characteristics were put on earth specific for me to appreciate, or not appreciate or whatever the verb is. because i had really been spending a lot of the last ten to 12 years without knowing it preparing for donald trump to happen. >> translator: is a contributor to rolling stone magazine and is the author of many books. >> his most recent book, "insane clown president." >> during our live through our conversation we'll take your calls, tweets and facebook questions on his literary career. watch with author and journalist

matt taibbi live from noon to 3 p.m. eastern sunday. >> now the ceo of doctor on demand, another telemedicine industry leaders find out innovation and technology can transform and improve the u.s. healthcare system your pepperdie university hosts this event. >> please welcome to the stage john figueroa, ceo of genoa healthcare. >> what an incredible morning. the inside that doctor emmanuel provided regarding the intent results and the future of the affordable care act as well as integrated care. and our industry is moving to a value-based system was fascinating.

equally as intriguing was a description of our complex and ever-changing healthcare system by our esteemed panel of doctors and healthcare administrators. i trust that their years of practical experience and i trust that they have certainly confirmed the complexity of our healthcare system. and the speed in which it is changing in america. i'm going to take a little bit of a different view on some of seeks comments, consider some of the complexity issues of the day, consistent with things that we need to do to change the system to make it better, but a slight difference from a quality perspective. today as intricate healthcare represents approximately 18% of our countries gdp. i think it is safe to say that the healthcare as an industry is perhaps the most important part

of our economy and growing faster something that was confirmed with all speakers today. because of this over the past decade we've been building healthcare around the triple lane, a concept that came ten years ago on what we need to do as a society within healthcare to increase and improve healthcare, to increase quality, to decrease cost and to improve the visit and the accessibility for our country. what we learned this morning is that we've made tremendous progress with this initiative, and that the next massive shift will continue to be toward value-based healthcare. getting paid for products and services on the basis of how well they achieve the triple lane. after reflecting on what we've heard today, i think you can come away with the few impressions. one is that in this country we

have massive issues with both cost and accessibility. throughout health care. but we don't have those major issues as it relates to quality of health care in america, and that's a little area where i take exception to some of the things that have been said, not only this morning but when you watch the news or when you talk about health care in the general setting, we sometimes lose the focus of the exceptional quality of health care that we have in our country. and it has remained constant from high quality perspective it sometimes that gets politicized and not talked about at all. the fact is that america has the highest quality health care in the world, and certainly the best technology to impact positive outcomes. we heard a lot of talk during the election campaign of our systems and comparing our systems to sweden.

we even heard our system compared to morocco today. no disrespect to sweden or morocco, but in my 26 is an industry i have never heard a patient safe i would like to get this procedure done in morocco. [laughing] never. granted, a lot of these countries that were talking about through the election process has health care coverage for all citizens. and that's great, but the other thing we don't talk about is that's not free. and for those of you who studied business at a great school of business at pepperdine, or anywhere else, you learn on day one in economics that everything has a cost. in fact, my grandmother who had a ninth grade education always said, nothing is free. our great system has come at a cost, no doubt. and it is up to us to again continuecontinue to drive qualia

lower cost and make it accessible to all. we have always been a caring nation, and the notion that we have allowed people to perish because they did not have insurance is frankly nonsense. and you are both cedars-sinai and mayo clinic talk about the fact that a number of the procedures and a number of their care is given at no cost at all to the patient. in fact, with the affordable care act they get paid pennies on the dollar are a number of procedures that they do everyday. most of our hospitals and care centers are not for-profits. in mental health, for example, 95% of community mental health centers, and these places take care of 90% of our countries severely mentally ill, are not for-profits. there are charitable organizations that would never turn away a patient who has no interest. a lot of the people who do those services are here today, and i

want to thank you or what you do for our patients and our health care system. granted, sometimes you may not get the highest -ranked hospital in the country to take care of you if you don't have insurance, but there's always a place for care in america. this is true before the aca and it is true today. i suspect it will be true when a new health care program is announced in d.c. however, it is also true and very possible that a major procedure bankrupt you in our system, or that in an intrapersonal be taken in during a crisis but can't afford preventive care. again, this happen before the affordable care act and it still happens today. we must continue to strive toward the triple lane as an industry, and we are. another fallacy is the large pharmaceutical companies are the primary reason for escalating health care costs total pharmaceutical costs in health care represents about 15% of the

total costs. even if drug inflation rates went to 0%, it would not change the overall escalating cost of care. today, 85% of prescription drugs are generics at an average cost of ten dollars per month per 30 day prescription. because our health care system still operates in silos, there can be a shortsighted emphasis on reducing costs in each silo. and i'm not advocating that there's nothing that can be done to the pharmaceutical industry, and are plenty of examples where costs are way too high. and when he doesn't industry address those issues but we can't take any of health care one silo at a time. let me give you an example of what happens when you concentrate specifically on pharmaceutical spending. in the spotlight is focused on,

if the spotlight is focus on pharmaceutical spending, and increases in as problematic. yet spending on pharmaceuticals may need to increase to achieve overall reductions in the total cost of care. for example, inpatient stay on them as you see increase in drug spans. a pbm or an insurance company if they see somebody experiencing 96% insurance rates from 20%, they will spend more on pharmaceuticals. what you to look at is the total cost of care. in drug spans, that's going up significantly, it has to reduce the higher medical costs. recently, we did a study that determine if, in fact, you're putting pharmacies inside these community mental health centers and you're taking away the ability for them to leave the center and then go get their prescription, severely mentally ill patients will fill their prescription at least 20% of the

time. if there's a pharmacy embedded in integrate and a committee mental health center, severely mentally ill patients take their meds 96% of the time. that's what the study from the journal of managed care and special pharmacies set. the net savings for the population of america because a 40% reduction of hospital stay, 18% reduction of er visits, amounted to over $400 million in savings on the basis of 500,000 patients. now, i do understand the word trillion, like any of us, but i do understand what $400 million and the impact to this patient population is. so that's what you want to leave you with, the fact that let's not look at silos, let's continue to work together to look for total cost of care and let's make sure that as a

society and the health care industry we continue to reduce costs, increase access and improve health. so with that we are going to a bit about technology, and the technology impact that is having on quality of care in our system. today's panel is pretty exciting. we were a lot of talk about telemedicine in earlier conversations today, and in last year symposium it was an entire symposium on data and technology and impact that it is having. today we have three great panelists and we also have a moderator that comes to us as one of our panelists last year, kathleen grave, who has a history of making sure innovation is impactful. she's learned that designers and one of the executives of watson with pbm and is currently now part of the watson program with the weather channel,

revolutionizing what we do with technology. please welcome kathleen grave. [applause] .. >> >> and the medical services provided.

is patient clinical care delivery through remote services critical care or emergency care that could include diagnose remote for critical conditions between the doctor in the position in the patient or a consulting team. telemedicine provides long-distance expertise with the specialists that would not be available in remote areas of the world or to a remote province or a remote area of the united states. the telemedicine association gives us an early example that the medical care provided of the monitoring of the nasa astronauts and that continues today also used for remote deployment to keep the troops save. with three areas of patient care and intelligence

solutions those key areas are of medical data radiology imaging that gives the insight that is needed to drive the information for the patient from the details of the data else so remote monitoring with congestive heart failure one needs to get the regular revivals of hydration of the patient. clinical consultation is the third in to allow for that to happen more often. the use of electronic information telecommunication technology to support is now common with the public health education and administration to include video

conferencing and the internet is a very common practice with indigene gent wireless communications there is no end to those innovations ann b. will see that come over the next few years as well. to be at the fingertips to transform that patient experienced never before have we had as much at our fingertips to take care of that triangulation so to include telemedicine we have the opportunity to increase access to high-performance system with the point of care and access of all levels and to minimize the

patient's insurance we have the chance to have remote access and out in rural areas it can be specific management with problem need such as heart disease or diabetes the pentagon which care management program is created. now available outside the metropolitan area so that when providers graduate they can still provide remote access and provide support to those doctors and patients that our remote those who may need frequent visits for critical situations consultation and training care management with the team of specialists to discuss case management

for rides an opportunity to have feedback or non clinical experts you could contribute to that information based on the environmental nature of the patient now experts can contribute from all facets of their expertise now is my privilege to bring on to the stage as well as their perspectives about the industry's growth in the specific business model and telemedicine. the first panelist, and mr. ferguson and chief executive officer at doctors on demand has led companies of all stages of growth from the founder to reach senior executive at paypal and also holds the deep commitment to

putting customers first a value that resonates with doctors on demand with testing class customer experience he helped to transform paypal into the customer focused team and to serve as the chief product officer. prior to joining paypal he pioneered technology to enable consumers to make payments quickly and easily using a mobile phone and with dawn mining gaming development he also worked as general manager helping to develop management software with customer payment products as a senior

product manager at got to to help service says he also held to manage customers $1.7 billion in loans and whole say bachelor's degree and an m.b.a. from vanderbilt. [applause] our second panelist is currently vice president and senior vice president at genoa the tallis' psychiatry coming in to the acquisition of his company a city based tellus psychiatry company he and his team have built the

technology for the company from scratch treating 50,000 patients across the country was the president of signature health care and to do health care service companies that he started. these two endeavors have grown from two employees up that over 150 all improving access in in markets. from 2010 through 2012 the director of planning a 150 ben health system redesign danville a model across three states his career began with mckinsey and company as a analyst for strategic initiatives for organizations inside and outside of health care and at the mckenzie hospital institute. receiving bachelor of

science from wharton and a bachelor prince did neuroscience with distinction in the masters of speeeight at wharton and he does not sleep. [laughter] [applause] the last panelist has a 20 your track record of sealock technology and health care services company's translating for the benefit for health care solutions into successful clinical information in his experience enables high a care quality to drive intelligent growth and serve as a catalyst for change at the very advanced heart of his business to work innovatively and collaborative leave to bring

the positive and outcome to the patients and families to jointly serve. prior with health care companies page one of the early leaders in the markets informs advanced ic you care so the strategy to build organizations with advanced ic you care with a staff end infrastructure with a continued innovation at his two prior companies they were both named to the 200 best public companies to 15 consecutive years he served on the board of directors for a variety of health care companies public and private

he earned his m.b.a. from harvard business from ann hurst. [applause] >> welcome to this stage we will get started with a round of introductions of pointed views and perspectives from each panelist. >> afternoon. the easiest and fastest way to be a great doctor there the of mobile lab border certified physician in 49 states as soon as arkansas passes some legislation momentarily me start off in the direct consumer market with a cash based solution for lack of access to the urgent care and we grew

quickly and quickly started to work more partnerships with large insurance companies they humana and united health care and now they offer a doctor on demand as part of their health benefits that has filled our growth and we got into mental health with the team of psychologists tend psychiatrist to work together with primary-care physicians to help provide this week of health care solutions for those of her part of the benefits offered by the employer or health plan. we are excited about the procedure of telemedicine is exciting for everyone in this room and everyone can benefit. it is not the winner-take-all market place

consumers or payers there are so many solutions that driving innovation meeting to health plans in the way consumers think about the way they become consumers in the marketplace. >> could afternoon. thanks for inviting us to share our experiences with you. telepsychiatry poorly focused on an hon -- primarily focused on innovating for the mental health population we are the largest outpatient telepsychiatry provider we have a team until the psychiatrist that we have a

system in-house to treat those that could not access psychiatric care. if they have community mental health clinics a lot of these settings don't have access to psychiatry but the providers can treat them using our platform we have held 50,000 patients and 80% could nazi a psychiatrist prior to seeing our own. one story i hope we can share is the importance to get the business model right we have had a lot of talk about this conference innovation is not as easy as to understand the staplers -- the stake holders a and the managers involved in a patient's care so you can

build something that works for everybody. we spent six years to get that right to we feel we are on our way to expand access and we could share those lessons with you today. >> our company is tech enabled services we are a mouthful and operate year round with a remote monitoring of intensive care units around the country. we are in 24 states and in 65 hospitals in the process of celebrating a company milestone we just wired our 1,000 dead -- abed nbc north of 65,000 patients per year we're the nation's largest

and what we have talked about so far today we've lived through all of those at our business model is almost perfect but not quite . we are getting their. the outcome 70 headlines is mortality rates reduce between 30 and 40% her icu if you talk about good health care outcomes people walking out of the hospital that is a pretty good outcome. and also good individual and economic outcomes. we deliver our service through a number of care centers across three

countries and six time zones and again we're always on call. the workload continues to be refined and our acute awareness dealing with multiple constituencies were that we are hiring in multiple cities for clinicians patient's family is hospitals, we are not alone the we have inherited a complex mix of business objectives the we're executing well across those objectives. thanks for having us. >> we know telemedicine is growing currently $20 billion market opportunity every year growing between 21% for the

next 10 years but still only 1% is happening in the country so i am curious blend into of business model how did you get started?. >> for us it came down to first understanding whoever stakeholders were we saw the patients who need services of course, we cannot treat them without a physician's so they were the second state coulter but because we chose to treat them in the institutional setting the clans were the three but then who would pay for the services? without considering the interest of all for witches say leg the model would not grow the right way some reading about patience and the services

they need the most ann providers are high quality and we see the average patient comes back to our physicians for treatment about 12 visits over a year so we have demonstrated stickiness. saudia compensate to make it worthwhile? they are already stretched so thin in the supply is short of demand so coming up with a compensation model to offer them of shifter they want or where they want to drive home with the clinic is important we have to focus on reimbursement sometimes that is left out of a conversation with innovation and health care can you find that pathway to reimbursement? they only have a limited shelf life

with grant funding, of pilot programs only go so far. and the medicaid population is driven because 48 medicaid programs to reimburse for telepsychiatry and we can expand at a pretty aggressive pace. >> from my perspective i had been here a total of three years as ceo and mine malinke might try to figure out who i was interested in interviewing for the ceo position and having been through a number of innovative defense -- event the analysis was fairly simple and straightforward. mentioning things that i

discovered is part of my diligence if it is reducing mortality rates by 30 or 40% during the estate's significant that has a good lead economic outcome on average between two and 6ro i each year that becomes very easy to see it had placed in it was an interesting opportunity. but you cannot outrun those themes so to keep things nice and simple with a great outcome with the tangible ro why in the area at least in our area with a severe shortage to deliver those services in outcomes in then

we can do the diligence. >> our story is pretty simple they manage their daily life of their mobile phone take account balance balance, send money, order cars to the airport, order food to be delivered so if we pick up the phone to get that call to get the appointment for next week drive and park and wait and wait and see the assistant then see a doctor to minutes? why do we do that? that was the founding principle of doctor on demand so we started with a simple service to diagnose and treat 18 of the top 20 reasons why they go into urgent care relatively simple to diagnose and treat and from there we could find a core group of consumers

who lack access or with just a value the convenience so it is fabricated among the consumers that tend to live in the urban populated areas you live and die by the mobile phone and they are looking for convenience is a natural way for them to get care and then one that consist of people in areas that access to care is a real problem for cry read all customer testimonials every day and it is a constant source of inspiration but also good feedback on how they perceive us i cannot tell you how many times i read thank you for your service i used to have to drive 75 miles each way. so we're focused on access and convenience as the two main drivers.

>> it is very important as part of the model but the reallocation of the same resources so supply is short and demand is high is there a potential to the model of delivering telemedicine?. >> we started contracting on an individual basis with doctors and clients with short blocks of time that they could experiment plan as we build up the volume we started to hire physicians full-time so i think we have been successful because we tried to build day national practice to employee positions across the board that no that patients experience is critical and more and more comeback and

request appointments with those individual doctor so a 30% of the visits are appointments come from consumers who want to see a specific doctor so we support that to do multistate providers of they come on the platform to demonstrate their ability to have a connection with the patient and deliver care we give them a larger pool of consumers so that is an interesting evolution that we as the typical primary provider they commute several hours away to get to the downtown location the live in the expensive part of the country so now we

have people who live in little rock arkansas with the much lower cost of living can now treat patients who lived in san francisco so it is an interesting phenomenon with jesse arbor triage pastas of living but the mechanism for optimizing your time to allow them to work for home to see the same number of patients with the same level of income but not have to be restricted to working in one geography of a country. >> with access is in our case we are delivering expertise we are sourcing and delivering the market's.

we have our own staff. we will license the physicians and will credentialed them at many dozens of possible so we can solve the access problem with the shortage of staff that many hospitals face. in terms of accessing supply what is interesting about our model is we contract directly with hospitals says physicians that joined us they can focus on providing care to patients they're not involved in coding, billing, a collection, they lot again to the system and have

connectivity with the hospital and practice medicine in the entirety of their shift and then they go home. so the people that are fed up chasing paperwork and bureaucracy and payments end answering questions from revenue cycle companies that is a pretty good gig. >> in addition to taking the of busy work off to get the doctor's license in more states, there are a few ways that telemedicine can help move the needle on supply to build golf hole deficit gap. so we're seeing that the

providers that work with us treat telemedicine in addition to their regular full-time job as a you take a 40 hour per week provider into 45 or 50 hours they could do weekends or mornings or afternoons. the second model is the specialist cancer support primary-care providers to have more behavioral a health care proposal of the psychiatrist isn't in we are helping the primary care to manage mental-health a little bit better. >> if you define day nurse practitioner to a treaty will not supply as we try to expand in what is the next

disruption of technology? how was that coming up the pipeline? is their news on other technology?. >> yes. there is a wave of innovation happening on the hardware side buchanan cram computing power like the camera in the phone today are so powerful you could hold them up to your throat and doctors can have an image of your tonsils that chances good as in person or some cases better with the light from the camera. we will see the cost coming down to low enough levels for the average household could have a connected it stethoscope way a blood pressure cuff over the

device is to take regular meetings and send them to your health record then we can develop models of care that our more proactive and without that data. augmented reality, are virtual reality, artificial intelligence but they are so far out that the applications of the business models cannot really be distilled or clairvoyant to know how those with pactel care but we can assume something positive will come of it as they get their hands on new applications of technology however i wouldn't suggest that

technology on its own is a panacea and there is so much on the table right now they can have a tremendous impact without creating any meaningful new technology. even before we start thinking about things like artificial intelligence. >> from our perspective there might be some big bang innovations with relentless incrementalism constantly trying to add features and function reality into simplified the work we're doing day today we have an active hand robust development team working

hand in hand to have the perfect lab for what needs to approve and to put things into production we're relying on third-party technology is we have audio video technology from that location and that they can read the bed from the bedside and all the bedside equipment working with every indication system that exists in the country

simultaneously and, currently that they continue to evolve that day then but to be fair our perspective is an incremental improvements leading away in that area right now we're busy enough with the incremental stuff. >> where does the cost fall for this happening? is it a reduction of cost? so given our model so it costs half of what they would take before they go to walgreen's

horsey yes 30 or 40% in to the urgent care clinic and it is much cheaper than going to the e are they could have coverage with those copays with the high deductible will cost $150 and on the paper side and that is the same principle and then going into the urgent care clinic so his say very strong line but on the employer side so those

who work shifts have restaurants it enable them to do a visit in the car or on the job to prevent them from being off shift for three hours the house to keep a happier perforce. >> at the provider system level so with those clinics and hospitals because many that we're working with the with that market premium with the staffing body toupee non-pay a doctor to relocate to an undesirable location.

basically we could arbor triage with the cost basis with it a more desirable place and on the paper cited the real impact the says the wine of the physicians that is 50% less in to be the acute treatment to provide a layer of care so that vastly l.a. is on the provider side >> we're in thin discussions for the system to go unnamed the tried to get in the door

and they said we will give you our worst hospital. see what you can do. so we don't want there to be any dispute to the numbers. they came back after one year they could not believe it with their return on investment. so he haddad as one aspect. when a the party in things we have seen that increasingly they are featuring the relationship so to the point that they will reference to have the

privilege of reading i see nurses and physicians to sarah but none have joined it in advanced ic you care was not there. that is pretty powerful. and then the person at the bedside. >> so with that pair provided patient and so what can you offer in terms of regulation or policy makers.

>> saw the regulatory framework so with a functioning businesses and those that we are applying was an indicator to meet at the interstate licensure paradigm. and if there is a regulatory shift to treat patients across the state lines so telemedicine is integrated

with the infrastructure idiocy that impact of change? en then somebody said and what we tried to do is make that easy and simple and to with the doctor's office or a practice and then replace of waiting room with a retail establishment when necessary. because there is indeed in the market for those solutions and added is a

long road to get there but with that formula the proof is out there. >> and i would add to that with to be agnostic but there is a tendency what they do in the house side world. than with those conditions and one of the things the we have learned with whole ecosystem that is important

to keep the integrity and from that night he perspective and having that infrastructure and hidden from plain view. and to have those decent technology but there is hard to recover from that. but there is those to put out that's oriented service and with that customer service.

so in that arena of disruption and to replace that's the at the three of us and others in the telemedicine space are those innovators. the second piece of a negative is fundamentally the reserve much more nimble and flexible we don't have walls or operating mandates torrid joint commission so does they create new incentives they have that flexibility using that technology we can skate with

the puck is going very easily we are not locked in. with that incumbency model. >> is there any future of a common platform? and then to feel there is a common approach if it is needed generational the??. >> a lot of them is the middle layer and getting the right think about payments he compared with a bank card your credit card or cash and because there is a middle layer of payment processing correct as the end point is

a little secular with that universal patient access with internet and high quality technology in the payer systems that our more uniform or workable in their applications that leaves us to competes not if we bub elbows with the right players for a preferred contract. >> you are speaking maya language here but what they got right early was respecting that your money is your money with unfettered access that enables them in the form of credit cards face up or mastercard this industry has to respect the consumer or the patient and and tell the

does unless they are respected it will never be fully controlled by the consumer. >> we are clinical to clinical or health to hospital if judy was here she could say there will be a world i dunno if we will get there any time soon of those complexities and any improvements and they don't change that care equation we don't have a relationship those are with the relationships such as have

those standards those are the a pretty exciting start to say how has the patience been treated?. >> the auto industry is another good parallel with the car came the ability only to drive on certain roads. if there is a car you can drive on any road then you have the tools and the vehicles and the infrastructure and a the highway. >> waiting for that one health care payments system we will open for questions.

>> that is a great question one thing they have done really well in his legislating to make sure that happens we take a lot of pride in having the data architecture and the system of health care is a constant battle with the hipaa said kidder to restrict and i am surprised at how strict it actually is. we have all seen and no people from when the data em

gets out there it is of a disaster so that is just having well-trained professionals coming from internet security background to make sure your policies and procedures that are used and the internal process most of the breaches come out from workers not knowing what they're doing for what types of cyberattacks are out there and that is a must have. >> so just to go a little further on that those

programs that mandates the network idea manage that particular benchmark? and then the nurse for the patient ratio? so heidi and manage those benchmarks we are collaborating with the bedside team we're not replacing bad soviet additive in the responsibility of those ratios that are typically a bedside ratios and then

complementary to the bedside staffing that they choose to employ a. >> [inaudible] >> if you could not hear have you seen any characteristics for bread telemedicine providers? so what we have come to understand a doctor to make the technology go way. we can trade the doctor and what it takes to train a

patient in person but most of those differences are very treatable but if we start with the sea negative student that is a much easier challenge that translates well into telemedicine space that is a good start with the employment ratio and also our physicians have two alternates from time to time from being the al flood end a situation or a consultant. and from your point in question battling to hire

good doctors also those who understand to toggle between those two was very different roles to facilitate the tiv is important of that client satisfaction so that is what we have had institutionally for while. >> ran the development of your company's and the sensitivity of the broader population. >> that is something we were gone every day prayer rarely

with the medicaid population that we deal with fellow whole host of cultures to have that rio grande situation we deal with a lot of that and minority communities and first generation communities that are establishing themselves in this country. one of the nice things about telemedicine is imagine have a physician who speak spanish and under stay ann / and american heritage month spends five hours a week treating spanish-speaking patients in 35 hours treating not so to take that provider with that specific

capabilities is a social benefit and for us to refine to the provider to fit the needs of that specific community?. >> with everything what we focus on to keep their prices as low as possible that is the most important thing we can do to make sure it is not only more convenient and sometimes it works against us and subconsciously i do not want discounted the sushi. [laughter] also with health care before a large part of the population sabin extra $40 is very meaningful so that

is cheaper than a clinic during a lot of good for lot of people. >> so one of the things they find ourselves doing not infrequently is having power providers speak on very serious issues with those family members to make those decisions about end of life and counsel them how to make those decisions. and independent of specific cultural norms and in the way to walk people through what the choices garner and what they represent to allow them the time in the dignity

that could be dictated to them over time as the important and value-added aspect to deny that is important to share because and i told people of is doing this panel the of the information that could be delivered. . . the intrinsic value of the patient's outcome and their joyful life and well-being as well based on a lot of what is delivered through your platforms. any other questions?

>> this question is more for samir. i work primarily with seniors and their families. seniors are often seen as being on the tail end of the adoption curve when it comes to technology, yet i see seniors have mobility issues, transportation issues, and multiple comorbidity at the potential ideal client for you. i've just seen firsthand very recently how underserved seniors are when it comes to mental health access. and so i'm just wondering how do you work with seniors to help them overcome potential trust or technology barriers so they can utilize your services? >> that really is a great question. goes back to where we started around getting the business model right, and his speech to the patient engagement side of things. the way we approach the senior

population is to piggyback on those folks have already established the right trust relationship with the seniors. so we will work with skilled nursing facilities or assisted living facilities, and it will be the folks at those are promoting tell a psychiatry to the elderly population there serving. that's a vastly different proposition that if i'm like in somebody's door and take some 30 seconds even just come to the door. because they don't know me. they are used to certain things in terms of where they can get care, how they get care, who tells him what good care is. so for us we are trying to plug into the existing frameworks, primary care, whatever they may be and have those folks promote our services to the senior population. >> just to build on that come about 15% of our users are actually over 60 years of age. so they taper off quite a bit

after 70s, but at least the 60, 70 population, you'd be surprised how tech savvy a lot of folks -- my mother 73, lives in a small panic consecutive unlike user as a good test whatever we have a new product release. i will say can use this? what you think? it gets to the broader point anytime you're developing a software solution or product that of all software, this is by far the most important thing you can focus on. just making sure your software is reliable, is fast and designed in a way that really, really simple to use is the most important thing you can do for accessibility for really everyone. >> if you get that right, you could leapfrog the problem. i think the ipad is a great example of this. you see both babies and octogenarians very readily using ipads without any united states come, without reading a manual. you get product that good, the

problem solves itself. >> i work for a children's therapy clinic which is for children with special needs. we have been dabbling with telehealth, but we're not sure if it's going to suit our client population pics i just wanted to if you had any comment on this particular client and whether you'vyou noticed any success ine industry? thank you. >> we have really little experience in that segment. with interest but so far we have not found supporting technologies to help us address that population effectively. >> you can make the case that you solve the problem that is much, much more complicated

figure getting patients nicus with barely any capacity to make their own decisions -- in icus. that seems a conformer, get a problem. to answer your question in specific, i don't want to be a broken record but it starts with what yo with the people who wern the ground with his patients. the occupational therapists, the physical therapists. listen to them, understand what it is that they think is good work on the patient population. that's our business model that will come in and not go straight to the patient's but here you out on what types of modes after going to be most effective, what other provider characteristics that you think are going to be affected here. you paint the constellation of what it is you need and then we can backfill that for you. but you know your population better than we do. >> i would just add, we don't work in this area, but i do think there are plenty of companies that produce white labeled software to enable a provider such as you to have

meaningful, remote sessions and consultations with your patient. i think especially with the technology that exist, particularly in your field with microphones and everything else, you can do a better job with some of that technology in place. happy to speak with you later. >> the question i have is i want to go back, and that is this -- [inaudible] very remarkable in terms of our ally. -- our white paper looks like some leading edge of some future movement, such as health insurance being sold across state lines as well. the question that comes back to me is what do you do in terms of managing quality? this may be more for hill and

samir, which is you guys are both inpatient care. you have direct patient care. how is the quality piece of it managed or regulated, and what to do about that in terms of measuring the outcomes? to talk about outcomes, how exactly do you measure those? >> and our answers are going to be different, which hopefully gives the audience more to chew on. our providers join the existing kicking that is taking to the patient. the patient part of the community health middle center. that community mental health center has care centers, documentation required, critical protocols. the provider will bring to the table certainly is reference check, credentialed and quality tested as a basic provider from our side of the table but as soon as a provider becomes part of that existing team for the patient, it's in the getting to provide up to speed on the existing quality standards.

when we're talking to our clinics the paradigm we use is it to be as if this provider were there in person. any united states can any requirements, any oversight that you're doing to a provider would be to on-site treating patients hold our doctors to the same standard. >> so we do a few things i wish our clinical often it would answers because he would do a much better job. but the first thing we do is we ask every patient after their video visit to rate us on a scale of one to five and give comments on the interaction with the doctor. that in and of itself is willfully in the industry we can provide immediate feedback to the provider about that interaction. perhaps they would have a 4.8 average rating and is something our doctors love. at the end of each visit they get to read that, they get to see that, they get that instant feedback from the patient asked to how it went for them. for those of you who are thinking, that's great but patients are always know what's

quality and what's not. for that we have 10% of our physicians time is spent doing peer review on other doctors. and so it's a double blinded. there's lot of anonymity there, so our doctors work together to ensure quality across the board. we have a whole host of other metrics some antibiotic prescription rates, overall prescription rates. we are tracking below industry averages on both of those. and a lot of other initiatives that are chief medical officer feels passion about that we drive. that's what's exciting about our practice as being virtual and technology driven is the amount of data that we consume and analyze and report back to positions is one of the single sources of delight and satisfaction which we measure for our providers to make sure that they are happy and productive. and they love getting that data. they love seeing how they are tracking versus other doctors in practice.

so just getting the real-time feedback loop has been a huge, huge lever and driving critical standards and outcomes. >> great. as we go to close i want to offer the continuity of this morning, and suggest that you may each have a t-shirt. and if you anything you might put on it, we would love your tidbits of wisdom before we close out. i know lou is holding onto a good one right there. [laughing] >> lou, would you like to go for? >> you know those shirts that are like, i don't know, they are british something, the queen has, don't, what does it say? >> keep calm and carry on. >> something like don't worry, healthcare is getting better, would be a nice thing to help people understand the perspective. removing spurts, d.c. moves in fits and spurts but each of the

three of us are out there pushing hard to try to make things better. everybody in the film is trying to make things better and that effort is all going to result in better health care, a better healthcare system in this country. >> something similar along the lines of help was on the way. i think this industry attracted me because of its relative level of immaturity with technology and adoption, at a think it's attracting a ton of other great entrepreneurs to come bring fresh perspectives in how to build services and experiences that will help drive up costs, drive-up quality, drive-up accessibility and so i think they're so much excitement and innovation going on in this industry that we may not benefit from but certainly our children will. so that keeps me going. >> and the lou, can you this out? >> a little plot year. if you read the book shoe dog, the nike founder, rita. it's a fabulous story with a lot

of behind the scenes stuff that you never imagine would be part of the nike history. and in that story, in the book, he tells the story about one of his teachers talking about the history of the oregon trail and exploration of the oregon trail. and he, he adopted one of the slogans as part of his entrepreneurial mantra, and that mantra became first the subject of my annual year in letter to my team and will close this out today. the t-shirt if a going to put on a t-shirt talks about the entrepreneurial adventure -- adventure we are on in telemedicine. the t-shirt would say that cowards never started, the week died along the way, and that leads us. [laughing] >> thank you very much. thank you, gentlemen. [applause]

i think we had some awards. thank you very much. he'll, thank you for today. >> thank you so much. what did you suggest? vip. you are all a very important to us. thank you very much. [applause] >> [inaudible conversations]

>> sunday night on "after words", nebraska senator ben sasse explores how to encourage adolescents and young adults to become independent, active and engaged citizens in his book the vanishing american adult. he's interviewed by stephen, founder and president of the millennial action project. >> by and large suits that are going graduate this spring and summer from college are going to change jobs three times, not just jobs, sorry, change industries three times in the first decade postcollege. that's new and all the unsettling and scary stuff that produce progressivism during the industrialization. was about the idea that job disruption created all these unsettling ripples into human capital and social networks. a lot of what people panicked about then exactly what we're going to experience at work speed forevermore.

with a 40, 40550-year-olds get disrupted and this intermediate not only out of jobs and firms without a full industry. we will have to a civilization of lifelong learners, and no civilization has ever done that. >> watch sunday night at night eastern on c-span2's booktv. >> army special ops aviation officer terry linfoot broke his back and a helicopter crash in iraq in 2830 is now paralyzed and is the first veteran to use full body technology called exoskeleton. and is given in the ability to walk again. he talks about surviving the crash and the use of technology to help injured veterans. >> good evening. for those you bob not yet met, my name is melissa giller, chief marketing officer for the regular patient and institute. thank you for being with us this evening. if you haven't attended an event to before you know we start each