To:

The Honorable Mark Begich

The Honorable Michael Bennet
The Honorable Roland Burri
The Honorable Kay Hagan
The Honorable Ted Kaufman
The Honorable Paul Kirk
The Honorable Jeff Merkley
The Honorable Jeanne Shaheen
The Honorable Mark Udall
The Honorable Tom Udall
The Honorable Mark Warner

From:
CEO Work Group for Health Reform

We represent CEOs from a wide range of healthcare delivery, payer and vendor organizations
that will have to work together to implement the payment and quality reforms envisioned by the
framers of the pending legislation. We recognize the profound opportunity afforded our country
at this juncture in the current debate. As a result, we enthusiastically endorse the general thrust of
the Patient Protection and Affordable Care Act and specifically the amendments now proposed by
your upcoming amendments.

The waste and ineffectiveness of the current healthcare system do not derive from
mismanagement or malfeasance, but rather from a hodgepodge of payment and regulatory forces,
built over decades, that have resulted in perverse financial incentives and obstacles to efficient,
effective care.

While the power to address these problems at a systemic level rests with Congress, we have
worked within our own organizations to improve outcomes while reducing costs. We and others
in the industry have endeavored to better coordinate the disparate elements of care, improve
decision-making with evidence-based clinical practice, and share best practices between
organizations. We have come together as a Health Reform Work Group to advance our common
interest in seeking the payment and regulatory changes that can enable us to more effectively
provide sustainable, quality care as partners across the broad continuum of provider types, payers
and key vendors to the industry.

But there is a limit to how much progress can be made in the current environment, in which
doctors and hospitals are rewarded for doing something rather than for doing the right thing in the
right setting. The proposed amendments will strengthen the Senate bill through the creation of
additional economic and regulatory incentives to transition the many thousands of separate and
independent players that comprise the U.S. healthcare system—large multi-hospital systems,
local physician practices, ambulatory surgical centers, home health providers and others—toward
an integrated, quality-oriented system by:
 Promoting and Accelerating Delivery System and Payment Reform. The proposed
amendments provide greater flexibility in the design of innovative system structures and
improved analytics and reward systems. This flexibility will accelerate the adoption of new
models of integrated, risk-based care. While subsequent regulatory refinements will be
needed as health care delivery evolves from an event-based to a value-based payment system,
we believe the proposed amendments represent an invaluable start in a process that will
ultimately provide Americans with improved health care at significantly lower cost.

 Strengthening the Independent Medicare Advisory Board. Authorizing comprehensive

healthcare improvement subject to an up-or-down Congressional vote, rather than the current
item-by-item approval, will facilitate forward progress without excessive consideration of
private economic interests. Enabling the board to make advisory, non-binding
recommendations across both public and private insurance systems will stimulate more
consistent, even-handed strategies across the entire system, thereby reducing cost-shifting and
excessive cost reduction pressures on the public programs.

 Administrative streamlining. Standardizing the many interactions between providers and

payers will significantly reduce overhead costs, while the increased use of electronic data
platforms will reduce errors and allow for the information exchange necessary for shared risk.

 Elimination of legal barriers. Requiring the GAO to identify regulatory barriers to

innovation and the sharing of risk and information between organizations is essential for real
reform to occur and will help create an environment of continual improvement.

(Attached please find a longer white paper addressing the thinking of our group.)

Signatories

David L. Bernd Robert Bessler, M.D.

Chief Executive Officer Chief Executive Officer
Sentara Healthcare Sound Physicians, Inc.
Norfolk, VA Tacoma, WA
Office: (757) 455-7070 Office: (253) 284-1865

William Borne Martin Hickey, M.D.

Chief Executive Officer President & Chief Executive Officer
Amedisys, Inc Alegent Health Clinic
Baton Rouge, LA Omaha, NE
Office : (225) 298-3501 Office : (402) 343-4411

Neil Kurtz, M.D. Jack Lewin, M.D.

Chief Executive Officer Chief Executive Officer
Golden Living American College of Cardiology
Ft. Smith, AK Washington, D.C.
Office: (202) 434-0509 Office: (202) 375-5403
Mobile: (202) 262-6608
 Gene Lindsey, M.D.
Chief Executive Officer
Atrius Health
Boston, MA
Office: (617) 559-8260
Mobile: (781) 799-7887
Michael R. Merson
Chair of the Board
CareFirst of Maryland
Owings Mills, MD
Mobile: (410) 409-9295
Lynn Nicholas
Chief Executive Officer
Massachusetts Hospital Association
Boston, MA
Office: (781) 262-6001
David Schmidt
Chief Executive Officer
SCAN Health Plan
Long Beach, CA
Office: (562) 989-8310
Mobile: (310) 739-2100
Steven Strongwater, M.D.
Chief Executive Officer
Stony Brook University Hospital
Stony Brook, NY
Office: (631) 444-2701
Paul Viviano
Chief Executive Officer
Alliance HealthCare Services
Newport Beach, CA
Office: (949) 242-5301
Robert Margolis, M.D.
Chief Executive Officer
HealthCare Partners
Office: (310) 354-4221
Edward G. Murphy, M.D.
Chief Executive Officer
Carilion Clinic
Roanoke, VA
Office: (540) 981-7831
Mobile: (540) 520-3887
Richard Noffsinger
Chief Executive Officer
Anvita Health
San Diego, CA
Office: (858) 554-1886 x 326
John H. Short
Chief Executive Officer
RehabCare Group, Inc.
St. Louis, MO
Office: (314) 863-7422
Joseph Swedish
Chief Executive Officer
Trinity Health
Novi, MI
Office: (248) 489-6792
Mobile: (248) 207-3613
Nicholas Wolter, M.D.
Chief Executive Officer
Billings Clinic
Billings, MT
Office: (406) 238-2609
 Effort Sponsors

Carol Emmott, Ph.D. Douglas A. Hastings

Managing Director Chair of the Board
Russell Reynolds Associates Epstein Becker & Green
Office: (415) 352-3363 Office: (202) 861-1807
Mobile: (415) 990-1146

Lynn Shapiro Snyder Richard Wesslund

Firm Member Managing Director
Epstein Becker & Green BDC Advisors, LLC
Office: (202) 861-1806 Office: (305) 858-0082
Mobile: (301) 520-1926 Mobile: (305) 458-1895