For a synopsis of the Roundtable, please read the Full Event Proceedings Document
Roundtable Event sponsored by Grantmakers In Aging, Grantmakers In Health, LeadingAge, National Alliance for Caregiving, National Coalition on Health Care, National Consumer Voice for Quality Long-Term Care, and OWL - The Voice of Midlife and Older Women
The recent wave of proposals to reform the health care system and “bend the cost curve” present a tremendous opportunity to improve care for the fastest growing, most expensive, and least well-served age group in the U.S.—our frail elderly.
Americans in advanced old age generally have complex health and social situations, limitations in self-care capabilities, and limited financial and personal resources. Yet the health and social services we need when old and frail are poorly planned, unnecessarily costly, and disconnected.
As the nation considers different strategies and policy changes to strengthen and streamline health care, we must also include a special focus on the distinct priorities and preferences that we will have when we are old and frail, as well as those of our family members and caregivers.
This roundtable focused on health care reform and elderly Americans living with frailty in their last years, addressing questions such as:
- How serious are the shortcomings in services and the expected growth in costs as the population ages? How much time do we have to make arrangements for the coming increase in numbers?
- What should we promise to individuals living with frailty in old age and their families? How does this differ from the current trajectory?
- Half of those who live past 85 years old will have cognitive failure. What health care, social supports, and financial arrangements would serve people touched by this challenging situation?
- Which of the current reforms and trials offer prospects of moving us toward a workable set of solutions—that is, more appropriate and desirable services, at lower cost? Are there additional strategies that should be tested and developed?
- What role might local coalitions, commissions, and communities have?
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- Joseph Antos, Wilson H. Taylor Scholar in Health Care and Retirement Policy, American Enterprise Institute Presentation Slides
- Shannon Brownlee, Senior Vice President, Lown Institute; Senior Fellow, New America Foundation; Instructor, The Dartmouth Institute for Health Policy and Clinical Practice
- Suzanne Burke, Chief Executive Officer, Council on Aging of Southwestern Ohio
- Susan Dentzer, Senior Health Policy Adviser, Robert Wood Johnson Foundation - Moderator
- John Feather, Chief Executive Officer, Grantmakers In Aging
- Jennie Chin Hansen, Chief Executive Officer, American Geriatrics Society
- Sen. Johnny Isakson (R-GA)
- Joanne Lynn, Director, Altarum Institute Center for Elder Care and Advanced Illness
- Anne Montgomery, Senior Policy Analyst, Altarum Institute
- John Rother, President and Chief Executive Officer, National Coalition on Health Care
- Mimi Toomey, Director, Office of Policy Analysis & Development, Administration for Community Living
Continental breakfast starts at 8:30 a.m.
Lincoln Smith, President & Chief Executive Officer, Altarum Institute
Susan Dentzer, Senior Health Policy Adviser, Robert Wood Johnson Foundation - Moderator
9:10 – 9:40 a.m.
Growing Old in America: The Status Quo and an Alternative Vision
Elizabeth F. Falcone, Legislative Assistant for Health Care
Shannon Brownlee, Senior Vice President, Lown Institute; Senior Fellow, New America Foundation; Instructor, The Dartmouth Institute for Health Policy and Clinical Practice
Jennie Chin Hansen, Chief Executive Officer, American Geriatrics Society
Questions and Comments
9:40 – 10:30 a.m.
Current Policy Plans and Proposals: “Building Blocks” for Improving Services for Frail Elderly People
Joseph Antos, Wilson H. Taylor Scholar in Health Care and Retirement Policy, American Enterprise Institute Presentation Slides
John Rother, President & Chief Executive Officer, National Coalition on Health Care
Questions and Comments
10:40 – 11:30 a.m.
Community-level Changes that Promote Living Well in Advanced Old Age
Mimi Toomey, Director, Office of Policy Analysis & Development, Administration for Community Living
John Feather, Chief Executive Officer, Grantmakers In Aging
Suzanne Burke, Chief Executive Officer, Council on Aging of Southwestern Ohio
Joanne Lynn, Director, Altarum Institute Center for Elder Care and Advanced Illness
Questions and Comments
Lunch is offered following the event
Anne Montgomery, Senior Policy Analyst, Altarum Institute Center for Elder Care and Advanced Illness; Visiting Scholar, National Academy of Social Insurance
Mr. Antos's research focuses on the economics of health policy—including Medicare and broader health system reform, health care financing, health insurance regulation, and the uninsured—and federal budget policy. He has written and spoken extensively on the Medicare drug benefit and has led a team of experienced independent actuaries and cost estimators in a study to evaluate various proposals to extend health coverage to the uninsured. His work on the country’s budget crisis includes a detailed plan to achieve fiscal stability and economic growth developed in conjunction with AEI colleagues.
Joseph Antos is also a health adviser to the Congressional Budget Office and recently completed two terms as a commissioner of the Maryland Health Services Cost Review Commission. Before joining AEI, Mr. Antos was Assistant Director for Health and Human Resources at the Congressional Budget Office and held senior positions in the U.S. Department of Health and Human Services, the Office of Management and Budget, and the President’s Council of economic Advisers.
Ms. Brownlee is a nationally known writer and essayist whose work has appeared in The Atlantic, New York Times Magazine, The New Republic, Slate, Time, Washington Monthly, Washington Post, Los Angeles Times, and BMJ among many other publications. She is best known for her groundbreaking work on overtreatment and the implications for health care policy. Her book, Overtreated: Why Too Much Medicine is Making Us Sicker and Poorer, was named the best economics book of 2007 by New York Times economics correspondent David Leonhardt. Ms. Brownlee’s current research and writing focus on issues surrounding clinical evidence, overuse of medical services, and productivity in the health care sector.
A former senior writer and editor at U.S. News & World Report, Ms. Brownlee lectures regularly at universities and medical schools. Her work has received numerous journalism awards, among them the Society of Professional Journalists Sigma Delta Chi Award, the 2010 American Society of Journalists and Authors June Roth Award for Medical Journalism, and the Victor Cohn Prize for Excellence in Medical Science Reporting.
Ms. Brownlee holds a master’s degree in marine science from the University of California, Santa Cruz (UCSC), where she received the Alumnae Achievement Award of 2012. She was named one of the 45 most influential graduates of UCSC in 2010, the 45th anniversary of the campus’ founding. In 2009 she was named one of four writers who changed the world by the World Federation of Science Journalists. A former Knight Journalism Fellow at Stanford University, she currently serves on the boards of Families USA and the Robert Graham Center of the American Academy of Family Practice. She is a senior fellow at the New America Foundation and an Instructor at the Dartmouth Institute for Health Policy and Clinical Practice.
Ms. Burke became Chief Executive Officer of Council on Aging of Southwestern Ohio in 2005.
Previously, she worked for Hamilton County for 17 years serving as the Acting Hamilton County Administrator, Director of the Department of Job & Family Services, and Director of Administrative Services (County Budget Director) among other positions.
Ms. Burke has a master`s degree in Business Administration (Marketing) from Xavier University and a bachelor`s degree in Marketing with a minor in Gerontology from Miami University.
Ms. Burke is President of the Board of the Ohio Association of Area Agencies on Aging. She also serves on the boards of Every Child Succeeds; the Leadership Council of Human Services Executives; Southwest Ohio Regional Transit Authority; and iTN Greater Cincinnati.
Ms. Dentzer, a renowned health policy expert, health policy analyst for the PBS NewsHour, and former editor of the influential journal Health Affairs, currently serves as a senior health policy adviser at the Robert Wood Johnson Foundation.
Ms. Dentzer completed five years as editor-in-chief of Health Affairs, which she transformed from a bimonthly academic publication to a topical monthly journal. She served as on-air health correspondent for the PBS NewsHour from 1998 to 2008, and remains an on-air analyst on health policy for the show. She is also a frequent guest on a number of National Public Radio programs, including This American Life and The Diane Rehm Show.
Ms. Dentzer is an elected member of the Institute of Medicine and the Council on Foreign Relations, and a public member of the board of directors of the American Board of Medical Specialties, a nonprofit organization overseeing 24 approved medical specialty boards that set standards for board certification for the nation’s physicians. She is also a member of the Board of Overseers of the International Rescue Committee, a humanitarian organization providing relief to refugees and displaced persons around the world. She chairs the IRC board’s Program Committee, which oversees the organization’s activities in resettling refugees in the United States and dealing with refugees and displaced persons in roughly 25 countries.
A Nieman Fellow at Harvard University in 1986-87, Ms. Dentzer is a graduate of Dartmouth and holder of an honorary master of arts from the institution. She is also a Dartmouth trustee emerita, and was the only woman to date to chair the Dartmouth Board of Trustees, from 2001 to 2004. She has served on the Board of Overseers of Dartmouth Medical School since 1993.
Dr. Feather is Chief Executive Officer of Grantmakers In Aging, the national association of grantmaking foundations and other organizations that work to improve the lives of older people. Prior to beginning that position in 2011, he was Executive Director and CEO of the American Society of Consultant Pharmacists, the national membership organization of pharmacists who specialize in care of older persons. Until 2002, he was Director of the AARP Andrus Foundation, the research and education charity of AARP.
For the seventeen years prior to that appointment in 1995, Dr. Feather held several positions at the State University of New York at Buffalo including Clinical Associate Professor of Medicine in the Division of Geriatrics and Gerontology and Executive Director of the Primary Care Resource Center. Prior to that he was Director of the Western New York Geriatric Education Center.
Dr. Feather is currently Chairman of the Board of Directors of the American Society on Aging, Treasurer of the National Hispanic Council on Aging and Board Member of the National Hospice and Palliative Care Organization.
Dr. Feather is an organizational sociologist by training, and received his undergraduate education at the University of Texas at Austin and his masters and doctoral degrees at the University of Michigan at Ann Arbor. He has earned the designation of Certified Fund Raising Executive (CFRE) and Certified Association Executive (CAE).
Ms. Hansen is currently CEO of the American Geriatrics Society. In May, 2010, she completed her term as president of AARP following six years on the AARP national board of directors. Prior service includes nearly 25 years with On Lok, Inc., a nonprofit family of organizations providing integrated, globally financed and comprehensive community-based services for older people in San Francisco. On Lok's groundbreaking fully capitated and coordinated service delivery became the prototype for the 1997 federal law that incorporated the Program of All Inclusive Care to the Elderly (PACE) into the Medicare and Medicaid programs. In 2010, Ms. Hansen completed a six-year term as a federal commissioner of the Medicare Payment Advisory Commission (MedPAC). She currently serves as a board member of the SCAN Foundation and the Institute for Healthcare Improvement (IHI). She also serves on the American Hospital Association (AHA) Equity of Care Committee and is co-chair of the steering committee for the Coalition to Transform Advanced Care (C-TAC). Since 2012, she has been appointed to the national Veteran’s Administration Advisory Committee on Gerontology and Geriatrics and the Department of HHS’ National Institutes of Health-National Advisory Council on Aging.
Ms. Hansen has received the Award for Productive Aging, a 2010 Innovator in Health Award from the New England Healthcare Institute and the 2011 Picker Award for Excellence in the Advancement of Patient-Centered Care in Long-Term Care.
Johnny Isakson is a businessman, a public servant and family man whose conservative, thoughtful and independent approach have made him a leader in Georgia for over 30 years.
Johnny began his business career in 1967 when he opened the first Cobb County office of a small, family-owned real estate business, Northside Realty. Johnny later served as president of Northside for 20 years, presiding over the company’s growth into the largest independent residential real estate brokerage company in the Southeast and one of the largest in America.
Johnny entered politics in 1974 and served 17 years in the Georgia Legislature and two years as Chairman of the Georgia Board of Education. In 1999, Johnny was elected to the U.S. House of Representatives for the first of three terms before being elected to the U.S. Senate in 2004. He was re-elected to the Senate in 2010.
In Washington, Johnny has proven to be a leader who gets results. When the mortgage and financial crisis hit in 2008, Johnny drew on his decades of experience in real estate in offering solutions to reduce the inventory of foreclosed homes and to restore the nation’s housing market.
The Senate overwhelmingly passed his legislation to create the Financial Crisis Inquiry Commission, styled after the 9-11Commission, to investigate the near collapse of the banking system and loss of tens of trillions of dollars.
Johnny continues to lead in Congress through his successful bipartisan efforts to address federal spending, reduce the debt and change the way Washington does business. He introduced the Biennial Budgeting and Appropriations Act to end reckless spending and reform the federal budget process by converting it from an annual spending process to a two-year cycle, with one year for appropriating federal dollars and the other year devoted to much-needed oversight of federal programs. Johnny follows his own advice and has returned more than $3 million of his own office budget to the Treasury over the years as a former member of the House and current member of the Senate.
In January 2013, Johnny was named to the U.S. Senate Committee on Finance, which has jurisdiction over taxes, trade, Medicare and Social Security and which plays a critical role in the debate over cutting spending and reducing our nation’s debt.
Johnny has worked to strengthen our Armed Forces, and he continues to show unwavering commitment to the men and women who have served our country.
On energy, Johnny is committed to lessening America’s dependence on foreign oil as well as pushing for alternative energy sources and conservation.
Johnny was an original author of the No Child Left Behind Act, the most significant improvement to our education system in a generation.
He continues to push for immigration reform that is built on a foundation of securing our borders first.
Johnny is a 1966 graduate of the University of Georgia and he served in the Georgia Air National Guard from 1966 to 1972. Johnny and his wife, Dianne, have been married since 1968 and have three grown children and nine grandchildren. They live in Marietta, Georgia, and attend Mount Zion United Methodist Church, where Johnny taught sixth-grade Sunday school for 30 years.
Dr. Lynn is a geriatrician, hospice physician, health services researcher, quality improvement advisor, and policy advocate who has focused upon shaping American health care so that every person can count on living comfortably and meaningfully through the period of serious illness and disability in the last years of life, at a sustainable cost to the community. She now leads the Altarum Institute Center on Elder Care and Advanced Illness.
She recently has been a consultant to the Administrator of the Centers for Medicare and Medicaid Services, a faculty member of the Institute for Healthcare Improvement, and a clinical expert in improvement for the Care Transitions project at the Colorado Foundation for Medical Care. She has also been a senior researcher at RAND and a professor of medicine and community health at Dartmouth Medical School and at The George Washington University.
Dr. Lynn has published more than 250 professional articles, and her dozen books include The Handbook for Mortals, a guide for the public; The Common Sense Guide to Improving Palliative Care, an instruction manual for clinicians and managers seeking to improve quality; and Sick to Death and Not Going to Take it Any More!, an action guide for policymakers and advocates. She has also authored amicus briefs for key appellate court cases and has been often interviewed by reporters. She is a member of the Institute of Medicine and of the National Academy of Social Insurance, a fellow of the American Geriatrics Society and The Hastings Center, and a master of the American College of Physicians.
Anne Montgomery is a Senior Policy Analyst at Altarum Institute’s Center for Elder Care and Advanced Illness and a Visiting Scholar at the National Academy of Social Insurance.
From 2007 to 2013, Ms. Montgomery served as Senior Policy Advisor for the U.S. Senate Special Committee on Aging, where she was responsible for developing hearings and legislation to improve nursing homes and home and community-based services in Medicaid, dually-eligible beneficiaries, health care workforce issues, elder abuse, dementia care, and community and social support services for older adults.
Ms. Montgomery has also served as a senior health policy associate with the Alliance for Health Reform in Washington, D.C., as a senior analyst in public health at the U.S. Government Accountability Office, and as a legislative aide for the Ways & Means Health Subcommittee.
Based in London as an Atlantic Fellow in Public Policy in 2001-2002, she undertook comparative policy analysis of the role of family caregivers in the development of long-term care in the United Kingdom and the U.S. During the 1990’s, Ms. Montgomery worked as a health and science journalist covering the National Institutes of Health and Congress.
A member of the National Academy of Social Insurance and Academy Health, Ms. Montgomery has an M.S. in journalism from Columbia University and a B.A. in English literature from the University of Virginia, and has taken gerontology coursework at Johns Hopkins University.
John Rother is President and CEO of the National Coalition on Health Care, America’s oldest and most diverse group working to achieve comprehensive health system change. The Coalition’s membership of more than 80 participating organizations includes medical societies, businesses, unions, health care providers, faith-based associations, pension and health funds, insurers, and groups representing consumers, patients, women, minorities, and persons with disabilities.
Prior to joining the Coalition in 2011, Mr. Rother served as the longtime Executive Vice President for Policy, Strategy, and International Affairs at AARP. There he led the development of AARP’s policy positions and advocacy strategies. Under his leadership, AARP engaged in robust public policy research and analysis, public education, and advocacy on health and retirement issues at the federal, state and international levels. Mr. Rother wrote numerous articles and was a frequent speaker on health, retirement security, the federal budget, and the boomer generation.
From 1981 to 1984, Mr. Rother was Staff Director and Chief Counsel for the U.S. Senate Special Committee on Aging under the direction of Chairman John Heinz (R-PA). From 1977 to 1981 he served as Special Counsel for Labor and Health to U.S. Senator Jacob Javits (R-NY).
Mr. Rother is a graduate of Oberlin College and the University of Pennsylvania Law School. He is a member of the DC Bar, the National Academy of Social Insurance, and the Gerontological Society of America.
Mr. Rother serves on several boards, including the American Board of Internal Medicine Foundation, the National Quality Forum, the Alliance for Health Reform, the Pension Rights Center, and Generations United. He also serves on the MacArthur Foundation’s Aging Society Network and the Institute of Medicine’s National Roundtable on Value and Science-Driven Health Care. He has consistently been named as one of the Most Powerful People in Healthcare.
In 2010 Mr. Rother received the Robert Ball Award for Outstanding Achievements in Social Insurance from the National Academy of Social Insurance for “lifetime advocacy to strengthen Social Security and Medicare.”
Mimi Toomey, MA, leads the Office of Policy, Analysis and Development at the HHS Administration for Community Living (ACL). ACL is the newest agency in HHS and brings together the efforts and achievements of the Administration on Aging, the Administration on Intellectual and Developmental Disabilities, and the HHS Office on Disability to serve as the Federal agency responsible for increasing access to community supports, while focusing attention and resources on the unique needs of older Americans and people with disabilities across the lifespan.
Toomey’s office identifies and analyzes emerging policy issues and trends related to the aging and disability populations and advances innovative program strategies consistent with the priorities established by the Assistant Secretary for Aging/ACL Administrator. She has over 25 years of multi-level experience on aging issues including directing local aging and disability community-based programs and national non-profit projects. She has been at the federal level for ten years and currently is focusing on policy as it relates to the Affordable Care Act around Medicare, Medicaid, prevention, workforce issues and innovations.
After four years in the Senate, Senator Mark R. Warner has established himself as a national leader in efforts to find bipartisan consensus both to make government more efficient and to create balanced solutions to reduce the federal deficit. He has also been a champion for our armed service members, as well as a leader in Congress in efforts to promote private-sector innovation.
From 2002 to 2006, Senator Warner served as Governor of Virginia, where he worked in a bipartisan way to turn record budget deficits into a surplus and recruit 135,000 jobs to Virginia, during which time Virginia was consistently recognized as the nation’s “best-managed state” and “best state for business.”
Before entering public office, Senator Warner was an early investor in the cellular telephone business. He co-founded the company that became Nextel, and ultimately made early investments in hundreds of start-up technology companies that have created tens-of-thousands of private sector jobs.