Community Leadership

Health Care Forum Report

T h u r s d ay , A u g u s t 2 8 , 2 0 1 4 | 9 : 0 0 a m - 3 : 3 0 p m
Elgin Community College: Seigle Auditorium Building E

CONGRESSMAN RANDY HULTGREN (IL-14)

TABLE OF CONTENTS
EXECUTIVE SUMMARY .....................................................................................3
First Panel: The Affordable Care Act (ACA) & the Consumer: 2015 and
Beyond ...........................................................................................................5
Second Panel: Health Care Innovations: Technology in Medicine .............5
Third Panel: Health Care Innovations: Access to Health Care....................6
I. REDUCING HEALTH CARE COSTS AND IMPROVING QUALITY.......8
Our health care system must operate more like a free market. .......................8
II. EXPANDING ACCESS TO HEALTH CARE ..............................................10
Small employer health insurance faces significant challenges. ....................10
Policymakers must take active steps to maintain consumer access to a wide
range of health care options, especially as the program transitions from a
fee-for-service model to a value for service model. ......................................10
Retail-based health care can meet the health care needs of the
underprivileged. .............................................................................................11
Policymakers must study how health insurance co-ops have impacted the
health insurance market. ................................................................................12

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

Health care technology, both biotechnology and health care IT, is becoming
an increasingly important part of our health care system. .............................13
Startup companies need help to survive the valley of death. .....................14
We must encourage the development of new health care ideas through our
research and education system. .....................................................................15
Policymakers must improve the FDA approval process. ..............................16
MATERIALS DISTRIBUTED AT FORUM ......................................................17
10 Key Policy Issues Facing Health Care .....................................................18
FORUM PROGRAMS & PARTICIPANT BIOGRAPHIES ...........................24

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CONGRESSMAN RANDY HULTGREN (IL-14)

EXECUTIVE SUMMARY
Our healthcare system in America has two faces: it provides state-of-the-art care, but is often
complex and frustrating. In fact, our system is so frustrating and unpredictable that Americans
repeatedly put their own and their family's health care near the top of their list of what most
concerns them. Americans are simply not fully in control of their healthcare decisionstoo
much of it is decided by insurers and the federal government.
Last year, I was confused with no one to turn to for clarity when I had to do what millions of
Americans have done: choose a family insurance plan under the Affordable Care Act. It was as
difficult to sign up as my constituents had told me. Like many Americans, I never trusted my
final decision because I had limited information and I had a hard time learning if I was actually
enrolled. I had to relearn the differences between deductibles, copayments and coinsurance on
my own. I had to gamble with making a plan choice based on my family's current health
situation, not on what could happen with their health in the following year. There should be a big
"buyer beware" sign required for consumers having to make serious choices based on those
terms.
Americans have every right to feel frustrated with the Affordable Care Act todayits far from
what they were promised. Consumers cant plan or predict whats up ahead for the ACA and
administrators and providers grapple with implementing it. Americans are increasingly worried
about rising health insurance costs, less coverage, lower quality of care, and their jobs being
turned into part-time employees. They worry their employers will no longer provide health care
insurance coverage and that they will fall into the gap where they aren't eligible for ACA tax
subsidies and can't afford to buy health insurance. They search for long-term economic security
but find unsustainable costs. Possibly most of all, Americans are concerned they will lose the
health insurance coverage they have now altogether.
These problems and more are why I organized this forum.
Like my previous Community Leadership Forums on Illinois' curriculum standards and heroin
and painkiller abuse and prevention, I convened this event to bring stakeholders together to share
information and work together to tackle Illinois health care challenges.
We heard from a broad spectrum of health care participants, including doctors, professors,
hospitals and other health providers, health insurance companies, health technology companies,
local government health officials, health trade associations, and those who represent and serve
the elderly. They discussed what works, and helped spot problems and devise strategies to
improve health care delivery in Illinois.

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

A
Randy Hultgren
Member of Congress

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CONGRESSMAN RANDY HULTGREN (IL-14)

FIRST PANEL: THE AFFORDABLE CARE ACT (ACA) & THE

CONSUMER: 2015 AND BEYOND
Our first panel covered whats ahead for the Affordable Care Act including potential reforms.
We addressed questions such as: How is the ACA affecting the health care system on key
metrics of access to, affordability of, and quality of health care? What challenges are on the
horizon?
Our moderator was Mark Grant, the Illinois Assistant State Director of the National Federation
of Independent Business (NFIB). Our panelists were (1) Jason Montrie, Executive Vice President
at Land of Lincoln Health, (2) Todd Page, Senior Vice President of Sales and Marketing at
AHIX.com, a division of JLBG Health, (3) Craig Rodrigue, Independent Insurance Advisor
representing the Association of Mature American Citizens, and (4) Steven Tucker, Founder of
HealthInsuranceMentors.com and Small Business Insurance Services Inc.
The Affordable Care Act poses many significant challenges to health care and small business
insurance professionals, especially those that strive to provide adequate consumer choice and
access to health care. Insurance providers told me the difficulties they face operating within the
ACAs demands and slim margins. Insurance regulations like the medical loss ratio exacerbate
costs, which translate directly into higher premiums for constituents and businesses. Instead of
leveraging technological advancements and health care innovations to improve health care
quality and lower costs, we are moving in the opposite direction. Despite continual medical
technology and treatment advancements, quality of care remains stagnant and costs continue to
rise industry-wide. Relieving these ineffective and inefficient mandates could be a first step to
opening up more options for insurers and consumers.
One thing is clear: policymakers must pursue a market-based health care system, because it is the
best way to drive down health care costs and still improve health care quality. They should look
in particular to one industry that experiences significantly lower costs and higher quality of
carethat of elective health care procedures , an industry driven by market forces instead of
regulatory control. Our first panel discussed these challenges, and how policymakers could best
address them.

SECOND PANEL: HEALTH CARE INNOVATIONS: TECHNOLOGY IN

MEDICINE
The second panel discussed health care innovations in technology, and asked three major
questions: (1) What technologies are transforming and have the potential to transform the
everyday health care experience of consumers, and how can these technologies be improved? (2)

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How can consumers adapt to these changing health care technologies? (3) What are the best
policy, economic, and industry conditions for improving research and development in the health
care technology area?
Our moderator was Brian Lemon, President of Central DuPage Hospital and Executive Vice
President of Cadence Health. Our panelists included (1) Jeff Coney, Director of Economic
Development at Northwestern University, (2) David Miller, CEO and President at Illinois
Biotechnology Industry Organization, (3) Dr. Harry Rowland, CEO at Endotronix, and (4) Dan
Yunker, CEO at Land of Lincoln Health.
Recent events, such as the Ebola outbreak, have put this topic on the front burner. Is the drug
approval process working? Can consumers obtain potentially life-saving treatments on time?
What about repealing the medical device tax, which hurts innovation in medical technology? Or,
should we improve other policies that impact the speedy delivery of innovative technologies to
the consumer marketplace? Medical innovations are vital to strengthening treatments and
reducing costs in the health care system.
Congress can and should act to promote medical innovation. For example, H.R. 3116, the
MODDERN Cures Act, speeds up the development of innovative treatments for patients with
chronic diseases and disabilities. Consumers need access to drugs that address conditions with
few or no medical options for treatment. More must be done to help consumers access vital drugs
and technologies, and quickly and safely get the drugs to market. Our second panel explored this
further.

THIRD PANEL: HEALTH CARE INNOVATIONS : ACCESS TO HEALTH

CARE
The third panel focused on recent developments in consumer access to health care. Major
questions discussed during the panel asked: What services are transforming and have the
potential to transform consumers access to health care? How can consumers best utilize these
changing means of access to care? What are the best policy, economic, and industry conditions
for improving this access?
Our moderator was Dr. Vikram Patel, President and Medical Director at ACMI Pain Care and
Board Member at McHenry County Medical Society. Our panelists featured were (1) Dr. Opella
Ernest, Vice President and Chief Medical Officer at Blue Cross and Blue Shield of Illinois, (2)
Mike Randall, Vice President of Clinical Innovation at Advocate Health Care, (3) Denise
Scarpelli, Market Pharmacy Director Chicago at Walgreens, and (4) the Hon. A.J. Wilhelmi,
Chief Government Relations Officer at Illinois Hospital Association.

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CONGRESSMAN RANDY HULTGREN (IL-14)

Our struggling economy has made it difficult for Americans to access health care. Health care
needs often take a back seat to putting food on the table and paying rent. We should gain a better
understanding of retail health care like that provided by Walmart and urgent care facilities. Can
they effectively fill the gap for those without primary physicians?
Improving access means managing costs, and we should applaud such efforts to do so. For
example, Affordable Care Organizations (ACOs), under which health providers contract to
oversee a patients total course of care, can play a key role in improving health outcomes.
Twenty million Americans are currently covered by ACOs. Illinois is in the midst of the
adoption of a statewide program to assign all Medicaid enrollees to an ACO provider. With
doctors overseeing billions of dollars in health spending under these arrangements, we should
explore transparency procedures, while allowing for innovation and consumer choice.
What follows are the best insights from these three panels, along with the keynote address from
Scott Becker, Partner at McGuire Woods in Chicago, IL, who spoke on the 10 Key Trends in
Health Care Reform he sees industry-wide.

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I. REDUCING HEALTH
IMPROVING QUALITY

CARE

COSTS

AND

OUR HEALTH CARE SYSTEM MUST OPERATE MORE LIKE A FREE

MARKET.
Panelists throughout the day noted that the health care system often operates counter to the free
market.
Instead of relying upon the market to lower health care costs, the ACA largely trusts in federal
programs and government bureaucrats. Mr. Craig Rodrigue, an Independent Insurance Advisor
representing the Association of Mature American Citizens, believed that federal regulations will
never truly succeed at driving down health care costs. After all, relying upon central planning to
cut health care costs is difficult and costly. For example, as Mr. Steven Tucker, the Founder of
HealthInsuranceMentors.com and Small Business Insurance Services Inc., argued, the medical
loss ratio has driven insurance companies out of business, and forced other companies to cancel
their insurance plans. This is because it tries to lower health care costs by arbitrarily preventing
administrative costs from exceeding an arbitrary threshold 20 percent for most insurance
companies. This either requires companies to meet a standard that they already meet, or forces
them to lower costs past what they can sustain.
While federal regulations and mandates will not drive down costs, the market can. As Mr.
Rodrigue explained, costs decrease while quality increases in the elective surgery market. This
occurs because consumers must pay directly for elective surgery, instead of depending upon
insurance. Thus, they pay attention to health care costs, negotiate with their doctors, and force
their doctors to justify their claims. Numerous panelists throughout the day noted this
correlation.
Mr. Tucker floated two broad solutions that could help the health care system function more like
a market.
First is Avik Roys Universal Exchange Plan, which gradually moves health care consumers
onto an improved version of Obamacares health care exchanges. This repeals the individual
mandate and the employer mandate, and deregulates the federal health care exchanges.
Second is Rep. Paul Ryan and Senator Ron Wydens bipartisan Medicare plan, which maintains
Medicares current structure, and gives recipients an option of a government-provided voucher to
use toward private plans that offer a baseline level of benefits. As companies compete with each

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CONGRESSMAN RANDY HULTGREN (IL-14)

other to offer the best plan, costs are reduced and consumers can choose Medicare if they do not
like their private plan.
Mr. Tucker encouraged policymakers to explore Indianas successful Healthy Indiana Program,
including their health care savings accounts. Health care savings accounts mimic the free market
by making consumers pay attention to price, because costly services deplete their savings
account.
Mr. Tucker also bemoaned that the ACAs rules and regulations created extensive health
insurance cancellations, a violation of a promise made by President Obama. Mr. Tucker believed
that buying insurance across state lines could address that problem. Mr. Rodrigue was skeptical
of this, because it undermines federalism. State health care insurance regulations reflect what
states believe are best for their residents.

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II. EXPANDING ACCESS TO HEALTH CARE

SMALL

EMPLOYER

HEALTH

INSURANCE

FACES

SIGNIFICANT

CHALLENGES .
Mr. Tucker, Mr. Rodrigue, and Mr. Todd Page, the Senior Vice President of Sales and Marketing
at AHIX.com, a division of JLBG Health, recognized that the ACA poses significant challenges
to small group insurance, the means by which small employers often provide health insurance for
their employees. Mr. Rodrigue, in particular, believed that in ten years, small group insurance
coverage will not exist.
As Mr. Tucker argued, the ACA encourages some employers to cancel their health insurance
plans so that their employees can buy their own plans, such as on the health insurance exchanges.
Mr. Rodrigue elaborated that companies historically offered health insurance because it was
compassionate and was an incentive for employees to fully invest themselves in the culture of a
company. Now, many companies find it more compassionate to terminate their health care
benefits. They find that it is a greater economic benefit to the company for the employees to seek
subsidies under the ACA. For example, under current law, employer provided health care can
preclude eligibility for other health care subsidies. Mr. Page agreed that companies are often
better off canceling their small group insurance plans than continuing to provide health insurance
for their employees.
Mr. Jason Montrie, the Executive Vice President at Land of Lincoln Health, also expressed
concern that some small businesses will soon be unable to offer health insurance. Insurance
companies should address this problem by giving small business representatives a voice in the
operation of their company, as some insurance companies do.

POLICYMAKERS MUST TAKE ACTIVE STEPS TO MAINTAIN CONSUMER

ACCESS TO A WIDE RANGE OF HEALTH CARE OPTIONS , ESPECIALLY AS
THE PROGRAM TRANSITIONS FROM A FEE -FOR-SERVICE TO A VALUE FOR-SERVICE MODEL .
Mr. Page said that the biggest health care challenge for 2015 is ensuring that consumers
especially those that use a preferred provider organizationhave access to a sufficient number
of doctors and hospitals. The ACA has made the problem of consumer choice especially
relevant, because consumers cannot change their coverage until the next open enrollment period
a year later. Many upcoming health care exchange insurance plans restrict consumer choice by
offering access to few providers.

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CONGRESSMAN RANDY HULTGREN (IL-14)

This choice problem is especially relevant in Illinois because, as many panelists brought up,
Illinois health insurance exchange was marked by little competition. While there were only 6
insurance carriers on Illinois exchange last year, there will be 10 this year. Mr. Montrie believed
that the health insurance companies, especially those without the dominant market share, have a
significant responsibility to increase competition by offering a superior product.
Our health care systems transition from fee-for-service, which compensates doctors for their
individual transactions, toward value-based care," a compensation model that takes into account
the value a doctor provides for their patient, could also impact consumer choice.
This change could be transformative for the health care industry. Mr. Brian Lemon, the President
of Central DuPage Hospital and Executive Vice President of Cadence Health, held that our
system will eventually transition to a system where providers are motivated and rewarded for
keeping people at home and healthy, instead of our current fee-for-service model.
Blue Cross Blue Shield of Illinois (BCBS - IL) is transitioning toward value-based care, as Dr.
Opella Ernest, their Chief Medical Officer and Vice President explained. Dr. Ernest argued that
this reflects BCBS - ILs mission to provide consumers quality and cost-effective health care.
BCBS recognizes that the best health care is by a physician and argues that coordinated,
physician directed caresuch as with an HMOreceives consistently high marks from patients.
Mr. Rodrigue worries that the value-for-service model transforms the health care system from a
cooperative model where the doctors and patients collaborate, to a hostile one where the doctor
decides a patients coverage for them. The ACA has especially encouraged this model.

RETAIL-BASED HEALTH CARE CAN MEET THE HEALTH CARE NEEDS

OF THE UNDERPRIVILEGED.
Ms. Denise Scarpelli, the Market Pharmacy Director Chicago at Walgreens, explained how
Walgreens is expanding access to health care in Illinois. Walgreens has 600 stores in Illinois,
and 56 in Chicago. Walgreens takes a preventative care mindset to their stores and provides
access to acute care when no other care is available. And, in last year alone Walgreens provided
435,000 flu shots to customers, and donated 40,000 shots to people who could not afford it.
This access innovation can be a great service to the underprivileged, but it must be used
responsibly to complement (not replace) the efforts of doctors and hospitals.

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POLICYMAKERS MUST STUDY HOW HEALTH INSURANCE CO-OPS HAVE

IMPACTED THE HEALTH INSURANCE MARKET.
The 2010 Affordable Care Act provided $3 billion of seed funding for states to create health
insurance co-ops, which are member-driven non-profit insurance companies. Illinois co-op is
Land of Lincoln Health. Mr. Montrie represented the co-ops perspective. He was optimistic that
the co-op model would be competitive with other insurance provider because in other states, they
have successfully captured a significant portion of the marketplace.
However, it was stated that there has been evidence in other states that the co-op model is
unsustainable. It was advised that Congressional policymakers should continue to examine
results from the health insurance co-ops.

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CONGRESSMAN RANDY HULTGREN (IL-14)

III. ENCOURAGING HEALTH CARE INNOVATION

HEALTH CARE TECHNOLOGY IS BECOMING AN INCREASINGLY
IMPORTANT PART OF OUR HEALTH CARE SYSTEM .
Health care technology, including biotechnology and information technology (IT), is
dramatically transforming how our health care system diagnoses and treats diseases, and cares
for patients.
Mr. David Miller, CEO and President of Illinois Biotechnology Industry Organization
persuasively championed biotechnology during his panel appearance. He held that the biotech
field will continue to produce cures for previously incurable diseases. He also agreed with the
late Steve Jobs that within the next 100 years, biotechnology will permeate all of society. Mr.
Millers organization, iBio, exists to keep Chicago at the center of this burgeoning field. Our
economy is at stake: every new biotechnology job produces 2.8 to 5.6 other jobs.
Dramatic improvements in health care IT can greatly improve and are already improving the
delivery of health care throughout the state.
Mr. Dan Yunker, Senior Vice President of the Metropolitan Chicago Health Care Council,
elaborated on how health IT improvements have already transformed many aspects of the health
care system.
While the banking and financial system is generally a connected eco-system, the health care
system has traditionally been far from it. We live in the 21st Century, but our health care system
is stuck in the 20th Century. Mr. Yunker held that the Health Information Exchange (HIE),
www.healthit.gov, will push the health care system toward this century. This initiative, according
to the governments website, makes it possible for health care providers to better manage
patient care through secure use and sharing of health information. Health IT includes the use of
electronic health records (EHRs) instead of paper medical records to maintain people's health
information. Mr. Yunker said that these efforts will improve, and already have improved,
quality care, patient safety and care coordination. They have reduced medication errors and
duplication and avoided duplicate testing and unnecessary hospital admissions. MCHC operates
the Chicago HIE.
While this expansion of health care IT relies upon big data, Chicagos HIE is taking significant
steps to secure the health care data and limit its application to appropriate uses. They are also
developing ways to help different electronic medical health record systems maintain
compatibility with each other. Efforts are being made to also make the states interconnected.

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Panelists all agreed that health technology is transforming how patients access health care.
The first example of this is telemedicine, which allows patients to visit their doctor online. Dr.
Harry Rowland, the CEO at Endotronix, argued that telemedicine would be especially helpful for
rural patients, because they may not have the time or resources to travel a long distance to visit a
hospital. Mike Randall, the Vice President of Clinical Innovation at Advocate Health Care,
explained that Kaiser Permanente is a leader in virtual health care visits, as it had around 10
million virtual visits last year, including by using secure email messaging. Mr. Randall believed
that virtual visits will eclipse health care visits within the next 10-15 years. The Hon. A.J.
Wilhelmi, the Chief Government Relations Officer at Illinois Hospital Association, agreed that
telemedicine has the potential to transform health care access in rural and underserved areas.
Dr. Rowland held that transitioning from a fee-for-serve model, where hospitals are reimbursed
on a transaction basis, to a value-based model, where hospitals are reimbursed for the overall
service they provide to their customer, will help make the telemedicine model more sustainable.
For example Pager, a mobile application developed by an Uber creator, allows users to visit
on-call physicians, either remotely or in person, and receive services such as a prescription. This
service was launched in Chicago this August.
A significant barrier to the increased utilization of mobile health care technologies is developing
a fair and accurate compensation model for services such as virtual visits, which still accurately
accounts for its value.
These technological changes can be driven by government policy, but Mr. Lemon held that
government cannot drive all of these improvements; health care stakeholders must take a
significant lead in driving innovations.

STARTUP COMPANIES NEED HELP TO SURVIVE THE VALLEY OF

DEATH.
Startup companies, a backbone of our economy and job creation, can transform the best ideas in
health care from a concept, to a concrete product. Unfortunately, challenges facing startup
companies often make even the best ideas fail, as Mr. Jeff Coney, the Director of Economic
Development at Northwestern University, explained.
The biggest challenge is the valley of death: the time between a drugs invention and when it
becomes profitable. Before a drug reaches profitability, companies must patent their idea,
transform it into a tangible product, study its safety and efficacy, work toward final FDA
approval, and develop a successful marketing plan. Each task requires access to capital that is
difficult for startup companies to access. Without this, the best ideas may never see the light of

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CONGRESSMAN RANDY HULTGREN (IL-14)

day, and consumers will lack access to drugs and medical technologies that could radically
transform their life.
Dr. Rowland and Mr. Miller singled out government policies that impact this valley.
Federal, state, and local policymakers must be aware of the broad impact that their economic
policies have upon these startup companies, including the rate, distribution, and efficiency of our
tax system, and the impact of government spending on an economy. For Mr. Miller, one example
of a poor economic policy is the 2.3 percent sales tax on medical devices, costing our economy
anywhere from 30,000 to 40,000 jobs.
Dr. Rowland also supported institutional research, development incubators and support
incubators, such as iBios program, Propel. As Mr. Miller explained, Propel provides early stage
life science companies with coaching, professional services, educational programs and
networking, mentors, and other grants and awards. They also provide these companies with
technical assistance for applying for various federal grants.
Angel investments can also help startup companies. Dr. Rowland pointed out that Illinois had an
Angel Investment program, which helps place investment dollars and up to $10 million annual
working capital into newly formed, innovative companies in Illinois. The program provides
angel investors with a tax credit worth 25 percent of their overall investment. Mr. Miller
supported a federal angel tax credit as well.
Finally, Mr. Coney believed that H.R. 2981, the TRANSFER Act, would help the companies
survive the valley of death, by helping the best ideas move from the laboratory or research
facility to the marketplace.

WE MUST ENCOURAGE THE DEVELOPMENT OF NEW HEALTH CARE

IDEAS THROUGH OUR RESEARCH AND EDUCATION SYSTEM .
The foundation of health care innovation comes from the development of new ideas. Our
panelists discussed extensively how to design an education system to encourage these new ideas.
First, Mr. Miller argued that health care innovation in our country depends upon ensuring that
America has the best scientific research facilities and education system in the world. Research
can be a primary leverage point for improving Americas economic edge. Unfortunately, our
country has fallen behind the rest of the world in math and science. Mr. Miller supported
expanding federal funding for scientific research, and improving how our system handles math
and science at every stage of a students education.
Second, Mr. Coney supported S. 2658, the Accelerate Biomedical Research Act, which reverses
sequestration for the National Institute of Health and allows Congress to increase funding for the

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agency. He believed this would help the NIH discover treatments, cures, and lead the country in
medical innovation.
Third, Mr. Coney supported S. 2115, the American Cures Act, which would establish a
Biomedical Research Fund and steadily increase funding for biomedical research.
Fourth, Mr. Coney supported preserving the Bayh-Dole Act. This act first allowed university,
small-business, and non-profit inventors to keep their intellectual property even if they invented
the product while using federal research dollars. Previously they had to assign the related
intellectual property to the federal government. Mr. Coney held this incentivizes the
development of innovative health care products, because inventors may personally profit from
their creations.
Finally, Mr. Miller believed that policymakers must be aware of abuses of the 340B Public
Health Service Act, which allows health care organizations that care for the underserved to
purchase discounted outpatient drugs. Companies that abuse their program privileges drive down
profits for producers of outpatient drugs, which discourages the development of new, innovative
drugs because drug companies may not be able to cover their costs.

POLICYMAKERS MUST IMPROVE THE FDA APPROVAL PROCESS.

The FDAs drug and medical device approval process is a significant hindrance to health care
innovations.
As Dr. Rowland argued, medical devices often take a long time to move onto the market because
the FDAs regulatory approval process is too unwieldy. As a result, the United States health care
system relies on much older technology than should be expected in our country. The same is true
of our drug approval process.
This relative dysfunction stands in stark contrast to the European medical product approval
process. Many companies in Europe are on the market three to five years earlier than in the
United States because drug companies need only demonstrate their drugs effectiveness before
going onto the market. Companies answer questions about the products effectiveness while the
product is on the market.
Panelists mentioned two main policies that can improve the FDA. First, Mr. Miller persuasively
argued that the FDA, which has a domain that encompasses 25 percent of American GDP, must
be adequately funded.
Second, Dr. Rowland persuasively argued that the FDA must explore ways to improve its stages
of product approval, and consider whether it should let certain drugs go to market before their
effectiveness has been conclusively proven.

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CONGRESSMAN RANDY HULTGREN (IL-14)

MATERIALS DISTRIBUTED AT FORUM

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10 KEY POLICY ISSUES FACING HEALTH CARE

By Scott Becker, JD, CPA, Lindsey Dunn and Molly Gamble
The last few years have been nothing short of fascinating to watch in terms of health care
policy change and implementation. The passing and now (somewhat troubled) passage of the
Patient Protection and Affordable Care Act is the most significant, but certainly not the only,
policy issue to gain national attention, from the industry and public at large. Following is a list
of, in our view, 10 of the top key policy issues facing the industry as well as some of the issues
surrounding each.

1.
Is the Impact of the PPACA Worth the Cost? A July 2014 study from the
Commonwealth Fund found 20 million people now have health insurance due to the PPACA.
Approximately 8 million people signed up for health care through federal or state health care
exchanges between October 2013 and April 2014. Of these, 57 percent, or approximately 4
million to 5 million individuals, were previously uninsured (with the others previously having
individual coverage). Another 12 million people gained coverage through other PPACA
provisions, such as Medicaid expansion (in 27 states, including Washington, D.C.), allowance
for young adults to remain on their parents' health insurance until age 26 and bans on health
insurers' denial of coverage because of age or preexisting conditions, according to The Hill. (See
"Study:
20M
have
insurance
under
O-Care,"
The
Hill,
July
2014)
In contrast, the PPACA created literally billions of dollars in new taxes. These include a
Medicare tax increase of .9 percent for individuals earning over $200,000 or married couples
earning $250,000; a net investment income tax of 3.8 percent tax on individuals, estates, and
trusts worth more $200,000 or $250,000 for joint filers; and an increase in the threshold for
itemized deductions for medical expenses from 7.5 percent to 10 percent of gross income, not to
mention the additional costs to providers and health care companies to comply with the law. (See
"Full List of Obama Tax Hikes" at atr.org)
In 2012, the Congressional Budget Office and Joint Committee on Taxation estimated
that the insurance coverage provisions of the PPACA will have a net cost of just under $1.1
trillion over the 2012-2021 period. A great question remains: Is the cost worth the gain?
It will be interesting to see when or whether the societal benefits of having 20 million
newly insured outweigh the billions spent for improvements in societal health care costs over
time. Will the law's unintended consequences lessen its ROI? Will the approximate $1.1 trillion
curtail health care spending in the United States? National health care spending grew at an
annual rate of 4 percent during the first 11 months of 2013, just above the revised all-time low

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rate of 3.6 percent for 2011, according to the Altarum Institute's Center for Sustainable Health
Spending and CMS. However, health care spending growth slowdown occurred in other
industrialized countries as well, suggesting it is not solely attributable to the PPACA. The White
House has said it anticipates an uptick in health care spending as newly insured utilize health
care services, but it will be interesting to see whether or how long that persists, and if health care
costs will start trending down for good.
2.
Should Federal or State Governments Control Health care Policy? A great
question exists as to whether states should be able to be laboratories of democracy, or whether
the federal government should develop top-down solutions for health care. Seventeen states
(including Washington, D.C.) decided to build their own Obamacare exchanges, while the rest of
states chose a partnership model with the government or the federally-facilitated marketplace. Of
those 16 governed states, 12 are led by governors who are Democrats, while the remaining are
led by Republicans and one Independent governor (Rhode Island).
Generally, state-based exchanges enrolled a higher percent of the eligible population than
states using the federal marketplace, Health care.gov. But just as there were problems with
Health care.gov, some states experienced setbacks of their own. In April, after undergoing
months of technical problems and putting applications on hold due to processing difficulties,
Oregon decided to shut down its troubled Cover Oregon marketplace and transition to the federal
marketplace. In May, Nevada did the same, scrapping its state exchange to join the federal
marketplace for at least one year. Massachusetts is still trying to save its exchange, but also
laying the groundwork to join Health care.gov. Some states have seen success, however.
Connecticut's exchange portal has performed remarkably well - so well that Maryland wants to
buy it and use it as a model for its own. Kentucky also hit its stride: more than 413,000
Kentuckians (or one in 10) signed up for coverage through the state's kynect system.
A Politico report last month suggested the federal exchange option - which was supposed
to be a temporary fallback for states - may become a longterm solution for the majority of states.
This was not the intent of the health care law. " But a shift to a bigger, more permanent
Washington-controlled system is instead underway - without preparation, funding or even public
discussion about what a national exchange covering millions of Americans means for the future
of U.S. health care," according to Politico. "It's coming about because intransigent Republicans
shunned state exchanges, and ambitious Democrats bungled them." (See "GOP's Obamacare
fears
come
true,"
Politico,
June
2014)
3.
Are High-Deductible Plans and High Out-of-Pocket Costs a Necessary Evil?
High-deductible health plans and out-of-pocket plans have long been a Republican tenet of
health care reform due to arguments around choice and free-market ideals. Interestingly,

19 | Community Leadership Health Care Forum

Democrats, who haven't as closely supported these plans in the past, intentionally or
unintentionally did so through the passing of the PPACA, which created marketplace plan
structures that include high deductibles and up to 40 percent cost sharing.
Republicans oppose the law for a number of reasons, but some have pointed out that their
recent attack on high-deductible plans departs from the party's previously held views. Last
winter, Ezra Klein wrote a column for the Washington Post's Wonkblog in which he noted his
confusion about Republicans' criticism of high-deductible plans. "What's confusing about this
line of attack is that high-deductible health care plans - more commonly known as 'health savings
accounts' - were, before Obamacare, a core tenet of Republican health care policy thinking. In
fact, one of the major criticisms of Obamacare was that it would somehow kill those plans off,"
wrote Mr. Klein. In that column, Mr. Klein wondered if some of Republicans' pushback stems
from the health care law giving a bad name to a policy they like. (See "Obamacare exposes
Republican hypocrisy on health care," Wonkblog, December 2013)
Some political debates around high-deductible plans and out-of-network payments
remind one of President Bill Clinton's passage of welfare reform in 1996. There, Bill Clinton
broadly put into place a Republication tenet much to the chagrin of some Republicans.
4.
What Policies are Generally Supported by Both Parties? Notwithstanding the
general concerns about health care reform, the ban on insurers' discrimination against preexisting
conditions, limits on age discrimination and the elimination of lifetime caps are popular concepts
amongst constituents who are Republicans or Democrats. In a November 2013 Gallup poll, those
who approved of the PPACA said the top reasons they support the law is because it makes health
care accessible to more people, they find it fair that everyone have health insurance, it provides
more health insurance options and it covers people with preexisting conditions.
5.
Who should be required, if anyone, to cover contraception? In Burwell v. Hobby
Lobby, the Supreme Court ruled in a 5-4 decision that a health plan offered by a private employer
that is a closely-held, for-profit corporation need not include contraception coverage. Here, it
reasoned that the concept of being forced to offer contraception violates the freedom of religion
of the owner of the company. Based on this ruling, a federal judge estimated that a third of
Americans are not subject to the requirement that their employers provide coverage for
contraceptives: Small employers are not required to offer health coverage at all, religious
employers like churches are exempt, religiously affiliated groups may claim an exemption and
some insurance plans that had not previously offered the coverage are grandfathered in,
according to the New York Times. (See "Supreme Court Rejects Contraceptives Mandate for
Some Corporations," NYT, June 2013)

| 20

6.
Was the Obama Administration Really Unable to Predict that Some Insurers
Would be Forced to Drop Catastrophic Only Health Plans, Leading to Public Outcry? Or was the
President Dishonest when he Promised Americans they Could Keep Their Current Plans, if they
Liked Them? Whether Republican or Democratic, we have largely learned that politicians are
not particularly honest. In 2009, speaking out to promote his health care law, President Obama
told Americans, "If you like your health care plan, you'll be able to keep your health care plan.
No one, will take it away no matter what." We've now learned that wasn't the case. There have
been a string of presidencies lately with at least one infamous lie that lives well beyond the
commander in chief's term, such as those about weapons of mass destruction, extramarital affairs
or wiretapping. It will be interesting to see what mistruths about the health care reform law, if
any, persist over time.
7.
Should Individuals Using the Federal Exchange Receive Subsidies? The
government now subsidizes buying health care insurance on the federal and state exchanges.
However, the original legislation did not specifically permit the subsidy of insurance bought on
federal exchanges. The heart of the issue is whether subsidies may be awarded in the 36 states
that chose not to set up their own insurance marketplaces and instead relied on the federal
government's exchange.
Most of the people who bought policies on the exchanges received some sort of subsidy,
though these subsidies were not authorized by the PPACA. The PPACA encourages states to set
up their own health insurance marketplaces, but it also created a federal marketplace as a
fallback. But the law's section on health insurance subsidies says they can be paid to anyone who
signs up for coverage in "an exchange established by the State." It doesn't mention the federal
exchange. This stems from a 2009 drafting error in the law, a basic mistake in the wording that
was never reconciled, according to Politico. (See "Democrats still haven't learned Obamacare
lesson," Politico, July 2014)
The U.S. Court of Appeals for the D.C. Circuit recently ruled in Halbig v. Burwell that
the federal government was not allowed to expand subsidies in this way. In contrast, earlier in
July, the Fourth Circuit Court of Appeals ruled differently. The conflicting rulings show
regulatory uncertainty about a decision that could affect more than 4.5 million people who were
found eligible for subsidized insurance in the federal exchange.
Amid this uncertainty, the name Jonathan Gruber has appeared a lot in the news lately.
He's an economist from the Massachusetts Institute of Technology and an architect of the
PPACA. In a video circulating the web, Mr. Gruber makes a presentation in January 2012 to a
nonprofit group and says the following, which would support the latest legal challenge to the
health law: "I think what's important to remember politically about this, is if you're a state and

21 | Community Leadership Health Care Forum

you don't set up an exchange, that means your citizens don't get their tax credits." He added, "I
hope that that's a blatant enough political reality that states will get their act together and realize
there are billions of dollars at stake here in setting up these exchanges." Mr. Gruber made similar
remarks to another group, as well.
8.
Is the Explosive Increase and Expansion in the False Claims Act Warranted or
Overreaching? Previously, the False Claims Act only covered true false claims. Ten years ago, it
was relatively easy to identify a bad intent or bad actor in an FCA case, many of which were
egregious and severe. Now the FCA covers any claim that derives out of a violation of the Stark
Law or Anti-Kickback Statute. This has led to a tremendous growth in health care FCA cases.
Under the False Claims Act, plaintiffs file civil actions on the government's behalf called
qui tam suits, from a Latin phrase loosely meaning "who brings the action for the king as well as
himself." The Justice Department can join a suit it deems worthy, taking over the case. It usually
prevails: Among cases it joined from 1987 through 2010 that had outcomes, 95 percent produced
settlements or judgments by 2010, according to a Wall Street Journal report. (See "Invoking
Anti-Fraud Law, Louisiana Doctor Gets Rich," WSJ, July 2014)
Two-thirds of the 753 qui tam suits filed in fiscal 2013 were in health care. Such suits
were behind 87 percent of the government's $12.3 billion in civil recoveries from the industry
over the five years through fiscal 2013. Some of the largest settlements involved allegations that
drugmakers overcharged or illegally promoted medicines in ways that led to improper billings to
government programs. But some say the FCA's provisions have given rise to plaintiffs who,
more interested in profits than fraud, often file cases with thin premises.
9.
Has Lack of Antitrust Enforcement led to too Much Hospital Power? A growing
body of literature demonstrates that providers with a higher market power can negotiate higher
than competitive rates. For example, an ongoing project from Robert Wood Johnson Foundation,
launched in 2006, is examining hospital consolidation and its effect on consumer prices and care
quality. In 2012, the researchers found when hospitals merge in concentrated markets, health
care costs increased sharply, often more than 20 percent. Further, those increases are passed on
to consumers in the form of higher insurance premiums. (The research does not distinguish
between for- and nonprofit hospital mergers.)
There has also been research on vertical consolidation, as hospitals acquire physician
groups and practices. This spring, a study published in Health Affairs found prices were most
likely to increase when hospitals bought physician groups rather than establishing a looser
contractual relationship with practices. (See "Vertical Integration: Hospital Ownership Of
Physician Practices Is Associated With Higher Prices And Spending," Health Affairs, May 2014)

| 22

When the FTC does choose to challenge a merger, it has proved successful: Since 2007,
the FTC has successfully challenged three hospital mergers, and a number of transactions have
been abandoned after the FTC threatened a challenge. But the aforementioned study findings
raise questions about whether FTC challenges are too few and far between, and whether the
commission only pursues case that are low-hanging fruit in an industry ripe with consolidation.
10.
Should Hospitals get Paid More Than Physicians and Surgery Centers for
Providing the Same Services? On average, ASCs are paid about 50 percent of what hospitals are
paid for the same procedure. Hospitals argue that this extra payment is in exchange for all the
other things that hospitals do (e.g., trauma and specialized care, uncompensated care, etc.) and is
necessary for hospital financial survival. Physicians and providers assert that these subsidies are
unfairly beneficial to hospitals and subsidize hospitals' ability to employ physicians and move
business to hospitals.
This spring, The Office of Inspector General recommended CMS seek legislation to
make it possible to reduce hospital outpatient department rates. CMS disagreed with the OIG
recommendations, which may be in part due to the financial stress already facing hospitals. Also,
CMS may be more subject to politics than the OIG.

Conclusion. Some of these 10 policy issues were to be expected in the rollout of the
PPACA, whereas others - not so much. We are keeping an eye on a broad mix of issues,
including how the government handles growing reliance on the federal exchanges, whether the
costs of the newly insured will reduce health care costs and spending in the long term, whether
antitrust enforcement will respond to studies linking consolidation and price increases, and get
more aggressive in a more noticeable way, and whether high-deductible plans are a necessary
evil to attain low health care costs. It will be most interesting to see how these, among many
other issues, pan out. Regardless of the outcomes, we know this to be true: It's a fascinating time
to work in (and write about) the health care industry.
59410616_1

23 | Community Leadership Health Care Forum

hultgren.house.gov

FORUM PROGRAM & PARTICIPANT BIOGRAPHIES

| 24

Welcome:
Thank you for joining me today for my Community Leadership Health Care Forum. I
am looking forward to a productive day addressing todays challenges to our healthcare
system. We are joined by high caliber experts to tackle the top issues facing 14th
District consumers, including the Affordable Care Act, medical technology innovation
and improving access to healthcare.
Our healthcare system today is extremely complex and few Americans have the ability
to make sound and affordable decisions for themselves and their families. Consumers
are facing rising costs and fewer options, and cant predict with any certainty how
upcoming changes in the Affordable Care Act will affect them. My goal is to give my
constituents the most relevant and up-to-date information to make informed decisions
as they engage the healthcare system and for everyone to walk away with new ideas
for solutions to improve healthcare delivery, access, and care.
I am thrilled you could join us today. Thank you for all of the work you do for our
community.

Randy Hultgren, U.S. House of Representatives

Keynote Address:
Scott Becker, Partner, McGuireWoods
Scott has served as a Partner at McGuireWoods since 2008 and is the chairman of the
firms healthcare department. He practices exclusively in the healthcare regulatory and
transactional area.
He provides counsel on healthcare transactional and regulatory matters to hospitals,
health systems, hospital chains, ambulatory surgery centers, ambulatory surgery center
chains, private equity funds and lenders, and healthcare industry entrepreneurs.
During the past several years, Mr. Becker has devoted a majority of his time and efforts
to ambulatory surgery centers and ASC chains, hospitals and health systems, private
equity funds and healthcare industry entrepreneurs. He provides advice and counsel
on a broad range of business and legal issues. Scott is a Harvard Law graduate and a
certified public accountant in Illinois.

Agenda:
8:30 am 9:00 am Registration in Seigle Auditorium Atrium, Building E
9:00 am 9:30 am

Meet & Greet Coffee Reception with all Attendees

9:30 am 9:35 am

Elgin Community College Welcome, Dr. Wendy Miller, Dean of Health Professions

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

9:50 am 11:05 am The Affordable Care Act (ACA) & the Consumer: 2015 and Beyond
How is the ACA affecting the health care system on key metrics of access to, affordability of, and quality of health
care? What challenges are on the horizon?
Mark Grant, IL Assistant State Director, National Federation of Independent Businesses, Moderator
Jason Montrie, Executive Vice President, Land of Lincoln Health
Todd Page, Senior Vice President of Sales and Marketing, AHIX.com, a division of JLBG Health
Craig Rodrigue, Independent Insurance Advisor, Association of Mature American Citizens
Steven Tucker, Founder, HealthInsuranceMentors.com & Small Business Insurance Services Inc.
11:05 am 11:20 am Break
11:20 am 12:35 pm Health Care Innovations: Technology In Medicine
What technologies are transforming and have the potential to transform the everyday health care experience of
consumers, and how can these technologies be improved? How can consumers adapt to these changing health care
technologies? What are the best policy, economic, and industry conditions for improving research and development
in the health care technology area?
Brian Lemon, President of Central DuPage Hospital, Moderator
Jeff Coney, Director of Economic Development, Northwestern University
David Miller, CEO and President, Illinois Biotechnology Industry Organization
Dr. Harry Rowland, CEO, Endotronix
Dan Yunker, CEO, Land of Lincoln Health
12:35 pm 2:00 pm Lunch in Dining Room, Building E

Keynote Address: 10 Key Trends in Health Care Reform,
Scott Becker, Partner, McGuireWoods
2:00 pm 3:15 pm Health Care Innovations: Access to Health Care
What services are transforming and have the potential to transform consumers access to health care? How can
consumers best utilize these changing means of access to care? What are the best policy, economic, and industry
conditions for improving this access?
Dr. Vikram Patel, President and Medical Director, ACMI Pain Care and Board Member, McHenry County Medical Society, Moderator
Dr. Opella Ernest, Vice President & Chief Medical Officer, Blue Cross and Blue Shield of Illinois
Mike Randall, Vice President of Clinical Innovation, Advocate Health Care
Denise Scarpelli, Market Pharmacy Director Chicago, Walgreens
Hon. A.J. Wilhelmi, Chief Government Relations Officer, Illinois Hospital Association
3:15 pm 3:30 pm Wrap Up and Next Steps, Congressman Randy Hultgren, (IL-14)

The Affordable Care Act (ACA) & The Consumer: 2015 and Beyond
Moderator: Mark Grant, IL Assistant State Director, National Federation of Independent
Business
Mark Grant is currently the Assistant State Director for NFIB in the state of Illinois. Direct grassroots efforts with NFIBs 11,000
Illinois members by providing guidance on legislative and political activism. Mr. Grant advocates for small-business-friendly laws
and regulations on behalf of NFIB small business members. Mark Grant has a B.A. of Fine Arts from the Southern Illinois University
in Carbondale.

Jason Montrie, Executive Vice President, Land of Lincoln Health

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

To d d P age, Senior Vice P re side nt of Sale s and M ark e ting, AHI X.c om, a d iv is io n
o f J L B G H ealth
Todd Page is currently the Senior Vice President of Sales and Marketin at AHIX.com. He began his career with Aon Corp. For the past
25 years he has been at JLBG Health, where he designed health care plans for over 300 associations and franchise groups including
the American Medical Association (AMA), the American Bar Association (ABA), the American Dental Association (ADA), as well
as the National Federation of Independent Business (NFIB). JLBG Health is the largest provider of private labeled Health Insurance
Exchanges in the US for Associations, Trade Groups, and Franchise organizations. AHIX.com, a division of JLBG Health, is an online marketplace to
learn and shop for health insurance plans.

Craig Rodrigue, Independent Insurance Advisor, Association of Mature American Citizens

Craig Rodrigue has been helping business clients formulate and implement their plans for life insurance, healthcare coverage and
disability protection for over 16 years. Craig Rodrigue has been helping business clients formulate and implement their plans for life
insurance, healthcare coverage and disability protection. As the environment for healthcare coverage has changed, he has been at the
forefront in keeping business owners strategically informed and in compliance with federal regulations.
Mr. Rodrigue appears as a guest on various Florida radio shows and news programs to discuss insurance, financial planning,
government and business issues. He has testified for the Florida Department of Insurance, serves on the Advisory Council for AvMed Health Plans and
as Committee Chair for National Association of Insurance and Financial Advisors (NAIFA) and is regularly recognized as a top contributing agent by
major Insurance Carriers for meeting client needs.
Mr. Rodrigue graduated from the University of Central Florida and has operated his own businesses for 25 years, giving him an expertise regarding the
needs and retirement plans of business owners. He lives in Southeast Orlando with his wife and three sons.

Steven Tucker, Founder, HealthInsuranceMentors.com & Small Business Insurance Services Inc.
Steven Tucker has been a multi-state licensed Independent insurance broker since 1995. Representing clients in commercial business
and individual consumer-driven Health & Life insurance in over 15 states, he has garnered a notable reputation in informing and
navigating through the far-reaching complexities of comprehensive insurance coverage on behalf of families and small business.
With an arsenal of insurance reform knowledge and real-world expertise, Mr. Tucker actively engages as a regularly featured speaker
delivering a unique insight and perspective to business employers, associations and advocacy groups and brings into context the new
laws ramifications and impact on business and consumers. With acumen and recognition under his belt, his pointed-delivery encompasses all aspects of
what ails the health insurance system in America while dissecting the changes and looming challenges of the Affordable Care Acts provisions.
Considered one of the leading authorities on small group market reforms, high-risk pools, HIPAA compliance, Medicare reform, and the Affordable
Care Acts new mandated taxes and regulatory measures, Mr. Tucker, an advocate for the family and small business, is not afraid to charter new water
in exposing the never-ending challenge of a demanding global insurance marketplace, bringing to bear the relative significance of cost shifting, and
the prevalent problems and re-examination of how health care insurance is delivered.
Founder of HealthInsuranceMentors.com and Small Business Insurance Services Inc. an independent agency for the last two decades, Mr. Tucker
continues to actively specialize in meeting the health insurance needs of the self-employed and small business owner.

H ealth Care I nnovations: Technology I n M edicine

Moderator: Brian Lemon, President of Central DuPage Hospital
Brian Lemon is President of Central DuPage Hospital and Executive Vice President of Cadence Health. Mr. Lemon is responsible
for all CDH operations. He joined the organization in 2012, bringing with him more than 30 years of health services management
experience.
Mr. Lemons background includes strategic planning, quality and safety management, performance improvement, and healthcare
organization governance. Prior to joining Cadence, Mr. Lemon served as chief executive officer of Vanguard MacNeal Hospital in
Berwyn, Illinois, the 427-bed Chicagoland flagship hospital of investor-owned Vanguard Health Systems. During this and a prior tenure at MacNeal,
Mr. Lemon contributed to the hospitals growth by serving in several progressively responsible management capacities, including vice president, chief
operating officer, and president and CEO. Between his tenures at MacNeal, Mr. Lemon was president and CEO of Holy Cross Hospital in Chicago.
Mr. Lemon serves on the board of directors and is a member of the finance committee for the Illinois Hospital Association. He also has held positions
on the boards of directors for the Metropolitan Chicago Healthcare Council and the Chicago Hospital Risk Pooling Program; on the Arthur Andersen
& Co. regional advisory board; as chairman of the American Health Walk, Near West Suburbs; and on the board of directors for the Berwyn YMCA.
Mr. Lemon earned his bachelors degree in biology from the University of Notre Dame, Indiana, and his MBA from the University of Detroit.

Jeff Coney, Director of Economic Development, Northwestern University

Jeff Coney serves as Director of Economic Development at Northwestern University, a position he was appointed to in September,
2007. He is also a member of the management team of the Innovation and New Ventures Office (INVO). His responsibilities
include selected intellectual property and license management, marketing and business development for INVO. Mr. Coney joined
Northwestern in 2000 as Director of New Business Initiatives.
Prior to joining the University, Mr. Coney spent 14 years as a software entrepreneur. He co-founded Facility Management Systems,
Inc., a local software company, which was sold to a publicly traded company. He has also had prior employment with Arthur Andersen, Metropolitan
Structures and The City of Chicago. Mr. Coney holds BA and MBA degrees from Northwestern and is a CPA.

David Miller, CEO and President, Illinois Biotechnology Industry Organization

David Miller is president and CEO of the Illinois Biotechnology Industry Organization (iBIO), a life sciences trade organization
that comprises leaders from the private, public and educational sectors. In this position, he also serves as the president and CEO
of the iBIO Institute, which orchestrates business leadership in delivery of world-class educational programs and job-creating new
technology ventures.
Prior to joining iBIO, he served in executive positions for technology start-ups: Vice President of Corporate Development for
AppsPoint Corporation in Silicon Valley; Vice President of Business Development and Vice President of Sales & Marketing for Clear Communications
in Chicago; and President of Joiner Associates, in Madison, Wisconsin.
Before that, David Miller served as business aide for the Mayor of Madison, Wisconsin, where he initiated a world-first, quality-productivity effort
based on Deming/Japanese practices; he also drove the citys efforts to establish the heralded University of Wisconsin Research Park. He served as
Managing Partner of New Age Housing, a developer of solar housing, and as a General Partner of Wyndemere Partners, a developer of energy-efficient
conventional housing, both in Wisconsin.
David Miller also initiated successful projects for divisions of Fortune 500 companies: as Regional Counsel for the Hartford Insurance Group subsidiary
of ITT, and as Real Estate Attorney for the Richman Brothers division of Woolworth Corporation. He earned his B.A. from Tufts University and his
J.D. from Case Western Reserve School of Law.

Dr. Harry Rowland, CEO, Endotronix

Dr. Harry Rowland has directed the Endotronixs operations, strategy, and technology development since inception. He received his
PhD in mechanical engineering from the Georgia Institute of Technology and a BS in mechanical engineering and MA in economics
from the University of California, Santa Barbara. Dr. Rowlands professional interests are at the intersection of transformative
technologies and emerging business opportunities. He has been active in research and development of micro and nanotechnology
fabrication methods for more than a decade. His projects have led to invited research at Sandia National Laboratories, New Mexico
and Trinity College, Ireland. Dr. Rowland has authored or presented over 15 conference and journal papers in internationally recognized peerreviewed publications such as Science and Nano, with his work referenced in more than 200 scholarly articles. He is an inventor on several issued
patents and pending applications.

Dan Yunker, CEO, Land of Lincoln Health

Daniel Yunker Dan serves as the CEO of Land of Lincoln Health, Inc., the first and only consumer operated and oriented plan in
Illinois. He also serves as Senior Vice President and Chief Financial Officer of the Metropolitan Chicago Healthcare Council, a
position hes held since 2005. Through this role, Mr. Yunker provides strategic executive oversight for MCHCs MetroChicago Health
Information Exchange, Business Resource Solutions, Human Capital Services and Employee Benefit Trust.
A thought-leader in health care finance, he is a professor of finance in the University of Illinois at Chicagos master of healthcare
administration program, educating the next generation of health care leaders. Earlier in his career, he served as a vice president at Aon Corporation
and director of Business Development at the Healthcare Financial Management Association where he was responsible for designing and implementing
programs and strategies designed to contribute to the success of members and their organizations. He was intimately involved with special projects,
educational programs and other HFMA thought leadership and resource offerings. In addition, Mr. Yunker held various leadership roles at Cadence
Health System, and is a founder of both IPS, a Chicago-based physician-practice management company and Air Angels, Inc. an aero medical flight
company.
Dan Yunker received his masters degree in business administration from the Keller Graduate School of Management and his bachelors degree from
the University of Illinois at Chicago.

H ealth Care I nnovations: Access

to

H ealth Care

M o d e r a t o r : D r. Vi k r a m P a t e l , P re s i d e n t a n d M e d i c a l D i re c t o r, A C M I P a i n C a re ,
L L C a n d B o a rd M e m b e r, M c H e n r y C o u n t y M e d i c a l S o c i e t y
Dr. Patel began his career at B.J. Medical College in India, one of the countrys premier institutions where he also completed his
Anesthesia residency and Board certification. He later completed a residency in Anesthesiology at the University of Toledo Medical
Center, where he also earned his Chief Resident status. University of Toledo Medical Center then awarded him a fellowship in pain
medicine and regional anesthesia. Dr. Patel has led a vital career in pain medicine.
Dr. Patel is board-certified in anesthesiology and also fellowship trained and board certified in pain management by the American Board of Anesthesiology.
He is also a certified Fellow in Interventional Pain Practice. A highly active author, editor, and pain management specialist, Dr. Patel has managed and
practiced at medical centers throughout Illinois, including Loyola University Medical Center near Chicago where he served as Program Director for
the Pain Management Fellowship program and as an associate professor of the pain management section in the Department of Anesthesiology. He has
helped publish Guidelines for Interventional Pain Management procedures under the auspices of American society of Interventional Pain Physicians.
Currently, Dr. Patel is the president and medical director of ACMI Pain Care in Algonquin, Illinois.

Dr. Opella Ernest, Vice President and Chief Medical Officer, Blue Cross and Blue Shield
of Illinois
Opella F.Ernest MD, serves as the Chief Medical Officer for Blue Cross Blue Shield of Illinois. In this role, she is responsible
for assuring the delivery of quality, accessible, cost effective care consistent with the mission and vision of Health Care Service
Corporation (HCSC). Dr.Ernest is committed to health and wellness and has over 17 years of clinical leadership experience.
Dr. Ernest joined HCSC in 2012 as a Senior Medical Director for HCSC Government Programs division. Prior to joining HCSC she
was responsible for the clinical model of care for dual eligible members as Senior Vice President, Medical Management, for HealthSpring, Inc. During
her tenure as a Medical Director for HealthSpring, she contributed to utilization management, quality and pharmacy programs. She has held physician
leadership roles with the Visiting Nurse Association, Advocate Health Care, and the Henry Ford Medical Group.
Dr. Ernest, a board certified family physician, earned her undergraduate degree from the University of Michigan and medical degree from the Ohio State
University College of Medicine. She interned at St. Joseph Hospital, Chicago, Illinois and completed her residency in family medicine at Providence
Hospital, Southfield Michigan. Professional affiliations include the American Academy of Family Physicians, Illinois Academy of Family Physicians,
the American College of Physician Executives and she is a Fellow of the Institute of Medicine (IOM), Chicago.
She is committed to the community and is actively involved with the American Heart Association, Chicagoland Chamber Workplace Well Being and
Prevention Practice Committee and serves as an advisor for the Healthcare Business Womens Association.

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

Mike Randall is Vice President of Clinical Innovation for Adocate Health Care. His primary areas of expertise include Accountable
Care Organizations (ACOs), clinical integration, strategic planning, clinical service line strategy, operations improvement, care
management, patient throughput, and facility planning.
Mr. Randall previously served as manager of business advisory services and hospital operations for The Camden Group, in Chicago.
Prior to joining the The Camden Group, Mr. Randall was a director at Sg2 Healthcare Intelligence. While at Sg2, Mr. Randall
led multiple engagements in clinical service line planning and technology adoption in the areas of orthopedics, neurosciences, cancer services,
cardiovascular services, and imaging. Mr. Randall completed an administrative fellowship at NorthShore University HealthSystem (NorthShore),
formally Evanston Northwestern Healthcare. While at NorthShore, he led a team in developing a tool that credited each hospital admission and patient
visit to an attending and referring physician. This tool has had a lasting impact on the health system by allowing them to understand, target, and enhance
referral relationships. He received his Bachelors degree from the University of Michigan and Masters of Health Administration from the University
of North Carolina at Chapel Hill.

Denise Scarpelli, Market Pharmacy Director Chicago, Walgreens

As the Market Pharmacy Director Chicago for Walgreens, Denise Scarpelli oversees the Pharmacy Operations of stores within the
Chicago land area and Northwest Indiana, consisting of 275 stores and $2.1 billion in annual sales. In that capacity, Ms Scarpelli
is responsible for sales, people management, strategic partnerships and expense control. nother key area is partnering with other
healthcare companies within the Chicagoland area to work on care coordination and healthcare reform projects. She has 21 Pharmacies
on medical campuses within the market. Ms Scarpelli has been employed by Walgreens for over 20 years serving in various roles from
Pharmacy Manager to Pharmacy Supervisor.
Denise Scarpelli received a Doctorate in Pharmacy from University of Chicago College of Pharmacy in 1996. She is an active member of the American
College of Healthcare Executives, Healthcare Business Women Association and the Illinois Pharmacist Association. In addition, she serves on UIC
College of Pharmacys Dean Advisory Board and Lurie Childrens Hospital CCE Board. She has also spent a large part of her career helping nonprofits
with support from pharmacists; organizations such as the American Diabetes Association, American Heart Association and the Chicago AIDS
Foundation.

Hon. A.J. Wilhelmi, Chief Government Relations Officer, Illinois Hospital Association
As Chief Government Relations Officer for the Illinois Hospital Association, (IHA), A.J. Wilhelmi is responsible for directing the
Associations overall state and federal advocacy and policy agendas to enhance coordination of IHAs and the hospital communitys
advocacy efforts and initiatives. Arthur Wilhelmi was a member of the Illinois Senate, representing the 43rd District between the
years 2005 until 2012. He served as Chair of the Senate Judiciary Committee and Vice-Chair of the Agriculture and Conservation
Committee in the Illinois Senate. In addition, he served on the Transportation, Gaming and Criminal Law Committees.
Mr.Wilhelmi has a BA from Loyola University of Chicago, with a major in English and minors in Philosophy and Political Science. In 1991 he
graduated from Chicago-Kent College of Law. After passing the Illinois State Bar Examination, he was sworn in as an attorney in 1993, and joined
the McKeown Law Firm. He developed a real estate and business law practice. In 2008, he joined Murer Consultants, Inc., a legal-based healthcare
consulting firm. In 2009, the partners opened a law firm, Murer, Brick & Wilhelmi, LLC. He and his wife live in Joliet with their two children.

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