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Executive Session Summary

Tuesday, June 7, 2005

Jackson, Miss.


Executive Session of the Working Group - Summary




Randy Johnson, Chair
Catherine McLaughlin, Vice Chair
Frank Baumeister
Dotty Bazos
Montye Conlan
Therese Hughes
Aaron Shirley
Deborah Stehr


George Grob, Executive Director
Jill Bernstein
Andy Rock
Caroline Taplin
Jessica Federer
Rebecca Price
Paige Smyth


Chair Randy Johnson opened the executive session of the Working Group (WG) at 2:30 p.m.

New Staff

George Grob introduced the new staff:

Jessica Federer is a “permanent” hire who has delayed beginning her graduate program for a year in order to work with the Working Group through summer 2006; she will support the work of the Community Meetings Committee.

Jill Bernstein, on a reimbursable detail from MedPAC, will be with the Working Group for six months and will work on the Report to the American People, working with the Report Committee.

Paige Smyth and Rebecca Price, both interns, hired for the summer 2005, will assist in research for the Report to the American People and work with the Report Committee.

William Hyde is permanent subcontract staff for the life of the Working Group and will be an essential member of the Web team, focusing on managing and uploading content to the Web site, and other related responsibilities.

Margretta Kennedy is permanent staff for the life of the Working Group and will be office manager and general administrative officer for the project.

(A complete, current, staff listing was provided to all the Working Group members present.)

Action Items

The Working Group discussed a variety of topics; Staff are requested to:

• In consultation with the Committee Chairs, prepare a broad budget for consideration by the Working Group and include in the budget analysis, identification of committed fixed costs (funds expended or obligated) and the availability and recommended allocation of non-committed funds;
• Submit a monthly accounting/budget report to the Working Group;
• Explore the potential role of partnerships with others for extending communications activities and report back to the Working Group on this

Statutory Requirements and Proposed Timetable

George Grob indicated that the law authorizing the Working Group is inconsistent regarding the time available to the Working Group to complete the work required by the law. The law includes time frames that would require over two years to complete; however the authorization for expenditures by the Working Group expires at the end of FY 2006, only 16 months away. While it is expected that the second year of funding will be appropriated, it is less certain that Congress will authorize, on a timely basis, an extension of the time during which the Working Group may incur costs. Without an explicit authorization to incur costs or commit funds until the funds are expended, the existing statutory cut off would prevail. Thus, it is essential at this time, to plan on completing all work by the September 30, 2006 deadline, to ensure that the project is completed whether or not Congress subsequently provides an extension. Later, if the Congress does grant an extension, the plan could be adjusted accordingly.

Chair Johnson initiated a discussion regarding the Working Group time table by discussing the merits of working on a compressed time table for the present, by reviewing the intervening dates implied by this compressed schedule. He pointed out the implication of the time frames provided by the law and indicated that the Report to the American People needs to be available by August 26, 2005. He asked how the Report could be completed and subsequently translated into Spanish (and any other languages, as appropriate), and be available by October. His conclusion was that the community meetings should begin by November 2005 and be completed in four months.

Dotty Bazos asked whether we could renegotiate the time frames with Congress immediately.

George Grob indicated that, though it might be possible to get “available until expended” language during the fall Congressional budget negotiations (and added that the appropriations committee staff asked to meet with us about this subject), that, in principle, this is not assured. and he counseled against counting on such a solution. Therefore, we need to have good contingency dates so that our enterprise would not fail if Congress does not extend our authority.

Community Meetings

Vice Chair McLaughlin suggested that the Community Meetings run an extra month, into or through April; George Grob thought that the Working Group could squeeze the post-Community Meetings period in order to allow for this. Aaron Shirley expressed the opinion that the Working Group shouldn’t dilute its impact by trying to visit all 50 states. Chair Johnson asked whether it wouldn’t be possible to conduct virtual meetings as a way of addressing the need to hold meetings in as many states as possible and observed that time would be needed after the Report is issued in August to translate it into other languages in order to be able to issues the translations by September or October. Therese Hughes asked what work the Working Group would need to be engaged in during September and October and whether some of that work couldn’t be undertaken now. Further, she suggested that the Working Group be a little more flexible now at the beginning of the project.

Vice Chair McLaughlin reiterated that the Report must be issued sufficiently prior to the start of the Community Meetings to allow it to be effectively used by the public as a source of information leading to the Community Meetings. She indicated that others experienced in conducting such meetings have said that six months are needed to prepare for the meetings and suggested that the schedule be modified to allow more time. She also praised the value of Dotty’s talking points: Mission, Vision, and Theme. Montye Conlan expressed disappointment over the short (four months) time frame allotted for the Community Meetings in the compressed schedule and expressed concern that it sent the wrong message to the public, especially since the time period was during the dead of winter.

George Grob responded that the Staff would examine the possibility of starting the Community Meetings earlier and how we might provide more time for them.

Comments regarding need for action:

Dotty Bazos pointed out that more time and energy is also needed up front for developing a strategy for obtaining the information we need and that if we go out before we are ready we won’t get what we need and the final results may not be satisfactory. On the other hand, Therese Hughes suggested that we need to get going quickly and that if we need to push the limits of our ability to proceed rapidly, we should.

A modified schedule, incorporating the advice of the Working Group is attached which includes the following dates:

7/21-22/2005 Salt Lake City Meeting/Hearing
7/26 Houston Hearing
8/16-17 Boston Meeting/Hearing
8/29 Report Launch
10/18 First Community Meeting
5/5/2006 Interim Recommendations
8/15 Public Comment Period Begins
9/29 Final Recommendations

Organizations to provide contract support for meetings:

Montye Conlan suggested another group that might be able to assist in running Community Meetings. George Grob agreed that there could be different groups and different types of Community Meetings; they didn’t all have to be done by one consultant. In addition, he observed that America Speaks had other suggestions regarding outreach besides the approach they used in Maine. Montye Conlan indicated that she likes America Speaks because they already have an approach for getting the word out to the public.

Committee Presentations

Community Meetings Committee, Aaron Shirley, Chair; and Therese Hughes (Co Chair, Strategic Outreach), Montye Conlan, Deborah Stehr, Richard Frank (Co Chair, Analysis), and Joe Hansen, members; Caroline Taplin (lead) and Jessica Federer, staff – Aaron Shirley asked that staff be designated to work with the committee and also asked for an all day, face to face, meeting of the committee sometime during the next three weeks. George Grob indicated that the designated staff lead was Caroline Taplin, that Jessica Federer would assist her and that he would attend the first meeting. Aaron Shirley wishes staff to begin work on demographic profiles of the 50 states.

Hearings Committee, Randy Johnson, Chair; Catherine McLaughlin, Dotty Bazos, and Patricia Maryland, members; Caroline Taplin, staff – Chair Johnson and George Grob provided overview of “Options for Future Hearings.” George Grob observed that the work of the Committees is an important component of the hearing schedule. Vice Chair McLaughlin clarified that Working Group time should be split about 50-50 meetings and hearings, but be flexible and responsive to availability of potential presenters. Meeting/Hearings are scheduled for July 21-22 in Salt Lake City and August 16 and 17th. Committees would meet at Salt Lake City on the morning of July 23. The hearing scheduled for Houston on July 26 would be run by the Hearing Committee and no Working Group business would be scheduled; other Working Group members would be free to attend. Vice Chair McLaughlin pointed out the meeting scheduling challenge presented by members being on more than one committee. Dotty Bazos recommended that we need a framework of issues that cuts across all the committees so that they can better coordinate their work.

Report Committee, Catherine, Chair; Richard (Co Chair), Brent, and Mike, members; Jill (lead), Paige, Rebecca, and Rachel, staff – Vice Chair McLaughlin indicated that the Committee is seeking ways to structure conveying a broad range of information to a variety of publics. The Senate sponsors of the legislation have indicated they are interested in “where the money comes from and where it goes.” The Report would provide information that would allow discussion of the four questions in the statute that are to be the subject of the Community Meetings. The Committee envisions multiple reports. The Report is not a single product, with a single deadline. It is envisioned as multiple products some of which will continue to evolve over the life of the project:

• The first product, which would be completed by the August deadline is a background report containing basic information, with summary charts, and appendices, bibliographies, links to other sources, separable materials. Readers would be able to could find information addressing any of the topics listed in the statute. This report’s audience is the policy community, researchers, and others interested in detail.

• The second report product is the reader-friendly web report -- it would be clear, concise and interactive, and about 25 pages in length. Among other things, it would include new analyses that illustrate the lifespan health expenditures of an average man or woman; under different circumstances. The life-span charts would include 4-5 variables, be made interactive so that an individual could see what their experience could be. It would include something similar for hospitals. We would need a fancy web site design with colors to show all this.

• The third report product would be about 10 pages long and would be reproduced in thousands, translated into several languages, put on the web sent in advance of Community Meetings to communities, advocacy groups, chambers of commerce, and distributed in multiple ways to a variety of audiences. It would start with questions, provide answers, and end with questions for the public that would stimulate Community Meeting discussion.

• The fourth version of the report would be a media-focused report on the web, contain op-ed pieces, so that, for instance, someone with MS could describe their experiences. This report site would be added to throughout the period of time that community meetings were being held. Through interactive capacity, we could keep writing these short story lines so people would keep returning to the Web site and the dialogue would keep evolving and continue helping by providing more information. The Media would like this version because they could cut and use material. This information would be tailored to local events/circumstances such as Indian reservations, inner city, etc. The information would be tailored to individual situations.

Only the third report above remains unchanged once printed and issued. The other three are dynamic and evolving. We keep adding to the bibliography as we learn of new information, sources, etc. At Catherine’s meeting in Washington with staff this outline will be fleshed out.

Dotty Bazos asked about the interactive piece with dollars and making choices. Vice Chair McLaughlin indicated that there could be a (virtual, electronic, online) jigsaw puzzle program that would let people make choices and would change as they made choices. She referred to possible use of Ken Thorpe’s simulations. Vice Chair McLaughlin reviewed the possibility of virtual town hall meeting in Starbucks or through other environments, such as Marriott’s, where a conference room at hotels in every state could be the “hot spots” for such meetings. Similar arrangements could be made with book store chains, community groups and others, to host virtual meetings. The reports could be sent out to them in advance, to be used to organize these events.

Communications Committee, Dotty Bazos, Chair; Frank Baumeister, Montye Conlan, Deborah Stehr, Therese Hughes, Rosie Perez, and Vice Chair McLaughlin (Web), members; Andy Rock and Jessica Federer, staff – Dotty Bazos indicated that the minutes from the Committee meeting that morning would be sent to all the Working Group members. The Committee reviewed the statute and emphasized the obligation to conduct a dialogue -- a two way information flow – with the American public. Dotty Bazos wants George Grob to fill the Committee in on how to have the staff involved and emphasized the importance of having Committee members committed, on board and up to speed with its work. The Committee desires that the Working Group seek informed recommendations coming from the public and wants all the different subgroups of the population to feel like they are heard and opinions are reflected in the final recommendations. Dotty Bazos asked George Grob to set up a Committee phone meeting. Chair Johnson asked whether we would use PR firms. Everyone was asked to send Dotty Bazos names of firms they had worked with. There was also a request that in-person media training be scheduled. George Grob reiterated the importance not only of media face exposure activities but also, significantly of help (staffing or otherwise) with the basic PR “grunt” work (making contacts, following up, generating press kits, etc.).

Other Staff Reports

Project Planning – Executive Director Comments

George Grob recommends that we specify all the dates on which the Working Group needs to meet from now on, for the next year, so that the members can put those dates on their calendars. He further recommends that, after setting these dates, the Working Group identify the questions it wants answered and possibly even meet to discuss and settle on these.

The next organizing principle should be the key dates we need to organize around, such as release of the report. Does the Working Group want a discussion guide that is separate from the report or could the two be the same document? Can we schedule the specific date for the report? Chair Johnson indicated that he supports scheduling well in advance and wants staff to come to the Working Group with recommendations for action: does the Working Group want the Executive Director, in discussion with Committee Chairs, to set some key dates? Does the Working Group want a meeting scheduled to decide the questions that will be addressed in the Community Meetings or does the Working Group want the Executive Director to agree on such a draft with the committee chairs?

The conclusion was that George Grob would create some decision, event and date options and propose them to the Working Group.

Media Training Needs

George Grob observed that the Working Group members are now “public officials” and need some training from that perspective. Deborah Stehr said she has some very basic information about dealing with the media that she would distribute to the members.

Chair Johnson adjourned the executive session of the Working Group adjourned at 5 p.m. large number of topics that were mandated.

Mr. Patton suggested including a format for the hearing where there would be a 30-minute presentation followed by Q&As, something very similar to the Government Accountability Office (GAO) conference.  This would be instructional and allow the basic questions as well as the more sophisticated ones to be answered.  The group agreed and adopted his recommendation.

The Health Report to the American People

Dr. McLaughlin gave an overview of The Health Report to the American People.  The report would include an analysis of cost/utilization and coverage/payment data as well a synthesis of the extant literature.  The synthesis would include summaries of reports and feedback from experts in the field on specific initiatives and reports to provide a critical combined analysis of the evidence.  The report would also include insight and information provided by the hearings about innovations and initiatives that are taking place but are not in the public press or published literature.

Dissemination of the report would take place through multiple venues, including the group's Web site; stakeholder sites; national/local newspapers, television, and radio; and professional and trade journals.  The idea would be to ensure that the report is disseminated as broadly as possible so many people could read it and give the Working Group feedback.

The information in the report would be presented at various levels of complexity.  There would be a full report (with multiple tables and data) on the group's Web site as well as shorter summaries targeted for community meeting, print, and radio usage.  These short summaries would list major points and provide summaries of the most illustrative data.  The approach would help to reach as many individuals as possible. 

The report will be the starting point for discussions.  A revised report with recommendations would be developed using feedback obtained from the community meetings, Internet, and other venues.  Dr. McLaughlin noted that a subcommittee will be created, and staff hired, to begin work on the report.  The subcommittee will obtain feedback from the Working Group on data and information to be included.  The report's outline will be based on the list of statutes that need to be covered.  The plan is to have a working draft of the report by the end of August 2005 to be circulated to the Working Group and a revised version completed by October 2005.

Legal and Ethical Requirements and Logistics

Mr. Patton gave a presentation on the legal, administrative, and ethical issues governing the Working Group.  He walked participants through the Federal Advisory Committee Act, also known as FACA or the "Government in the Sunshine Act."  He pointed out the following legal requirements:

  • There needs to be 15 days' advance public notice of a meeting, and the location must be accessible to disabled individuals.
  • At a minimum, there needs to be written public input for every meeting.  It is recommended that this be done electronically so all comments can be made available for public review.
  • Any documents prepared for the Working Group need to be made available publicly and posted on the group's Web site.  All documents need to be retained for the duration of the advisory committee.  This includes E-mails to staff or all group members.
  • E-mails to the group as a whole need to "cc" the staff so they can be saved as part of the public record.
  • There needs to be a designated Federal official at every meeting to make sure the interests of the Government are maintained.
  • The group is required to maintain detailed minutes of every group meeting.  The Chair needs to certify the minutes within 90 days after each meeting.  Alternatively, the group may decide to post a version of the transcript on its Web site.
  • Closed meetings are not allowed except to protect trade secrets, or confidential commercial information, or to hold administrative working sessions.  Subcommittees, however, do not need to meet publicly as long as their work is discussed during a public meeting of the Working Group.
  • Group decisions cannot be made by private telephone calls or private E-mails.  If decisions are to be made through telephone calls or E-mails, they need to be open to the public.

Mr. Patton discussed the ethics, conflict of interest, and financial disclosure obligations of the group.  He indicated that the Senate's ethic rules apply to non-detailed staff, but there are fewer restrictions for group members.  Group members can chose to adopt commonsense rules and ethics guidelines.

Mr. Patton noted that if a member has a rate of pay that is above 120 percent of the GS-15 level, he or she must provide a financial disclosure form.  Also, individuals who work more than 60 days a year on committee business need to provide a financial disclosure form.  Usually, this will include only the Chair, Vice Chair, and Executive Directors.  He also reviewed the process for reimbursement, explaining that it takes approximately 10 days to be reimbursed after the signed forms are received.

After the presentation, the group agreed on the following:

  • In lieu of minutes, the group will post a copy of the transcript online.  Members will have a chance to review the summary and correct typographical errors before it is posted.  A small summary of action points (two pages or so) will also be developed.
  • The group will use a salary scale comparable to that of GAO or the Executive Branch for new staff hires, except for consultants.
  • Committee members will be paid for 1 day for preparation/travel for each group meeting.
  • Members will be paid on a prorated hourly basis for self-reported hours of subcommittee work.  For some people, this may trigger the 60-day financial disclosure requirement.

Structure for Future Meetings

The group discussed issues about using technology to facilitate attendance at the meetings, scheduling of future meetings, forming subcommittees, and disclosure of proceedings after the meetings.  The group agreed to the following next steps:

  • Dotty Bazos, and Patricia Maryland will join Dr. McLaughlin and Mr. Johnson as members of the Hearings Subcommittee.
  • Dr. McLaughlin will approach members to join the Reports Subcommittee.
  • Mr. Johnson also mentioned that there is the potential of creating a General Communications Subcommittee.  Dr. McLaughlin reported that she has been working with several members to develop a Web site that is easy to navigate and user-friendly.  She presented some preliminary templates for the Web site.  She also encouraged all members to provide feedback on the Web site in the next few days.  The site will be publicized to the general public during the summer.
  • Dr. Bazos suggested—and the group agreed—that future committee meetings should be scheduled  so that they are predictable (scheduled on a certain day of each month, for example).
  • The group agreed that it would be best to have face-to-face meetings, but members may also attend meetings through other methods (telephone, two-way interactive video, etc.) if necessary.  Dr. Frank noted that face-to-face meetings would be helpful in the beginning for members to get to know each other on a personal level.
  • Brent James, M.D. commented that he had been contacted by external parties to talk about the committee's discussions.  He asked if there were any limitations on talking to external parties.  Mr. Johnson suggested that a good response to inquires would be "we are in the process of being established and there will be information on the Web site that you will be able to access.  You will also be able to submit information through the Web site."

Mr. Johnson thanked everyone for their hard work and ideas and wished all safe and pleasant travel.


Prepared by Cygnus Corporation, Inc., for the Agency for Healthcare Research and Quality under Contract No. 290-01-0001.