tv Fox 5 Morning News Sunday FOX November 3, 2013 8:00am-9:00am EST
meyer -- welcome to the program. >> great to be here, bob. appreciate it. >> this ship is the first new aircraft carrier design since the nimitz class since 1972. >> if you look at this ship from afar, they look alike, other than the island being a little bit further aft but that's where the similarities end. really all electric. we have taken all the steam that goes outside of the propulsion plant and replaced steam catapults -- put electric on it, we have taken all the rotating antennas that you would see on them nimetts class carrier -- we have really automated the entire inside of the ship whether it's from elevators the way the storage conveyors are set up, the way we feed the crew and all that
in the end has resulted in taking five to 900 people off the ship which results in $4 billion less. if you were to go and -- >> what are some of the things that you've also done to increase what is really the most important metric of any aircraft carrier which is the soaredy generation rate? how is it you can launch more aircraft crafter on the ford than you can on the nimitz? >> the ford class as a generation rate that's 33% greater than a nimitz class carrier. we went back and how do you get planes landed, refueled, rearmed back onto a catapult launch and that's really a combat capability of the ship. first thing we did is actually went to nascar and said how do you turn your cars around so quick and we learned some things from them on how do you arrange a pit stop so that you can get the cars in, refueled, get new tires on them and go. and so when we built the flight
deck arrangement on the ford class, we specifically arranged the flight in such a way that the refueling stations and the stations for rearming the aircraft are arranged so that as soon as the plane lands and taxies, it can get basically everything done in one location and then we can taxi it back onto a catapult and get it off the ship. a lot of people seem to think the electromagnetic launching system is the reason -- rest of the layout of the flight deck and the ability of the plane crews to get the plane turned around and on the catapult. >> you have fuel stations on the center of the ship not just at the deck edge so you have refueling options. cost for all of this capability, cost remains a challenge, every major program is -- faces the same challenges. what are you guys doing on this class to take cost out of the program? >> first thing as i mentioned earlier, the big cost driver on an aircraft carrier over its life cycle for a nimitz class is people. it represents 40% of the total cost of the ship over 50 years. designing the ford from the
bottom up, we realized people are expensive for all the reasons that the countries sees, medicare and social security, long-term health cost so first thing design the ship to take people off the ship and done it, taken nine to 1200 people off. the automation helps reduce people. we have also designed the ship with new materials and air conditioned portions of the ship to significantly reduce the maintenance we are going to have to do over that ship on the life of the ship. from a construction standpoint we work closely with huntington newport news to work on new processes to put the ship together and while no one will say that we are happy with costs of the first ship for a lot of reasons, some of those things that we did, some of the things we couldn't have anticipated the first ship of the class we are taking all those lessons learned and roll that into the second ship of the class and build that ship for significantly fewer man- hours and cost than we are building 78. >> capability standpoint, the ships will be the same. >> absolutely. >> they will have the same capabilities?
>> absolutely. >> talk about the navy is fond of saying and you and i just before we were talking just a moment ago where you mentioned that this ship is going to be in service 50 years, you know, enterprise behind you was in service 51 years and that the class itself will almost make it a century in service. what are some of the features you're designing into this ship so that over the long term the ship can be easily adapted over time to handle missions that we may not even consider now? >> great question. in fact it's one of the three principle reasons we did the ford class in the first place. the first was to take people off and reduce the cost but second thing is this ship has three times the electrical generating capacity that's the nimitz class carrier has and design margins built into it so that as war fighting technology evolves over the years, that this ship will support it. from our perspective, you know, the navy and looking at directed energy weapons, lasers, tore peed does if --
torpedoes -- this ship is designed to handle additional capacity and electrical generation, and other margins on the ship itself. >> two technologies that are new to this ship among others is the electromagnetic launch system as well as the new arresting gear to recover the aircraft once they come back. but both have had teething problems. are you confident that you're in high enough readiness levels that this ship is going to make it to the fleet and not have sort of embarrassing problems? >> yeah, i think we certainly have had technological challenges like tv is a good description. but we have a land based test site up in new jersey for e malls, that by this time we have done dead load shots without aircraft on it and then launched over 250 shots with aircraft, actual aircraft on the e mall system, the entire inventory the navy has.
i am confident we are reducing the risk and ahead of schedule on putting a lot of components on the ship. we have had technical challenges with some of the components there like you would with any new developmental arm like this but e malls, you can ride on e malls roller coaster today. the technology itself is not new. the scale on which we are talking about is different. >> the newport news is a monopoly, it builds a great product, the navy is happy with it. serves the nation for a long time but it is a monopoly and right now d.o.d. is considering whether it is going to allow other monopolies to go through. what are the best ways to run a monopoly and what advice are you giving d.o.d. folks when they ask you that question? >> well, obviously, any situation where you only have one person building it has some unique challenges associated with it. anytime we can introduce competition into the process,
we would like to do that. having said that, they build a great product, nobody argues with the product at the end of the day, you know, what i work with the company on a day-to- day basis is understand and given the defense budget where you are and financial issues that the country has, it's incumbent upon us to continue to drive port ability in these programs and the best way for them to continue to get business and keep building this product is to drive that -- and without that, the cost of these ships -- the issue is we are a carrier nation and a carrier navy but at any price that's a tough question and we are going to have the conversation with the hill. what we are focused on driving affordability in a product we have and if we can do that we will continue to build the great warships. >> thanks for joining us. >> thank you. coming up, streamlining costs on the world's biggest and most expensive aircraft carrier. you're working -- watching "this week in defense news" from the defense building in newport news, virginia. [ telephone ringing ]
newport news ship building was founded in 1986 and today the nation's largest shipyard and the soul maker of its aircraft carriers, sits on 550 acres near norfolk and employees 23,000 employees. the company is division the huntington ingalls industry which also owns ingalls ship building in mississippi. rolf barchi worked here for 32 years and now the president in charge of the ford program. the 31st aircraft carrier that the company built in its history. rolf thank you very much for joining us. >> great to be here. >> talk to us a little bit. what are some of the lessons you've learned on -- learned on the ford program that are going to shape how you guys build kennedy and enterprise especially when it --
>> cost is paramount today. budgets are constrained so you have to deliver more value with everything you build so what we've done when we initially designed the ford was to put enhancements in the build process in that design. 3d product model was created. that allows us to visualize and show our craftsmen how to bring things together, whether it's a space you're outfitting or a piece of steel and forming the shape of the hull. all that did deliver good results to us, a lot more to go. some of the things we are doing, every piece of ford hull that came together or the compartment outfitting plant we have kept track. how did we do and what we we do different. we rolled the lessons learned back and the team that's working cn79, the john kennedy right now are taking those in and modifying processes, buying new tooling, looking at training if it requires different kind of training to enable them to bring the cost savings, you know, on that next carrier. >> you guys also have been using 3d visualization to make
sure that spaces don't require rework, that you put the door or the motor or pump in the right place that has access to it. >> absolutely. what we can do today, we can print out at any level of maturity for a given space say you want to see how the space looks in six months, we can print out this is how it should look in six months from where you are today. our craftsmen love that. that goes along with work packages, you know, an individual job can share the spatial alignment of that job or the components involved in it. it's been helpful. >> i've been told in order to achieve your costs on the kennedy that you've got to take as much material and labor out of ford as you possibly can and we are fairly evolved in the build process now even though there's another two years until 16 when -- '15, '16 when the ship is commissioned. >> tracking everything we buy, we've got a little bit left to buy and we've leveraged the vendor base for bulk buy, bringing value in. met with all of our vendors,
had the discussion, what else can we do to help you bring costs down as you deliver us a valve, a cable, a pump? and we've gotten great feedback so that outreach to the vendor base has really been beneficial. in the manufacturing side at the shipyard, we are still looking as we transition now from steel and the welding and the hot work into cable pulling installation and testing, we are looking for avenues there. a lot of land based testing was done on this ship for the different array of components to prove them, then we move them onto the ship and then do integrated testing on the ship so we are leveraging the land base, making sure we got what we wanted in laboratory setting or land based facility and we know those lessons learned wrapped it into our test program. >> the navy historically would build one carrier every four years but now that's slipped to one carrier every five years and that was a budget consideration. what sort of challenges does that present you as you try to, you know, keep stuff on schedule, preserve key skills,
preserve your employment base? >> the challenge is the longer the duration between them, the harder it is to retain your trained workforce. we make a big investment to bring people in, make sure they are -- they know how to do the work, especially of lot of this is difficult. for example on this ship on the ford, we brought in 800 electricians, some were existent in the company and many we hired, put them through a rigorous training program. they are down there pulling the cable that we saw today and, you know, wiring up these complex panels and ultra-- that ultimately will participate with the testing of those panels so the longer duration between the ships, you could have an issue keeping those folks and -- >> that you have to gap some of your workforce. >> yeah. >> do folks -- one of the things i'm always impressed whenever i go to a shipyard is that there's the brute labor part of it but also the micrometer work. do you have trouble explaining to people how complex and how much of this is actually art, not totally science? >> absolutely. i think, you know, a lot of folks don't know a lot of laser alignment goes on from putting
the hull together, installing components within a space. so all that finite measurement, finite adjustment happens as part of this big ship construction so when it comes out, it meets its design parameters and really gives the navy a platform from which they have opportunity to adjust and deliver their mission. >> your first apprentice school near the gate where it says 1919 which you're building a new apprentice school and in order to preserve core key skills and train folks for the future. are you still getting as many candidates as you had expected and what sort of benefit is that going to be strategically for the company over the coming years? >> i will tell you we are getting more applicants for the apprentice school for each year than we could ever, you know -- >> about 250 a year? >> yes. and we have many, many more times that that applied for it because it's a very -- it's recognized as a very good program. i will tell you my personal experience, i have worked with a lot of apprentice graduates, they have brought so much to the company and so we invest
heavily in them and we will continue to do that and they really -- you know, the folks that go through this, they come out and are fantastic performers so -- >> you're even getting college grads who want to have work when they graduate. >> absolutely. >> advertiser, thanks very much. >> thanks for having me. it's been great. the commanding officer of the navy's newest carrier as he prepares to get his ship ready for duty. stay tuned.
bringing a new ship to life is one of the toughest jobs for a commander. bringing the first of a revolutionary new class of warships is even tougher. that job falls to captain john meyer, the first commanding officer of ford. he began his career piloting ea6 prowler warfare jets and commanded a squadron, served aboard the harry s. truman and commanded the amphibian ship. sir, thank you very much for taking some time with us. >> great to be here. thanks for having me. >> what is the toughest part of your job today? >> the hardest part of my job today is to create the right culture on board this ship and in the command. of you creating -- i view creating a culture of excellence, command climate that's going to set the tone for this ship that will last 50 years. >> i think that's far and away the most pressing task i have. along the way, i need to ensure the safety of all of our sailors, to make sure that they can do their job safely on board the ship which is under
construction right now and i also need to ensure that we are properly trained. and when you talk about training, we are doing the training that's well out in advance of some of the navy's school house systems on a myriad of new technology and new systems that run the gamut of the dvr, the new radar, new reactor plants throughout the ship. >> so one of the questions that a lot of folks have is, you know, the gap between christening and commissioning the ship and the commissioning may 2016. >> march 2016. >> march 2016. tell us what are the enormous number of things that have to happen before we get to that date. >> tremendous amount of construction that needs to go on yet. shortly after christening the ship will be moved closer to us right here, moved to down the waterfront and she will be on the water floating and the construction will be completed there. concurrent with the construction, the testing program will begin so the testing will begin for the catapults, it will begin for a host of systems throughout the ship, the reactors will start
to come to life, if you will, through a series of testing and evaluations and then they will go critical at some point and they will be tested in their conclusion. >> how large is your ship's company right now? >> ship's company right now is almost 600 sailors. final crew will be about 2700. >> talk to me a little bit about what is the major difference that sailors are going to find when they report aboard this ship. >> in the grand scheme the carrier serves the same function and has essentially the same layout but as soon as you walk on board, you will quickly get lost because it's different from a nimitz class aircraft carrier, the principles are the same but the layout entirely different. sailors will notice that immediately. also notice that the berthings that they sleep in is much smaller. so instead of having large size berthings, more smaller berthings with their own included heads inside them so every sailor has essentially
their own private head and smaller berthings facilities. >> you're not going to be going all the way down a passageway about 150 feet to find a shower? >> well, that's a huge improvement in quality of life for the sailors. if you look at how they go to the showers or each the rest rooms on the current model in the nimitz class, sailors have to put on gym gear, carry their towels and shampoo and that sort of thing, walk down the hallway and find a common shower or a common head. now with all those facilities located inside the berthing, i think that the crew will take much greater pride and ownership of those particular spaces for one thing and a convenience factor is just unmatched to what we have in today's carriers. >> you've been in the service for a long time. you're an avenue carat but -- aviator but also know how to drive a ship. do you foresee that being any sort of challenge or change the mental model in how folks are going to drive this ship?
>> unique and different sight picture from where the bridge is. the bridge is a deck higher so it's a little higher, further atf but the site picture is not that dramatically different. we've got some computers and simulations that will help to prepare us not only me -- >> they are designing a similarity now for it so that folks can -- >> they are. and before we ever get underway under our own power, i and the rest of our bridge team will run through a rigorous set of simulators here in norfolk but also up at the surface warfare officers school in newport, rhode island, fully trained in that regard, they've got great simulation, i am confident they will be able to take care of that. >> you're also an aviator and i wanted to ask you about the e- mails. folks for decades have been talking about the advantage of an electromagnetic catapult. what's the advantage? >> it expands the capacity for aircraft. the current steam catapults are really le limit of their operation in terms of high gross weights, also in terms of
low weight aircraft. e malls has got a much wider range of operation, also in the higher end for aircraft that we really don't know or haven't even designed yet. got to remember this ship is going to be around for 50 years. so i think the emalls is more than capable to handle the aircraft today, also the character of tomorrow. >> sir, thank you very much for joining us. >> you're welcome. coming up my notebook.
the most expensive single weapon america buys are aircraft carriers. so expensive they are paid for in installments. and america's new carrier the gerald r. ford is the most expensive yet, costing more than $16 billion to design and build. carriers are worth the cost however because they deliver a unique capability that lasts for decades. the world's first nuclear power carrier, the uss enterprise was deactivated only last year after an astounding 51 years of service. the new ford class carriers could remain in service for nearly a century. critics say aircraft carriers are obsolete dinosaurs and vulnerable to missile attack and require too many assets to protect but new defenses and strategies being developed to counter those threats and allow carriers to remain valuable military and diplomatic tools for decades to come. the ford's most important feature is its large well thought out flight deck that can get within striking range
of nearly any point on the globe but a carrier is useless without an air wing that can penetrate enemy defenses. that's why the navy can't wafer from fielding stealth aircraft especially long range strike and reconnaissance jets that assure she remains relevant and maintain an unbeatable punch. thank you for joining us. before we go a special thanks to the navy and newport news ship building. have a great week. yñ
this week we will -- hear what the affordable care act is doing and what it isn't doing for patients with chronic diseases like ms. i'm steve usdin. welcome to "biocentury this week." >> your trusted source for biotechnology information andable sis -- and analysis, "biocentury this week." more than 2 million people around the world are affected by multiple sclerosis, a debilitating autoimmune disease. ms is caused by the destruction of milen, a fatty protective coating that surrounds nerve fibers. without it signals can't move through nerves causing loss of muscle control and other symptoms. drugs slow and prevent milen destruction slowing progression and helping patients manage their disease but even though patients have more therapies than ever, nothing repairs milen so they can't reverse the loss of muscle function. since 2004 the milen repair function has been conducting
and coordinating research for a goal of getting drugs to patients by 2016. cutting in half the time it usually takes to go from a concept to a new drug. if it works, the milen repair foundation will not only change the lives of ms patients, also create a model that could be applied to other diseases. in the meantime, patients living with ms are wondering how the affordable care act will affect their ability to access the expensive drugs they depend on. we will address that in this week's affordable care update. we are joining by scott johnson and gail mederos. you're both ms patients as well as being actively involved in trying to drive the development of new drugs. i want to start with you, scott. you've said that the model for developing new drugs is broken. there have been a lot of new drugs for ms developed that have come on the market in the last couple of years. do you still think it's broken? >> when you say that the system is broken, i think that's for
all diseases, not just ms in particular. and there are several drugs on the market now for ms. all of them are to suppress the immune system. none of them are about repairing damage and that's what we are focused is how can we repair past damage? >> gail, you have kind of seen it from both sides, from being ceo of a biotech company, now leading a trade association, you're on the board of a company that's developing an ms drug. do you think that there's an opportunity here for patient organizations like milen repair foundation to make a difference in the speed of which -- of drug development? >> absolutely. the disease foundations have been instrumental in investing both high risk drugs that really are break-through drugs and also in developing knowledge based tools, access to patients and thought leaders that can help advance the whole
field. so we see the disease foundation is playing a role both in developing specific therapies but also really raising the tide of the knowledge base and providing tools such as bio markers, animal models and assays that allow multiple companies to more rapidly advance their drugs or discover their drugs and also to improve the odds of success by having the best state-of-the-art tools. >> scott, you've said, i've heard you say that your goal is to be able to shave 50% off of the time it takes to go from discovery to a drug. how are you going to do that? how does a group like the milen repair foundation have that kind of dramatic result? >> that is a dramatic result and you're absolutely right. we are not shooting for just five or 10%. we really are looking for actually 50 to 70% of the time and you asked about the kind of why i say the system is broken, because it does take a long, long time to get all the way
from discovery biology to fda approval and there's a lot of different participants in that value chain and i think that one of the things that we do to try to speed that up is be an overall coach or manager and think strategically about the entire value chain. and i think that's one thing that really does set us apart is that we try and work with the academics to build collaborations there in a way i don't think the companies can do very well. we also can work with many companies at one time and partner with them and work hard to bridge the -- so that they are positioned well for pharma to pick up and that's how we address that and what we find is all those different elements all kind of work together and build on each other in terms of taking time out. >> can you give some examples of some of the specific things that milen repair foundation has done to try to move the science ahead? >> sure. so if we start at the front end on the discovery biology side, one thing that we do that i think is very different is, you know, to do really great science today, you've got to be
really narrowly focused. but when you're talking about any particular disease, you need a multidisciplinary team to attack that. and there really aren't mechanisms or avenues in academia for true deep collaborations, so what we did is build a collaborative team that includes now about 45 full- time equivalent scientists in academia that we fund and we manage that process in terms of we worked with them to put together a research plan and that might sound kind of just like a basic thing to do but most disease organizations do not have a research plan and having a real road map to where you want to go is really key. >> gail, you did a study that's come out recently about collaborations between patient groups and industry. one of the things that i found interesting was there is a kind of misalignment in some cases between their expectations of what they are going to get from these collaborations. >> i think one of our findings
was that there needs to be good alignment and that starts with understanding what the goals of the project are and what the outcomes of the project would be. we actually saw very good alignment in a number of areas understanding patient needs, caregiver needs, access to clinical trial designs and centers and clinical trial enrollment. so in a lot of areas there was very good alignment. there were a few areas that were misaligned and those tend to be a lot on pricing, market research. i think some of that is just terminology, that in business we oftentimes talk about understanding the market as a euphemism for understanding needs. and yet disease foundations may interpret market research as
increased drug sales, not understand patients or understand the fit of a drug. >> we are going to talk more about that. later in the show we are going to talk about what the affordable care act means for patients with chronic diseases like ms. you're watching "biocentury this week." obenshain tried to outlaw. birth control pills. rape or incest. criminals, felons shows, a month law, in bulk. instead of dictating to women, criminals. this ad.
courageous innovation. we are talking with 2ms advocates who are also patients, scott johnson and gail mederos. most of the drugs -- or all the drugs on the market today work on the immune system. they don't actually prevent ms from progressing, and they certainly don't give anybody function back. you've got an idea, the myelin
repair foundation that you can address the fundamental causes of ms. how is that going to work? >> if you think about it, you know, myelin forms in the body as you grow and i think it continues to form until about the late teens, typically, they see the brain myelin ating so we know it is a natural process. most likely healthy people don't have ms, like other cells of your bodies there's -- myelin is actually the coating on your axons, so it's probably being remodeled constantly and likely in ms the real problem is when it gets damaged, that repair process is being prevented. so we see this as a doable target because essentially we are not trying to convince the body to do something that's foreign or different, we are trying to allow it to do what it's being blocked and so the focus has always been on the immune system and ms because it was considered an autoimmune disease and people didn't think you could repair the brain and
that's what we are talking about is repairing the brain. >> nih spends $116 million a year on ms. the market for ms drugs is $10 billion a year. why is something like the myelin repair foundation even necessary? why isn't this happening from a public sector, from the private sector already? >> well, there's been a lot of treatments and advances for ms, most of those are -- or all of those right now are attacking the -- and suppressing the immune system so there hasn't been a lot of research into the repair of myelin, which has long been the holy grail but it's a tough, high risk approach and a lot of the pharmaceutical companies and biotech companies just haven't had the tenacity to work on that. >> scott, you certainly got the tenacity to work on it. what are the milestones? what have you achieved so far and what are the milestones that we might see coming up in the next few years? >> actually when we started, as
gail pointed out, no one was interested in myelin repair, no one thought it was possible or therapeutically relevant. so we set out a 15-year plan. when we started people said maybe in 50 years there will be repair and we said we want to do it in 15. in five years we wanted to do enough discovery grade biology that many companies became to view it as an area that they should start thinking about it. we were pleased within five years of the time we started doing research i would say there were at least a dozen companies at that point then that really saw myelin repair as the next generation of ms treatment. our 10 year goal was to have our first clinical trial and we actually, 10 year point won't come until next year but we actually beat that goal by about 30 months. we had our first clinical trial, began at year 8 and -- >> that was for -- >> that's exactly right --
our ultimate goal was to have treatment to patients within 15 years and so we really made a lot of progress on all those fronts and i think there are many companies now that view it as really the area they should focus on. the bar set relatively high in terms of immuno suppressants. we've got 80 scientists working on myelin repair and this is a worldwide team and it truly is a team effort and made tremendous stride. >> 15 years, that's 2019 that your goal is to have a drug on the market that's repairing -- that's doing myelin repair by that time? >> that's right, yep. >> and imagine that myelin repair is not limited just to ms. probably going to be applications if you're successful in other kinds of diseases? >> absolutely. so the learning that is taking place at myelin repair foundation could impact other diseases of the brain including
dementia and -- >> alzheimer's? >> yes. >> and you think this approach of having a foundation that's kind of trying to take an overarching view and basically patients taking control of their destiny or trying to, is that something that's applicable outside of the ms base? >> i think absolutely. and i -- it's funny, i don't really think of myself as a patient advocate which i think is the label but i really see us as pioneering a new way for nonprofits to be the overall coordinator of research. and i think that there's a lot of different participants in that value chain and as i said, you know, there are certain constraints that all of them have and actually nonprofits have more freedom to operate than anyone else in terms of what we can do and how we work with others and that's the key role we are trying to demonstrate and demonstrate that you could use the same process that we are pioneering for any amount of diseases. >> we will continue our discussions about chronic diseases in this week's
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i'm pleased to be joined by ken thorpe of the partnership to fight chronic disease and dan mendelson ceo of -- patients who have ms have to get access to drugs and to care now. how is that going to work under the aca? what are the issues that you have to think about? >> when patients go to sign up for products under the exchanges, they are going to see their premiums but they really need to be thinking about, though is the fact that deductibles in these plans are very high, $2500 on average for the silver plans and $5000 for the bronze plans and in
addition, the co-payments that they will have to pay specifically to their drugs are also going to be very high, typically a percentage of the cost of the drug. >> so ken, what does that mean for people? what's that going to mean for access for people's quality of care if they are going to have these very high co-pays, for example, for drugs, they are going to have really high co- pays when they go to specialists? >> it's going to be a problem because many of the new people signing up on the exchanges are people that have pre existing conditions and perhaps on this date couldn't get access to health insurance coverage so they are going to be coming on buying insurance now with the expectations that they are actually going to get their prescription drugs and other services almost fully covered for them. so the concern that i would have is if you have a patient with three, four, five chronic health care conditions -- >> which isn't uncommon? >> not uncommon at all, that they are not going to fill and refill their prescriptions because of the expense. you can look at a plan where you're paying 40% of the cost
of providing -- or getting prescription drugs in addition to the 25, $2600 deductible so that's a real heavy lift for a lot of people. >> some of the lowest income people will have premium and co- pay assistance. so that will help a little bit. it's the kind of the moderate low income and, you know, one of my concerns about this construct is it looks like pharmaceutical companies are not going to be allowed to offer co-pay assistance for this population and that's something that could really help a lot if they are able to do that. >> that's a huge deal. so -- and that was something that was influx. is it really a dumb known that -- dumb deal that it's known -- >> it is undecided. the question really is whether they are allowed to and if not, then, you know, perhaps through some kind of a foundation structure. >> so that's something that drug companies have done in the past when patients are on medicare and they can't get co- pay assistance, they give money to foundations, to patient
groups and those groups in turn give money to patients to help them with co-pays but it's not the efficient way to do things, is it? >> again, it's problematic. i think that it really gives a major issue back to the policy makers and it's going to really be incumbent on the administration and the congress to think about access and to make sure that people who need these medications are actually getting them. >> so can one of the other elements of the affordable care act besides the exchange structure itself with setting up so-called acos, affordable care organizations, in theory they have could be really good for people with chronic diseases like ms. how is that working out? >> the organizations could potentially be very effective. the real key ask whether they -- is whether they change how they practice medicine. the focus has really got to be on preventing the growth in chronic disease in the first place and more effective engagement and management of patients with health care conditions and that's not something we do very well so i think the real key is not just
linking providers together in an organization. the real key is are we really changing the way that we both prevent and deliver health care services to chronically ill patients. >> are the acos going to be able to do that? >> the successful ones are going to have to figure out a way. the only way for them to really save money is by keeping their populations healthy, cutting down on readmission rates, making sure that preventable hospitalizations don't happen. that's going to be a change in the style of how those services are delivered. >> but -- and you say the successful ones. another way to look at it is some are going to be basically looking at a capitation model where they are going to cut back on services in order to hit their numbers, right? >> some of them are going to focus on it that way, but, you know, again to the extent that we are really measuring quality and we have metrics that are looking at performance, they may not come out so well in the quality side. so i think, you know, again, to really do this right is not just cutting services but it's really engaging patients in new ways of delivering services.
back with dan and ken thorpe talking about the affordable care act and chronic diseases. ken, the affordable care act, kind of the issues that we have been talking about have all been around the exchanges but there's actually a lot bigger issue, particularly around medicare for patients with chronic diseases. is the affordable care act getting us to where we need to be? >> no, i think that's a real problem. the affordable care act largely dealt with expanding health
insurance critically important component of reform. but what it didn't do is really deal with some of the long-term financial issues facing the medicare program. so for example, since 1985 about 80% of the growth in medicare spending is due to an increase in the prevalence of chronic disease. so today about 1/4 of medicare patients are diabetic. that's double since the mid 1980s. another 25% are pre diabetic. yet there's nothing in the medicare program that's really designed to effectively prevent the progression towards diabetes and there are certainly no care coordination in the original medicare program designed to keep diabetic and chronically ill patients healthy. those are two major holes we need to fill in the discussion about entitlement reform. >> agreeing completely that the affordable care act does not solve all the illinois of the health care -- ills of the health care system, it had provisions that moved it along alittle bit. the quality provisions that are now used to pay medicare --
they include diabetes metrics and so you have now medicare health plans more focused on chronic disease and that's a positive thing. it hasn't fixed everything but it is positive. >> one of the things when you look at the proceed re-- press releases coming out of cms, it looks like the federal aviation administration rather than medicare. do we have too many pilots? is it time to move from pilots into action? >> i think we have too many pilots. we need to have a balance of implementing things we know will work and we have a long history of data on interventions that we know are very effective, programs like the diabetes prevention program that are intensive lifestyle intervention program that works. health coaching, transitional care, team based care. we know it can be very effective so i think that we need to have a transition towards implementing best practice programs and then do targeted pilots on areas that
we don't have enough information on. so for me personally, i have pilot fatigue. we are not one pilot away from a miracle here. we need to have a balance of implementation and targeted pilots. >> so, dan, you know, congress isn't going to pass new health care legislation anytime in the fore seeable future. >> it's interesting, steve, while the payments are coming down in fee for service medicine, more and more medicare beneficiaries are voting with their feet and leaving that system and going to medicare advantage so we now have more than 30% of medicare patients opting into health plans that actually do have an incentive to care for patients of chronic illness and it is more significant than we see in fee for service. >> that's this week's show. i'd like to thank my guests, scott johnson, gail mederos,
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