try to have flexibility in our model. we asked for guidelines, not micromanagement. all of my markets are different. i cannot do it exactly the same way. one of the problems is thinking that because it worked in california it will work the same in dc or somewhere else. customers of the reason that kaiser did not scale. customers were not willing to go to the model. now, i think we have different market conditions because if you think about consumer choice in the world most of us lived in your employer made the decision by selecting a health plan. there was a lot of angst among the employees. the market is becoming much more in it to have much more

of an individual market command i think when individuals have the choice and see the cost scale between the different options, they are willing to make decisions about taking a narrowera narrower set of choices or this particular set of providers because i understand the value trade-off equation is my expense. that is different than when your employer makes the choice for you. so there are different market conditions today which allows more of the kaiser type model to flourish again. >> one more question. thank you. i will ask another question.

the question is, already talked about patient outcomes. the diabetics improving the cancer patients living longer? >> we have outcomes, the things that we measure. diabetics are getting better in terms of the standard measures. we don't yet have mortality data on that. the ecology area is near where the measurement development is earlier. but i have no doubt that patients are healthier.

>> we are seeing results headed in the right direction, but it is early. when i will say is, on the oncology side we created to cancer oncology aclu's for the 1st of the type that were disease pacific. one of those was moffitt cancer center. we arecenter. we are trying to try patients to the very best facilities. if you think about how cancer is handled every hospital is trying to manage it, and get there are clear centers of excellence. we are trying to make sure we have an opportunity to drive to the center of excellence that handles the volume and has the expertise we are giving patients and members a chance to get care at the best facilities. >> here is a question.

what is the role of provider competition or consolidation in the transition to value -based alternative payment models? many argue that they must march together to have a scale and resources and clinical immigration necessary to keep the transition. is this accurate? >> i would say that integration we believe is necessary to provide the kind of care that a lot of us have talked about. thank you. but integration does not imply that it has to be ownership, shared ownership. you can have virtual integration. some are highest performing groups, smaller practices that are affiliated with one or two hospitals that are not owned practices. integration, we think, is a condition, but ownership is not.

>> the one comment i would make is that we bought a multi- specialty practice just outside of tampa, florida for the highest quality practice in that area command the interesting part was there to main suitors were hospital systems. philly doctors came and said comeau we would like you to begin this process because if we are bought by either hospital system we know we will have to compromise our approach to medicine and admit more patience than we think is right. we got in that makes because we want to learn, thought this was the right partner command they made a compelling case but how they would be compromised to permit the patient. are you getting that doctors best and most objective opinion?

>> let's switch over. with all of the buzz in california how do you think this will affect the industry? will it ever pass? >> transparency will help, but i'm not sure how much. drug company should be able to list why they think this is right. why is not how things work on a normal market. consumers decide whether it is appropriate. so transparency can help, but they already publish

pharmacokinetic and make studies that are supposed to demonstrate if any drug comes along how much it reduces the length of stay and how much money the system saves from doing so, and typically show that the drug will cost more in terms of the total cost of care. transparency alone is the issue. we need to have more competition. competition is what leads to pricing signals that matter. >> you want to comment? >> this issue of front -- price transparency, one should not oversell it. martin who work as an economist work at the ftc and was clear and pointing

that out commanded is, if you have a noncompetitive market you still have very high prices, so you do need some form of competition, and very often it does actually come in the form of made the product. there are a lot of people down. i have never been so down on it because they can in fact exert the competition which we have seen. the other problem is in the us there is no one price for anything. it varies by insurance company, products. what do you pay for colonoscopy?

probably 50 prices. if you look at the cost of making that drive, that's only part of it. and to make people understand what costs are. so i'm not sure what you actually get masking for costs information.

all kinds of information. >> we have a reasonable amount of information. >> do you see tools such as peer boss drug advocates. >> not really. if there is a perception, puerto rico perception, that is something larger companies pay attention to.

you will not be super aggressive because i know that has policy and political qualifications. these metrics can help but don't necessarily give you a real expression. they can compete and deliver prices. the uk has this agency called nice. they use these things so much that economists like to assess, does this truck cost

more than 20,000 pounds sterling? if it doesn't we won't recommend reimbursement. a lot of people in washington agencies and academics think that's beautiful. the problem is, it leads you to funny situations. about ten years ago nice was trying to figure out whether to reimburse. and because the drug was expensive they decided to reimburse for the drug if you are already blind in one eye but not if you could see from both of your eyes, the idea being that was not a biga big deal because you still have another i could see whereas if you only had one you would be totally

blind and that would be bad. we won't pay for it to treat people who could see in both eyes. he can understand why the average person thought that was completely ridiculous. it is critically important to have site in both your eyes. and so when a bunch of people are sitting around room making these decisions they are not always thinking about what the patient wants in that case the patient might have said it does not look like it, but, but i do want to see in them willing to pay for it. but consumers don't have the opportunity to deliver this person.

>> here he comes. >> the public debate about spending on pharmaceuticals has been mostly this debate you have heard replicated on regulation versus competition mobile what i say about the work being done is that it is bringing the voice of the commission to the debate which has been largely absent. by raising questions about the relationship between the price and efficacy of drugs is making an important contribution i think it will add a lot to the debate.

>> i noticed the english you are using. how do you value this? he put a different price on this than a ratea rate 22,000 and a which is making 25,000 could command many economists would say, well,, well, which are says no value it as much. which is a mission to cover misuse of english. so ultimately you asked if you want to distributed on the basis of price and ability to pay? we could do this mode you like everyone to have access?

and if he sent a letter to become the collective decision because then you are asking me much i'm willing to pay for someone whom i don't know i may not like if i did it this treatment. to argue that the market can solve this doesn't make sense to me. the birds made that decision and i am sure that they relented. they repent when they see popular pressure, but that is a difficulty that was alluding to. we do not know what value to

put on a quality adjusted life. the britts sort of do, but they relented under pressure we don't want to discuss it. this congress won't even allow costs to be entered in cost effective analysis. congress hates cost-effectiveness analysis because it might implicitly put a value on human life. that is how shall we are. this is a larger issue than to say what i would be willing to pay for drug. it always turns out clearly in the case when you see the people who actually get this drug often on public programs are in jail and it becomes a collective decision. at some point our students will have to come to terms.

i think that we can, forcan, for a couple of years, still sweep it under the rug. what you would not catch me doing is to say, yes, we should cover it command yes we should pay a high price commander should cut social spending and lower taxes. that would not happen to me. i can guarantee it. >> i did want to comment on this as well, but i did not want you to explode waiting to get an answer out. let me make a couple of comments about pharmaceutical pricing. the margin on pharmaceuticals around the world is a fraction of what is the us. we should be asking a question about that. while we pay so much more endo we willing to fund the world innovation and research and development. i went on a delegation trip in minnesota the germany and the gentleman in charge of pharmaceutical purchasing germany asked us why you

allow for pharmaceuticals to be advertised on television. has anyone seen the chart that shows us from the spending from before we haven't has ent veta afterwards? and so you have to ask about efficacy. when we went direct to the consumer it exploded. we are one of the most nations in the world spending on pharma and get our outcomes and health levels are nowhere near other places. there are baseline questions that we need to ask about whether or not we are willing to fund the world on this and the fact that we restrict ourselves for negotiating is something that continues to amaze me,

does not give more attention in the press,press, debate in washington dc. the largest purchaser does not get to negotiate the price. it is absurd. >> am tempted to end on that. thank you. question is from the congressional office. only about 2 percent of people use them. will make is the last question. in massachusetts we are required to make that information available to our members command the key barrier has been you can tell someone the price of procedure.

we talked about the price for colonoscopy, but could you tell them what they are price would be given their policy copayment. the website. the question is right. the ticket still low, but it is starting to grow. >> i was completely agree with andrew command i cited that example in my comments. they are encouraging them. it is certainly available through our website. the take-up has not been a strong as we would like to be, but it is better than the national numbers. >> the base reason why computers don't use these tools is because they don't actually save any money if they use a less expensive hospital.

by and large the economic incentive is not there is a part of what draws hospital economics. it does restrict competition and the ability of it directs the highest quality lows caused care. so this is a huge problem that we must do more to address which involves two different lanes, antitrust and competition reducing barriers to entry and i ever side we have to give more opportunities to patients. in that way the insurance company has the incentive to make sure they are holding hospitals accountable. >> there is also a fallacy that if it costs more and is higher quality.

we believe that the data does not bear that out of all. >> massachusetts publishes a cost report every year, and it turns out that the drift has been toward more expensive facilities, and other words, they have these prices, but in fact rather than what you would expect people not know the prices in gravitate toward the cheaper, less costly facilities, it was the opposite. everything is going to ask both of you, are these binding prices, what was in the past? in other words, if i go to a dr. dr. that i thought was low-cost, my guaranteed to

get low cost? in some senses it binding, or what am i looking at? >> today they are estimates within a range and based upon history. it is not an absolute contract, but gets you within pretty close proximity. >> maybe the popularity will grow over time. >> let's make not the last word. i would like to thank our panelists. [applause] you guys have been a studying -- stunning audience. fill out your evaluation form and we would appreciate that. we would like to thank congressman crenshaw's office. i would like to thank allison myers.

programs and politics, nonfiction books in american history. american history will be live from the national world war ii museum in new orleans. we will tour the museum exhibits and take calls and tweets. our new program road to the white house rewind takes a look at past presidential campaigns through archival footage.

former governor and democratic presidential candidate mark o'malley. >> tito has the best access to congress.

give best access by following c-span another capitol hill reporter on twitter. stay with c-span, c-span radio command c-span.org for your best access to congress. >> next on a look at the criminal justice system from the perspective of two former prison inmates. this is an hour and 20 minutes. [inaudible conversations] [inaudible conversations]

ladies and gentlemen, thank you all for >> thank you for coming. i am a visiting fellow at the american enterprise institute and a columnist at the washington examiner. and i think you have seen especially in this last year a discussion our criminal justice reform, over criminalization of all sorts of things. we will focus on specific aspect. mymy thoughts on why i picked prison specifically. i have libertarian leanings. i am a catholic. justice and mercy need to be played out. on the other hand, i don't know or think that we would it into a question of maybe we are locking up the millions of people we lock up to make our people safer.

having prison sentences serves a deterrent effect. it keeps dangerous criminals off the street. we call these correctional facilities. bracketing the debate, although that will be relevant, once people are in prison are they being harmed? how we treating them in a way that will benefit or hurt society? i think we know the answer to the question maybe. .. forward. i ask them asked them who they felt within their lives and i write about lobbying and politics and i run a former lobbyist politician. on mine right is my right is a lawyer and fellow republican congressional republican study

committee. he passed through the revolving door and became a lobbyist in 1999. he wrote a book which was big reading in my house with my brother when he was in law school it was scalia's dissent. it was an excellent book to get your final up and running. it is was against mandatory minimums and on my left, jeff smith former missouri state senator congressional candidate who a lot of us stumbled upon in a documentary called ken mr. smith still go to washington and he is now an assistant professor at the new school in new york. the reason i bring them here as they both have served time in prison. so before we get to the substance quickly.

i was a lobbyist and the leader ended up being the scandal in the bush administration, and i was basically charged with honest service fraud. in a federal prison camp in maryland i forgot to mention i said the documentary name is ken mr. smith still go to washington and what i have in my hand is the brand-new book for sale in the lobby called mr. smith goes to prison which tells his story very well. can you quickly tell us?

>> sure. i was in the senate in missouri and the moderator asked a question i found too intrusive and i took the end. no. [laughter] i will try to convince this as much as i can. russ carnahan who was a successful two-term governor and senator and sister and secretary of state. about three weeks before election day to the consultant billed himself as a practitioner of the political dark arts. he told by aides he wanted to put out a postcard detailing my opponent of the race.

he wants to do this, should we give him the information and what should the voting record tell him and i replied i don't want to know what you do. so does that mean we should do it? and they said okay so they gave him the voting information which was publicly available. about a week after the campaign my attorney prepared an affidavit for me to sign in response to a federal election commission complaint. it provided any knowledge about the postcard even though i knew my aides had that with the person who figured it out and i found a false affidavit.

my best friend called me and told me that the man who had done that five years earlier had just been picked up by the feds for mortgage fraud, bank fraud, illegal weapons possession, spousal abuse, cocaine distribution, human distribution i let my aides get mixed up with this monster and my best friend and i said what are we going to do what they come but if they come and knock on our door because this guy says five years earlier i can deliver something to you that a state senator so my best friend and i talk about that for a couple months and little did i know that entire time he was wearing a wire; a chance to stay out of prison was to do something similar and i didn't do that and i was sentenced to a year in federal

custody for about ten and a half months. >> part of where i want to start here is from your experience and your knowledge professionally, does prison do anything to help criminals and can it can if your dose if it or does it just sort of ruined lives. they should be kept away from civil society. there's no doubt about that. i don't think anyone would disagree about that. they have a problem where they would keep offending person may be the only solution.

for some there's a lot of people that were uneducated. these are not master criminals. if we ratchet up the penalties people will be more inclined to follow the law and that is in the population might not like -- i met with and read the code to figure out what they were and to cost-benefit analyst us. they sold drugs because they wanted extra money. and i should say it captured my experience almost perfectly. there is a method called white-collar prisons because not only are we white-collar but there are no white-collar prisons anymore so most people than my camps for violations serving minimum mandatory for drugs so it was a wide array of people. some people needed to age out.

they had just limited to brain functioning and they needed to grow up and mature. other people who didn't speak much english and limited education were able to get their ged while they were there and they have helped. for most of the people though it is just killing time and people would say that's okay if you're bored your board doesn't bother me. but it should because while you are sitting there like a can on a shelf in the job market is advancing, technology is advancing, your family is moving on. everything is changing and you have no responsibility when you were in prison. you may have a job that's a lot of makeshift straw this. man is a creature that can get used to anything and that is what happens to prisoners you'll hear they get institutionalized so you will hear what it takes to become a decent prisoner. you stay out of fights and arguments and you don't touch

people's other laundry so it's just that sort of stuff. but you go to the commissary and have a limited amount of things you can buy. you learn that lifestyle. there's a comfort in that that and when they get close to leaving to get nervous because they are afraid of the choices. so, for a lot of people, long sentences without any meaningful programming, and i will address that, because unless you were able to get a drug treatment, were you -- or you get your ged, there's nothing else available that will help you react when made and that is a problem so when you look at recidivism rates and people come out and reoffend the people who will do the right thing. some people will be fine and will try to do the right thing. after a few years they are not going to be up to make ends meet. they have their family to support and they are at risk to go back to the lifestyle that sent them there in the first place and so i do want to talk

and say there's so much more that can be done on the programming side of things but it has to be coupled in a way that not only do the do more to treat them while you're there because his compassionate and in our interest and reoffending but also we have to shorten the sentences to satisfy some of the ten or 20 years living in that kind of confinement. connected you see anything where you thought people were being helped or improved or anybody that left sort of better impulse control or more prepared for the world when they came in? >> i wish i could tell you differently but in my experience , presented a lot to create criminals and almost nothing to rehabilitate people. if i'm going on for too long just to stop me. but the first way is the prison reinforces people's tendencies

to operate outside of like the rules and outside of the normal economy. when you get roughed up -- locked up most prisoners are destitute. they get into prison, they don't have someone on the outside to put money in their books. maybe some of them do for the first year but then people say they kind of forget about them and so the problem with that is you don't have it made coming to your soap computer and cut-and-paste to the basics of personal hygiene are when you're looking virtually on top of hundreds of thousands of other people and hygiene is a really important for a lot of reasons i could get into later but the point is if you want to have a normal lifestyle where you make

you have to find a helpful indicator range from things that are totally legal like those that develop their artistic talent and those that go portraits of other guys do things the hard little bit less legal like bookies who make book on the prison basketball games to the guys that run barbershops which the business is fine with to those that run tattoo parlors which i'm fine with. to them the most too bad the most lucrative hospital which is used for smuggling contraband. so, there's all types of -- and i would tell you i agree with almost everything you said except i found some very skilled men and i would say that in my experience there's not a single concept you could learn that you

could learn inside the prison new product launch, quality control, territorial expansion, mismanagement, barriers to interest. i heard every one of these elucidated numerous times using so much different lingo. unfortunately there was no training at all in the business world but they have we have learned through success in the drug world, no training to turn those into formal enterprises on the street. there was a computer course that was offered. there were three courses while i was there, one had a prisoner teaching so that prisoner didn't really care that much from most of the time and so if you did in 20 go you didn't have to go into them there was the course

because what better way to compare someone for successful reentry than to learn how to code tomatoes and water for two weeks. and then third is a further with the computer skills are supposed because to course for everyone on their way out. finally, we have been salivating the whole time over this room 12 brand-new computers but no one ever got to go in. it was locked the whole time. i sat out the computers and i was an aggravation and southeast kentucky and the ceo tells us sign in so the sign in the form and he's as we all sit down and he's a youth event button on the bottom rack, push and. so the computer turns on and we sit there for about 90 seconds. a prisoner says custards playing with the mouse and says if you push the -- shut the f up.

so we sat in silence in about 40 minutes and he says you're a member that little button, push it again and didn't get the f back to your cell. but since we had all signed in, they could tell them that we have successfully completed a computer skills course and now the prison could get their stipend from the federal government for having done that. so that i would say was sort of the indicative of the amount of reading the petition going on. so that's where i want to go now is with programming that it does happen. it's supposed to be part of the federal system for the state system and do they try it and what can work? it seems like a good thing they would learn because that is a huge part of what sort of creates a coming apart at some

go to computers and others don't. are they care they are based, are they just -- can you teach somebody something .-full-stop or is it to lead by the time -- what would you want to see? these are eight discourses. they are taught by inmates. most of the program is taught by inmates and so i didn't take hydroponics but i could take a class on current events or crochet and get credit and it was all busy work and it was just the prison administration wanted to show that they were keeping us busy. when they go to the review you would give them a certificate i'm so busy working hard rehabilitating youth. they felt so good about this column of the road and on.

but i talk about it and i think that it's so corrosive because these are people that need to learn the rules. check was saying there are people that do these things that are -- i didn't really care about that. it's just i thought this is the place where you've broken the rules, the lowest of the low. the prison doesn't -- isn't fair to isn't there as a people are isn't fair to people or in idle hands and end up doing the wrong thing so the program was lackluster. in terms of things i thought others drug treatment but there's fewer addicts then people would think at least in the federal system there were only a couple people that came in that were really strong out in the throes of an addiction that needs help and there were people that have dependency and probably needed help that it's not like they committed their crimes. they were trying gimmick money. but the thing i think is missing

the most is cognitive behavioral therapy and some sort of psychological hurt and some therapy. a lot of these folks come from communities where that is frowned upon and there's people everywhere but frown upon this. but the lack of impulse control to just sort of emotional disconnect, these are lots were lots of behavior that antisocial and that is what got them in this position and now they are great the most antisocial place in the world where you are walking around with headphones on screaming music to no one. somebody is calling a foul in a basketball game and those are things you have these people in a fishbowl and they might not

seek help otherwise but while you have them there there are certain things you could do to work with them to get them thinking about their thinking patterns and get them thinking about their behavior and choices they are making at the roots of those traces. people do what they were raised to do and they are not even thinking about it otherwise even those of us to try. they are not thinking of any of that and it's not cool to think that either so we headed to hundreds of the prisoners prisoners and we had one trained psychologist and she was the head of the drug treatment program. she didn't want to do any do any more work than that so when i was there after a while and i had two girls i was missing terribly and i knew some of the others the others that are missing were missing their kids we talked about putting together a group and we said let's put together a father's group so that we can talk about ideas about how to stay in touch with her kids and usable minutes like the guy that creates pictures,

anything you can find to stay close to your children that's what you want to do and you also want to be able to say i'm bummed out. you don't go cry on your bunkmate's shoulder. to have a group like that i thought this would be a sure winner for you to the psychologist wanted no part of it she wouldn't respond to my e-mails asking if we could group together so there's a lot of service to talk about, family reunification and how important it is to stay close but close but there's not a lot that gets done and like jeff said, that is the level of concern. it's sort of i checked the box and gave you your computer training doesn't matter if you learned anything so i think the states do a better job from what i hear that the federal government is really far behind. >> i'm going to ask you in a second about something that's been alluded to in your book you used the phrase about how you have to behave to not have other prisoners make your life

horrible. but before you talk about that i want you to see what you can about programming. do you think psychological help as possible, helpful, what are your thoughts on that? >> i agree with everything kevin's head. you have crochet? [laughter] and i'm a master now. >> i put in how to teach five different courses, and instead i was put to work and i see a couple of you have the book if you turn the book on the back you can see what my job was. i worked in a warehouse on the loading dock and you can see the crew i worked with. you can probably tell which one i was. [laughter] anyway, so no. i'm not trying to be like -- you do the crime you do the time and you do the time how they want you to and about how you want to do the time, so i'm not going to complain about my job but i

definitely think i had a decades worth of teaching experience and i had been a state senator and i would have loved to teach a course as i applied first to to teaching black history course because i was a black history study major in college and i hope it could have been interesting. i wanted to teach a current events close. i applied to teach -- that i realized anything that had any political or ideological charge was never going to fly and so i applied to teach a job interviewing and resume writing that could teach a little bit more about that but they ignored all the requests. although about three weeks before i got out, they did finally moved me which was interesting. i had fallen off of a -- -- removed about 35 we moved about 35 or 40,000 pounds of food a day into freezers that were bigger than this room and i fell off the top of a freezer a few weeks before i left and i don't

think they were going to move me that the lieutenant governor of missouri had to visit the next day and then they figured he might have come in response to be falling even though it was totally confident in who they figured he might have some juice behind you than they did move me. [laughter] and they sent me to the education department and then i was heartened at least it wasn't going to be long i hope i get to teach and the guy in charge of that said inmate, but the education level and i said phd and he said all right .-full-stop you are sweeping the classroom. so i swept the classroom for my last month. >> that's one thing i would say not to put it to too much on the bureau of prison because i was going to teach a writing class as well because a lot asked me to edit things they were doing either court filings or coursework or correspondence courses and they would ask me to write and i think writing is a lost skill. anyway, but in prison and be miserable and so i said --

someone said what you teach a class in writing and thinking, resume, cover letters, basics like that and i have to say part of the problem was no one would have come. a couple of the guise of seeking out privately that they were not going to come from five to six at night because the prison wasn't kind to make them. there were some who were interested but i didn't want to put it all on the present that they should have made them come. that was the thing so the head of education i said -- he said out of 50 people go to this class and it doesn't even hold 50 people within electrical class and i said they aren't going. he said then why am i getting them all certificates and i said because you don't know who's there and who's not. he said how do i fix that and i said you stay and check attendance when people come out and he said forget it. >> what you said really spoke to

said people would come out and ask me for help but they wouldn't go to class. all the time people wanted help, they wanted tutoring on their ged or help writing a resume, all that stuff they would quietly come to my cell and ask so there's definitely interest and i've actually say like pretty insatiable thirst to figure out what they are going to do next and how they are going to acquire a skill but yeah doing things for multipurpose and wasn't always interested in that. so there's a lot of research actually on prison education programming and the corporation they just did a study of dozens of other studies of prison education programs around the country and it shows before first of all there's a 43% reduction in recidivism for prisoners to advance education while they are incarcerated and second, for every dollar that we spent on prison education programs and vocational training varies in almost 6-dollar return and reduced cost related to that

recidivism and that makes sense if you think of the 43% reduction in think it's costing on average $31,000 a year to incarcerate someone that you can see how much money we'd save doing we would save doing it so what kind of courses. you talk about therapy, therapy would be so important because people don't have an outlet and prison teaches you so many things. it teaches you a way to behave like to suppress all in motion all the time. >> this is good to be my next question if you talk in the book about the code that making eye contact or seeming to frankly there is a way that you have to behave which is antisocial in a way that you have to learn the rules of survival that probably are counterproductive outside. is there anything -- i mean i can't imagine it being something that all would be easy to fix or is it rooted in the fact that it's sort of the prison versus prisoners is there anything that

could be done even if you were just dreaming that could make prison not foster that code that pushes people towards the end >> i would say yes there is. and that code what results is number one, a tendency to suppress all in motion because you learn very quickly that any show of emotion is a sign of weakness. to be like i'm so excited for the visit i'm going to get this saturday now. you don't tell anyone else about your family, you don't tell them how much you miss your kids. you don't do anything because then they know how to get to you and people play a lot of mind games and have a lot of time on their hands. they've developed really sort of acute senses for other people's weaknesses and they will print on the sea were not to express any emotion and of course you develop a tendency to overreact to small fights because if

someone cuts ahead of you in line and you don't step up your weekend everyone knows your weekend then people will find other ways to try to exploit that and so all these tendencies that you develop of course are totally dysfunctional out in society and that's the root of the problem. does it have to be this way you ask? don't think it does. i was in a prison in texas that was the most positive place where the camaraderie and the enthusiasm for learning xe did anything that i've experienced among phd candidates at the new school. [laughter] i'm being honest. it was a nonprofit called the prison entrepreneurship program which full disclosure i'm on the board now, it operates inside to prisons in texas. they ran a nine-month long curriculum where it culminates prisoners that compete in a shark tank like business plan competition. they have nine months with the hope of executives and students from all over the world who advise them advised them on the creation of these business plans

and the sort of positivity and just genuine care and concern and love for one another i felt like it was similar to that of a great winning high school team or college team and the recidivism rate for graduating to prevent the last 11 years, 6%. less than one tenth of the national recidivism rate and several men started multimillion dollar businesses as well. so i think there are ways. we see examples of ways to create an atmosphere that's very different. >> so there are examples of these things being done right. >> i don't want to disagree, and again when i read the book it was i scared everybody telling my story because he really told perfectly well. the one thing i would say is my sense of soft folks there as there were too many bill gates

just waiting to be born and i think i afraid sometimes we romanticize the prison population to think that these are people you would have a dinner party. this is everybody's least valuable players. it's not a great group of people to hang around with. i say that -- i was there so i'm not trying to be above it. the device of the things they are people would put it right on me that i was with them and i get that it's just that these are low skilled, low education bad social skills, all of which i think can be dealt with. but i don't want to mislead people into thinking they are all budding entrepreneurs because what worries me the most is when people would come up and say i've got this business plan i'm going to come out with a map. they don't even know an iphone is that they had an ad is have an app is going to sell and be like gangbusters if somebody just heard of this idea and they've been sitting there for six or seven years.

they have no market research or anything. they didn't know what they did and now. so i felt like with some people you shouldn't worry about being your own boss and you get out you should just hope to be a card and a machine somewhere. you don't need to compete with wal-mart you just need to be a greeter at wal-mart, just hold a job, get something that pays the bills and put you and don't crush your dreams. but you're going out with a felony conviction, you don't know what the job market is like and so i thought the prison could give people a little realism by giving so much space they let people dream unrealistic dreams and i thought that was really counterproductive for the people who really needed a dose of reality as to what they were going to face when they got out. i was the exact opposite. i was fortunate my circumstances were so much different, so i could exempt myself from that. i knew i was going to do when i got out that a lot of these guys don't and they get scared that

they are allowed to dream unrealistic dreams i don't think that's helping them. >> i want questions from all of you in a minute. but i have one last topic for these two. reentry. when they get out of prison, you know, are there existing programs? you studied a lot of things that work, and also just so that -- i mean people here who haven't had anybody close to them go in and come out of prison what are the challenges that besides not having seen an iphone box >> a huge challenge his family and community support. we talked about how heartbreaking it is to watch men who work i don't know what the wage laws for your job that i made $5.25 which are what people say that's not bad and then i told him that was my monthly. for 40 hour working in the warehouse and so but of course like you, i was lucky. i have money.

most of my money went to my lawyers and then i had to pay a big fine for the government so that was most the money but i still have enough to have someone send me a hundred bucks here and there so i always had money on the books if i needed it. most of these guys you're working making between five to $25 a month and not only do you have to buy the basics of like personal hygiene but if you sometimes have child support over years accumulating while you are incarcerated and then just to stay in touch with your family where i was, that phone calls were like a dollar 50 cents a minute for me to call home. for others it was even more. there were some prisoners is not just $14 a minute. the fcc changed that in a ruling that came out last week that thanks to the great work of kevin's organization and some other organizations as well. but this is a a huge part of the reentry is the reason that a lot of family members have because guys didn't stay in touch and

they don't fully understand just how hard it was to get the resources to stay in touch. you never told people how bad it is in there. you don't tell people, that's part of the code. you don't want people feeling already worse than they already feel so you say everything is fine. so getting the family back together is a challenge and they perform background checks and that is a huge obstacle. one of the reasons i'm an advocate for entrepreneurship is because so many people won't hire you and i'm not saying everyone is going to get out and do an app. i know you have a he might have a slightly friendly disagreement about this stuff but basically these guys could run their own trucking company. they could run their own landscaping business and become their own barbershop and they could run their own janitorial business. they have that entrepreneurial spirit and that is what led them into the drug trade because they said i don't want to work at mcdonald's and think $7 an hour i want to do better and so the

challenge though is channeling that energy into something that's legitimate and then also literally figuring out a way to get them just the basics like a halfway house. my halfway house was worse than my prison. i don't know what yours was like but my halfway house was crazy. and when you put people right back in that place, 650,000 people every day conducted or six of the communities, the same communities they've already failed but now they have the stigma of a prison record and they are broke and they have to pay for the house and they their drug testing and further transportation "-end-quotes to look decent job a decent job interview it's surprising to me sometimes that one out of three people don't reoffend. how they are able to get back on

their feet. we need practical therapy, therapeutic resources, not po's that are like beer, be here at this time time eventually i will buy you a cute. you need to be here for the drug test with somebody to counterbalance that and say hell are you feeling about being back here, what do you need can help you? can we help you with bus passes? can we hope you learn to use the internet tax you don't do any employers or have anyone you can list as a reference? have people you can talk to. a database of employers like second chance employers willing to hire people. it's great to see coke and wal-mart be on the box but we need productivity and need people to step up and say one of the researchers that it takes to identify, recruit, hire and then support and retain people who are incarcerated. >> and again, i'm a conservative libertarian but that sounds like the perfect sort of thing for a nonprofit sort of vocal by local state-by-state level.

do you think that should be part of the criminal justice system. he was the brother of the company owner and he came out and said we want to help you can use bake some bread. he started baking bread and you know there's some good cooking. >> i miss the not chose. but he made about are totally different and experimented with different stuff and went nuts and everyone wanted and it grew hundreds of percentages and it got acquired by a much bigger company because it's been so successful and they decided they were going to made it their mission to be a second chance employers almost 40% of their employees are people who came out of prison and gave him a big

summit for employers all across the pacific northwest to learn what they are doing and so i think the government could have a role in connecting people back to wherever you're from and connecting you to those resources. i'm not optimistic given my prison experience they are going to take that seriously because frankly one of the ceos when people would leave his mind would be i will see you in six months. it jackasses like you that remind me i'm always going to have a job. >> i think the reason is because the halfway houses you are were still under the department's control. i was still serving my sentence when i left so i had to do home confinement for a couple of months and i got to go to rockville and quickly get the home confinement that if i have to go to hope village in dc i know a lot of people have been to hope the ledge and and it's

worse for a lot of people. the ceos are stealing things from inmates and some people would pass up a halfway house time even though they wanted to be closer to their family and communities and start getting a job they did did to go to the halfway house because they didn't want to deal with it so there are some standards that could be set. even though i didn't have to spend time there, they have a good reputation because they really spend time getting people on the phone. they require a certain amount of time applying for jobs and that is their whole focus is you're going to apply to ten jobs at a server if a server is a set of period they are making them do that so they are really on demand so i think that is a good thing. you mentioned coke and wal-mart and i would just say this is one of those cultural changes that need to happen. >> so, coke, wal-mart, target of some of the companies voluntarily said we are not going to put on our application whether you have a criminal conviction. we will find that out.

but we don't want to knock you out of the consideration based on that one fact alone so that is a smart movie did on their own. there is no law that requires that. president obama announced he is going to ban the box for federal contractors. i will just say this as a conservative i think an employer can ask whatever they want so this idea to me is less about what is actually going to do because a lot of guys i served with the couldn't get asked on the application they would submit their resume and be a ten-year gap with nothing to take long for someone to figure out where you've been or on some people list the prison jobs because they don't want the gap and they did do some work. so i'm not so optimistic about that. it has to be a cultural change. there is no wall that is going to do this to make people hire vendors and give them a second chance. we have to do that. i do not -- i had to do community service because after

the trials i couldn't afford to pay fines i have to do 200 hours of community service and i live in montgomery county. this progressive county in the world more than a side of the weight. psychedelic. if bernie sanders or not the answer to maturity is a fascist up there. and so this is the greatest place you should be able to come home to and yet i got turned down by three different places to do community service because of my felony conviction. the place is a blanket policy is not to hire felons. i don't seek to be paid, have a law degree at just want to stack blocks in your bookstore but they will not hire me. so forget banned the box and forget about even not asking me. how about getting rid of policies that don't allow you to consider me at all? so again i think it's cultural. i think it's just saying and knowing more people who've gone to prison saying i'm not going to write it off because you served some time. i'm going to judge you as an individual and get to know you and i think that's what has to happen.

it's not a government solution though. >> one possible solution and we might be -- i think that even people on the right kind that's when people on the right might find this interesting. remember what he said people got out, that feeley that feeley and david the incentive structure that operates for prison wardens and prison administrators. they have a job because they know this could be a constant supply. what but if we turn it on its head? what if we gave stipends for bonuses to the ceos who worked in prisons basically a feature packed everyone who came out of prison and they went five years without precipitating then we gave a 5,000-dollar bonus to the co at the last two prisons where they were housed? maybe if we turn the incentive on their heads than prison guards would be more focused on boosting you up then tearing you down. >> i totally agree with that. i would take the sword of war do not have the facility and put it on him to create that culture

and i certainly would want to know -- i think they judge themselves now on nobody escaped today. you know. [laughter] but everybody that leaves prison is reoffending. said the bureau could at least track that information how are the differences of these doing. they were this close to being inmates themselves and so does the training for them. is there any locality or county.

to commit to some liberal policies right now -- spinnaker just want to say it's only going to come flying --. nathan deal of georgia, rick perry in texas the recidivism rate is like 23%. they are doing great. the best present i have ever been in that house in texas. at the liberals and cynics might say the reason the rate is so low is because they execute so many people.

governors have led the way over last five or six years both on the front end on sentencing reform. not only did he focus on this but then he ran for the reelection. once again with an accolade and then to go to my question first, gentlemen, thank you there's times you regret what happened to you but i think that it's been my impression working in irvine schools and areas to one population is probably least represented as prisoners.

so that's good and by question kind of comes along with that. you talked about old about this has been the reaction of so much to you personally that your message i think is an important message. are they beginning to act, obviously it's going to be multiple things but. only in only a political only in the political lines as is being received differently it's just as you imagined, some people -- i didn't want to be the one that came out of an expert and it's not because i didn't want to relive the experience. i worked for families before i was invited so i was involved in these issues and i have been on the wrong side of these issues when i was a staffer on capitol hill and i wrote the walls when i was young but i thought i knew everything. as a part of this was a little

bit attendance at just the idea that if it doesn't appeal to me as conservative any more that we would than we would with politicians sentences for cases they knew nothing about. so i thought i wanted to get that message out and i am lucky that as jeff said there are so many other conservatives are doing this and a personal level, you know, you think that you are getting so much support because of the people who are talking to you. it's a self-fulfilling prophecy. i know there are people who -- but i don't like is any other walk of life experience matters. and since for conservatives if you're a businessman complaining about the epa they would say you know because you are out there as they are screwing from your business we want to hear your viewpoint. if i said was in my experience of the justice department they would say of course you said that because you broke the law. said nobody has done more to fight crime and eventually. he digitally. he was the chief during 9/11. he ran rikers island but if you're going to dismiss him because he has a conviction -- either way, just never talks about jeff never talks about reforming the law for his

conviction was that i talk about mandatory minimums but i wasn't subject to one. he doesn't talk about tax reform area talking about the system that we saw coming and unfortunately we have experienced, so i'm a big play, i can take it but i don't become a discount it as that that experience that it's discounted because people think it is a note if i had. i would just as well not talk about this. i helped create that system as part of a staffer being a staffer and so the reaction is mixed. obviously there is a sample of people that come to the events where i'm selling my book. but i go on to conservative talk radio and i go wherever i can.

i talk about rape and my standard talk because i think it's important to talk about. we tolerate a rape culture inside prison. there are more that have been in prison than they have been on the street, that happen outside. so how do we handle that? the laugh about it. our pop culture is the staple of the detective shows, law and order state prosecutor says don't drop the soap to the perpetrator going away. how callous do you have to be to think that no matter what happens to you on the inside you deserved it because you broke the law. that's crazy. and unfortunately a hugely disproportionate number of men.

they come out and tragically attempt to reclaim their manhood in some ways i'm a good messenger for it because i was a policymaker and i actually worked on the kabul justice reform as a policymaker and then i am a researcher, too and so it came from that angle. and with the one the one respect i'm not the right messenger. i am highly educated, not represented at the prison population. but in a perverse way i can reach people utterly can't reach and so i'm hopeful that i can do that and spread the message to people that otherwise wouldn't have listened. >> speaking of, you may have noticed that we are all white. he was attacked, jeff was attacked in the campaign just as a well-known caucasian when he was running in the district was

largely black. >> we invite people here to get a diversity summit = yes in some people say no so i want to apologize for that. >> im a lawyer and a writer. we have 6,000 federal prisoners that are being released and he talks in his book about the reason why, one of the reasons why he was doing inventory on the loading dock because he had -- he could read that he had math skills so i'm curious there's been a lot of reports about how there's a limited number of books in prison libraries. they don't allow newspapers, so what are the 6,000 prisoners going to do if they can't even read and they have minimal math skills? you can't even back at the grocery store without having literacy skills or math skills.

>> do either of you experience this also? >> we had newspapers, we had a library that i worked at for a little while. i had books. again, part of this is not everybody is in their dying to read. some people can and want to and some people to use the time to self educate because there isn't classes. >> that's not the norm. but be honest if they've are really starting their education some of them they wouldn't be in the position that they were in. but in terms of the 6,000 coming out i just wanted to say because sam has been having to respond on this a lot this is into the obama administration decision this is the sentencing commission it if we cannot tolerate the lowest of the low -- so there's been news reports

about 6,000 people being let out early from federal prison for drug offenders and if you listen to bill o'reilly think you should run to your basement and lock the door because they are all violent folks. they are not. i was in prison i just got six months ago when all the people got their letters in the level to reduction and so what happened is the sentencing commission over a year ago said the drug houses were too high, the right lines were too high and since the sentence was driven by the weight of the drug that was involved in the offense they reduced the trigger of that so for most people think of a slightly shorter sentence. you have an 11 year sentence he would get a nine year sentence and they said it's not fair to not include that for the people that are already serving its get rid of some of the overcrowding that we have and just as in equity matter let's do it this way people work people about to go into court and had to have a good record in the prosecutor was allowed to object. the judge have to had to agree to this is that the people that are coming out there's been this fear mongering going out about 6,000 people, federal prisons

with 70,000 a year in state prisons without more. these are like a handful in each community and these are people that are serving drug offenses who serve substantial amounts of time who were coming out anyway so if you were worried that they were not ready for society they want it to wanted to be ready a year and a half either. those that want to tackle the bigger prison issues will have a hard time because these are the lowest hanging fruit that we have in the system. >> what are we doing to help them do have much bigger problems. they are the lowest of the low do but do they have literacy skills?

for some of them you mentioned some examples of things that have worked in some cases. they worked at a local level and it could be expanded and adapted into situations that on the question of people that are illiterate getting an education and prison. if i said was the recidivism rate he would give the number that you heard that if i said that as the number of people going back to jail or is that the number of people just

reoffending come is that the number of people that have technical violations you start to drop off and not know a lot of researchers don't have the answer to that either we don't have good data so even when we talk about the programs that work for matheny to do is also assess its programs, so i'm all for them doing the programming that we think works and reduces education as an example of that but i want to measure tested. and then if it works, you know, sort of spread elsewhere in the country. >> that might be the best answer possible. we need more data. >> the microphone is coming from right behind you. >> good evening. >> my name is elizabeth charity and find a fan of the corporation services and up and as i was in the corporate world and then what i did is i lost my job and i started volunteering in the juvenile justice system and detention center.

and while i was there i volunteered about 20 years and what i did is i wrote a grant and i gave it to the floor of governor george abbott and i started a 12 week job readiness program.

they are accustomed to metal detectors and things that we . we need to go further back than the juvenile justice system and make it so that it is not considered -- and stop normalizing the experience of the criminal justice system for a big substance of a population. >> again, i want to know if i can maybe get statements. >> we can talk about that after. [inaudible conversations] >> ma'am over there in the salmon colored shirt. >> ii serve on the board of the advocates for the goucher prison population fellowship which offers programming in a high-end support goucher college offering liberal arts degrees at the only prison for women in maryland as

well as a minimum security prison in jessup. we have a friendly audience, but talking to people who are much less sympathetic, whether we are talking to a ceo who might only have a ged and no longer gets a subsidy to take a community college course how is it that we talk, spending yet more money talk to the skeptics. i was once one of them, and sothem, and so sometimes it helps that i remember what i was thinking at that point. and it is still helpful sometimes to be working on

these issues and talk to someone on the hill who is like comeau why would i ever shorten the sentence for anyone who committed a crime you think, wait, wait, wait. because there is no evidence it is reducing crime. it is not helping recidivism. recidivism. but there is still just this -- turn on fox. >> especially among conservatives there is a deeply ingrained sense that justice needs to be served and these people do not deserve sympathy or help. >> until they know somebody who runs afoul of the law which is happening more and more.more. some of these people who come out and are supportive of the right, look through the family tree and you will find someone who went to jail and all of a sudden they have a first-hand experience with the criminal justice system. some get it for other reasons.

you know, that old, stale debate. and so, but how to talk to them, i really think that it is about appealing to self-interest because you cannot make someone feel compassion. they talk about personal stories command, and that reaches people in a lot of cases, but sometimes -- i don't want us to not be tough on crime. it is tough on criminals, individual criminals. if i want to show how tough i am in's and some -- sentence someone to 2020 years i may feel good about how tough i was, but if i just made them a worse offender, destroy the family half of them will say but for the grace of god.

the other half even though they knew ii was doing exactly what they were doing, us work. we all do it. it's an evolutionary thing we have. >> quickly i agree with kevin, self-interest. money. money in public safety is how i talked to conservatives. do you like spending $80 billion year of your money?

>> and they say it's because they give plasma screen tvs and comfy beds. >> you at the comfy or bad. >> my bed with the stick to that fake. and i talk about public safety a lot. you know, these people, 93 percent of prisoners in this country are coming home whatwhat we do to them, like comeau we are sh it paying our own nest. we are -- these are americans. we will see them. maybe they will live in your suburb, but when you go down town for the opera or for the baseball game you will see them. and if you want them to come out even more damaged, broken, and angry then they went in, then you have got the right recipe. >> yes sir.

>> good afternoon. great talk. obviously entertaining, but speaking of entertainment before i aski ask a question i wanted to know, are you familiar with the comedian kevin hart? so, i went to see him recently and can relate because he is under 5-foot nine. i am 5-foot seven. no go go it is interesting to here the rationality uses is he basically says i knowi know the consequences are going to be a fog in the fight with this person. is a difference between the way some people think. and it comes out okay versus someone who says it's going to, bad and i think i need need to walk away from that. so i have been able to stay

out of prison because i have avoided a lot of situations where i could have made the wrong decision and maybe it was because of my mom or dad but as a result i would be the whitest guy in prison. i would be the guy they would pick out and say you uncle tom, i'm going to do this to you. do you are people you spoken to actually believe the things they did that got them put into prison were wrong? 's i think there is a.where you decide maybe i'm wrong, maybe i should have been put in prison, there is no perfect answer. do you think -- because i don't understand what you said the supposedly got put in for. >> i lied.

does not matter whether you lie about jaywalking or structuring financial transactions are killing someone, you still lied to the fed. i did know about that. so it sounds sort of technical comeau but the underlying crime was a campaign finance violation. and then the obstruction of justice was signing a false affidavit saying i didn't no anything about the meeting. so that is what i did. do i think i did anything wrong? i think i broke the law, and therefore in this country i've done something wrong.

i also have perspective on it and you get a lot of perspective on it by watching the presidential campaign i don't want to get into too many details, but he has a super pack. his political alter ego is running the super pack. they don't need to coordinate because they spent the 1st six months figuring out exactly what they were going to do with that hundred and $60 million. i was an amateur, naïve, stupid. as a neophyte i made the mistake of doing it and illegal way. with some politicianwith some politician has done since we came here together on sunday. the fact is i did the crime,

so i had to do the time. one of the biggest misconceptions is that prisoners all say, i didn't do it. they will tell you they did. it's a long story. there are going to plan raw meat in my freezer jacket because they were going to give me in trouble. i was not ceiling and so therefore they thought i was a rat. i had to start ceiling. it was aa threat that i would have to utilize security prison. and this guy is like comeau what are you afraid of? they are murderers there.

the only differences i missed. >> very smart and thoughtful and he had shot at people. he was in the drug trade and had shot at people and freely admitted everything. i believed he was intelligent enough and ambitious enough and hard-working enough. it was prison. it did not matter if the boxes were stacked perfectly adding care. he was like, that's not right. change it around. he had pride in his work. i think he would be fine on the outside. even though, sure, there were guys already plotting. but that was not the norm.

most of the guys wanted to fly straight. >> that was my experience as well. he knew what you are doing, with the penalty was. he had no idea what the penalty was. or you thinking? he wasn't. he made a decision in the spur of the moment my charges, lobbying charges, essentially bribery charges because i disagree with the theory of events ultimately in the hope that they would do something for my clients. that was lobbying. it was what was my intent. i would have done anything to stay home with my daughters.

i was going to have to incriminate others, testify against people i work with, members of congress. so that is my sob story. i live with it comeau what to prison, and did not seek sympathy for people who were serving much longer sentences for similar mistakes, things. so i will take my lumps. you asked for it. watching you hang out with. the people there did not think about the conduct, and if you had said the penalty is five or the penalties for 25 it would not have altered their behavior because they were not thinking about doing cost-benefit analysis. this growing field of behavioral economics would inform more policies because there are things that you can do to prime people to make better decisions or to

at least punish them in ways that respond, story justice, likable person whose fall drugs, be accountable, go to a clinic where people are trying to get off drugs and let them see the repercussions of what the drug trafficking did, don't let them sit in a cell for ten years with a have no face-to-face conduct. there are other things that we can do, but the whole idea of these people made mistakes, they are not innocent. every black guy in the system would say this system is racist. no one was in they're fighting trials. what matters is not whether they are guilty. the question is, isis, is the punishment proportional to what they did? and i don't think it is. that is what we need to reevaluate.

>> i think this has been a great discussion. most cheerful thing to me is that there are programs and smaller scales that have worked. this is now been taken up across the ideological spectrum, criminal justice reform broadly. i would like to go on forever, but we are incapable of doing that. i will say just book is available outside. just a quick note. i got the book and still have the dust jacket on. my five -year-old said what he says about every person in the newspaper, is that your friend? what is the book about. suddenly all the older kids gathered around and thought it was an interesting story and informative thing me talk to them about. my oldest asked if she could read it. by it, don't buy it. but i thought that was an

interesting thing, the exposure to that. but you're supposed to visit and care. i see it getting picked up across the spectrum and hope that the solutions on the local level bubble up. >> speaking of located in the book, four -year-old son is very gregarious and walks around to everyone says, high command you read dan i went to prison? [laughter] thank you for coming. [laughter] [inaudible conversations] [inaudible conversations]

>> >> i that the result the one i would write to write a second biography. of course, i did write that book i thought i'll be standing next to the president's speaking to 3500 of the most important people

i had an idea i might do that or do the book later but that ideal the moment to be goofy i will do it. is important for a ready to take politics seriously but it never make an idol of politics. people have done that worshiping that idle rather them that god who heals the sick and poor and it is a fine line

>> good afternoon. i'm nancy, whichley, chairman and ceo of the foundation and i'm delighted to welcome you today to our briefing on transforming health care to drive value. we have an exceptional page of speak -- panel of speakers. they're all on at the forefront of driving -- the way we deliver

care, consume car, and pay for care. copy of their presentations will be posted on our web site, after the program. we have an impressive audience and want to invite you into the discussion as well. so at the conclusion of all of the speaker's presentations, if you want to fill out the blue card in your folder and hand them off, we'll be looking for them and bringing them up here so you can address the speakers. the first speaker is well known to all of you, dr. patrick conway. he is someone who has a lot of titles. he is the deputy principal administrator, the deputy administrator of innovation and quality, and the chief medical officer of cms. dr. conway is responsible for overseaing and improving the program that serves millions of americans who access health care

through medicare, medicaid, chip, and the marketplace, also known as the exchanges. he personifies excellence in public service, brings a unique background as a physician, a strategy consultant and a researcher to his position. and he brings a talent, real talent for problem solving and a tremendous passion for finding and increasing the quality and value of the healthcare system. he has received the secretary's highest award for distinguished service, and with that, let's welcome pat conway. [applause] >> thank you, nancy, i all apologize, i am stoic my voice is a little odd and i have to leave after i talk. i try not to do that but was told i need be back in baltimore for some things. so, i -- i've been chief medical officer for five years, cms is

like dog years to feels like 35. and true story. when our our communication folks the other day said patrick you need a new picture. you look older then when you started. i went home and asked my wife, die need a new picture? she said, yes. so, i will move threw the slides relatively quickly if i can. hmm. perfect. and i'll adhere to the time limit. so if you think.the affordable care act, three major changes, one, insurance coverage were at the lowest insurance rate in roared history for the united states, another set of data come out yesterday and we'll talk about that today. i will talk about health system tropes formation, delivery system reform, focus thing coasts and quality of care. next slide. this just shows a cbo estimate from 2010 and then looking again

at 2015, predicted over $20 billion in cost savings from reduced medical trends. both our own actuary and independent analyses now saying that a portion of this change is due to structural changes in the system and delivery system reform. if you go to the next slide, this is from harlan, who is a hard-core health services researcher. you don't have those people say jaw-dropping results in "the new york times." just to call out a few results from a study over 68 million beneficiaries, reductions and n mortality from 1999 to 2013, this is also testing me itch don't have my glasses on so this will test to see if i have my slides memorized. reduction mortality, reduction in hospitalizations at a population level so less medicare by-riz being hospitalized even as the

population ages and becomes more frail. reduction in cost for inpatient admissions and reduction of hospitalizations in the last six months of life. not on this slide, our own quality measures for cms. over 59% of the measures improved significantly over the last three year so significant improvements in quality across the u.s. next slide. thank you. this just -- we'll test to see if i have to look it's -- our frame for delivery system reform. we talk about incentives, both privateer and consumers, value based purchasing, alternative pavement models and care delivery, true population health management and also engagement of patients in their care through shared decisionmaking and other means, and then we talk about information, which is transparency about quality and costs of care, but also the right information at the point of care. i'm still a practiceing

precision, take caring of children with multiple chronic conditions and that information at the point of care is critically important. next slide. this is a payment framework. you do not need to memorize but was published 18 months ago now. four categories of payment alines with a lot of the private sector folks you'll have for item and from a payment framework released from our learning in action network. category one, fee for a service not link to call the or cast. category two, fee for service with a link to quality or cost. classic example is hospital based purchasing. category three, alternative payment model built on fee for service, like bundled payments and then category 4, true population based payment to a provider. these are all provider -- youle hear from private payers and others how they're also moving to value based payment. next slide.

this president and the secretary announced in january of 2015 specific goals for alternative payment models. this is category three and four, where the provider is accountable for quality and cost of care. 50% by the end of 2018. we settling thing goal for the federal government but we want private sector actors, which you'll hear from today to move in the same direction, private payers, provide efforts, consumers, purchaser groups, employers, et cetera. the second goal was value based payment. at least 85% linked to value by the end of 2016 and 90% by the end of 2018. we're on track to meet those 2016 goals. we also launched the healthcare payment learning in action network to really partner with the private sector to achieve the goals we have agent eighth of the continue largest pairs, cma and the private payers, over

80% of the population, over 25 states engamed. large employers, over a thousand provider groups. we have a summit that had people representing a huge portion of the u.s. population, really driving to achieve these goals. so if you look the next slide. this is graphically shows the goals. the dark blue -- in 2011 we had zero percent in medicare in alternative pavement model. 20% at the end of 2014, and continue to grow so just graphically shows you the shift you're seeing in payment in the u.s. the last thing i'll say here, my seven-year-old son has this stat memorized. cms spends approximately a trim dollars a year across all proms. more than $2.5 million a day-more than 100 million an hour. so in the course of this two-hour discussion, 200 million plus. our goal is how do you spend the dollar alleges wisely as possible? how do you partner and catalyze change that improves quality of

care for people developed and generates healthier people for our country and it's smarter spending. on the next slide, this just shows our value based payment program. key point here in the middle box, you seek hospitals right now have eight% of payment via readmission and other value based purchasing programs tied to quality and value, physicians and clinicians nine percent for large groups, seven percent some smaller groups. it's a significant amount of payment tied to the quality of care delivered do beneficiaries. on the next slide, i'm now go to out of the innovation center, so started leading innovation center two and a half years ago, as you know, ten billion over ten years to catalyze new payment and service delivery models to improve quality and lower costs. this lists all of our mother-in-law -- major models. on the next slide, on the accountable care organizations, we have more than 400acos in

the medicare shared savings program, almost 8 million beneficiaries in 49 states plus puerto rico, and with our medicare shared savings rules and we're work only another set of rules right now, some of the benchmarking issues which we said publicly we're looking to improve this program over time. i'll talk about some of the results. the other important note here, if you think about medicare, 2% growing in medicare advantage. 20-plus percent in alternative pavement models. you already have a minority of medicare in what was traditional fee for service, and even within free true additional fee for service the vast majority of payments was a link to quality and cost. on the next slide, this is our pioneer aco result. first mod toll be certified be the actuary improves quality and lowers costs and we built into the medicare shared savings the learnings from pioneer. the other learning from pioneer,

generally people can go in or out of. pioneer, first model out of cmi so i think at that point we were at a different stage. people could only exit. so by definition, the numbers are going to go down over time. every time one exits, it gets a lot of press. we tried to explain this. i've given up trying to explain it well. i'll talk about a next generation model which we think a number of these organizations now are decidings, do they go into track three or stay in pioneer or move to next generation aco. the key opinion is we want an array of payment models that immediate providers where they are and we have a principal that providers should have choices around the pavement models as long as we're all driving to improve quality and lower costs. dramatic improvement inside quality and patient experience and over $400 million in colls savings. so, successful model that met the bar in lowering and costs.

we think there's some key attribute smears got a robust interest. we hope to announce the select entities soon. prospective attributions. know your population. full cappitiation, and you can choose a lower amount. patients, select their aco. voluntary app attribution, the patients says this is my accountable care organization, and then things happen like rebate tooth the beneficiary to stay within network and also enhanced care coordination service it because the provider knows they're part of the network, waivers, think things like telehealth. smoother cash flow and a benchmarking mechanism no longer just historical. actually looks more similar to mid care advantage where you're looking at regional benchmarking approaches. so, on the next