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tv   AEI Discussion on Health Care Choice and Competition Part 2  CSPAN  December 28, 2018 1:17pm-2:56pm EST

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refused to do anything about this unnecessary gun violence. they will not take action. in the end the only things i'm beholding to in this district are the people that i talked to every single day and my son's legacy. i'm running because i'm a mother on a mission. here in marietta, to represent everyone. >> new congress, new leaders, watch it all on c-span. >> next the panel looks at how the healthcare industry could provide more options for consumers. [inaudible conversations] attention everyone, we are back in session. welcome back to the next stage of today's aei conference on
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healthcare that matters. real choices for real competition and the vice versa. i want to introduce for our second panel of debate reggie hers engler who will moderate the panel, the nancy mcpherson professor of business administration at harvard business school. a lot of firsts and honors, first women to be tenured and shared at harvard business school. first to serve on many established and startup corporate healthcare and medical technology boards. initiated of course nonprofit and healthcare at harvard and the first faculty member selected by the students as their best instructor and a lot of her second and third or maybe on this panel as a matter fact. reggie's work was key to introducing consumer driven health plans and focused healthcare factories such as status requiring diseases.
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just this year she was awarded the honorary fellowship of the american college of healthcare executives of the leaders of america's hospitals. then she was also one of the 100 most influential people in healthcare world addition by group media and proven to be an invaluable partner in developing this conference and the ideas that have fueled it. reggie her slinger.[applause] >> thanks so much, a little scary to be introduced by tom. i told him no sumo wrestling images. no go over swiftly and pictures of gulliver being tugged out by the little gideons and most of all, no pictures of somebody with their rear end sticking out. that was a brilliant moderation. thank you. thank you so much for permitting this panel to happen. this panel is really about the entrepreneurs who you see here
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and they are all entrepreneurs who started or were key elements in companies that helped to solve the problems of the u.s. healthcare system. and as brian so eloquently said is the powerpoint on? i went to mit but they didn't include powerpoint. how choice and competition can help solve u.s. healthcare problems. in the problems that the panels spoke about with those costs. those of uneven access, those despite our brilliant healthcare providers, including
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my daughter who is an endocrinologist. the quality of the u.s. healthcare system. i'm just rapidly going through some of the problems, cause problems that healthcare costs are exceeding not only inflation but workers earnings and of course the excess it's taking more and more of a bite out of low and middle income people. it's tremendously wearing some. in the quality despite the brilliance especially of our providers and the extraordinary medical technology events that are happening. for example, there is a company out of philadelphia that has a drug that eliminates blindness in children with congenital
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blindness. and there are many more such extraordinary technology innovations on the horizon. nevertheless, we lack other relevant countries in things that could be treated despite the cost. so innovation is possible in other sectors but the economy. for example, the food industry if you look at the cost over time food used to be, you are to young to remember this but food used to be a major item of people's expenditures and it no longer is quite as major an item. and bills have also gone down substantially in costs become
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reliable because it is militantly efficient become much more environmentally friendly. these are just are just examples in a good way. that doesn't mean you cut cost but that cost can be reduced while quality is increased. in healthcare in contrast and medical care if we look at the cpi medical costs seem to continue rising and quality and therefore because of the cost problem access continue to be a problem. so how is it that innovation people talk about innovation and almost theological sense and there is no van fair there
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so what is it that innovation actually does to reduced cost while enhancing quality and access? let's look at the food industry. one thing that happened in the food industry is access to food became much greater. in 1930 the first supermarket was developed it was called king colon and mr. colin had the phrase to advertise his supermarkets of pilot high and sell it low so from 19 on i like that better than most of the phrases i hear now at least you know what he's selling. nowadays there are 40,000 supermarkets supermarkets have become ubiquitous and likely
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he's gonna turn the whole industry upside down and become it will become even more iniquitous and more accessible than it is right now. but amazon i'm referring to the $19 billion purchase of whole foods supermarkets. there's a lot more choice so's grocery stores carry 40,000 more items than they did in the 1990s. the quality is much better, much less processed food. much more prepared food. you might think all that choice is overwhelming but when i go to this supermarket and look at the 50 brands of yogurt that are available how do i make a choice? all i need to do is pick up the yogurt and it tells me the price right there.
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tells me the rda, tells me the calcium, tells me the sugar content. tells me things that i'm interested in knowing. but contrast to medical care suppose i needed a mastectomy. or any of you guys needed a prostatectomy. without being crude, what exactly would you pick up to tell you the price and the quality of what it is that you are buying and how readily available and trustworthy with that information be. these are the things that made the supermarket industry more of the food at home or competitive. so with new production methods and store refrigeration new ways of preparing food greater access to technology.
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credit cards. actually we are going down credit cards very soon, green resolution in the production of food itself. consumer information comparative prices, ingredients. health information.and consumer involved into a lot more self-service supermarkets used to be dominated by clerks who would or would not hand you what you wanted. now it's a consumer who does the bulk of the shopping. these are the critical elements in the cost-reduction quality improvement and access improvements of food. so can this happen in healthcare? yes they can. we have examples of that sitting right on the panel so if i will ever shut up you will hear from them. when you teach in a case based school where you say to
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somebody what you do and what you think about what she thinks. that's hide their heads. so what you think? what do you think? i never get to say what i think and i'm very gabby.i'm almost at the end. so what are the production methods doctor bhatt who traveled 23 hours from india to join us who will tell us about a very innovative low-cost high-quality weight of delivering cancer care. about access? cvs? tom moriarty this senior executive of cvs and about 1200 minute clinics, will tell us about ways new ways of
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accessing care. my friend tony miller from bar and will tell us about this will blow your mind. new way behind health insurance that responds to many of the issues that were raised in the prior panel. consumer information the ceo of change healthcare, change healthcare is a pipeline that runs about a third of the claims data in the united states. it's coupled the data to a terrific consumer information panel and it will tell us about that. and tele dock is a wonderful change healthcare and tele dock is about is about 500 million, something like that, and revenues is the leading telemedicine service and doctor
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lewis levy ceo will tell us about that. the theme of this panel is the private sector, can work to solve many of the problems of cost access and quality. but, it has got to work with the inner framework where it can do well what it can't do well. so tony, i wonder if you could start us off? would you like to stand here? doesn't this look like space age? >> press green? >> hi everybody my name is tony miller reggie gave me a great introduction.16 years ago i was actually here working with members of congress trying to
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convince them not to legislate plan design. some of you might not recognize that we started the first health reimbursement, products in the late 90s we have about 35 ãand fortune 500 companies take them and we built the first of what we call the consumer health driven plan. i was caught trying to tell congress don't compare it with the hd hd. it's really ãthat she can see how effective i was. we went and hid for a while and i've been working on an idea that i want to talk about today for 10 years. instead of grabbing a label consumer driven healthcare we actually went out and talked consumers and we talk to them about how they actually use the healthcare system. we use it and healthcare is terrible at marketing. it's always been terrible at marketing. in fact, we call it the healthcare system it's really the illness bearing treatment
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system if we call it that it would be like i don't want a lot of that. so what's interesting is we use healthcare in a way that is sexy today, it's called ondemand. we use it in a very on-demand way. a symptom or need arises we try to enter the system, try to solve it quickly and then guess what we don't want to stay there. it's a health policy fantasy we want an aco. that's not what we want. we actually want to leave and get back to our everyday lives and make things work. so we are observing this behavior, what we would like to do. great, i want to backup. one of the things we did is i'm going to start with this very provocative thing, could you make assurance on-demand? i know a lot of the policy people right now are saying that's impossible because what is will happen is people are going to wait until they are
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actually sick and then by the coverage. then they had been paying into the risk pool and making it affordable for all of us. hang onto that and i will explain how you make assurance on-demand. you have to start with design thinking. this is a nice quote i like, if you plant cities for cars and traffic you get cars and traffic. if you plan cities for people and places you get people and places. so if you plan healthcare for annual plans, doctors, hospitals, drugs, guess what you get? healthcare for plans doctors hospitals and drugs. what if you plan healthcare for treatments, health and caring? what would that look like? it would look very different. i'm going to skip these pages for brevity but you can grab it later. if you take a policy oriented view you end up at the wrong
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thing. for example, price control. what you get with price controls? i was one of these lazy people 30 years ago i worked for united healthcare when they were just united healthcare. we went out and started building networks and guess how we actually negotiated prices. anyone want to guess? reference-based pricing. we started with i will pay you 130 percent of medicare. what that did is it said medicare sets clinical value. the fundamental things that's wrong in healthcare is not prices. it's how we set clinical value. and i will come back to that in a second. now what we get because of that? we get to the times percent higher cost because what we've done from a policy perspective. so what if you actually let consumers arbitrage that opportunity. here's the problem with the shared savings programs with pilots with the aco's we missed the third leg of the stool. the plan sponsor saves money and the provider saves money
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and no one gave any money to the consumer for making different choices that's a really bad idea. we need to do that.so i'm going to jump ahead to the next slide. this is the perfect depiction of the problem. this is produced in jama and covers what i call the three c's of healthcare. the three c's of healthcare are coverage, care, and condition. on the left is coverage designed by age courts, the size of the actual dollars by age courts. the color of the ribbon is called service categories. what are service categories? part a, part d, part b, hospitals, physicians, drugs. let me tell you something folks, disease doesn't recognize part a, part b, part d. it is a really bad idea. and what you see is every noodle that goes into that center fusion that's care, hospitals doctors and drugs. okay. guess how we actually consume?
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you go over to the right and how we actually consume as consumers as we consume via condition. even jeff to really released hepa this morning he told everybody he was a cancer survivor and that's how we are all uniquely tied together as humans.we all have conditions. what's crazy is that noodle soup, see how all the things get bent when you get to the end where we go hand a car to a consumer and say you have health insurance coverage, go consume. connie woke up this morning is that i can't wait to have more no hospital? that's not the way it works. what we have is a condition and i'm gonna skip this is the ato's, here's what's crazy, this idea of an aco is the best that all things you need as a consumer. this is data you get the presentation that shows you in minneapolis is a bunch of care systems about how they perform across different conditions. no aco performs the best across all conditions. saying i want an acl over all
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these things is a crazy idea. what you are missing is the thousand points of life that the fee per service system has created. they want to throw everything away. the services has done something great. there are a thousand points of light in care delivery that allows to innovate cross care delivery and drive better condition treatment health outcomes. what we had the opportunity to do is step back and talk to consumers about how would they want to design a health insurance plan. this is how they want to design a health insurance plan. what they want to start with as i want to personalize my coverage at any point in time based on my conditions, not on my doctors and hospitals. on my conditions. i would love to know my exact cost in advance. just my cost. don't resend me this crazy thing that says it's not a bill and then say here's what the charges were but don't worry then we have benefit
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adjustment, contracting adjustment, that's silly to talk to consumers that way. underneath conditions there are treatment paths. every condition has multiple ã ãso i have back pain, i could get back pain solved with physical therapy for a very simple co-pay of $35. i could solve it with back pain injection. could be steroids, could be something else the cost me $50 or i could get a spinal fusion done.guess what? very expensive, how many of you want to start with spinal fusion? does the other thing that's crazy about this idea. which is humans hate anesthesia and scalpels. they want to avoid them. when someone needs to be exposed to them as the alternative, so guess what, there's actually a specialized rehab provider in your market that guarantees a nonsurgical outcome if you start with them.
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guess what we should charge for that? zero. getting the consumer to buy that releases actuarial value to the entire pool. then what would happen if that consumer doesn't resolve with that underlying condition, they then would get the spinal fusion but now from the center of excellence in their market and pay a different price now been what they would have paid if they just jumped to it. this is what's so crazy about the modern world we live in. people say all these modern startups, i'm going to put health insurance on the modern ã the question you should ask is what is the insurance card a modern text deck allows you to create? what allows you to create is a contextual based model of what does the consumer need to stop then deliver that precisely when they need it. let me give you some examples, this is true data on a bond analysis that shows will unlock in actuarial values. if you start an orthopedic procedure with pt, what's the surgical rate?
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if you start with anything else but pt was the surgical rate? they are almost double across all the conditions. almost double. can you imagine the number of procedures that are done across these things that are costing ã ãby the way, here's how you make health insurance on demand, the first shared connie. if we were all in employer group, we are all subsidizing each other's buying habits. i would ask you please don't take your meniscus scam and start with ãbplease start with pt. you are going to save me some money, probably save you some money and probably you could save a bunch of pain. make sense? here's how you can make insurance on demand. what if every employer done over the last six months? they have built a forward budget under health benefit liability. it's forward funded. the dollars are there. there's two other institutions that do that too, they happen to be called medicare and medicaid. so we have trust funds. we have forward built the
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liabilities. what's really scary is what is the algorithm we are using to build the forward liability? we are in the room with health quality people. how many of you have had the health care here year after year? that's a bad algorithm. i laughed at my actuarial friends and i said you were the first data science. you become a last. because your algorithms stink. and what's really important is we have something in the machine learning world called markup properties learning a machine learned view of the disease. when you do that you built coverage that looks like this. you're going to start by saying let's get back to insurance, let's actually have something we call core meets the aca requirements, guess what else doesn't happen in the binder planned?no deductibles, no
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coinsurance, ever. they force consumers to do fuzzy math. they can't do. when did the price to get aside in healthcare? after it happens. so this whole idea of transparency, and get a get people shopping, is a stupid idea. the only people who have the data necessary to do that are insurance companies, intermediaries like change, who get to look at the practice patterns of what people actually do as they produce and deliver these services. then what you're going to do is create a derivative of that price and take the risk associated with what you are supposed to do as an insurance company by building a single price point. this is why you don't use deductibles. deductibles are stolen from the ãindustry and brought it to health insurance. health insurance is only a 100-year-old concept in this country. it's fairly new. deductibles and pnc were built for specific law events. your house burn down you got covered but if your business
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burned down and he did have a policy your house policy doesn't cover your business loss. deductibles in healthcare mix lost events. i mixing my pediatric diabetes with my broken leg, with my myocardial infarction, it is a really really really, really bad idea. hopefully this next time around congress do not do an hp hp it's really bad concept. how many think we need a deductible for cancer? it's crazy. so then what you do is you take that employer's plan and say i'm going to allow people to buy anything when they need it, if they need it and when their needs change they can buy what they want. the key to that is healthcare is implantable. how much of healthcare is plentiful? i.e., the treatment. anyone want to guess? over 70% of the stent is
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planano one plans for cancer but when you get it you can plan the treatmentpath. when you plan the treatment path you can start price tags along the entire journey of what the consumer is need and then also reflect what the people look like. it looks like this, knee pain i carry with this, or knee pain injection, your mri is covered but if you're getting a knee arthroscopy you get atomized coverage, you are buying just the need ãand buying it from example hospital united hospital or buying from the asc and the price you're going to pay as the consumer for the itemized coverage is going to change based on clinical value and the price of the underlying services. and you got something very unique for the first time in
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healthcare. you are taking a coverage decision with the clinical choice and you are marrying it to the point of need. not the point of enrollment. the point of enrollment is a really scary time for consumers.why? you've asked them to do three jobs, one, become an actuary predict what plan is right for you. two, be a clinician i figure out based on what you are going to consume how the plants will work. and three, be a fortuneteller. prick the future. no wonder why people are all upset. if you could actually make insurance on demand it takes the coverage in clinical decision at any point in time i'm now activated as a consumer. this is what it looks like. this is actually how we use it. we create a clinical anthology and ai engine that converts every consumer sentiment to what they need. i have ãband lot if you want to know what ear infection is. then we show you how it's covered. depending on where you go with the otitis media your prices change. if you go to something like tele-dock it's going to be free. if you go to the convenience clinic it's gonna be free. primary care is $20-$50 i will talk about the range.
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or if you go to a specialist is this, if you go to the er it's $500. don't go to the er with otitis media. i have seven kids, i now know how it died diagnose otitis media, i don't need a doctor tell me what it looks like. the difference in primary care is depending on who you pick so we build an apathetic view of how the provider performs on this specific procedure talking about their cpt force, grabbing a 99213 versus 9215 and so on to build the price tags for consumers. we just give the consumer a price certain tag. that is all you're going to pay. no matter what happens. here's how we build the prices. this is real data from the minneapolis twin cities market on variation on neural tosca b. if you want to get the one that's $2300 from united hospital, they are the bar over to the right that's above the market need. an old insurance product that
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is how we all have to price. what binds us is no, i now get to price with precision across where somebody's actually consume it from. then i subsidized differently. i actually increase the group subsidy to the higher performer. i make errors more affordable for anybody. economically nudging the consumer to get to the right thing. here's the other thing amazing about a line plan. when you start with buying you get a pay raise, you pay less for healthcare and have no deductibles and no coinsurance. when you're at this point of decision you have to decide do you give your pay raise back to the bloated healthcare system. if you want to give it back, knock yourself out, but if you want to keep it, we will get you to buy that most cost-effective alternative just below that. this is all the buying plan performs for people. this is the winners and losers chart for the people in the audience. we show people the depiction of 2000 member group. and what we are showing is people that do better under the buying planner above that x
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access and people doing worse, not so good, when you build condition based design is i can cover all the things you are worried about i'm going to cover them efficiently. what is all those things you can plan for where there's a lot of price variation and you can shop for it better and better make sure i nudge you north of that line. i'm going to make sure, what's really interesting about this actuarial scatterplot is traditional plan designs can't touch people's past this 50% of claims expense. you gone into your out-of-pocket deductible max plan. very different concepts.this is how the ãsavings came from. we can drive anything from 15 to 20% savings for employers. we are actually achieving 33 percent, we are not bending the trend. we are breaking the trend. employers have saved a third from what they would have
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preemptively spent in other insurance products by putting in a buying plan. thanks. [applause] >> so, tony miller among with his other accomplishments was the first in the united states to successfully develop a platform for deductible healthcare plans. against really formidable much deeper pocket competitors. so great, tony. our next speaker is tom moriarty. tom is a senior executive vice president of cvs. he is in charge of policy, and we had to have a token lawyer on this panel. not so token by any means, tom will tell us about how cvs will solve some of the issues alluded to in the prior panel. and that is how do you break care out of hospital vertical
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integration that you talked about so eloquently. tom b&. >> thank you. so we have a presentation too. green button. good morning everybody and thank you for the opportunity. i think you'll hear some very similar scenes from me that you heard from tony as well. but i wanted to spend a few minutes to talk to you about sort of the thesis of the transaction that we just completed with aetna and how we are going to bring it to life and how we are going to bring it to the market place. because i think that access point, the need for care and local care, is paramount.and we have a fundamental belief that the healthcare system can necessarily be reformed from outside, reform has to come
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from within. and with the players there now and changing what we know and using data to drive the change. that's fundamentally what we will be looking at. if you look at the current system, obsolete everyone knows the challenges. the current system is fragmented, it's complex, it's episodic, and obviously very, very wasteful. you all know the steps in terms of how the same it performs against other markets. a stat to me that is staggering is this country is at $3.2 trillion healthcare economy. it represents 18 percent of our gdp.and over the next several years it's going to go up to about 20% of gdp. those additional two point increments is $250 billion that won't go to education, will go to infrastructure, will go to other key national priorities unless we change. and start looking at where cost is. why we have increased costs. in fewer outcomes. the current system is not sustainable. and it needs to be transformed. our vision is really new front door to healthcare.
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in the introductory remarks we have almost 10,000 locations across the united states, we feel that as you build within communities, healthcare is a full contact sport. it takes a number of contact points to really address the issues at the patient level. at the consumer level. and to what tony said, the system is built not around currently the consumer and we need to change that. the consumer and the patient feel empowered and have access where they needed, when they need it, and how they want it. we believe we can improve engagement, improve health outcomes and ultimately because of that increased engagement, lower healthcare costs. the priorities, the local, we are local. make it simple. we really need to break down, bring transparency.i think one of the things we've done around drug pricing alone, we have the ability today, based
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on where you are in your plan design, at the doctor's office or at the pharmacy counter to tell you what your doctor has prescribed for you and show you lower cost therapeutic alternatives. up to 5. we brought that into the doctor's office through the existing emr systems. when your doctor wants to prescribe you drug a, she will see that where you are in your co-pay, deductible, lifecycle, etc., if she is prescribed drug a it's gonna cost you x if you'd do down the list it gets you to the lower price of therapeutic alternative. you can have that choice as a consumer. if it's not done at the doctor's office it can be done at the pharmacy counter. it is working with a lot of the players that are represented today but more broadly in the system. it's leveraging the existing capabilities of bringing the interoperability into healthcare that's hugely important. we have five priority areas. common chronic disease management, we all know that
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lack of adherence to medicines roughly $300 billion a year is wasted. because we have emergency visits, doctor visits, and unintended outcomes because of lack of adherence to medicines. i think it's roughly 90% of all disease conditions has pharmacy and pharmaceutical products as the first line of defense. when a drug goes through critical trial with fda you have adherence rates that are off the charts. 98 ã99 percent, why? there's a care management system built around that patient during clinical trial. the drug that gets approved by the fda goes into the open market, adherence for that drug where is 98 ã99 percent in the clinical trial drops below 50%. how do we replicate in a meaningful way what is happening in the clinical trials into the real world? that's where local access, access to information, and alternative points of care become hugely important. readmission prevention, everyone knows when you leave the hospital you have a drug regiment that's been prescribed
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to you when you leave the hospital. there is nobody there to do the medication reconciliation for us to what's currently in your cabinet at home with what's now being prescribed at the hospital. the big percent of readmissions, drug to drug interactions, because that reconciliation is not being done. other areas, you have therapies that are being transferred from hospital into non-hospital settings. in fusible therapies as an example. to better manage that transition is to lower the rates of readmission, the cost savings are huge but more importantly, the patient experience improves in incredible amounts. site and care management, this was referenced before, unnecessary er visits and other visits, cost the system a tremendous amount of money. both to the system itself but to the consumer to patient. roughly 50% of folks come into our minute clinics do not have a primary care provider. roughly 50% come to us on nights and weekends when primary care isn't available. we need to extend access to
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these alternative sites of care, to provide that axis but also to provide lower-cost sites of care. optimize primary care, this venture will be an extension of the primary care into providers. it's nonreplacement. there are other models that are looking to replace.this is an extension. the one statistic i use here to demonstrate this point we know patients with diabetes see their physicians roughly 4 to 5 times a year. they will see their pharmacist and talk to their pharmacist 18 ã24 times a year. so how do we leverage information that is in the medical records that's in the patient record, to drive to maximizing points of engagement when the patient, when the consumer wants to engage? it's not the phone call at night at dinner time. it's not the letter. it's the face-to-face contact with the care provider that's available. that's fundamental to what we are talking about and the chronic disease management is the last area. fundamentally if you look 10,000 folks each day are aging
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into medicare. we know what that means budget wise as we go forward in terms of cost impact. but also as we get older, unfortunately, we develop multiple conditions and the management of those, very complex, how do we bring engagement, information, and transparency, to do a better job in that regard? so why do we think we can make a difference? well, today roughly one in three americans interact with cvs today. over 75% of the populations within five miles of one of our pharmacies. little bit more than 4 and a half million folks come to our pharmacies each and every day. now with aetna we have over 45,000 medical professionals who will be available across our enterprise to work on these. we have currently 's folks engaged in text messaging. but most importantly is the interaction engagement we have
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with health plans across the country.as we look at aetna and bringing this together in innovation, because of the channels that we interact with today, we have a really distinct ability to leverage and bring this to the market much more broadly and really drive change across the entire system because of those existing relationships. so, this is the problem statement. we all know it. 2.4 trillion, that's the medical spending. estimated 2.1, just on chronic disease. these are estimates that are published but if you take a 25% estimate, that drives to a range of savings. if you think of what that savings can mean across the board, not just from a cost perspective but from a patient experience perspective. then you are really looking at reforming the system. it's leveraging what's in the data and data is great but if you can't make data actionable and bring it to life, and bring
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it to the patient, bring it to the consumer, you're not going to change the behaviors that need to be changed.you are not going to drive the change in behavior that needs to happen and you are not going to change the way the system currently works. so that is the thesis for what we are going to be building. we firmly believe we will make a difference. we have a number of proof points from our cvs world. but i think and make a real difference. one of those, maybe we will talk about it during q&a, is the way the current payment systems are structured and this annual cycle of essentially bidding for lives that we have both in the commercial world as well as medicare. we need to make investments in patients that extend beyond the year before the benefits are actually seen and achieved. we should be looking at underwriting cycles at the federal lever and even the commercial. we can create different models that allow for those investments to be realized. you are savings, driving change, and underwriting model makes sense. i hope we get some of these
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questions. thank you. [applause] >> often what people think about cost control they think about controlling prices. i think what tom has illustrated is it's not about price control. it's about delivering care in a fundamentally different way. ... ...
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rate of people coming and entering and leaving health insurance policies is very, very expensive, and unfortunately he couldn't come so you're stuck with me telling you about this amazing plan. very interesting in brazil, why isn't it in the united states? we'll return to that question. our next speaker, dr. rajiv bhatt, part of a innovating delivery of cancer and, again, this is isn't about -- it's not going against medicare, not any of those things.
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these are fundamental innovations, the old-fashioned we we have done it in the u.s. and we have changed how we produce things. rajiv. >> good morning, ladies and gentlemen, and it's a privilege to be here. big thanks to ridge nine gentleman, paul miller and aei for invite us here today. i'm basically a surgical oncologist, clinician, and in part medical interpreter as well, so you get to see a bit of both the worlds. it is a cancer care organization headquartered at bangor, and it is a doctor's initiative organization, it's promoted and
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clinch by doctors, and it's the larger cancer scare provider in the private sector india with more than 2,000 beds, 60,000 new registrations, new cancer indications seen every year. last year we performed 18,000 major cancer resections, almost 13,000 radiation therapies, and more than 58,000 chemotherapies through the centers around the country. the key financials are there for all of you to see. it's fairly strong. we have a revenue of 108 million u.s. dollars with the reasonably good -- and the company went public in 2016. current shareholders are both national and international, ifc and cdc being there as well.
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so, it's a fairly universal organization and doing well after its initial start. what is instructive here is to see the evolution and how it appeared, and it began in the early 90s with a doctor who is radiation oncologist, chains at the md anderson here in texas. and he along with a group of doctors, set up india's first private dedicate cancer facility. this is against the background of an area that was severely lacking in appropriate infrastructure for cancer treatment, and the quality of care that was being delivered was suboptimal and there was perception that cancer was noncurable and essentially end of life disease, and against this abrupt thing particular center was set up, and in a shoe
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short years it was flooded with so many patients that they were essentially looking to expansion. there was need. people did want better and quality cancer treatment, and it was in the early 2000s that acg was formed, along with backing from private equity investors and it was in the background of a lot of skepticism how the capital investment would be recovered because is was capital intensive to set up a high-tech comprehend send cancer center and what is the viability of a single speciality business model. traditionally everybody went to major specialist hospitals which cancer was a senior part stop against this background that the expansion plan was put into place, with a uniquely info saidtive -- from there to today, is a told you with the largest
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cancer provider in the private sector, 26 cancer centers, but now the background is a rising incidence of the disease and there is a huge gap in the infrastructure and resources and we clearly need an improvement in outcomes. so the challenges remain, and it is a dynamic and constantly evolving field. therefore, 80% of the care is in cancer. small part in fertility treatment. precision medicine through the strand vertical, and this is actually a very vital part of the entire organization because it provides the bioinfo matics and specialized clinical does decisionic and research services and a very small percentage of multispecialty hospitals for various reasons that it is a vertical on its own as well. now, what you must understand is
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that india is very diverse. i mean in terms of its language, its people, its culture, its cuisine and everything, and healthcare is no different. healthcare is also very different. the amount of health care spending at that time each of the states does ranges from low to average, very few states actually having a good healthcare expenditure, and it's surprising the most populous state has the lowest insurance penetration, 10 mrs., but the largest budget in terms of healthcare outlay. so, its an extremely complex and diverse situation in the country, and after this the disparates disparates in the rural and urban health care, almost two-thirdses of the population live in rural areas there is would severe lack of resources and 20% of them will have access
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to high quality care. in addition, 70% of the care in any disease in the healthcare condition in india, is in the private sector. only 60% of the patients have insurance so the majority will pay out of their pockets, and that is where the choice and competition will come in, because it is their own money that we now have to look around to see what they get value from, and in order to approach these challenges, came up with this innovative model, addresses accessibility and affordability and that model is essentially the doctor-driven enterprise, 320 oncologist friday various subspecialties in the country, and it's a very innovative partnership model and i can give my own example.
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i'm a surgical oncologist, i practice in the city in western india. and i started practicing in the mid-90s after being trained at a specialized cancer center, but without the leverage of a comprehensive center within my own city. and this led to a lot of fragmented care. my patient would come to me for surgery, i operated at one hospital. go and see another medical oncologist at another hospital for chemotherapy and then for radiation oncology they have to go to mumbai, 400-kilometers away or to other centers which was still 100-kilometers away. so, clearly there was ad in for establishing a comprehensive cancer center, and as an individual, i didn't have the necessary resources or the professionalism to be able to put up this enter mice on my own -- enterprise on my own. hcg had the expertise and the
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input necessary financially and otherwise, but what it didn't have was local know how. so it made a perfect win-win situation, or these two segments to partner. so i partnered with the hcg and we brought a comprehensive cancer center two and a half years ago and that is how this model works across all the centers. there are partners and the partners are oncologists. thes and what it does is is brings much needed high-tech care within reach of people who actually need it, closer to their homes. and there are multiple ways in which we utilize this arrangement. the spoke, the hub, and what it does is it moves care from the metros to the tier two and tier three cities and traditionally if a patient has cancer they
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come to the treatment member with two or three family members so you have loss of wages, stay for treatment, ronalding and boarding and tremendous loss of income. so when you transfer the care to the tier two and three cities you make it more affordable and more accessible and that's the way the model works and the quality assurance and the rest of the protocols which will determine adequate level of services is given from the core of the hub, to the various spokes. so, that's how it works in -- we're the spoke' and have surgery oncology, radiation therapy, medical oncology, we have the nuclear ising and we have lab medicine. but for things which are more intensive, like molecular oncology, genome nicks or cyber knife for robotics we look back to the hub, and short time after
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beginning the center, we realized that people within the radius of 250-kilometers also found it very difficult to keep coming back here for repeated consultations and repeated treatment schedules so we started outreach clinics at these various places, where we set up clinics. these are outpatient clinics women do basic lab tests and infusion centers for day care chemotherapy so you have the spokes extending into he rural and semi rural and semi urban areas. the spoke becomes a regional minisomebody a patient who is at the right end of the spectrum can avail of all the level of care the benchmarks that the hub is there to provide. so, in effect, virtually they're getting all the treatment being thousands of miles away and at a
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much more cost effective price point. this is geographically -- you can see the coverage area is fairly large, covers neighboring areas as well, neighboring states, and it has turned into now the spoke has turned into a hub for specialized medical services. what are the characterrics? i think one of the first is the -- it cuts down the cost of cancer treatment, and if you see a comparison of the cost of cancer treatment for various cancers across the board, you can see that the cost in india is considerably lower than in developed countries, and this particular cost cutting has happened in a number of ways. it hasn't taken away from the quality as i will show you. the technologies, although
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they're there, are not as expensive as in the it. a pet scanning in the us u.s. $2,500 and in india would cost 300 u.s. doors. raidation therapy, one of the specialized radiation therapy methodologies, costs $10,500 in the u.s., but it just about $2,500 in india. and radio surgery, $45,000 in the u.s. and $6,000 in india. so, clearly there is value for money in what is being done. the other interesting thing here is that the -- even within the hub some spoke model the costing at the spokes would be less than at the hubs so the consumer or the patient has a choice where to go to get that level of care because he is paying out of his pocket. this cost cutting doesn't come at the cost of quality. the focus is constantly on the outcomes and we have published
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ruts which show the outcomes in a number of cancers are at par with most comprehensive cancer centers across the world, and there are a number of ways which we ensure quality little one is the multidisciplinary approach and the tumor wood boards. we have a regular tumor board that discusses the patients individual imaging and lab data and then make treatment plans and that is implemented. complex case are discussed with the specialist at the hub, through a virtual tumor board, and this allows us to access for that patient who is at our center the best possible decisionmaking process. we build in the nuclear imaging data, the molecular genomic data that may be required and this produces a huge opt of data, big dat and data analytics which help us make better decisions, and this focus on outcomes ensures we don't compromise on
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quality. the performancees reviewed on an annual basis at our in-house actual meetings. you can see the adoption of conservation breast surgery with this kind of model over the years, about 10 years and now we're at levels writ is with the rest of the world. under the typical example if this appropriate and effective use of the pet ct scan, which is molecular imaging and when we relied on previous image, the ct scan and mri, we would miss patients who had metastatic disease buts now we can detect this with the pet scan. the difference is fivefold in terms of detection of met testacies of cancer. that would change the treatment plan. we would know they had more
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metastatic disease but would relapse soon. the outcomes are completely different. so, a simple strategy of using the appropriate investigation, effectively, not blindly, more rationally. will clearly lead to cost saving in terms of what we do. we have now moved from an era of one size fits all to precision medicine. we have patients, subgroups in whom we predict the response to certain treatments and then we decide what kind of treatment that person should receive. so, that the outcomes are much better. there's no point in applying costly medication to the entire group of, say, stage one breast cancer when you know that within that group there are about five to six different subgroups. so, this precision medicine means is giving the right treatment to the right patient at the right time. accomplish by doing that itself,
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it will cut a lot of costs. and using this precision medicine we can leverage adequate resources, provide integrated offerings, we have one of the largest cancerbuy repositories. the hospital information system and the cloud-based emr provides adequate dat for us when we do the analytics to provide a background for real-time decisionmaking and this is something we're in the process of implementing. it's possible in the clinic to know that in the past so many thousands of patients treated in a similar way had this -- type of outcome, and be able to advise my patient, being right there in the clinic, based on the data analytics, which is essentially our own data, not data from the western world and
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past statistics. so, clearly this model is working well. and i will conclude with a quote from a champion crusader of equality and justice who said that 0 of thumb forms of inequality, injustice in health care is the most inhumane and shocking. that, ladies and gentlemen, is martin luther king king. thank you very much for your attention. [applause] >> so, one other thing about hcg that they don't pay dividends and they take the --" a publicly held enterprise -- they take the money that would normally be paid out in dividends and use it to subsidize people who otherwise could not afford it. just like to restate what the hub does.
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cancer cure is tremendously expensive, radiological equipmenter is horrendously expensive. $50,000,200,000,000. it requires extraordinarily smart and expensive resources to run these machines. ph.d level physicists who specialize in calibrating them and ancillary personnel, all of this resources are in that hub, and they maximize the utilization of the hub. the resources of what is called medical oncology infusion, which takes a long time, is very painful, psychologically debilitating, those are done now in the spokes. they're there in the community. it is economically -- specially to a country like ours where we have mostly hubs and virtually no spokes, and so much more
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humane model to boot. so thank you so much. >> teledock provides second opinions and provides information to consumers. tell us how teledoc works and how it can help a patient pick hcg or md anderson or dana farber. welcome. >> thank you. i'm the chief medical officer at teledoc. i'm my own journey into telemet sin, really began about 18 months ago. was the chief medical officer at
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a company well-known to reggie, best doctors, one of the k series at harvard business school that you taught for many years along with a founder, dr. jose halperin. started ted brigham and women's hospital by two professors, ken, who passed away this year, along with jose halperin and that was really a way to access top level medical opinions anywhere in the world. so we're a global company. and 18 months ago we were acquired by a very large telemedicine company call tela doc and the vision of the company is to -- with the acquisition of best doctors and the acquisition this year of a another expert medical opinion company that provides physician services globally, advanced medical, headquartered out of
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barcelona is to private a very comprehensive medical care virtually, and this really sets teladoc apart from a lot of other telemedicine companies which tend to be more or less what would be considered point solutions. so you might have a telenephrology program that might be helping individuals who are on home dialysis in cleveland, so it's a very specific kind of use case, if you will and what the thesis of teladoc is to provide comprehensive virtual services globally. so i want to share a little bit about the company but i want to share a couple of thoughts. reggieed and specifically but what can be done to accelerate growth from a regulatory standpoint. so i want to address that as well. so, we are transforming how people access health care around the world.
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peek talk about convenience, outcome, and value, and also like to stress, having taught the past 30 years at harvard medical school, accessing quality care, not just accessing convenient care, and i think it's an important distinction to bring out. we are in our space in the u.s. the only publicly traded company, and we have access to over 50,000 medical experts. we have 2,000 employees around the world. we're currently in 125 countries. and we have very good uptake in terms of individuals downloading the mobile app. why is that important? it's important because it really drives digital engagement, and a lot of -- currently we're living in the world where consumers are increasingly in their lives
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accessing services such as uber-and amazon without even thinking about it, yet with healthcare i would say that people are still thinking in terms of, i've god a problem, who do i need to go see? and they're not thinking so much in terms of a virtual solution to meet their healthcare needs and that's why the digital downloads are so important because that allows all different types of digital kinds of marketing, geofencing and all different types of strategies to really increase the uptake of the service. and as you can see on this slide, it's a very expansive clinical services. so another important part of the company in terms of the overall digital consumer experience is to make that experience an easy one. so, it's by no means the object of the company to confront the consumer with, here are the 25-50, 100, different services you might be interested in, but
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really to work with leading companies around ai solutions on the front end, to have smart spellens around the navigation so that in a couple of sentences an individual can describe what is their healthcare need and then basically navigate them to the virtual service we think can best meet their need in that time. and here you can see a little bit of about the company. we are really feel that we have managed to deliver virtual care value at scale. we're coming into a busy season in the u.s., and on a given day we may be doing over 10,000 visits. we'll be doing over 2 million virtual visits this year areason and it's rapidly growing. so, when we look at how many members have access to our services, and how many visits are we actually generating, we're noticing that year over
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year on a percentage basis, increasingly the visit rate is outpacing the membership growth rate, meaning higher out iization, higher uptake. you can see here on this slide where around 6.3% in terms of overall utilization. we have maintain different distribution channels through large and small carriers, mall, medium and large sized companies, but where you see the larger statistics there in terms of where do you get utilization of up to 15%, it's really where we can the most directly communicate that individuals have this service. so, for instance, for large corporations, where we have been brought to there as an employee benefit, we have the most direct access to the individual as opposed to when we might be behind a carrier and might be a little bit more difficult to get the message out.
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and we're very proud of the outcomes. we -- i've done a lot of work around asking peach of the individuals who come to tela doc what would do if you didn't have access? would you have just got an box of tissues and this care is additive or gone so see your regular primary care provider, urgent care, emergency room and we also do followup on these cases. so what we have been able to demonstrate is that there is a proximate connecticut saving of $472 for each visit based upon the avoidance of er and urgent care, and we are also noticing 92% of the member issues are being resolved by this service. so it's by no means additive or another thing before the person actually got their medical issue resolved. important point.
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similarly, we have a pretty robust behavioral health program which actually is ten times the size this year as last year. so we are very proud of the fact that behavioral health is growing quickly and it's effective. so we do surveys of individuals in terms of how well this service actually improved their behavioral health condition and we're noticing important improvements both in terms of depression and anxiety scores. we also have the expert medical opinion services, and these are the services that were part of the legacy best doctors and advance el medical and these are services in which virtually we are interacting with individuals and then gathering all of the relevant medical information. hospital charts, imaging, we actually repeat the pathology to make sure that the original
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pathologic description is correct and we find 20% of the time it incorrect. we also do cost analysis on all of these cases, and find that by giving individuals the right diagnosis and the right treatment path, we're able to have a significant impact. most of the model in terms of the expert medical opinion services, are delivered as employee benefits, as well as delivered through a lot of global insurers, but we are also locally involved with health plans directly. so for instance, care fist, the large blue plan in the baltimore area has a pretty robust patient-centered medical home program and the expert medical opinion services of teladoc are services that are then rue to anally the case managers are taking -- routinely the case managers are taking their case test top of the pyramid, cases
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that are the most costly and complex, and referring them directly into the network. in terms of a couple of thoughts, in terms of what could really help accelerate the growth of virtual care services. i would say two things. one is interoperatability, we heard recently about india and the frustration that you faced in terms of individuals who might need as part of their comprehensive cancer treatment, a surgical approach, a medical approach, a radiation oncology approach and having three disparity systems in india that didn't necessarily talk to each other and the smart approach of having this kind of integrated hub and spoke model. well, i invite anybody to come to boston, stand on brookline avenue and you can see on your left-hand side the brigham and women's hospital, on the
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right-hand side, beth israel deconnest medical center. i have had admitting privileges and they don't share information. crazy, in this day and aim, you can have a headache, get -- eye good-go to another harvard teaching hospital and not have that sharing of information. so i think that a lot of the solutions that we have been talking about today, one always has to think but in terms of interoperate ability and the importance importance of that because it filters into every single conversation. jeff mentioned the idea -- you can go to a different imaging center and could be a fraction of the cost of the first place. if that illinoising center doesn't share information week in primary care doctor, if there's the incidental finding
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of the adrenal carcinoma on the m.r.i. was not looking for and is long, it's problematic even if the consumer gets $100 because they did the right thing and drove an additional five miles. and with -- it's great that one could be directed to that provider that is providing the procedure at a fraction of a cost of the big university center but it's the tying in of the information, and we're very proud of our partnership with cvs. and all of the work of troy brennan in terms of trying to tackle chronic disease management -- [inaudible] -- we have a partnership with cvs where we are being white labeled and providing basically the telemedicine back end services for the virtual aspects of the
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clinic. i think that relationship can really accelerate and grow with just much more of a fueling. so i think that everybody knows the ease with which you could go and speak to a financial adviser and fidelity net benefits and your -- all on one page and then you can go speak to any financial adviser you want and i think that there really does need to be this democratization for the consumer that you own your healthcare data and can go anywhere within the healthcare system and seek the care because that i think really is on a medical quality basis fundamental. more towards the telemedicine, i think that two things that are important to us -- well, many things but two i would like to highlight, one would be around
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the rules that are currently before congress that have to do with regulations having to do with where is the patient and where is the provider at the time that the telemedicine service is being rendered. dr. david shulkin, our recently joined the medical advisory board, the secretary of the va, and i'm sure a number of people in the room know him. and he shared and -- anecdote where he was in the white house demonstrating to president trump, speaking to one of his patients, and trump enjoyed interacting with the patient very much, and then he basically wandered into trump's office and said, you know, mr. president do you have a minute in the said, sure, what. he said well that patient was in
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a healthcare facility when you were interacting with them, and the importance of that is that currently the justice depth is blocking us from enabling our provided to interact with patients when they're at home. they have to be in a health care facility. so veterans are literally driving an hour or two to get to a healthcare facility in order to have a virtual interaction, and the president was like, that's ridiculous, and sure enough he was able to call up the justice department and get that turned around. but those kinds of laws of where is the provider and where is the patient, still exist, and we really do believe that virtual care services should not be hindered by those types of rules. we also think it is time that people begin to think a little bit about what we want to do with state licensure.
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so currently for individuals who would like to work a little bit more with teladoc, if you're a provider in montana and absolutely love doing the telemedicine, if you want to get more visits on our platform, we have a lot of volume coming out of california and texas and new york and new jersey, but as a montana physician, you -- we will need to work with you get that multistate licensure in place, and does that make sense? we are taking care of individuals in the general medicine. this is pretty straightforward kind of medical care. we're talking about literally coughs, cold, urinary tract infections. toes it really make sense to put doctors and going through that whole administrative burden of multistate licensure because they want to help people out virtually and i submit it would be time to think about that as well in terms of legislative
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things that could be done to help these kind of services grow. i thank you so much. >> that was wonderful. >> my pleasure. >> thank you. [applause] >> so, our next speaker is nils, the ceo of change, the new name for mdon which is a pipe that does claims processing of about a third of the insurance claims in the united states. it bought a little company called change. change's purpose is to enable consumers to use this voluminous amount of price data to make more better purchase decisions for themselves. neil? >> thank you for coming.
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>> thank you, professor, and thank you, tom and amy for the opportunity to speak you today. as as professor mentioned, our company's -- green button, right? >> the company has been around for 40 years, really started out in producing an electronic form mat the main transactions in health care around administrative and financial transactions and ultimately grew and i'll talk more about this -- at the facilitating clinical data. we spent $32 billion in the country over the last decade or so, fomenting or really financing the growth of electronic medical records so now that they're fairly ubiquitous, specially inpatient,
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not so much or outpatient or rural set budget we're getting there, which digitized the final mile in health care, and so this is a company that actually really touches most of the major players and almost a lot of the minor players. we sometimes i joke we take care of one person, choir patriot actor offices, and -- choir pratt, to offices and there's an ahoma therapist who is paid by a insurance plan and we send them a check, too. you have heard from folks who have spoken today, we have extremely innovative people like the bird project, as tony mentions and long history of innovation, giants in the industry like cvs and now cvs aetna but there's still a very long tale in healthcare and we take care of a lot of that long tail. 14 billion transactions and as professor mentioned, a trillion dollars in healthcare claims in the country are managed how to our network and software
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products. thought i'd talk about a couple of key areas, price and cost transparency and patient experience, both of which were enome newsily high lited in the record that couple out from the secretaries of hhs, the treasury and the labor department. on here it talks abouts, as brian mentioned earlier, how concentrated the markets are, our number was 90%. it what footnote, too. the number the report came out yesterday was 77%. so i'll probably have to change the slide a bit. but really points out a couple of things. one, markets are consolidated. there is actually more turnover in people making new decisions about physicians and other care gived every year that sometimes people feel. by and large, patients are dissatisfied with their healthcare experience that doesn't necessarily mean their physician or their provider but it's really the whole experience and as you heard from many speakers, including brian dish won't go on -- the burden on consumers continues to advance. one thing we thought about is looking at how we needed to
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improve the patient experience. who is actually done this? we talk about the patient experience, like it's a little bit of a black art but we have had people focusing on the consumer experience in this country and around the world, for many years, and as another industry's data has become digital. financial services, retail, many other industries, so we formed the joint effort with adobe and microsoft around improving the patient experience at scale, all the way from the largest healthcare institution in the country, down to very small providers, who are just figuring out how to use the internet to get people to come back for a followup appoint. which i have to tell you in many mall plays occupies an enormous amount of time and this advanced instrument, called the telephone. which is probably not the best way to do that. just to give you an idea on the scale because we have the very -- large companies here like cvs-aetna, we process 14 billion tran servings every year and at one point one of the
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senior executives of adobe said, how many transactions do you think we saw from consumers in adobe experience cloud last year? i didn't think this would go well for me but nevertheless i said, i don't know. tsunami he said 233 billion. so you can please shut the heck up about your stupid 14 billion tran satisfactions. consumer experience is a lot bigger than health care, although you healthcare people don't seem to have fir its it out. we're excited about rolling this out. a gifting a lot of traction in the market. the other area i want to talk about briefly is around efforts around data and price transparency, so, some of you may be aware back in march, administrator had announcement or conference, big i.t. con front fer the healthcare industry, talk about the next stage in blue button downloading dat from the va, my healthy data
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and programs that provide more access to data controlled by hhs, cms, va other, government connected entities. professor strictly familiar with our company because his true view product came from a small company we bought four years ago called change health care whose name we adopted because it thought it was cool name. i knew this proctcalled true view, which is one of the largest footprints in the country for providing price and cost transparency dat and then we heard interoperate credibility mentions and folks are who familiar how this is advanced may be air ware of the health alliance we provide the network for. like many of these net new york businesses the interoperate ability of clinical data which has not got tonbreak line yet is advancing but like many network businesses it starts very slow for a long time and then you hi
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the curve. the commonwealth net work is sharing information for $39 million in the last 12 mons after four i've five years of work and increasing by 2 million a month. so once you get the two-side market and the network externality it starts to grow and with the 21st century counteract and further encouragement through legislation there and the new aspects coming out of washington, we expect this interoperatability area to continue to advance rapidly over the next few years. so finally some of the data i know tony showed some great data whop he is doing and cvs has enormous amount. this true view price and cost train sane si solution, voted number one by this organization that ranks healthcare software every year, called class, somebody mentioned earlier about the design thinking. we may have one of the largest design thinking -- the head of design of bank of america so if
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anybody here is a bank of america custom and use the app the did that. and this sort of scale around understanding how to take design thinking, the people we hire from the d school, at stanford, combined with an a.i. group one the large nest health care and a bunch of behavioral economists we hired from the various places you get behavioral economists at, have all combined in understanding not only how to produce software that is usable by people and let's remember the average american read at a 7th . with this interface is not interfate mend porns and ph.ds and health care policy expert its, it's for john and jane q. public. it is more likely to shop and the report of those who haven't had a chance to read the report, and brian mentioned this, talk about shoppable service, illinoising, a great example of that. where there is the ability to help people be better shoppers. we now have examples of this
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from all the customer that have been using this for years and i think this is a good example while we'll certainly have people innovate, that will be truly transformative and we still have millions and millions of people involved in the healthcare system and it's not going do change in three monthed and spent a lot of time trying to take the bigger companies in the industry and put and the smaller companies and help them take advantage of this trends towards attracting and retaining patients as a core competitive advantage and understanding how to produce better healthcare consumers and hopefully trying to move the ball. thank you very much. >> thank you. [applause] >> we're so lucky to have these people here. they're all here because i wrote case studies about their companies, and i wrote 53 other case studies to fill --
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education how to make healthcare innovation happen. so theres is is a lot of shoulds, you should do this, you should do this, you can't do that. how do you actually make it happen, actually very hard subject to teach, because the entrepreneurs don't know health care and they're terrified that people like you will be in the room, and then healthcare people by and large don't know entrepreneurship, and so i'm grateful to you not only for being here but for participating in these case studies. we have one minute, tony and tom, for you to comment on the impediments or the changes in policy that would make things better. one minute. tommy? >> so, well, one, don't legislate plan design. let the market figure out plan design. i think we were the innovator
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inside of ra, the first article we did back in 1998 was, what they're doing is illegal so we have an uninformed group of people and now has 30% mark share. i think the second thing is we did talk but the idea of silo data. i think that regular laker to -- we shouldn't tolerate this anymore at the consumer level. this idea that a plan gets -- somebody gets to keep your data and hipaa is a problem. there is a trump card in hipaa called the consumer and they can say i want my stuff. so anything we do regulatorily there would be helpful. >> tom. >> our experience is similar to telado contribution the patchwork of regulation at the state level so at he look at how toed a answer health care there are professionals who can do more than they're currently allowed to do, whether it's a pharmacist, nurse prayer or others, so getting them to practice at the top of their license is hugely important solving this current crisis.
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but it is we have to almost go state-by-state to make that happened and the more we can get to a standardization around this the more we can accelerate health care more broadly. >> so, you told us about what would make your laudible efforts even better. i'm grateful to all of you, you have been marvelous. [applause] >> tom, are you going to grow dues these -- introduce -- >> we're just a short transitional break. the secretary will be here at 12:20. >> great. conversations] [inaudible conversations] >> government funding ran out last friday at midnight. at we enter day seven of a government shutdown negotiations continue on a bill that could
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past both chambers of congress and get the approval of the president. watch live coverage of the house on c-span, the senate on c-span2. ♪ ♪ >> the united states senate, uniquely american institution. legislating and carrying out constitutional duties since 1789. >> please raise your right hand. >> wednesday, c-span takes you inside the senate. learning about the legislative body and its informal workings. >> arguing about things and kicking them around and having great debates is the thoroughly american thing. >> it is a cooling saucer and he longer you're in the senate the more you appreciate that cooling nature.
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>> we'll look at its history of conflict and compromise with original interviews. key moments in history, and unprecedented access. allowing is to bring cameras into the senate chamber during a session. >> we're here. >> follow the evolution of the senate into the modern era. from advise and consent to the role in impeachment proceedings, and investigations. the senate, conflict and compromise, c-span original production. exploring the history, traditions and roles of this uniquely american institution. premiers wednesday at 8:00 p.m. eastern and pacific on c-span and good online at c-span.org/senate to learn more about the program. and watch original full length interviews with senators. view farewell speeches from long-serving members and take a tour inside the senate chamber. the old senate chamber, and other exclusive locations.
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>> california will have seven new members of this in the 16th congress all of whom are democrats and all of them represent stricts previously held by republicans. harley rude da this first of hour representing districts in orange county, south of los angeles. he is a businessman and attorney. he and his wife also opened a homeless shelter for families when they lived in ohio. katy porter in he 45th 45th district oversaw the implementation of a $25 billion settlement between mortgage servicers and homeowners on behalf of the state of california. she is also a law professor at the university of california irvine. mike live victim was elected represent the 49th district. he has worked in environmental law and the clean energy industry for most of his career. he also spent time as the executive director of the orange county democratic party and is a
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fundraiser for hillary clinton's 2016 presidential campaign. gill cisneros is a navy veteran and was laid if when he won $266 million in the mega millions jackpot. he and ohio wife used some of the money establish scholarships and educational foundation. democrats picked up a fifth seat in the los angeles area, katy hill, was elected the 25th 25th district, just north of the city. she used to run a nonprofit for the homeless. at age 31 he she will be the younges me on california's congressional dealt gages. t.j. cox was elected to the 21st district south and west of fresno in the san joaquin valley and has a degree in engineering and worked for a time as other mining inning mere. i later received a business degree and opened several businesses in the area, including two companies that process locally green nuts. and josh harder was a
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electricitied to represent the tenth district, locate further north in the sawn joaquin valley. a venture capitalist and talked business at a local community college. new congress, new leaders, watch it all on c-span. >> next a look into the trump administration's defense industrial policy. representatives from the administration congressional staff and private industry talked about what their respective branches and companies are doing toen sure that all u.s. defense and national security tools are being used and how they are addressing potential threats to the country.

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