for an observation payment. a significance difference in the level of payment. >> one other major position is whether you should have put the person in the hospital or not? >> exactly. typically, they're not questioning the care we provide. they acknowledge the person needed to be there. they are saying should not have been an inpatient and that dramatically changes the level of reimbursement for the patient. although they are looking at critical access claims in some areas. >> i've been told on the hospital wage index is that rural hospitals can constantly pull more and more behind compared to counterparts in other places, would you think that would be an accurate statement? >> yes, it is, because the data the cms used to determine the wage index is several years old and what happens is the wage data goes down. you're paid less. therefore, you have less to spend on salaries. it becomes a cycle where you end up paying less to your staff. you don't give the pay increases that maybe an urban hospital would give.

and so you constantly gradually fall behind urban areas so that does become a problem in rural areas. >> similar are observations on wage index from ms. peterson or mr. stover? >> the wage index relative to critical reimbursement is not as significant as a pps setting. however, the idea that physicians and specially trained nurses and nobody flebomotists and technicians can be recruited to rural areas for less than when they would earn in the urban areas is simply not true. we compete on a national level for these very, very scarce resources. >> same observation, mr. stover. >> yes, mr. chairman, i would agree with my colleague, ms. peterson. >> my last question would be on telemedicine, are you getting reimbursed -- do you have

behavioral health also? >> we do, yes. >> are you being reimbursed for behavioral health in the same way for other health items? >> we are. >> your goal is to recapture all costs? >> correct. and to integrate behavioral health into medical clinics as well. >> do you have any studies that would indicate how much better people do with other health problems if you're dealing with their behavial health problems at the same time? >> well, it's interesting, in our diabetes program, a component of our program is around medical adherence and lifestyle and behavior changes which needs a small mental health component as well for behavior change. so we're incorporating into that. we're not through with that study yet to be able to publish it. but we're offering, now, mental health services on college campuses and schools and one that will continue to grow, and probably our biggest demand right now. >> my personal belief that even -- certainly societally if you deal with mental health like it's every other health issue,

the cost comes back many, many, whatever you spend come back, i think, many times. but my personal belief is, even in the health care context, that you deal with every other health issue in a more effective way if you deal with behavioral health like it's a health issue, rather than you've got lesser reimbursement and less of a commitment, whatever that i hope we can get there. i'm glad that you're getting there on your telemedicine program. any other questions? senator murray? senator cochran? >> no, thank you, mr. chairman. >> would you like a minute? >> no, thank you though. >> let's properly close out here. we'll leave the record open for a week for questions to be submitted. we thank our panel for coming and we are going to adjourn until 10:00 a.m. on thursday, april the 16th. thank you all for being here.

that can't be right. on may the 16th. thank you all. this week, we're bringing you american history tv in pry time here on c-span 3. tonight's focus is the atomic bombings of hiroshima and nagasaki. programming includes remarks from president truman's grandson clifton truman daniel. from our real america program, the atom strikes. from 1945. a u.s. signal corps film that documents a manhattan project report on the destruction caused by the atomic bombs. on american artifacts, it's a look at the hiroshima/nagasaki

atomic bomb exhibit from washington, d.c.'s american history museum. starting at 8:00 p.m. tonight on c-span, it's energy expert mark millings with mills with a presentation that suggests that oil and gas production from fracking is entering a new phase of construction. here's a preview. >> this is what's fascinating, unwittingly when the silicon valley investors started pouring thousands of dollars into hydrocarbons, the people that changed the game are the guys in silicon valley -- which will unlock even more cheap oil than natural gas in the future. here's what's going to happen, three complimentary things take place over the next decade.

first, we will get underlying improvements in the existing technologies, at least equal to that that's already heard the drilling, the operational cape abilities for pumps, seismic mapping. the aggregate 4 or 500%. that will happen again. secondly, what will happen is we'll layer in new stuff, advanced automation. automated ones are far more economically efficient. we're going to add things like robotics and industrial drones, that will layer into the system. and the third thing is, all of this will be optimized with analytics and big data. it will uberize the entire shale industry. >> that's a short portion of tonight's program featuring mills.

a look at health innovation in the health care industry. a stanford university dropout who started a blood testing company and who forbes magazine calls the youngest self-made female billionaire. the clinton foundation hosted this event. >> we have here today i think a fascinating opening panel. i want to bring them out and talk about -- disruptions in a positive way they have made in health care, why they do it, and how they measure success in terms of people. so let me first introduce our panelists and i'd like to bring out elizabeth holmes, she

dropped out of stanford when she was 19 to start this company. a company that is now employing more than 500 people and valued by investors at about $9 billion. not bad work you will see she's quite young, i met her at henry kissinger's birthday party with george shultz who was 92. i thought anyone with that sort of age span has got a bright future. since i'm closer to 92 than her age. it looked like a wise move. let's bring elizabeth holmes out, give her a hand.

josh cushner is the co founder of oscar health, who wants to do something really interesting, which is to reinvent health insurance, and how people interact with their annual physicals. i had a highly unusual conversation with the chairman of one of the largest european companies who happened to be dutch. i asked if he wrote health insurance. he said, yes, i do, but we don't make any money on it, insurance companies write it and the government subsidizes people by income based on their need. but he said, we shouldn't make any money on this, we should make all of our money out of traditional insurance lines. i thought, i wonder if there's a single solitary soul in america that would say that. interesting. this guy's got an interesting idea, let's bring out josh

cushner. joe is the founder and chairman of massimo corporation. it was sort of a garage start-up that now employs more than 3,000 people worldwide and it's production of -- and distribution of a market leading measure through motion and low profusi profusion. >> i'm of know joe through his commitment to build a coalition to eliminate preventable patient deaths entirely by 2020. he just had his annual conference not very far from here in irvine. it's a fascinating struggle with so far a very good result.

and an amazing thing, it will be interesting to know why he thinks he can do that. let's bring him out. our last panelist is jeffrey selberg this is really import t important. they're great friends of mine, and they have worked for years. we can bring debt, the debt we run up every year consume iing

down. after years of beating their heads against a wall, they decided that actually all the real structural problems are in health care, combined with the aging of the population and they decided they would be a part of the delusion instead of sitting on the sideline complaining about it. >> let's bring jeffrey selberg out and thank the peterson foundation for what they're doing. let's just begin with something elemental. why did you decide to do what you're doing in health care?

let's ask all of our three reformers in the middle here. what ever possessed you white you were still a teenager to do this? >> i had the opportunity to spend a lot of time thinking about what i could do with my life to make a difference. and i've always believed that the purpose of building a business is to make an impact in the world and that we're all here for that reason. to me, nothing matters more than the reality in our health care system, when someone you love gets really really sick, by the time we find out about it it's often too late to do something about it and in those moments, nothing matters more, if i could

spend my life trying to change that, we could make a difference in the world. spending a lot of time thinking about that led to the realization that we live in a system in which people can only get a diagnostic test paid for by insurance once they're symptomatic for a condition. and so the ability to create a preventative karin from structure where people have access to the information that can change outcomes by making it incredibly inexpensive, by making it less invasive could help to realize this change where people start getting access to actionable health information at the time it matters, and that's what our life's work is about.

>> what does it mean to reinvent health insurance. we thought we were doing good just to get 10 million more people health insurance last year some people did. explain what you mean when you're trying to reinvent health insurance. >> the vision for oscar came about when i opened my health insurance bill three years ago and realized i had no idea what it meant. over educated and at the time was starting a business, and i realized i didn't know my benefits were with doctors or hospitals, had to pay claim, the list goes on. if you think about health insurance, in reality of a cost

perspective, the idea we had when we set out to make the data more transparent and understandable and relatable, but what we've been able to accomplish, we've been able to take the data we've got in -- provide people better access to better care. primarily because we know a lot more about them. so there's not been a ton of innovation in new york in 15 years. we feel grateful we're going after. health insurance has been sole from brokers to companies and for the first time ever, the consumer matters.

>> you're marketing to the individual market? which is about nine or 10% of the total number of people who could buy health insurance in the company. >> to date, we only started about 14 months ago, we didn't start the company because we believed there was a void to be filled, we started the company because we felt people deserved a consumer experience. what we say, we want to do everything we can to be

proactive, we're paying people to go to the doctor. we're paying people to get flu shots, giving away free generic medicine, free physician visits, being proactive is what we're hoping to accomplish. >> what percentage of your potential market exist? >> even in new york. new york has all these -- new york insurance is generally -- this whole health care debate, before the health care law ever passed, 80% of the policies in the individual market lasted two years. or less.

talk a little about that. there's almost no understanding of who these people are and how they struggle to become insured. 10% of people who signed up for oscar which is a decent market share. the most interesting fact about us which we haven't ever disclosed is that 40% of our members signed up for us, because they heard about us through existing members, no pun intended we claim to be the first ever viral health insurance company but i think the best way to acquire customers is by having a really good product spending our time

to accomplish. >> talk about your core business into this awe deficiency effort to try to eliminate every preventable death in the health care system in america. what made you think you could do it. >> i want to congratulate you for your innovation. with this commitment based approach of holding people accountable, you have impacted 430 million people around the

wor world. it's more important what you do and how you do it, because how you do it teaches others what to do in their own role. i've been around the medical space for 20 years, i remember when the institute of medicine first reported in 1999 to err is human, and reported 100,000 people were dying from preventable causes in the u.s. hospitals every year. i was shocked. but a lot of great smart people jumped in, and i thought, okay, they're going to take care of it. and i went on doing what i did, making nonevasive monitors. a few years ago, the new data came out that showed over 200,000 people were getting killed in our hospitals from preventable causes. that's when i realized, maybe it's time i step up and try to do something about it, i would

be fortunate enough to get to know a lot of companies in the medical technology space, a lot of great hospitals and clinicians, a lot of amazing people like you, president clinton. i thought maybe if we brought everybody together, bring in the hospitals, government, the patient advocates that provide this powerful voice, when you think about 200,000 people dying every year, it's a number that runs through your head unfortunately. i think stalin said one death is a tragedy, a million are statistics. when you think about that one life that impacts the family left behind, it grashs you and makes you want to do something 37 we borrowed shamelessly with your permission. created this commitment based approach if you're going to come to our meetings, you're going to make a commitment. from my everything nearing

background we started unpeeling the problem, seeing what are the things causing these preventable deaths, from hospital acquired infection to medication errors, to lack of monitoring, when people are give en opiods. it stops pain, but also stops them from breathing. anyone who can use it, to come up with. the last two years we've now gone from saving 600 lives a year, to over 6,000. and we hope maybe next year we can report 60,000 lives saved. >> let me ask all three of our innovators before we come to

jeffrey it's technology that -- what role does it play in creating the health care system we want. and what if any economic imperative actually blocks it from creating the system we want. that is. are you at all disrupted markets, with noninvasive technology. whoever thought of an insurance company giving you medicine, all this stuff how are we -- how is it going to come out, how would you measure the success of what you're trying to do, and how much of it does it depend on the whole system transforming itself? how much do you think about the health outcomes in america, and how they're not as good as they

are in other countries, but we spend more money? where is the end of this, and what is the role of technology going to be? how do you think other people in your line of work should behave? where is this going? >> we've always seen technology as a tool. it's a tool we believe for empowering the individual, because we believe very strongly that the answer is to our challenges in health care lie in empowerment of the consumer and enabling people to take more control over their own health and, therefore, their own outcomes. what's been interesting to us about our model is, we decided we were going to start billing

at 50% off of medicare great reimbursement rates. and that's medicare and medicaid reimbursement rates over time by definition based on the way we're billing. technology can serve as a tool for facilitating change in policy for empowering the individual to then get better access, in our case the diagnostic space, 80% of the decisions that are made in health care are driven by this military data. you can change outcomes and we strongly believe that one of the things this country is so great at is innovation and creativity and applying it toward helping to solve policy issues, in this

case our work, without having to raise taxes. >> i want to come back to you. let me ask, you made your money and you did a lot of good with your medical device work one of the things you said earlier this week, some of the people in your line of work think if they share information, if we have truly prehencive medical efforts, which will be easy to do. do it in a way that lowers costs. how do you get people to join? what -- how come you think you can do this and still be successful and so many people don't? how do we break down that

illusion that nontransparency is good economics. it's disastrous over the long run. >> first of all, with your help, you've been a huge source of inspiration. people want to get involved by what we're doing, by coming and helping start the movement sooner or later we're going to become victims or recipients of a great health care system, that not only has amazing technology, amazing doctors and nurses, but it provides a safety and quality care with dignity. i try to reach out to the ceo's and say to them, 20 years from now, after you retired, how would you like to have left this industry. because if we don't all share the data, we can't get to this patient data superhighway where

we can can create algorithms. if we're in the hospital and looking at the vital signs data, that's helpful to predict where we're going if we get the data from the electronic record from extra, from labs, all of a sudden, smart algorithms can predict, we have 50 companies who have made the pledge so far. we need the rest, if we don't get everyone to agree to share the data. we're not asking for the internal data, we won't be able to get it. i made the analogy, 11 blind men try to find an elephant. if we don't know the size, we don't know what we're touching.

>> josh, this insurance model you briefly described to us just as some layperson listening like me, it sounds like you're saying if i promote wellness, i can insure people for less money and still make money. is that right? that's what you're trying to do, right? >> absolutely. >> what we want to do is to insure for wellness, now, since -- and presumably, the bigger problems like medicare and medicare follow your lead if you could do this, that way you could be truly disruptive. what do you need to happen

that's beyond your control for your business model to have a good chance to succeed? >> great question. i think it's mostly about aligned incentives. i think there's a lot of things that we're doing that are differentiated. how does technology move the industry. if you're not a technology company in the next decade, you won't be a company, i think this is just an unprecedented change in the world where everyone either needs to adapt or move on there's so much that we can do, for example, amazon and google

know when a woman's pregnant almost immediately based on what she's searching for. but a health insurance company doesn't know until the claim is paid three months after birth. our ability -- our ability to understand what's happening in the system in realtime enables us to actually take something that is real, we can't prevent by giving away free medicine. if someone is sick, they're going to be sick. we can understand what's happening and point them in the right direction. i think over time our ambitious is to work more intimately with systems, and we're starting to have conversations around that to say how can we work together. how can we enable you to work with a customer in which we're capable of doing.

the best overall experience. i think in many ways the insurance companies and hospitals are butting heads. hopefully that will change over the next years. >> it's interesting you gave that specific example. it's another version of the point elizabeth made about early intervention through technology not being ensurable, because you don't know you're sick yet. both elizabeth and joe have different noninvasive technologies. that's what they do for a living. let me go -- jeffrey, how -- these people are really amading, right? don't you feel better living in a country where people are doing this stuff? so how do you propose -- what

are you going to do with what they know? in other words, how do we align the incentives and the health care system and government policy and all of that so that their ideas can bloom? and others too, people that aren't on the stage. we have a system that has for a long time punished people who did what they were trying to do. and under inverse them, and everything now we're getting to the point where we're into neutral. we don't have our pedal to the metal. we're not creating a 21st century wellness system first of all mr. president, i want to share joe's gratitude for you. it makes it easier for us.

i'd say the second thing is that we believe going out and doing it is the best way, if we find ourselves in policy inside the beltway, we're going to be there for a long time it's one of the reasons why the institute of medicine said it takes 17 years for these kinds of innovations to be fully spread. our thinking is just what elizabeth is doing. you go at it and find the ways to scale right now, all three of these innovations i would call exemplary innovations. our idea is to get the exemplars to the standard. we're working with the center for clinical excellence.

they found five percent of the primary care practices they survived, highest quality, lowest in terms of per capita costs, by far. they visited these practices and found ten attributes, the essence of the high performance our idea is that we need to find that essence and find ways to spread the scale you're limited to publishing, that's what we found in philanthropy, the spray and pray approach our thinking is, we have to get out there, we have to mobilize, we have to work with all the stakeholders, especially patients, to create the demand necessary to pull through this kind of high performance.

as we do that, i really hope we do collaborate with all three of them. we do wonderful things and we find those barriers after trying to scale it, then we'll circle back to the policy piece the know how transfer is more important. >> just on that note. what we noticed when we first launched oscar 14 months ago, we launched a number of things that had never been done before. we give away telemedicine for free. it costs you 0, the idea for us is, if we could understand what our customers need in realtime, we could pinpoint them to the right place and it would make sense and save them money and save us money. at the time, everyone thought we were mad.

now a lot of insurance companies are starting to do it as well and copy us. our approach from the get go, i remember when we submitted our first business plan, it was almost three years ago, to our first investor, he said what if people copy you? the way we responded at the time, we hope people do i think if they do, a lot of people are starting to be inspired by the idea of working in health care. a lot of purists want to work at the next -- copying the idea of certain funk ailty of this speech as well. >> how do you personally measure

success. how do you keep score in what you do? >> for me, it's completely about every single day how many people's lives are better because of what we do, when we -- the first time that i was able to income one of our wellness centers, which is the place we call where people give their samples, and see a woman who had taken a bus from about 100 miles away to come into phoenix, because she couldn't afford the ability to do a test anywhere else, even though she was insured, her deductibles were too high and she was pregnant and she needed to understand certain information about her body and when we were able to take care of her,

watching that emotion and what that means, in the context of one person's life who is now better because of what we did, that's when everything we do is evolving. >> that's pretty consistent with what they said. you don't mind if you get competitors that are doing better than you are doing. you think you can get rid of every avoidable health system by 2020. i told them a couple days ago, you'll actually get there in september of 2017. anyw anyway, you basically said the same things. if you were dictator of health care in america, you could do two or three things. what do you think the most

important things to do are? if you could change things based on your perspective, what would you do? spend more money, change laws, whatever, what would you personally do if you were in control of what everyone does in health care for a month? and we'd all have to follow your lead? >> i would unequivocally make it clear that access to health information is a basic human right. and i talk often about the fact that in california today i can buy a gun and shoot myself, but i can't order a pregnancy test. it's illegal, because somehow that information is too dangerous for me to be able to handle. until we get to a point in which every person has a human right to get information about their own body, we will not change our

health care system, because individual accountability can only start with understand iing had a chance to do work in louisiana with communities that were heavily obese. you listen to people talk about the fact that they're lazy, and that was not the case at all, they had no idea what to do to change their health. and if you can empower people with information you can educate, you take the first step in being able to facilitate the change. in our country there are 26 states in which it's legal for a consumer to be able to order lab tests. in all the rest of them, it's not, to say that by law an individual doesn't have access to the information is a symptom of the overall problem in our system, at the end of the day it is that individual

accountability you were talking about type ii diabetes. 80 million americans are prediabetic, 90% of them don't know it, and all you need is a simple glucose test to be able to tell you. >> all the conditions are reversible? >> completely. with individual accountability. >> so what change would you make if you could d -- if you were dictator of health care? >> first i would start over completely. >> good answer. >> i think i would just enable people to understand their health and understand everything that they have access to. i find it amusing at times that a child in africa with a smart

phone has more access than you did when you were president of the united states -- more access to information, i don't know how much it's going to cost me when i go into a doctor's office on park avenue, and i don't know why i'm going to that doctor. enabling the doctor to understand what they have access to and why they should go to one place versus the next is a good place to start. there's a structural disadvantage to our system because the health care system in the u.s. was built on a b to b business. when you're selling to companies, you're not selling plans that are right for the consumer always. i know there's a lot of people here, especially in the audience that are doing their best to change that. there needs to be a structural shift that's focusing on what the end consumer wants.

>> i start off by thinking innovation is the best medicine. the general accounting office, i would create a general innovation office, before the president or congress says anything i'd ask, how does that impact innovation? whether it's new patent laws, new health care laws. how does that impact innovation, we don't want to impede innovation. i look for getting rid of misaligned incentives. right now there's a perverse incentive to make errors in hospitals. if you go to get your car a tuneup and the next day you go to pick it up, and the car has caught on fire, they don't ask you to pay for the tuneup. they usually give you a new car. if someone goes in for a him implant and one of those ten

things that can cause preventable death happens to them, the insurance company still gets billed for that initial thing they went in for. what if we said, we're not going to -- the hospital has created processes to avoid these situations, we're not going to pay. imagine for a moment what hospitals would do. they would make sure all the processes were in place to make sure people don't get hurt. group purchasing organizations getting paid by vendors to negotiate for the best product at the lowest price. they're getting paid a percentage of fees by the vendors, what do they do all the time? i think aligning misaligned incentives and making sure we don't lose the innovation edge that our country has, that the

world relies upon. >> i empower the patient and i empower communities. we have the technology now to bring information to people we they can activate and engage in their own health process, we have an expert culture that's not giving up very easily, however, there is a sense, this isn't just health care, i think this is across the ages where there's this buildup, this vested interest of, i have the expertise, come to me, i'll take care of you. we have the technology to bring this expertise out on a decentralized basis. i don't think there's anything more effective in terms of care from a quality outcome and a cost outcome than an active engaged patient and surrounded by an active engaged family, surrounded by around active engaged community that's where i think we have to go.

>> i don't wan the to end this on a downer, but i think -- i love this stuff, i could keep you here until tomorrow morning, i think it would be a mistake for us to conclude this without recognizing that if all this were as easy as all of you highly intelligent deeply committed people make it sound, we would have done it already. so talk to me about -- this will be very good for all the people who are here. talk to me about at least one frustration you've had in doing what you do. how you manage it, and how do you in your business and how would you recommend us in working on health care -- what

are we most likely to flub up and how should we deal with it? >> one of my frustrations is that you come up with a new smart phone and within six months everybody has it. you come up with technology that saves lives and reduces costs dramatically to our health care system, it takes 17 years before it gets adopted. there's a problem with that, and i think it stems from this third party mentality, a third party taking care of you, paying for that care, a third party negotiating for things that the hospital should use that they should know what they want. so the frustration is, how do you get rid of this 17 year cycle that along the way kills and hurts people. today our technology, the first

one we invented over 100 million people are being monitored with it. 3 million are being impacted positively from saving their eyesights to saving their lives. that translates to half a billion dollar savings around ulee to the u.s. two randomized controlled trials shows it reduces blood transfusion dramatically. 90% reduction in blood transfusion, yet it will probably take 10 more years before it gets adopted. >> what should we do about that? that's. >> patient advocacy. >> you're like the little engine that could, you keep pushing the rock up the pill, that's sort of been my strategy in life. the less time you have to push rocks up a hill, the more you'd

like a different way. how can we? what legal or institutional changes do we need to avoid, it would be hard to get anybody in america to stand on this stage and say i'm for this 17 year time line, it's the greatest thing since sliced bread. by all means let's wait 17 years and let people die in the meantime, we have lots of things that no one would ever defend up front but we all every day shrug our shoulders and live with such things. you want to go next? >> i may get in trouble for saying this. >> god i hope so. somebody's getting in trouble here. >> i feel grateful i've interacted with extraordinary

people in the health care space, i think what has been frustrating and at the same time motivating has enabled us to bring on people in the world i've had the opportunity to work with. they don't care about the patients. there's been some systems that we've interacted with that are so ecstatic about the ideas of working with us and creating a better experience for the people that go to their hospitals, certain physician practices that realize they can make a tremendous amount of money, maybe even more, but provide a much better experience, there are some that look us in the eye and say, why would we ever change? because we're making really good money and we don't really care. so it's funny, we live in this idealistic world, and we get really excited when we have a meeting with one of these people, it fires me up for a couple months. but at the same time, it's

frustrating that in a world in which you're providing a service to people where their health is the primary thing in their lives that people don't really care about them as individuals sometimes. frustrating but also motivating. >> i think it goes back to empowerment of the individual and the consumer as a way to not have to deal with sometimes the confusion that exists with some of the established entities around something simple like, do you want to save money? sometimes these conversations we can come in, save you $80 million a year, $100 million a year, that should be a simple conversation especially when

you're not asking for anything in return. but the entrenchment is so great that trying to work through those systems, trying to work through existing policies in our mind is harder than empowering the consumer and creating an inf infrastructure outside which by by definition will make that change because of the way you're empowering the individual to take ownership and because of -- for example, we started billing at the rates we bill, we publish all our prices, everyone knows how much a lab test is going to cost them, before they get a test every single time, that's making a shift in the system by acting outside the system. we really believe in that as a way to make a change. we try to spend most of our time focusing on ways in which through individual engagement we can facilitate that change as

opposed to trying to convince the existing system to change because that could take a really really long time. >> my biggest frustration is data and health care is so opaque in terms of performance. and if i had the step that i'd like to see us take is make all data open source, all of it and the idea that it has -- that it's proprietary, i think there are other ways to compete. you go into a grocery store, there are no prices, you go to the cashier, they tell you the bill, i mean, that's how health care is. so what elizabeth's doing is groundbreaking. with data, i think we can shine a light continually on best performance. and consumers can see what best

performance is, but so can providers, the primary care exemplars didn't know they were exemplars. >> i want to tell you why i asked all these questions. i found that the resistance to change that was self-evidently good like just the examples you've all sighted was often rooted in self-interest, that's what you talked about, but also the comfort of the way things are, people find -- a lot of people reach a point in life where they don't want to think

about doing things in a different way. it's the inertia they drill into society is enormous, the advantage it gives to the status quo is staggering, the idea of changing people boxes within which we around reality, it's a real problem. the third big problem i found is, if you want to make a change that will make things better, but has more moving parts than the way things are, that's really hard, i'll give you the best example with energy. you want to build a coal fired power plant, you have to go to one contractor to build the plant, one to supply the coal, one governmental agency to approve the plan and the rates and you're off to the races. someone else has done all the rest of the work. you want to create just as much energy in a much more expensive and labor-intensive way by

having massive building retrofits. something i try to do, a lot more moving parts. >> costs you less money, save the environment for our children, and create a heck of a lot more jobs. i spent decades, a long time working in my foundation in the caribbean where they have the highest electric rates in the world. it should be 100% clean energy region. but if they buy oil from one purchaser and somebody gets it and then the appropriate political people get their contributions and you have old fashioned generators, there you go, you're contributing to climate change and bankrupting the country and it would be a lot cheaper to be in totally clean energy. what a way to market a region. it's hard to do because of the

moving parts. the reason i'm saying that is, we're coming to the end of this program, and it don't mat ter what the policy is, that's why the world desperately needs people like you, that's why we will always need innovators, brains will always be more attuned to the comfort of the present than the adventure of the future most people's brains and yours aren't. there will always be money, more money in the status quo, one reason i admire trevor, sitting at our table. he gets up and he's still the little -- like -- he's still a liberal reformer he was as a young young person. he tries to think of a way to push that thing down the road in the right direction, a lot of people dosht do that, we will

always need the disruptive innovators, we need you and so that's sort of off topic, but it's true. i want to thank you for what you've done with your lives and encourage you to keep going. for all those other reasons no matter what you achieve, we will need someone to disrupt what is going on. and i thank you for it. [ applause ] >> we have about 10 more minutes, you have people who are involved in health care across this valley and the country. a lot of them like me wonder if we'll ever see the east coast aga again. go figure. so i want to give you a chance

to close out in a totally different way. i want you the innovators to ask them to do something. if you could get everybody who came here committed to developing a wellness model of health care, community by community. what would you ask them to do. go in any order you want. >> i think while data is critical and is king i think action is king and i think action that's inspired by love -- i think if we start all loving other people's children, the way we love our own. all of a sudden these issues step out of the way, so i hate to sound like the beatles or whoever, but please just give more love to the world.

[ applause ] >> my wish would be that every person here takes just a minute to think about what it means for health to be a basic human right and a right that every single one of us has, that every single person we love has in the context of ultimately being able to change what we know in this world today around having to say good-bye too soon. if we start to see access to our own health information as our human right then we will start to engage with it, and we'll start to become more interested and look through a different lens at understanding it, and then using it to change our lives. we should not be living in a world in which we know more

about our credit card data than what the cell blood count on our lab report means, and that starts with recognizing that we have this right, the right to the health and well being for those we love, for ourselves is the most fundamental human right. when we know that, we'll begin to change our system. >> very much in line with what elizabeth just stated. i think what i would ask is, as you're developing your businesses, you don't necessarily think about your business as much as the product that you would want for yourself, and i think a fundamental prince pelg of what we've done is we wanted to create the health insurer that we would be excited for our family to use, and get the access to care that we would want for ourselves.

i think that sets the bar at a much, much higher level. so i think that's it. >> i had an old mentor, when he would hear me ex-tolling all these big virtues, he would say, so jeff, what are you going to do on tuesday? >> i think you all have a dream, a vision, passion it's time to ex-cute. what are you going to do on tuesday with that vision. [ applause ] >> well, i'm going to do something off the books. would anyone here like to ask any of them a question? i'm going to ask, how can you -- do you have plans to go beyond the individual market?

and how can we -- how can you get traditional insurance companies to adopt some of your changes? when will you have enough data on this prove that what you're doing works? because it's not like -- there are some insurance companies that really are trying to promote wellness now and they really do recognize that they can keep rates down now that there's no cost shifting that they have to eat and -- or there's less anyway. how do you think we can move from what is only 10% of the insurable americans in the individual markets to the other 90% with your model? what do you think -- when can that begin to happen in earnest? >> to -- first we're expanding to additional states next year hopefully, california and texas,

and we will also expand into the group market at some point. it's not our top priority at the moment, but again, we didn't start the company because we wanted to provide insurance to individuals, we want -- we started the company because we wanted a better type of insurance for everyone. so that will definitely happen at some point. in terms of data on what we're doing, there's been a tremendous amount of data in terms of engagement. some of which we've shared publicly, which is 85% of people have given us access to all their previous medical health records, 90% of people have filled out detailed health risk assessments. we have, you know a large cohort of our users speaking to us through telemedicine, our amalars for the health insurance nerds in the room pretty much went above the lowest in the

state on the individual market and i think we're, you know, one of the other insure roars that asked to drop prices after the initial -- initial year so we're actively doing our best to kind of continue to introduce new products, see if they succeed or fail. while we have had a tremendous amount of success to date we will introduce things over the next years that don't work and i think if we don't that will mean that we're not trying to innovate enough. but in terms of working with other insurers and hospital systems, we are already starting to have those conversations to kind of get our products to as many people as possible. >> i think it's really important every year that you make a report about what does and doesn't work because everybody is going to start following

this. this will be -- there's enough action now in the insurance business, everybody is going to start looking at this and it's very interesting the -- joe's conference on preventable deaths there was a lot of talk about how troubling it is when people don't have access to their own records on everything and how we could clearly store them securely and make them available to individuals and to their designated providers, people they approved it to. this is a -- it's a huge issue, it's the next big thing. you know, it was kind of touching almost, the government made an effort last year, almost a year ago now, to publish the first comparative data on, you know, medicare and medicaid and

there was a lot they didn't have. you know, in terms of what the results were at different healthcare providers and pennsylvania is the only state that -- or at least was the first state that started regularly reporting the impact of what did things cost and what were the results in hospitals throughout the commonwealth of pennsylvania and they -- every year they found out that there is no connection between price and quality, the only connection with quality is how many times do you do it, whatever it is. but still we're just -- we're almost in the stone age in real access to data and empowerment and that's the one thing that i have heard in different ways from all of you today. that maybe is a message we ought to send out there that it only hurts for a little while when you practice transparency and then pretty soon you can't

believe you didn't do it. you're stunned at how long it took to get around to it. everywhere i work in the world where things are transparent they're working well and where they're not it's not so hot. i just went back to indonesia last year ten years after the tsunami, unrecognizable and it was the first global disaster that i believe was ever conducted with virtually 100% transparency, where did the money come from, where did it go, who got it, what did they do with t you could get it all on the internet from start to finish, everything should be done like that. but it's an unrecognizable place now. so that's the sort of thing i wanted to -- you know, i got that from all of you in different ways, but if you really want a patient citizen centered health system,o