Remarks as Delivered at Alegent Health’s 2008 Symposium

Good day. Thanks for that warm introduction. A few months ago, I met with Wayne Sensor. We talked about our visions for health care in America. He told me about Alegent’s struggles and successes in improving their health care. He impressed me with Alegent’s commitment to transparency, science-based policies, quality measurement, and prevention orientation. It’s gratifying to see your approaches to health and wellness succeed, when so many of them are reflected in the President’s health care agenda.

So I was delighted when Wayne invited me to come speak to all of you about what we’re doing at the Department of Health and Human Services to complement your efforts to improve health care for all Americans.

One of my responsibilities as Deputy Secretary of Health and Human Services is to oversee agencies like the National Institutes of Health and the Food and Drug Administration. In this capacity, I learn about fascinating new things before anyone else. For example, I was recently briefed on an exciting new drug that a team of scientists at the National Institutes of Health just discovered. It’s a drug that will confer immortality. Unfortunately, it the Food and Drug Administration says that demonstrating efficacy will take forever.

Seriously, though, over the past several years, President Bush and Secretary Leavitt have been working hard to enact some serious, needed, meaningful reforms to improve health care in America. Our efforts are predicated on the belief that a good, effective government can do certain limited things right. It expands scientific frontiers. It convenes people and groups and sparks conversations and collaborations. It fosters — instead of interferes with — a competitive marketplace. It helps the needy.

Look at Medicare’s Part D prescription drug program, for example. Since consumers win when companies compete for their business, in 2003, President Bush worked with Congress to create a system in which seniors get to choose between companies that compete to meet their demands for prescriptions. We used the power of the federal government to establish and fund the framework rather than to mandate decisions that consumers and companies would prefer to make for themselves. Congress defined a basic plan, but 90 percent of seniors chose plans that offered more choices.

And now, more than 38 million Medicare beneficiaries have some form of prescription drug coverage. Costs are down. Satisfaction is up — 86 percent of seniors tell us they’re happy with their plan, which is staggeringly high praise for any program — government-run or not. We drew a line between government-run and market-run health care, and we succeeded.

Or look at stem cells. A decade ago, scientists discovered how to isolate stem cells harvested from embryonic people. It was amazing scientific breakthrough. But there were troubling aspects.

So in 2001, President Bush drew a line. He recognized that sometimes we as a society need to take moral stands — and that sometimes government needs to provide the leadership to encourage them to do so. So he decided to fund embryonic stem cell research with ethical conditions to ensure taxpayer dollars would not encourage the destruction of embryos.

Just recently, researchers have succeeded in creating genetically matched stem cells without harming embryos. When President Bush drew a line on embryonic stem cell research, he showed that while we support technological advances, we also recognize the importance of moral restraint. Now, we’re looking forward to seeing what advances and therapies are to come from the new discovery.

Health Savings Accounts are another example of how we have let individuals make choices to promote health care access. We decided to remove some of the distortions in our tax code that penalize families who want to have more control over their health insurance — rather than simply purchasing whatever their employer offers, assuming they’re even employed. So we created tax-free, portable Health Savings Accounts. Health Savings Accounts combine a tax-free savings account that can be used to pay medical expenses with a high-deductible, low-premium insurance plan. Employers can contribute money towards the premium and can also put money into the savings account. For 2008, an individual can contribute up to $2,900 and families can contribute up to $5,800 to pay for current medical expenses or save and invest for future medical expenses.

The key to Health Savings Accounts is that whatever the original source of the money in the savings account, the money becomes the beneficiary’s. Health Savings Accounts give Americans more incentives to consume health care more carefully and thoughtfully. Health Savings Accounts help put the power to make health care decisions where it belongs: in the hands of the consumer.

And now, more than four and a half million Americans have been helped, including many Alegent employees — and millions more will be helped in the future as word about HSAs spreads — by this new vision for affordable health coverage.

Another way to promote access for uninsured and underserved Americans is community health centers. In 2001, President Bush launched the Health Center Growth Initiative and set a goal to establish or expand health care options in 1,200 communities across the country. Since then, we have exceeded that goal through the President's expansion initiative, funding 1,236 new or expanded health center sites. The President celebrated this milestone just last month here in Omaha. That brings the total of comprehensive sites around America to over 4,000 — serving well over 16 million people. In doing this, we are bringing more health care options where before there were few.

But we have more to do. President Bush has set forth a bold vision of trusting in the American people to make their own decisions in strengthening the doctor-patient relationship, in working with our world-class doctors and hospitals, and in encouraging medical innovations and cutting edge technologies.

So we’re working to determine the appropriate role for the federal government and to make changes that will have a long-term impact.

We’re continuing to improve the accessibility of health insurance and eliminating more of the inequities in our tax code that make it harder for individuals to afford medical coverage.

We are attempting to prevent medical errors by working with doctors and hospitals to integrate health information technology and computerized physician order entry. CMS, for example, will no longer reimburse for events that should never happen. These might include a wrong site surgery or foreign objects forgotten in the bodies of surgical patients, or even conditions that hospitals should prevent from happening, like decubitous ulcers, or bedsores. We expect insurers, and eventually doctors, will follow suit.”

We’re working to reauthorize SCHIP and focusing it on its primary mission of helping low-income children.

As a new challenge has come upon HHS over the last decade — securing our homeland — we’re keeping our communities safe from all disasters, whether manmade or natural, while encouraging families and businesses along with governments to take the initiative on emergency preparedness at home and in the workplace.

And we’re bringing about a health care system that focuses on the unique needs and challenges of each patient — a personalized health care system. I believe that personalized medicine really embodies the balance I mentioned earlier about the role of government.

When most Americans think about our health industry, they start thinking of a lot of four letter words — and they certainly can be creative. When we at HHS think about our health industry, though, we think of a few different four letter words.

• What kind of care will people get?
• What’s it going to cost?
• Will it be any good?

Unfortunately, far too often people don’t have the tools they need to answer those questions. Frequently, that information doesn’t even exist in any form useful to them. Their health care isn’t driven by value.

Today, I’d like to offer you President Bush’s and Secretary Leavitt’s perspective on value-driven health care. In the federal government, we see personalized medicine as the directions we need to take in science, medicine, and technology — in particular genomics — to advance the understanding and quality of health care at an individual level. It’s about making health care more individually-tailored and more information-based than it is now.

For thousands of years — throughout human history, basically — medicine was an art based on what people could see, feel, and hear. In the last century, medicine became a science based on laboratory work —a rigorous, vastly-improved, instrument-based version of what had gone on before. Now, however, we’re entering into something new. Personalized medicine is health care that is based on the power of computation.

It’s about analyzing vast swaths of data to make health care more preventive, predictive, and personalized. It’s about sensors that allow your doctors to detect the first sign of cancer and information networks that allow scientists to scan hundreds of thousands of records for a hint of a cure to a debilitating disease.

Personalized medicine is when doctors, pharmacists, and other health care providers customize treatment and management plans for individual patients based on information that is readily accessible at clinics and hospital bedsides — information like medical history, genetic variability, and patient preferences. It’s when patients have more information about their choices of treatment and the implications that will follow. Not incidentally, personalized medicine could ultimately save a great deal of taxpayer and private-sector money as well.

Unfortunately, none of this will happen overnight. We can’t just snap our fingers and make it happen. Fortunately, consumers have companies like Alegent working to make health care more value-driven. I appreciate your partnership with Siemens to open the first all-digital hospital in Omaha, your efforts to score the quality of your care, and your tools to allow consumers to calculate their costs. It’s amazing how effectively you’re improving care while keeping costs down.

In the federal government, President Bush, Secretary Leavitt, and HHS are working to complement the work of private groups like you, to develop a shared vision of personalized medicine, and to bring it to fruition more quickly than it might otherwise develop. They have determined that our role as the federal government is to create a platform that allows all the elements personalized health care needs to flourish.

For example, Secretary Leavitt recently released a report detailing all of our Department’s efforts surrounding personalized medicine. The report touched on how we’re wrestling with questions about the structure of our regulatory framework and how best to enable and encourage the market for different aspects of personalized medicine. It discussed how we’re bringing together all the parts of HHS working on topics related to personalized medicine. And it showed how we’ve made a commitment to enabling consumers to choose what’s right for them — genetically, psychologically, and economically.

Some of Secretary Leavitt’s top priorities are directed at bringing this vision of personalized medicine about. The necessary foundation for personalized medicine is health information technology that enables value-driven health care. So Secretary Leavitt has established four cornerstones for value-driven health care:

• Electronic medical records,
• Standardized quality measures,
• Price transparency, and
• Incentives where everybody strives to deliver the best quality care at the most competitive price.

Over the past year, Secretary Leavitt met with consumers, employers, and providers in communities around the country, and encouraged them to commit to his cornerstones for value-driven health care. And now, as a result, plans covering 100 million Americans have signed on to adopting the four cornerstones.

While most Americans are still probably thinking of their four letter words, though, when it comes to personalized medicine, we think of some three letter words…NIH, FDA, CDC, CMS…

In fact, many of our agencies are working to develop the rigorous evidence for and applications of different aspects of personalized medicine:

• NIH is supporting genetic research worldwide by providing data for genome-wide association studies. NIH has created a web-based process, called dbGAP, for making the data available to qualified researchers. This summer, NIH published a policy governing the use of this information. That work will be one of our mainstays as we develop principles throughout the Department on genetic information in research.
• CDC’s National Health and Nutrition Survey — which has been collecting valuable data for decades — is now focusing on the genetic contributions of their sampled population.
• We recently led the way on developing standards for family history in electronic health records — something private industry had been hesitant to engage in due to privacy concerns under HIPAA.
• CMS is reimbursing for more patient-centric treatments, like Medicare’s Part D preventive screenings — which will lead to huge cost savings.

CMS is also beginning to leverage its market share to develop different aspects of personalized health care, such as electronic health records. For example, just last year, we began testing and implementing the first set of e-prescribing standards through CMS. And we are now requiring all providers and pharmacies transmitting prescriptions electronically for Medicare-covered drugs to comply with any CMS standards in effect.

We can succeed on personalized medicine if the government provides scientific leadership, encourages cooperation and collaboration among the right people at the right time, and resists the attempt or desire to micromanage.

Just as we saw how the President’s approaches to Medicare reform, stem cells, health savings accounts, and community health centers succeeded, Alegent’s successes in implementing value-driven health care reforms show us that we’re on the right track with personalized health care.

As we in the federal government continue to develop and implement personalized health care initiatives, I want to assure you that we want your expertise and insights. You have the skills, the knowledge, and the technical ability to develop personalized medicine as rapidly as you want. Your consumers are already benefiting from your commitment to value-driven health care. Just how fast our health care system advances depends on how aggressive you continue to be, and how much you spread the word to your colleagues around the country.

Personalized medicine holds great potential for the entire health care industry. Its promise is great, and the future of this new frontier is very bright. Together we can rise to the challenge of personalized medicine. Thanks for listening. I hope I’ve given you some helpful thoughts — and I look forward to seeing your great developments in this area in the future.