things that are on the agenda right now. It remains to be seen how much will survive in the proposed legislation.

Q: Your organization, the California HealthCare Foundation, is dedicated to improving the health of the people of California through three program areas: Better Chronic Disease Care, Innovations for the Underserved, and Market and Policy Monitor. Tell me how these programs play in to healthcare reform.

A: Our sense is that in the long run, healthcare as it is currently configured is unsustainable. All three programs are designed to attack what we see as the basic elements of our cost problem. The system right now is dramatically tilted toward acute disease management and high cost, inpatient hospitalization. We think the real benefits in terms of reducing costs lie in attacking the chronic disease problem. We don’t focus on the development of guidelines on how diabetes, asthma and hypertension should be treated, but rather on narrowing the gap between what experts say should happen with these patients and what actually happens.

Q: How does that work with the current incentive structure in healthcare? Right now physicians get paid and get paid more if patients are in an acute condition and get paid relatively little for preventive care. Are you working on restructuring incentives?

A: To be honest, I think that’s probably not work we can do on our own. The primary physician doesn’t get paid if her patient is in the ICU, but she is at least beginning to be paid for the adequacy of the control of her patients’ blood sugar or blood pressure. So part of why we were active in helping to catalyze the pay for performance model was to start changing the incentives for the physicians who are treating chronic disease. One problem we’ve noticed is that many physicians don’t have good “population management” tools, such as registries, to be able to capture these data, so that’s something we work on.

Q: As the head of a foundation that engages deeply with providers, hospitals, government, insurers, payers, and patients in California, and with particular concern for underserved communities, how do you see California positioned in this debate?

A: It’s interesting. A lot of the leading actors in Congress are from California. We’re certainly ahead of the rest of the country with regard to the existence of large groups who provide care in an organized and systematic way. We’ve always had Kaiser and large, sophisticated medical groups. However, some of our in-state regulatory decisions are lagging in terms of the types of developments that will allow cooperation among small practices that will be necessary to deliver care in a rational, organized way.

Q: You have said in recent statements that measures passed as part of the stimulus package, including health IT financing, comparative effectiveness research, and support for electronic medical records implementation will create much greater reform to healthcare delivery than what is being proposed as part of healthcare reform packages being considered now in Congress. Can you explain some of the implications for this technology?

A: Comparative effectiveness and support for IT adoption by physicians are an essential part of the infrastructure necessary to reform healthcare. Are you familiar with OpenTable? It brings to mom and pop restaurants information technology sophistication, visibility to customers, other benefits of being in a big chain without having to shut down and become a chain restaurant. So modern technology can bring to small physician practices that same kind of sophistication. The promise is that some modern technology and service solutions can help drive the same outcomes as the large practices.

OpenTable has taken away the need for restaurants to have their own server and IT staff. Think about the analogy for a small physician’s office. Most small practices don’t have an IT staff and would never be able to sustain a huge system for tracking patient information. I think this model provides some hint about how we might be able to achieve the group-wide outcomes and sophistication of a huge practice.

CHI represents very technologically advanced companies. Yet the healthcare industry is probably 15 years behind other industries on IT. If the industry is to be focused on increasing both efficiency and quality and being able to measure them, let alone improve them , we can’t rely on one-off, ad hoc, retrospective research projects, which is basically how we know what little we do know about the quality of care.

Every other industry has a data and analysis stream that allows them to analyze quality and efficiency in real-time. Take the example of Walmart. Walmart knows more about its customers than most doctors know about their patients. They know what the customer has bought, what they bought last week, what they’re likely to buy next week, and exactly how long it will take the store to restock the shelves with those items. They don’t hire someone to do all that days later. If we’re ever going to have a shot at being able to afford knowing what we’re doing, let alone improving what we’re doing, we have got to have a robust digital data stream that is a part of how the industry is run.

Q: As a physician who specializes in AIDS, do you see advances being made in the diagnosis, treatment and prevention of AIDS in the next 25 years?
A: I used to run the AIDS clinic at Johns Hopkins and I still see patients at the AIDS clinic at San Francisco General, arguably the two best clinical centers for AIDS in the world. I am living proof of how far we’ve come. Ten years ago, if I had a patient with AIDS and a mildly increased blood pressure, I really wasn’t going to sweat the blood pressure. Now I have to be up on PSA tests, colonoscopies, lipids, because I expect my patients to be alive 20, 30, 40 years from now. In recent weeks there has been some really promising news on the first AIDS vaccine. I continue to believe that we have got to work on behavioral changes to halt the spread of HIV, but in the long run, what we need is an AIDS vaccine.

Dr. Smith will be participating in CHI’s California Healthcare Policy Forum on Nov. 5 from 11:30 a.m. to 6 p.m. Click here to register for the event.

CHI-Advancing California biomedical research and innovation

California Healthcare Policy Forum Spotlight: Ian Morrison

In the run up to CHI’s annual California Healthcare Policy Forum, which this year, will take place on Nov. 5 at the Mark Hopkins InterContinental Hotel in San Francisco, I will be interviewing the various opinion leaders we will bring together to discuss California’s innovation economy, its place in the current healthcare debate, and how healthcare reform promises to change the provision of care in years to come. Ian Morrison, internationally known author, consultant, and futurist specializing in long-term forecasting and planning with particular emphasis on healthcare and the changing business environment, will be the moderator of the event and is the subject of my first interview. He combines research and consulting skills with an incisive Scottish wit to help public and private organizations plan their longer-term future and promises to deliver an impactful, interactive session among industry leaders, policy makers and academicians on the future of healthcare in America.

Registrations are still available for the event. Click here for more information.

Q: What will be the focus of this year’s California Healthcare Policy Forum?
A: It’s going to be a very interesting meeting. The focus is going to be on helping attendees get a handle on what healthcare reform means for CHI’s constituents, its members made up of leading biotechnology, medical device, diagnostics, and pharmaceutical companies, and public and private academic biomedical research organizations. Not just where healthcare reform is headed but what this means to innovators in California. On the one hand, healthcare reform is on the front page the New York Times everyday, but it also affects the day-to-day business of CHI’s members. This collection of leaders of industry is going to be able to give their views and my job as moderator will be to draw out those stories in an interactive setting.

Q: What do you feel participants will gain by attending the event?
A: Participants are going to get a cutting edge view of where we are in the debate from people with interesting perspectives on health policy and issues of innovation. On that first panel, we’ll be able to drive toward the “so what” for those in the innovation industry. Dr. David Gollaher, CHI’s president and CEO, will represent CHI members and what they are talking and thinking about. Dr. Alan Garber is a distinguished health policy expert, an economist and physician who specializes in the evaluation of medical technology. Dr. Sharon Levine is a physician at Kaiser, one of the senior leaders there responsible for thinking about public policy and the deployment of new technology so she’ll bring the perspective of what it’s like to be inside a large organization that makes decisions about the use of technology. And Michael Goldberg a leading venture capitalist, will talk about the effects of healthcare reform on the finance industry and ultimately, on the biomedical industry that relies so heavily on this type of investment. The panel will talk about such issues as the use of comparative effectiveness research, potential changes to reimbursement, the fact that more people will likely be covered at lower pricing and the resulting tremendous cost pressures moving forward. This panel will set up the conversations later in the day, which will feature CEOs from leading companies in the various sectors that make up the biomedical industry, giving them an opportunity to focus on what healthcare reform means to them and the various specifics they are concerned about.

Q: How do you see the provision of healthcare changing in the years to come? What part does innovation play in the new paradigm?
A: I’ve been an ongoing observer of the system for 30 years starting off by doing technology assessment. I think the environment going forward is going to challenge medical technology to deliver on the promise. It’s not just about “more is better” or “anything new is good.” That just won’t do in the future. Anything that is new in the future is going to have to demonstrate dramatically superior performance, meeting an unmet medical need where there really is nothing else available. One of the challenges I’ll pose to the group is why is it that in this industry, innovation means more expensive, where in every other industry, innovation means “better, faster, cheaper”? I think getting at the source of that is going to be an important contribution to this meeting.

Q: How must executives change their thinking in order to grow with the changing needs of the American consumer and/or the changing healthcare system?
A: I think executives need to gain clarity on what the goal is. The goal has been to find something novel that physicians can be persuaded to use. The hurdle is going to be much higher now. It’s going to be about delivering value in a much clearer way, relative to existing therapies in quality, outcomes and cost effectiveness.

Q: You mention in your writing the need for consumer education and the popularization of the concepts of how to improve the system in order to improve access and outcomes. How do you propose this to take place?
A: There’s a lot of misinformation. We are stuck in the notion that more is better and denial of anything is always bad. There is a real misunderstanding of how much healthcare costs and why. The basic problem is the average American household can’t afford the average cost of care. Everyone being subsidized by the richest 2 percent of Americans simply won’t work. So part of the collective education of consumers is the understanding that it’s expensive, costs are going up, the component elements of that are partly because of bad behavior on the part of the consumer, partly because of the high cost of care, partly because of the fragmented system providing care, and medical technology is one contributor to overall cost escalation. More judicious use of technology is a direction we’re likely to head in.

Q: What part of the California Healthcare Policy Forum are you most looking forward to?
A: With this event, we’re going to have an opportunity to interact with some decision makers on the public policy side at the state and federal level that are active in medical technology related issues. This is going to be a tremendous chance for people to learn about the “so what” about healthcare reform for people in the innovation industry and I think it will be a discussion not just cheerleading innovation but really drilling down on the challenges and encouraging them to think about how we can evolve to better meet the needs of the American public.

Register now for the California Healthcare Policy Forum.

CHI-Advancing California biomedical research and innovation