GARY AND MARY WEST HEALTH INSTITUTE
10350 NORTH TORREY PINES ROAD, LA JOLLA, CA 92037 www.westhealth.org

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Organizations Filed Purposes: MEDICAL RESEARCH WITH HOSPITALS TO LOWER THE COST OF HEALTHCARE AND ENABLE SENIORS TO SUCCESSFULLY AGE, LIVING LIFE ON THEIR OWN TERMS WITH ACCESS TO HIGH-QUALITY HEALTH AND SUPPORT SERVICES THAT PRESERVE AND PROTECT THEIR DIGNITY, QUALITY OF LIFE AND INDEPENDENCE.

CONDUCTING MEDICAL RESEARCH WITH HOSPITALS TO REDUCE HEALTHCARE COSTS WITH A FOCUS ON SENIORS.

IN 2019, THE GARY AND MARY WEST HEALTH INSTITUTE ("WHI OR "INSTITUTE") ACTIVELY CONDUCTED APPLIED MEDICAL RESEARCH, IN CONJUNCTION WITH THE HOSPITALS LISTED ON SCHEDULE A, TO GENERATE THE EVIDENCE NEEDED FOR HEALTHCARE PROVIDERS, POLICYMAKERS AND COMMUNITIES TO ADOPT MODELS OF CARE THAT BETTER SERVE SENIORS AND THEIR FAMILIES. THE ORGANIZATION IS COMMITTED TO LOWERING THE COST OF HEALTHCARE AND ENABLING SENIORS TO SUCCESSFULLY AGE IN PLACE WITH ACCESS TO HIGH-QUALITY, AFFORDABLE HEALTH AND SUPPORT SERVICES THAT PRESERVE AND PROTECT THEIR DIGNITY, QUALITY OF LIFE AND INDEPENDENCE.THE INSTITUTE CONTINUED TO ADVANCE A NATIONAL RESEARCH AGENDA TO CREATE HEALTHCARE DELIVERY MODELS AND DRIVE NEW POLICIES AND PRACTICES TO IMPROVE CARE, INCREASE ACCESS AND REDUCE COSTS FOR OUR FAST-GROWING, DIVERSE POPULATION OF SENIORS. IN ADDITION TO ITS COMMITMENT TO LOWER THE COST OF HEALTHCARE, THE INSTITUTE HAS THE FOLLOWING ACTIVE RESEARCH FOCUS AREAS:1. ADVANCING SENIOR-APPROPRIATE ACUTE CARE MODELS - THE INSTITUTE IS RESEARCHING HOW PROVIDING SENIOR-FOCUSED CARE IN AN ACUTE SETTING, SUCH AS IN THE EMERGENCY DEPARTMENT (ED), HOME AND COMMUNITY, CAN HELP SENIORS AGE SUCCESSFULLY.2. ADVANCING SENIOR-APPROPRIATE CHRONIC CARE MODELS - THE INSTITUTE IS EXPLORING HOW TO IMPROVE CARE FOR SENIORS WITH LONG TERM-ILLNESSES AT HOME - WHERE THEY PREFER IT MOST.3. ADVANCING SUPPORTING SERVICES - THE INSTITUTE IS COLLABORATING TO ADVANCE AND INTEGRATE COMMUNITY-BASED SOCIAL SUPPORT PROGRAMS AND NUTRITIONAL SERVICES THAT SUPPORT INDEPENDENCE FOR SENIORS.LOWERING THE COST OF HEALTHCARETHE RISING COST OF HEALTHCARE IS A GROWING ECONOMIC AND PUBLIC HEALTH CRISIS THAT HURTS THE U.S. ECONOMY, THREATENS INDIVIDUAL FINANCIAL SECURITY, COMPROMISES CARE AND REDUCES PATIENT ACCESS. EXCESSIVE SPENDING ON HEALTHCARE PLACES SIGNIFICANT BURDENS ON AMERICAN BUSINESSES AND FAMILY BUDGETS AND ENDANGERS THE FUNDING OF VITAL PROGRAMS SUCH AS MEDICARE AND MEDICAID. RISING COSTS FOR MEDICAL TESTS AND PROCEDURES, PHYSICIAN VISITS, AND HOSPITAL SERVICES DUE TO AN OUTDATED FEE-FOR-SERVICE PAYMENT MODEL THAT REWARDS VOLUME OVER VALUE AND MARKET FAILURES THAT ALLOW EXORBITANT PRICES FOR SERVICES AND PRODUCTS, HAVE MADE HEALTHCARE EXTREMELY EXPENSIVE LEAVING PATIENTS WITH LESS COVERAGE, MORE OUT-OF-POCKET COSTS AND RISING PREMIUMS.MOREOVER, IT IS A COMMON MISCONCEPTION THAT BECAUSE OF MEDICARE COVERAGE SENIORS (OVER 65) IN THE US ARE SHIELDED FROM THE BURDENS OF THE HIGH COST OF HEALTHCARE. OLDER ADULTS, ESPECIALLY VULNERABLE AND FRAIL SENIORS, EXPERIENCE COSTS BOTH DIRECTLY (ONLY A PORTION OF DRUGS AND SERVICES ARE COVERED) AS WELL AS INDIRECTLY VIA PERVERSE INCENTIVES ON HEALTHCARE SYSTEMS THAT DEMAND PROFIT OVER PATIENT OUTCOMES. ULTIMATELY, IT IS ESSENTIAL TO LOWER THE COST OF HEALTHCARE IN THE US IF SENIORS ARE TO SUCCESSFULLY AGE IN AMERICA. GIVEN THE SERIOUS AND URGENT NATURE OF THIS ISSUE, WHI HAS ADDRESSED THE COST OF HEALTH CARE VIA SEVERAL AVENUES. THE INSTITUTE HAS DIRECTLY SUPPORTED WORKSTREAMS FOCUSED ON LOWERING THE COST OF CARE - WHEN APPROPRIATE IN COLLABORATION WITH THE WEST HEALTH POLICY CENTER (WHPC) - AND HAS ALSO PUT SIGNIFICANT EFFORT INTO ENSURING THAT THE MAJORITY OF THE RESEARCH UNDERTAKEN UNDER THE BANNER OF SUCCESSFUL AGING ALSO SPEAKS TO DRIVING VALUE AND COST REDUCTION FOR CARE EXPERIENCED BY SENIORS. OVER THE COURSE OF 2019, WHI ORGANIZED ITS WORK INTO SEVERAL AREAS OF CONCENTRATION, WHICH INCLUDE WORK DESIGNED TO HIGHLIGHT AND BRING ATTENTION TO THE SERIOUSNESS AND URGENCY OF THIS CRISIS AS WELL AS PROPOSE BOLD SOLUTIONS TO MOVE FORWARD. SPECIFICALLY, THREE COMMON SENSE REFORMS - ALLOWING MEDICARE TO DIRECTLY NEGOTIATE PRESCRIPTION DRUG PRICES WITH DRUG COMPANIES, ACCELERATING THE MOVE TO A VALUE-BASED CARE SYSTEM AND INCREASING TRANSPARENCY ABOUT THE VALUE OF SERVICES - WERE ADVANCED AS KEY TO LOWERING HEALTHCARE COSTS, IMPROVING HEALTH OUTCOMES, AND ENABLING THE CREATION OF A SYSTEM THAT IS MORE TRANSPARENT, COMPETITIVE, AFFORDABLE, PERSON-CENTERED, QUALITY-DRIVEN AND SUSTAINABLE.RAISE AWARENESS OF SPENDING CRISIS AND URGENCYTO FOCUS THE ATTENTION OF POLICYMAKERS, ADMINISTRATORS, THE BUSINESS COMMUNITY, AND THE GENERAL PUBLIC ON THE HEALTHCARE CRISIS, WHI LED AND SUPPORTED SEVERAL KEY EFFORTS IN 2019. BUILDING ON EARLIER SUCCESSES WITH PUBLIC SURVEY WORK DONE WITH THE NATIONAL OPINION RESEARCH CENTER AT THE UNIVERSITY OF CHICAGO, THE INSTITUTE IS RESEARCHING THE AMERICAN PUBLIC'S PERCEPTIONS OF HEALTHCARE AND PRESCRIPTION DRUG COSTS THROUGH A THREE-YEAR ENGAGEMENT WITH GALLUP THAT STARTED AT THE END OF 2018 TO DEVELOP A RECURRING NATIONAL SURVEY OF KEY ISSUES REGARDING HEALTHCARE COSTS. IN ADDITION TO DEMOGRAPHIC AND DESCRIPTIVE DATA, AREAS OF FOCUS INCLUDE: * PUBLIC PERCEPTION OF THE US HEALTHCARE SYSTEM FROM COST AND QUALITY PERSPECTIVES * MEDICAL CARE FORGONE DUE TO COSTS * UNDERSTANDING AND TRANSPARENCY OF PRICES FOR DRUGS AND HEALTH PROCEDURES * FINANCIAL BURDEN ON HOUSEHOLDS DUE TO HEALTHCARE COSTS * ENGAGEMENT WITH THE POLITICAL PROCESS AROUND HEALTHCARE COST ISSUESIN 2019, TWO NATIONAL SURVEYS WERE PUBLISHED WITH FULL REPORTS AND SUPPORTING MATERIALS FOR PUBLIC CONSUMPTION TO DRIVE VISIBILITY AND AWARENESS OF THESE ISSUES AND HOW COSTS ARE IMPACTING THE LIVES OF AMERICANS EVERY DAY. THE FIRST GALLUP/WHI SURVEY ON HEALTHCARE COSTS WITH A SAMPLE SIZE OF 3,500 RESPONDENTS WAS UNVEILED AT THE HEALTHCARE INNOVATION SUMMIT (HCI) IN WASHINGTON D.C. IN APRIL AND ACHIEVED A SUBSTANTIAL MEDIA IMPACT, WITH COVERAGE OF THE SURVEY IN MAJOR NATIONAL MEDIA.THE SECOND SURVEY ON HEALTHCARE COSTS, USING A SMALLER SCALE SAMPLE SIZE OF APPROXIMATELY 1,000 RESPONDENTS, WAS RELEASED IN NOVEMBER OF 2019 TO IMPRESSIVE MEDIA COVERAGE, INCLUDING THREE SEPARATE SYNDICATED STORIES IN THE ASSOCIATED PRESS AND SUBSTANTIAL SOCIAL MEDIA DISTRIBUTION AND CITATIONS OF THIS DATA BY ELECTED OFFICIALS AND PRESIDENTIAL CANDIDATES, IN PARTICULAR FOR THE POLL'S STRIKING RESULTS HIGHLIGHTING THE SHARE OF ADULTS WHO REPORTED KNOWING SOMEONE WHO DIED DUE TO THE UNAFFORDABILITY OF CARE.WHI ALSO ACTIVELY CONTRIBUTED TO THE SUCCESS OF THE WELL-ATTENDED 2019 HCI SUMMIT IN WASHINGTON D.C. THE SUMMIT, WHICH FEATURED FORMER GOVERNORS AND ADMINISTRATION HEADS, RESPECTED HEALTHCARE REPORTERS, AND BUSINESS AND HEALTHCARE LEADERS, HAD OVER 1,000 IN-PERSON ATTENDEES AND GARNERED THOUSANDS MORE ONLINE.DEVELOP ACTIONABLE POLICIES TO LOWER DRUG COSTSTRATEGIES TO REDUCE THE RISING COST OF PHARMACEUTICALS HAVE BEEN A KEY COMPONENT OF THE COST OF HEALTHCARE WORK. IN DECEMBER OF 2019, THE HOUSE OF REPRESENTATIVES PASSED LEGISLATION (HR3) THAT WOULD ALLOW MEDICARE TO NEGOTIATE DRUG PRICES. SINCE WHI HAS DEMONSTRATED THROUGH ITS RESEARCH THE POTENTIAL BENEFITS OF DIRECT NEGOTIATION OF DRUG PRICES, IT WAS GRATIFIED TO SEE THE ENACTMENT OF HR3. IN SUPPORT OF BROAD POLICY CHANGES IN THE AREAS OF DRUG PRICING AND SIMILAR AREAS OF HEALTHCARE COST CONCERN, WHI PROVIDED DATA SCIENCE EXPERTISE TO PROJECTS (LED BY WHPC) MODELING THE HEALTH COSTS OF CURRENT DRUG PRICES AS WELL AS ESTIMATES OF THE SAVINGS ASSOCIATED WITH CHANGES IN THE MEDICARE PARTS B AND D PROGRAMS.ADDITIONALLY, WHI COLLABORATED IN DEVELOPING THE EVIDENCE FOR LOWERING PRESCRIPTION DRUG PRICES AND ENSURING THAT THIS EVIDENCE WAS PRESENTED TO APPROPRIATE STAKEHOLDERS IN THE LEGISLATIVE, POLICY, AND MEDIA MILIEU. DEVELOP ACTIONABLE POLICIES TO REDUCE VOLUME INCENTIVES IN FEE-FOR-SERVICEVALUE-BASED CARE (VBC) WHICH INCORPORATES RISK FOR BOTH HEALTH AND SPENDING OUTCOMES INTO PAYMENT RATES HAS THE POTENTIAL TO REDUCE MANY OF THE VOLUME-BASED FINANCIAL INCENTIVES THAT ARE DRIVING UP PER-CAPITA HEALTHCARE COSTS. IN 2019, WHI SUPPORTED AN IMPORTANT COLLABORATION IN WHICH WHPC AND THE DUKE-MARGOLIS CENTER FOR HEALTH POLICY ORGANIZED AND PARTICIPATED IN EXPERT ROUNDTABLES ON STATE AND NATIONAL MODELS OF VBC. THESE THOUGHT-PROVOKING ROUNDTABLES PLAYED A KEY ROLE IN DEVELOPING LANDSCAPE ASSESSMENTS OF SUCCESSFUL MODELS OF VALUE-BASED PAYMENT REFORMS TO SUPPORT THE SPREAD OF VBC AT THE STATE AND NATIONAL LEVELS. TOGETHER WITH A FOCUSED, EXPERT-GUIDED REVIEW OF THE LATEST PAYMENT REFORM EVIDENCE, THE INSTITUTE AND DUKE-MARGOLIS ARE DEVELOPING A ROADMAP FOR IMPROVING CARE VALUE AND REDUCING COSTS THROUGH PAYMENT REFORM. THE ROADMAP IS CURRENTLY IN PUBLICATION/PRODUCTION AND FEATURES ACTIONABLE, PROMISING STEPS TO ADVANCE PAYMENT REFORM, AND TO ENABLE HEALTH CARE ORGANIZATIONS TO SUCCEED IN LOWERING COSTS. IN ADDITION TO THE ABOVE, THE DUKE-MARGOLIS CENTER WAS TASKED TO BUILD ON THEIR PAST WORK INVOLVING A RANGE OF STATES INCLUDING COLLABORATIONS WITH STATE POLICYMAKERS AND RESEARCHERS, CMS, AND HEALTH CARE TRANSFORMATION LEADERS TO DEVELOP A SET OF RESOURCES TO ACCELERATE EFFECTIVE STATE-BASED REFORMS.

THE RISING COST OF HEALTHCARE IS A GROWING ECONOMIC AND PUBLIC HEALTH CRISIS THAT HURTS THE U.S. ECONOMY, THREATENS INDIVIDUAL FINANCIAL SECURITY, COMPROMISES CARE AND REDUCES PATIENT ACCESS. EXCESSIVE SPENDING ON HEALTHCARE PLACES SIGNIFICANT BURDENS ON AMERICAN BUSINESSES AND FAMILY BUDGETS AND ENDANGERS THE FUNDING OF VITAL PROGRAMS SUCH AS MEDICARE AND MEDICAID. RISING COSTS FOR MEDICAL TESTS AND PROCEDURES, PHYSICIAN VISITS, AND HOSPITAL SERVICES DUE TO AN OUTDATED FEE-FOR-SERVICE PAYMENT MODEL HAVE MADE HEALTHCARE EXTREMELY EXPENSIVE LEAVING PATIENTS WITH LESS COVERAGE, MORE OUT-OF-POCKET COSTS AND RISING PREMIUMS.TO TACKLE THIS CRITICAL ISSUE, THE WEST HEALTH INSTITUTE CONTINUES TO LEAD EFFORTS TO RAISE AWARENESS OF SPENDING CRISIS AND URGENCY, DEVELOP ACTIONABLE POLICIES TO LOWER DRUG COST AND REDUCE VOLUME INCENTIVES IN FEE-FOR-SERVICE AND DRIVE TRANSPARENCY IN THE HEALTH CARE SYSTEM.TO SUPPLEMENT AND BROADEN THE INSTITUTE'S MEDICAL RESEARCH ACTIVITIES, THE INSTITUTE ALSO PARTICIPATED IN PUBLIC EDUCATION, POLICY WORK AND THE DISSEMINATION OF RESEARCH FINDINGS TO THOSE INTERESTED IN REDUCING THE COST OF HEALTHCARE SERVICES AND DEVELOPING SENIOR-APPROPRIATE ACUTE, CHRONIC CARE AND SUPPORTIVE SERVICE MODELS THAT SUPPORT INDEPENDENCE FOR SENIORS. THE INSTITUTE HAS PROMOTED THE DEVELOPMENT AND IMPLEMENTATION OF POLICIES WHICH ADVANCE TRANSITION OF MODELS OF CARE, HOME-BASED PRIMARY CARE AND PAYMENT MODELS THROUGH CONFERENCE PARTICIPATION AND DIRECT INTERACTION WITH POLICYMAKERS IN BOTH THE REGULATORY AND LEGISLATIVE ARENAS.

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