Welcome everybody and thank you for joining us today. My name is Chris Jaffe and I'm with advise insurance. We're partnering with your health care provider to offer this exclusive event featuring Doctor Scott Gottlieb and Seema Verma. Education is at the heart of what we do here at advise. Medicare is complicated and we help Medicare beneficiaries like yourself. Understand it. Now, unlike other Medicare insurance agencies, we go beyond just helping you choose the right plan for your needs to provide helpful education such as the webinar we're hosting today. Our feature presenters are going to cover a lot of great information, but you probably have some questions along the way. So please feel free to submit them through the Q&A feature at the bottom of your screen. And if we don't answer your questions today will follow up with you at a later date. Today's event is divided into 2 parts, beginning with what is sure to be an insightful discussion on the future of health care in America. With two of the leading health policy experts in the country, former FDA commissioner Doctor Scott Gottlieb and former CMS administrator Seema Verma. Their insights will help you understand what to expect in the coming months and years. Now in the second part of today's event, you'll have the opportunity to join a discussion featuring leading physicians from your health care providers practice. They'll help you connect what is happening at the national level with what is happening to health care in your very own community will also answer some common questions about Medicare. Be sure to stay with us for the entire event for a chance to win an Amazon gift card. I'll give you instructions for entering the drawing later. I am now pleased to introduce our moderator for today's event. She recently concluded her term as the longest serving administrator of the Centers for Medicare and Medicaid Services in modern history. Confirmed by the Senate in 2017, she oversaw health insurance programs for more than 140 million Americans, a budget of $1.3 trillion, almost a third of the federal budget, and more than 6000 employees, she was the architect of CMS, Strategic Vision, implementing more than 16 strategic initiatives aimed at transforming the American health care system to lower costs, improve quality and increase access. I am of course referring to Seema Verma, and while it's impossible in our time today to do justice to her many accomplishments, we are thrilled to have her here. So with that, I'd like to welcome Seema Verma. Well thank you Chris and it's just wonderful to be here today and welcome to all of the patients that have joined us. And I think we've also have a few clinicians on onboard as well. We've got patients from Summit Health, Intermountain Healthcare Village, Medical and. The Henry Ford Health system so welcome to everybody. It is my great pleasure to be here with, uh, Scott Gottlieb, who many of you know or see a lot of on TV. Scott probably doesn't need an introduction, but I'll give a small 1. Scott was our 23rd FDA Commissioner, but he is been somebody that's been very active in health policy on a range of issues when he was at the FDA, he was known for getting through a record number of generic drugs approved and also made significant. Policy accomplishments around tobacco control and also addressing the opioid epidemic, but most of us have been seeing Scott around when it's come to the Covid virus and I was just thinking, Scott, I was remembering the last time that I saw you are in person and that was actually maybe early January. I don't know if you remember this, but we were having dinner and you said, you know, I'm I'm really worried about this coronavirus and the implications for our health care system so. That was our last in person interaction an I thought that may be a good way to start this discussion, 'cause I know that many of our viewers have a lot of questions about Covid virus and especially the vaccine. So maybe to just kick things off. What are your thoughts and how do you think that the vaccine distribution is going? Thanks for the questions Seaman. Thanks for joining me here today. It's great to be with you again. You know you advance a lot of a lot of important initiatives that meta care including. Initiatives to help improve access to medical care during the crisis and then things you doing. Tele health. I think I want to ask you about some of those. Some of those policy reforms I think really enabled patients to contain get access to important medical care during the crisis. With respect to the to the vaccine rollout right now, I think that you're seeing supply increase quite dramatically in the marketplace. I'm on the board of Pfizer's, you know, they've doubled the amount of vaccine that they're putting into the market seeing. J&J getting vaccine authorized and starting to put substantial supply into the market. Modernista increases supply as well, so I think we're going to see availability really start to open up more widely to broader age population, and I think by the time we get into the late spring summer months, this is going to be widely accessible and the challenge isn't going to be supply. It's going to be demand. I mean, initially the challenge was distribution. We didn't have enough sites initially to distribute the vaccine. And that was really the challenge that we had in December and into January. Then the challenge became supply. Obviously you have a lot of demand and you didn't have enough supply. I think that the challenge is going to become the demand side of the equation as we get into later weeks and we're going to hit a limit on how many people really want this vaccine badly enough to go out and seek it and line up and spend time going online and registering for it. My guess is there is about 100,000,000 Americans that will take the vaccine right away. I think that there is another 25 to. Fifty million Americans who will get vaccinated once becomes more widely accessible. Easy for them to get access to it. Maybe at a pharmacy and then beyond that, I think we're going to get more people vaccinated, but I think getting above 150 million Americans is going to be a struggle. I think that the demand is going to soften, and I've said for a while that the demand is is deep, but not wide, that there's a lot of people who really want the access to the vaccine. But it's not as broad as you think. If you look at last year, we vaccinated 125 million Americans for the flu. That's really the low hanging fruit I think. For the population that's going to seek out this vaccine, but the good news is that it's going to be more widely accessible. You know, I think most of the people who want access to the vaccine are going to be able to get access to the vaccine by April. I mean, I think access is going to be broad in April. That doesn't mean everyone is going to go online at the beginning of the month and get the vaccine, but that does mean I think most people are going to get an appointment regardless of their age. Right now, we vaccinated about 60% of those above the age of 65. About 70% of those above the age of. 75 We've fully vaccinated more than 25% of the adult population, so we're doing, well, this is X is really broadening, and I think we probably will capture about 60% of the adult population. Children are another question, I mean whether or not we vaccinate children in the fall. Well, I would agree with that. In my home state of Indiana, they opened it up to age 50, so that was the best thing about turning 50 last year. As I got to get my vaccine and I was really impressed with the process. But as I'm talking to people across the country, that is not the case in every state that they haven't opened it up to that age level. And there's still lots of parts of the country where it's still 65 and above. You know your thoughts on that in terms of how quickly that that may change and. You know you mentioned kids for example, but you know when do you think that's going to happen? 'cause I know that that hasn't been necessarily been clear about whether children will be eligible for the vaccines. Yeah, you know. And I'd be curious to get your thoughts on this as well. And what you think that there's a lot of state to state variability and some of? It's hard to explain. You talk to people in different States and similarly situated people across different state lines are having very different experiences and I would have thought I understood that early on because a lot of states. Put in place different policy measures about how they were going to, you know, sort of dictate access to the vaccine in terms of how they prioritize, but you know, you start to see more convergence right now, and the policy is in terms of how states are determining access, and I would have thought that the experiences that people are having across state lines would be starting to converge more than they are. But you talk to people in some States and having very different experiences. I mean, some states in some states have gone to a purely an age model, probably the most prescriptive, and that is Connecticut. The state I'm in, where they very clearly, you know, sort of created access back tiers based on age, and they respected that pretty pretty strictly. Other states have had hybrid models where they've made it accessible based on age, but also other criteria like place of employment, making it available, essential workers, teachers, frontline providers. But it's it's odd to me that you're still seeing a very big difference in the experience across state lines. I think over the coming weeks it's going to start to converge. Connecticut's a good example because they are making it available based on age and they're making it available to right now it's I think 55 and above. They've lowered it by the end of March. It's going to be 45 and above, I think. Once you're rationing access to people age 45 and above, the next step is just to open it up widely, right? You're not going to. You're not going to ration it to 35 and above or 25 and above. I think you gonna let the man get softer as you get to the younger age groups who. How do you? What's your? What's your impression of the? The different experience you were there when when some of this was, you know, being debated about how, how prescriptive the federal government was going to be in terms of telling the States how they had to, how they had to ration access. Yeah, you know, I think what's what's worked well in terms of getting large numbers is opening it up as much as possible, and I think the more restrictive and the more permeations I think that actually makes it more complicated, you know? So going moving down those age band seems to go quicker. That being said, you know, I think that parents across the country or anxious to see schools open. And so opening it up to teachers, I think was a really important piece of this. And you're also hearing people that have underlying health conditions. You know you brought up a good point though. Earlier around the demand issue that you know is everybody going to act when it's available? How many people are actually going to get vaccinated? And you know I was looking at the meta care data around flu vaccinations and we sort of use that as a proxy. And really, looking at the data for almost the last 10-15 years. It's kind of hovered around that 50% number, and you know, despite all kinds of different efforts over the past few years, it's been difficult to get it above that. So you know, I'm kind of curious to your point. Are we going to hit sort of a plateau with people not wanting to be vaccinated where I'm also hearing this in the nursing home population in terms of the staff, there were a lot. Obviously there was prioritization given to nursing homes. Early on, but you know a lot of the staff weren't comfortable with it and those numbers were actually pretty high on the staffing, so that may change overtime, but we're still hearing even some health care workers that have hesitancy. What's your thought on what needs to get done in that you know, to sort of help people? Be more comfortable with getting the vaccine. Yeah, I'm surprised by the Medicare data on flu. Actually, that is a little bit higher in the 65 and above age set. And I agree with you. I've heard the same thing about talking to the governors about the experience in the nursing homes where they did a very good job. Being able to get the patients vaccinated there was, you know, wide uptake. But the staff were refusing the vaccine. You know, I think some of this is hesitancy. That will be sort of resolved over time as people gain more comfort with the vaccine. But vaccines been in a lot of people. So we have a pretty big safety database at this point. Obviously not extremely long term follow up data, but you have you have longer term follow up data on the cohort, certainly from the controllers you know I'm going to butterflies or one of the companies that marketed one of the vaccines. I think the challenge is going to be that we're now going to be vaccinating against the summertime when prevalence is going to be declining. I think that we're going to have a pretty quiet summer. I don't think we're going to see a lot of covid around during the summer, and so, whereas demand was brisk in December and January when it was really. You know, broad epidemic and people wanted to get vaccinated. I think when you're getting into the months of May and June, you're not seeing a lot of covert. You know, a lot of people are going to say especially younger people who don't feel that they are at significant risk of cover. They're going to say, you know what? I'll wait until the fall did vaccinated. So I think that that's that could cause demand to fall off as we get into the spring in the summer, and some of the people who are sort of more marginal in terms of their desire to get vaccinated will become even, you know, even less desirous of it, or might say, well, I'll just wait until the fall. Especially as now we're going to have a conversation about. Fact, we're probably going to be boosting people in the fall. I think that's going to now be a discussion, right? People be getting another vaccine default? You know, my hunches, and I'm currently at your thoughts on this. I'm gonna put this back to you, but my hunch is that we're going to have low levels of infection this summer. We're going to continue to see trends come down. Summer is going to be relatively mild, and then we're going to as we head into the fall cases will build, but we really won't see a big building cases until we get into maybe November. I think you know, September, maybe October will still be relatively low levels of. Infection around the country. Maybe some some states that have isolated outbreaks and so this might be a decision that we have the ability to make later in the fall. So I guess a couple of points you know in terms of the trends we definitely saw. You know, kind of may. June things actually went down, but then in the South when it got really hot, people started going back inside. You know more cooler settings with air conditioning. You saw this big spike. I would agree with you though that you know we're not going to see the number of hospitalizations and deaths be at the numbers that we've had before, and a lot of that has to do with getting the the older population. Immunized people over 65. I mean, that's where we were seeing in terms of the hospitalizations that the greater percentage was with an older population. So just by virtue of getting them immunized, I think hospitals should be in better shape and shouldn't have the surges that they've experienced in the past. We're also testing less and so we've seen a decrease in testing and that may be impacting the rates, but I would just agree with you generally that between last year the number of people that. They got their back senior, sorry the vaccine and the number of cases that we've had in the past. You know, we're definitely going to see a slowdown as we hopefully approach more herd immunity. But again, I think it's, you know we. Also, there's also the risk that ask people are getting vaccinated and you see the rates coming down that people tend to be a little bit more LAX and that there may be, you know, a little bit less mask wearing and the precautions that people have been taking in the past, that that may relax and that can have an impact. As far as the the summer epidemics that you talked about absolutely agree with you people. We saw those epidemics in Phoenix and Houston and Miami when people were driven back indoors for air conditioning last summer in prevalence of decline and then you saw these regionalized epidemics because people went inside for air condition. When it got really hot in those cities. Houston Phoenix. I think there's a possibility we avoid that this year in part because stopping people be more cautious and we're now in an environment where a third of the Publix had covid, so they have some background immunity. Anne, and that's that's going to confer cross immunity even to this new UK variant. The more contagious be 117 UK variant, and we're going to have at least, you know at least 40 percent, 50% of adults vaccinated. For for this you know, where are you? You probably at 60% of the public with some level of immunity, and so at that point you know you're not herd immunity. This state threads right here at a level of immunity where it doesn't spread as much. You look at final point and I'll stop talking. You look at South Dakota right now. That cases are way down why they they probably have 60% of the population with some level of immunity between prior infection where they had a very bad epidemic and now they're doing a pretty good job vaccinating their population. Now I think that's a that's a great point, and this summer will be that test, right? I mean, if we can get past that July, you know, and kind of look at where we were last year, I think that gives us a good indication of of where we may go. And it is interesting that you bring up South Dakota. It's it's what's been interesting to me is sort of seeing. These states that have had very different approaches on, you know, walk downs and mask mandates and and how they've done and how they'll do over the long term. But you know, I think one of the things that I know is on a lot of people's minds. Are the new variance. So what are your thoughts on that in terms of you know, how does that impact things and then also in terms of the vaccines that are out there, does that mean that we're going to have to have booster shots? Does that mean that we're going to have an? You know, even if there is a booster shot, does that mean we're done, or is it this something like the flu shot? You're going to have to come back every year and get a, you know, an update. Yeah, I mean I think for the foreseeable future this is going to be an annualized. A booster, you know. It's hard to. It's hard to know what's going to happen in three or four years with this. Whether or not this starts to recede into a less fearsome virus, but at least for the for this fall, I think we're likely to see a situation where people are going to be getting boosters, especially people who've been vaccinated. Now you want to take, you know, more robust community into the fall. We don't know how durable the immunity is from the vaccines were going to have to measure that over time, and so, especially if you're talking about a more vulnerable population, you're going to want them to have more maximal protection heading into the. To the fall in the winter. Now those studies are being done companies. Both Pfizer Moderna, looking at both new vaccines. They're developing new vaccines that try to cover these variants more precisely, as well as looking at a third shot of the existing vaccine. Does a third booster confer enough additional immunity that you get a pretty robust protection anyway against these new variants, and therefore you don't need the new vaccine? That's that's designed to target these variants, so even answer that question, but I think that you're likely to see people get boosters is fall. And that will also have the advantage of getting people on on this sort of annualized schedule. I mean, right now all been vaccine at different times. You tell. They tell folks they have to come back in a year. No one, no one knows what that is, because they'll forget we got their shot, boost everyone in the fall. Now you've got everyone on on an annualized schedule in terms of the new variance. You know there's there's three right now that we're worried about the B117, which is the UK variant, which were worried about it because it's more contagious. That's going to become the predominant strain in the United States. Already 40% of infections in Florida, 30% in California and in in Georgia and Texas, and so that will become the predominant strain. I mean, that's what's going to be circulating here in the US. It is more contagious. That doesn't mean that it's going to be a fourth wave. Another epidemic of B117. It just means that it's going to take over the virus, and so it might take over 100,000 infections a day. Or more likely, it takes over 10 or 15. You know 20,000 infections a day and an most of the infections that are happening will be 17. The other two variants that we're worried about that aren't as prevalent in the US, and we're not sure there more fit, meaning we're not sure that they really have an advantage like B117 dozen or more contagious are the South African variant, which is called B. 1351, and the Brazilian variant, which is called P1, and so the concern is and we don't know this for sure, but the concern is that people have had the old strain of coronavirus can now get reinfected with these new strains. And it's possible that the vaccines are less effective, but less effective doesn't mean not effective, and I think we're very unlikely to lose these vaccines. I think even if there is a decline in effectiveness and some of the data so far has shown about a 20% decline in effectiveness, you still dealing with very highly effective vaccines. And then if you boost them again and that gives you an additional boost against the the new variant, you end up having a vaccine that still is pretty effective. Final point I'll make is, you know. The question is, is this. Is this the future? Like every year we're going to have to get a new vaccine. Just like with the flu, and it's going to have to cover the new variant. I think we don't know. We first of all, so this is all conjecture, but I think the answer is probably not. Most people who are looking at this who understand the biology of the virus and understand the way that it's evolving think that there's sort of a finite number of ways that this virus can change itself to evade our immune system, but still be able to bind to our E 2 receptor. Remember, it has to do two things if it wants to mutate and be successful. It has to change that receptor binding domain in a way that is not recognized by our immune systems anymore, but it still has to attach well to our lungs to the ace two receptor and so it's not easy to do both and so if it changes self to evade our immune system, more likely than not it's going to change in a way that it doesn't bind as well. So there's probably a finite number of ways that this virus is going to mutate and and a lot of people think it's already done. A lot of them, like if there is 30 things that's going to do, it's already shown us 20 of AM. And maybe there's 10 left. Then we'll have to figure out those 10, but this isn't going to be like flu where it's an endless series of mutations in every year. It could be completely novel an evade our prior immunity Corona virus is going to sit somewhere in between like measles, measles. The measles virus can't mutate in a way that it can accept different proteins on its surface. So it if it mutates, it can't. It's unable to do that. It's unable to change its surface proteins. Flu, on the other hand, as you know. Yeah, yeah, and sometimes within a season this probably is in the middle somewhere you know, can mutate and change the surface proteins, but only in a finite number of ways. So I mean that brings up an important question and I know when when I was getting my vaccine we could actually, depending on the site they would tell you this site has this type of you know this vaccine available. But what are your thoughts on this in terms of, you know the effectiveness and you know we've heard a lot of if you can get a vaccine, just take one man. And that's been pretty much, you know, the the thought on this an even with these new variants. If your vaccine that you've had, even if it's not specific to the new variant, you're still going to have some level of immunity that may help you avoid hospitalizations and deaths. Want to sort of get your thoughts on that particular and then area? And then are we going to see any other? Is there anything else in the pipeline in terms of new vaccines that may be coming and may help the supply of vaccines? Yeah, I mean, I think your point is the right one, which is if you're offered a vaccine, get vaccinated now. These vaccines are all highly effective and I think it's hard to make cross comparisons between the vaccines they were tested in different populations at different points in time. They have different features. You know that the. There is some belief that the Johnson Johnson vaccine, which is a viral vector vaccine, elicits more of a T cell response. The M RNA vaccines are listening more of an antibody responses, so you're getting a different kind of immune activation, but they're all highly effective. I think that you know if you're sort of offered the opportunity vaccinated. You should get vaccinated, and these things are going to get worked out over time. We're going to understand the durability of the immunity of the vaccines are confirming how much they are, listing an antibody response, versity saucepans, you made a great point. Before about, you know the hospitalizations in the overall sort of morbidity in the population, which is that we need to understand that that vulnerability to population is being sharply reduced with vaccination. People who are most vulnerable to Covid are being protected that that protection is not 100%. People are still at risk of contracting it, but they're at much less risk. I mean, that's what the data shows and the data is pretty convincing at this point, and so if we're in a situation where we have 15,000 infections a day in the summertime. That's not the same as 15,000 infections a day last summer, because now the case mix is going to be probably skew much older, younger, much less vulnerable population, and so it represents a different level of risk, and we need to start back doing that into how we judge policy right now. I think policy makers are still very focused on prevalence and how many infections are there a day. And that's OK for now, but I think once we get more, the vulnerable population vaccinated, we need to look not at prevalence alone, but. What is the overall vulnerability the population to the infection? Can we tolerate a certain number of infections a day knowing that it's going to represent much less death and disease, and you know, I suspect we're going to see a real divergences between and you look at this data closely between hospitalizations and cables, right? I mean, you already seen you re seeing hospitalizations come down a lot of that has possession date. And actually, I'm curious to get your thoughts. And it's probably people have been hospitalised, some of them are for prolonged period of time, and so they're going to remain. Housewives people have had sequelae of Covid, but I suspect you're going to see as a divergences between cases and hospitalizations where there might have been several linear relationship. That relationship will be right Bonaparte. Now I agree with that. I think that you're going to continue to see a decrease in the number of hospitalizations, but you know you could see ups and downs in terms of the number of cases, but the people that are going to be impacted, our younger population and so chances are they're not going to be winding up in the hospital or. Facing mortality, so the picture looks looks better ahead, but Scott, what can we expect? Are there other vaccines that are being developed? You see that also helping? 'cause as demand goes up, you know to have some others in the pipeline. First of all, I think we're going to have all the supplies we need in the United States. I think we're going to be in position to be able to, you know, start world, yeah, why, right? You know the government is contacted for an amount of vaccine that can cover the population population. Probably twice now. That said, I think they're going to end up stockpiling a certain amount for the fall to potentially use as boosters. But I still think we're going to be in position if things go well and there's no manufacturing snafus. And the companies continue to produce, and there's no reason to think that they won't. We're going to be in a position to have. Enough vaccine to cover the entire population and stockpile to provide for boosters in the fall. Now there are other vaccines in development. The two that the one is probably furthest along right now is by Nova Vax, which is a protein based vaccine, another one by Astra Zeneca, that offer potentially certain advantages in terms of how they are stored and how they are handled, where they don't need the to be kept in as cold temperatures for extended periods of time, so they might allow for delivery in more austere settings is basically 3. Vaccine platforms one is the M RNA platform which is Pfizer and Moderna. The other is viral vector platforms which is Astra Zeneca and JJ an in protein based platforms which is Sanofi and Nova VAX. Those are the furthest along and just sort of give a very brief explanation of both. They're all doing the same thing at the end of the day which is delivering to your body. That spike protein and doing it in a way that your immune system can see it and in develops an immune response to spike protein. Let's you develop T cells and B cells that are programmed to recognize the virus. If it ever gets into your blood because you've now been exposed to that one component of the virus that the immune system can recognize, which is the spike protein. But they do it in different ways. Let's talk about what you know, what the future holds for healthcare. The Medicare program. Obviously we made a lot of changes around Tele Health and making sure that patients could access health care, even though a lot of them were quarantining at home, but. What are your thoughts on sort of the future impact? You know we were trying to still get through the vaccine distribution process and all of that, but you know, at some point we're going to get to that point of herd immunity. What do you think that the long lasting impact will be on the health care system? Yeah, I mean, I'm going to put this back to you because I think a lot of the long I think the most visible, durable changes in the health care system is going to be changes. Insight of service changes in ways that people access healthcare system. I think that we've now sort of. We've taken, you know, the adoption curve and accelerated for things like Tele Health and you did a lot of that. You put in a lot of the changes that enabled that. I think that's going to be durable. So I mean, I would put the question back to you. Is how durable do you think that those changes are going to be? And and also some of the things that I think it's worth talking about some of the things that you put in place to try to. Create the reimbursement mechanisms for that to enable that rapid adoption of telehealth and you know and just just for my own microcosm, you know we had multiple pediatric visits and we never used it before. All of a sudden we were using Tele Health and we found out we liked it and it worked really well. And there were things that you know you could do just as efficiently, so I think we've sort of forced people to now acclimate themselves to this. And a lot of people have discovered it's actually quite efficient. Yeah, I would agree with that. I mean, you know from from the see Ms standpoint, the agency had been looking at Tele Health for awhile because I think it had the ability to address lots of different problems. Accessibility issues in rural areas, nations facing an opioid epidemic, and so to be able to provide more mental health services remotely. So when the pandemic came, you know we really scoured all of our policies to make sure that Tele health could be widely available. You know, buried in the Medicare program was, you know, Tele health services were. Only available in rural health areas and even the Tele health that was available there were a lot of limitations. There's a lot of services in the Medicare program that require them to be in person or in the case of nursing homes. That says you can only have one Tele health visit a month. So we had to really go through the entire program. Every single area to make sure that we had this widespread use. Really kind of, you know, took off all of the guardrails and just opened it up. And you're right, it's been a dramatic adoption an on both sides, I think. Patients were reluctant originally and sewer providers and they were sort of forced to use it. And like you said, I think people have appreciated it going forward. I don't see Tele health replacing in person care, but I think it's something that can augment it and it's really going to be up to the doctor and the patient to decide when is it appropriate to have an in person visit and when do we feel more comfortable doing this remotely. You know, in terms of the longevity, Congress is always has already said that for the Medicare program, they're going to allow. Mental health services to be a permanent benefit and it won't be just in rural areas. It will also be, you know, throughout the entire program, no matter where you live. But there's still a question of all the other services that have been provided remotely. Right now they're even doing Tele health and emergency rooms, and so whether that will be continued, I think this is going to be a big question though for policy makers to sort of figure out what are the parameters around Tele health, is it appropriate for every visit? Or is it more of the low level? More routine visits that you can do remotely is as a check in, but you know something more complex. Would we actually feel comfortable? Do we think that that's going to provide the appropriate quality to do that remotely? And I know for the agency those were things that a lot of the staff had a lot of questions about, and so I think there's going to be some more study around this, not only for the Medicare program, Medicare Advantage plans, but really payers across the board. That being said, I think there will be some. Ovation of the benefit across most insurance companies to some degree, but you know it just may vary in terms of what they allow for what types of services, but I think we've all learned a lot from this. The other thing that's been sort of exciting is when we think of Tele Health, we're thinking about it in terms of just these routine interactions that you have with your physician. But what's been really exciting is you know late last year probably, November, December. See, Ms even went further with Tele Health and we. Allowed hospitals to provide services outside their four walls. We call that first. We had hospital without walls and then we actually called it hospital at home. And so we've learned a lot of a lot more about remote care and remote monitoring and how those can be really important to managing a person's health. And, you know, for hospitals that were facing issues with capacity, if they were able to move some patients and they've actually seen some very successful models where patients were being able to be monitored at home, and that's that's really important. No one really loves staying at the hospital. And to know that you can still have some connection to the hospital and they're still going to be monitoring your care. That is something if there's an issue that they can provide, you know, send out in an ambulance, or send a nurse to see you everyday. I think those are some really important advancements that really may impact hospital care, an even for our routine care. In terms of that remote monitoring where you may have a system where even if you're not going in to see the doctor, there still have to have a way of. Monitoring your care. Lots of implications for home health and also for nursing homes. You know nursing homes who are really impacted significantly by the Covid virus. And I think there's going to be a lot of discussions going forward about nursing homes and whether there could be some more alternatives. You know we have home health services and a lot of personal care services that are available, but maybe with remote monitoring there could be sort of a new era of innovation around home care that may prevent. Hospitalizations or longer hospitalizations, and may allow some alternatives to nursing home care. What do you? What kind of use cases were you seeing with Tele Health? Do you think is going to be the most enduring when you were looking at the patterns of utilization? Yeah, I mean, I think the mental health services were very clear. You know, throughout the pandemic, you sort of saw some changes. You know, for different specialists we saw an increase during the. You know, I would say the more significant quarantines in March and April, and then it, sort of. Slow down as things were opening up, but mental health services have really remained constant. So even as service areas of the country were opening up and even for the most part now things are open. You know you're still seeing high levels, or still a lot of billing for those evaluation and management type visits. We especially in the mental health area. Those have always remained high. I would think that that's going to be durable, 'cause I think consumers have come to like being able to access health care through Tele health. Well, it's just more convenient. You know, especially for Medicare patients where sometimes driving may be a barrier to Karen and in rural areas who have been very significantly impacted by covid, this could be a real alternative and and even for many areas in the country, they face shortages when it comes to specialty care or subspecialist care. And so. This is also an opportunity to augment those services across the country that will increase quality. Yeah, so let me ask you just pick your brain. I know a lot of our viewers have questions, you know, post Covid world. What can we expect from the Biden administration in terms of health policy? What types of things do you see coming up and what we can expect from the new administration? Yeah, I mean broad question. They want to put it back in your area. Else I mean, I think the most profound things are actually going to touch on your area. I think that coming out of this there is going to be increasing focus on a lot of the accrued morbidity. In fact, that people haven't kept up with health care over the last year. People missed visits. Miss vaccinations didn't go for cancer screenings, and we're going to see increase rates of health problems as a consequence of that, you know, we were seeing also, addiction levels increase again in the country rates of alcohol use of increased. And so I think that there is going to be a lot of emphasis on how do we expand access to health care services to try to work off and try to address some of that accrued morbidity. And so you're going to see the administration focus on ways to expand eligibility for some of the existing programs. You know, arguing that people make, we need to make sure people have access to not just adequate health care, high quality health care because of because of the hit that we've taken collectively as a population. You know what that looks like? I think you know. Your guess is as good as mine, but I think it's going to look like what we've seen. You know, expansion eligibility for the Affordable Care Act, expansion of Medicaid, trying to get more. Make sure more people are in programs and in trying to make sure the programs are resourced adequately. Deliver services and where their money is going to probably be made up where they're going to try to find some money to pay for this is from the technology from pricing on some of the new technology, and we already saw that in the. In the Covid relief bill, where there weren't a lot of pay, fors in that $1.9 trillion bill but one of them was on drug pricing where they had something specific in there that took down reimbursement for drugs as a way to help offset some of those costs. Now, that's that's a great point, you know. I think that the coverage piece has been a big thing for the Biden administration. That the recent bill does include a lot of expansions for people on the Affordable Care Act. They all say, I think they want to see more states expand Medicaid coverage, but as you know that that decision is up. To the States and the finances on this, I think are going to be significant. Any coverage expansion and I think that some of those are temporary, but they've also included some more special enrollment periods and put a lot more money into advertising to help people be aware of the of the new options. But I think over the long term, how we pay for the health care services or for these expansions is going to be important. You know from my perspective, I think that the administration is also going to be focused on how do we make our healthcare system more affordable and more efficient? Because we can keep putting people on government programs, but ultimately we've got to figure out a way to make our system more affordable and so things like value based care, I think are going to be really important. But I know for a lot of our Medicare patients that are watching, you know, sometimes it can be overwhelming, and both, you know, I've worked on the Medicare program. What advice do you have for some of our patients in terms of approaching all of the different options that they have? Yeah, I mean you, you're in a better position to answer that than I am. Terms of having run, running the programs, but you know, look, I think that there is much better tools in place right now to make comparisons between different plans and what existed at the outside. The program. I was there back in 2005 when Medicare Advantage in the party drug benefit first got underway and it was hard to look across different plans. The tools for making comparisons about you know how you as a patient would would fare in a different plan just in terms of looking at what your drug spend would be on a different Part D plans just didn't exist. Now they exist. I mean, now there's really good tools for doing that, and so I would encourage people who are looking for a plan to take advantage of the tools that Medicare is built and the tools that have sort of been built up outside the program to help inform those decisions. Yeah, I would agree with that. You know, one of the things that we worked on for the past few years was to empower beneficiaries and make sure that they have information so that they can make decisions that are going to work best for them. On the Medicare website, there's compared comparative tools so you can kind of figure out. Do I want to be in Medicare Advantage? Or do I want to be in the traditional program so they help you make that decision, and then if you do choose Medicare Advantage, using outside advisors is it can be helpful using a broker. You can also call the one 800 number to have your questions answered, but the website for the first time was updated. The Plan Finder tool and it even allows you to put in your Medicare number and automatically updates all the medications that you're taking so it makes it much easier to pick out that Part D plan so. We've really encouraged people to shop around for plans over the last four years, premiums have gone down by about 34%, and in some areas of the country, those price decreases or even more significant, so it's always a good time. You know, during those open enrollment periods to shop around, obviously we want to make sure our Medicare beneficiaries you know, check to make sure that your doctors in the plan that that you're picking the other new thing that's come out with the Medicare program, is the ability for plans to offer more supplemental benefits. And I think what we've all realized from Covid is that there's a lot of things that goes and go into somebody's overall health, and the health outcomes that that may be achieved. And a lot of that has to do with sort of the social determinants of health, and we've allowed the health plans to provide more benefits so it could be something simple like you're coming home from the hospital. You just had surgery, and they may arrange for meal service. Or it could be a ramp that the insurance company will agree to pay for in your home. Just to help you go up and down the steps so there's a lot of new benefits, I think in the past we've seen dental benefits and you've seen hearing aids, but we're now in a new era where we're seeing a lot of creativity from plans and they're offering new benefits. I think there's a plan in Florida that provides pest control services because they recognize that that was something that was impacting a lot of their beneficiaries in terms of controlling asthma and other respiratory illnesses so. Really just encourage people to shop around. There's always during open enrollment there's opportunities to talk to volunteers and outside advisers. You know what I found is that everybody's needs are unique. You know your health care needs, the types of doctors, the medications that you're on, and so it's always a good idea. You know, if you have questions to get some outside help. Yeah, and the tools have gotten a lot better. I mean, I've navigated some of them, they've gotten a lot better. What's available on the Medicare website to try to make those decisions? Well, I know we're getting some questions from the audience, and so I'm going to take a look at some of these and will try to answer them. One of the questions that we just got in it says my cardiologist won't accept Medicare patients. He says that because Medicare would take many months and even longer to pay him an that there's delays in paying him were a part of Medicare's business model. Is that true? Anne also related. I think there's a question here that says Medicare is not is not accepted in the secondary. Insurance won't pay either. So as the former head of the Medicare program, I can say there was no effort to try to push out providers. In fact, we try to do everything that we can to encourage providers to participate, and we've seen the number of providers remain relatively stable. You know, there's a lot of providers that don't want to go through the paperwork process. We obviously do a lot of background checks on the providers. But you know, we actually had an initiative called patients over paperwork to make the process easier for our providers. Now if you do have a provider that's not in the Medicare program. You know that what that really means is that they're not going to accept the Medicare rates and that they can potentially bill you if there is a difference between what Medicare may reimburse. So that's always something to to check into. Also advise people you know get outside help when you're picking a plan or seeing a provider you know even advise health, they can help you with that. You want to make sure that the doctor that you are used to seeing is part of the Medicare program, and if they're not, you understand what the implications will be. You know, in terms of any out of pocket expenses that you may have another question that we got here was says when you're ready to retire, when should you switch from your employer insurance to Medicare so that there's no lapse in coverage? Well, that's a great question because you know, if you don't do that in a timely way, you could face some penalties with the with the Medicare program. The big decision is Medicare Part a, Part B, and which one are you going to take? This is something that's very different. For every person, it depends on whether you're going to have access to health insurance when you do retire, so does your employer offer some type of benefit. Is your spouse still employed and do they have an insurance plan? I think the most important thing is you want to make sure that you have seamless coverage, and so if you don't have access to another plan, I would advise that you do that as quickly as possible. Get some help with that process. Figure out whether you want Part A and Part B. But officially you have, you know, eight months after the time that you retire to sign up for a new plan. So it may be again depending on your situation, you want to make sure that that seamless and you can start that process before to make sure that there's no lapse in coverage. But even if you have something with your spouses employer or an employer plan, there's sort of that eight month period to do that election on Part A and Part B. Again, this is something that we encourage people to get. Outside help, because everybody's situation is different. That's something that you know are some of the folks around advise can also help with as well. Other question here is that why are Medicare costs so very Dan? Why is that not more regulated? Well, Medicare is a highly regulated program, and so we do set the rates for services for every single service that the program pays for. That may vary in the Medicare Advantage program in terms of out of pocket expenses. There is also variation, however, when it comes to different geographies. 'cause one of the things that the program takes into consideration, our labor costs. So it may be. More expensive to cover labor costs in the Boston area as opposed to Topeka, KS. So there is some variation but a lot of thought goes into what the base payment is and then there is some variation because of geography. The other question that we get I always got this question a lot was when you're covered by Medicare tests that were a regular part of your annual physical lab tests and actual exams and the doctors offices are no longer covered. Does Medicare provide a lower standard of care and is there another option? So you're right, the Medicare program does not cover an annual physical the way the program was set up in laws that it talks about. Providing, you know more treatment services and that's considered more diagnostic. However, there has been a recent change that was not recent. Probably the last 10 years with the Affordable Care Act that we they do provide annual Wellness exams. And so it's really important when you're making your appointment to. Specify that what type of service you're looking for. 'cause an annual physical may have some blood work, some laboratory services, and that wouldn't be covered. An annual Wellness visit is something where they're doing a risk assessment. They're not going to be doing labs, but they'll still obviously check your weight and height and some routine things, and they also do a risk assessment and try to identify potential issues that you may have, so that's just a distinction that you want to make sure you're very clear on. Again, Medicare Advantage plans may have different policies, and so in that case would encourage you to talk to your plan will Sky as we wrap up from from a doctors perspective, any advice for our Medicare patients? The look ahead, you know. Many of our patients as you said, have delayed some of the needed care an we have seen. You know some concerns in terms of people getting cancer. It's more advanced stages. Any other general advice for our Medicare patients for their overall health? Yeah, look, I think I think people should try to get care this summer. If they've delayed care, go to the dentist, do the things that you might have put off, especially people who are vaccinated, fully vaccinated. I think that prevalence is going to decline. The vaccines have demonstrated to be fairly protective against the virus. I think there's going to be an opportunity this summer to really get back to normal activity. Well, I think that some all the time that we have today to take questions, but really appreciate Scott. It's good to see you Anna great conversation and but it's been been wonderful seeing you and thank you for everybody that participated today. Wow, that was an excellent discussion. I'd like to thank Doctor Gottlieb, an Seema Verma for sharing their thoughts with us today. I don't know about you, but my mind is swirling with all of the great information that they provided. Now at this point I'd like to invite you to hear more about health care in your area from physicians representing your health care provider. To join the discussion, simply click the button on the screen that says attend session. Here under your doctor's practice, you'll be able to join the sessions as soon as this portion of the event ends. I'll give everyone a couple of minutes to locate the right discussion before we get started. _1619176009074
