are doing related to privacy and just that environment generally. >> yes. i think, you know, you're absolutely correct about that with personally identifiable information and where you store information and all of that. that candid answer is i think there needs to be a lot more work done in terms of how do we make sure we have the right privacy standards. they're top line and fairly basic and companies intuitively do the right thing. so they regulate themselves to figure out what they should do. the most progressive privacy we see is in europe and if we're over there, i mean, you have to be exceptionally clear of how you use data and what form and all of that. i think we have some work to do here in terms of what we do with people's data, but in my view, it's not a hard problem to solve.

this is about having rules as opposed to a technology issue. the technology part is easy. you can take data, store it anywhere, protect it at the whatever level you want. that's not the problem. the problem is do we allow people to use this data for any other purpose? is it clear what purpose it's for? and are we aligned with the person who we got the data from? right? that's where things break down. i think there was another -- either that or you're flexing your hand. >> so where do you see innovation working to help employers, particularly large employers, connect locally with community-based programs? >> yes. so in this day and age, you can see -- let's say you have 100,000 people that you're working with. you can actually see what they're doing online. you can see what they care about. more importantly, you can actually see exactly what providers are doing online.

so you can see what cardiologists or oncologists or general practitioners are doing, who they respect, who they are listening to for advice, how your employees and providers are talking to each other. so when you actually look at the actual world of what's happening, you can start to say, hmm, how do we shape that? again, because too much of what we say is inside our company we'll share information rather than say, okay, who are the physicians in the network that we're in? what are they doing? how do we actually have a better relationship with them? that's pretty easy to do. doctors are online. they have an mpi number. you can see exactly what they do. and i think of like -- i'll give you one example. like probably can say this. a big clinic that -- very famous clinic you all know actually looked at what their providers do versus what they think they're doing, and it's not the

same thing. so we have to also start with how do we actually impact the people who are prescribing medicine or implanting devices or doing things to make sure that the whole ecosystem is actually working together as opposed to just shaping the views of patients? and we see this over and over and over again that that's a big issue. >> can you address the issues of hipaa and political resistance to privacy? because i think those will both have to be looked at. >> yeah. i don't know that i can solve that for you in 30 seconds, but i do have an opinion on it which is that we have to stop -- i wouldn't say politicize things but stop talking emotionally and talk factually about what we can do. because if we actually look at what we can do in terms of guidelines and storage of data it is not that hard. it is -- we get worked up with,

you know, is this something going to be misused? all right? so i don't know if that is addressing at all what you said. okay. that's a good way to end. yeah. yeah. okay. you just raised one of the hardest things out there on the planet practically. other than saying how do you, you know, cure poverty. right? okay. i'm at the very end so i think i should stop and then thank you very much for having the time to listen. [ applause ] ♪ ♪ ♪

♪ ♪ >> hi, i'm joanne kennan, the executive editor for health care at politico. we have three people here, all physicians, right? who are going to talk to us about population health. i'm going to introduce them, tell them -- have them say what they do, and then spend a couple of minutes defining population health because it's one of those eye in the beholder kind of things. we don't have common definitions.

so let's start with dr. catherine baase. correct? >> yes. >> she is the global director of health services at the dow chemical company, and she is in charge of keeping everybody there healthy, right? >> that's true. so in that role, i'm responsible for our occupational health health promotion, epidemiology research, health policy, health benefits so the landscape of health with really the mission to accomplish better health for our people because that's related to all of our other corporate priorities. and when i say our people, i mean dow people broadly. employees and families and retirees and to get better value for the dollars we spend. >> okay. then we have dr. steve peskin executive medical director for population health at horizon blue cross blue shield of new jersey. >> i bet know what population health is, right? good morning. thanks to the chamber for

organizing this. i'm general internalist by clinical training and lead our efforts in population health which we'll get into much more more at blue cross, blue shield more deeply. we're the largest health insurer in the state of new jersey and i jokingly or seriously say the ford fusion american car is my office and spend time out in the ecosystems from doctors up to the largest health systems in the state on a whole variety of efforts around consumer engagement, physician behavior change and efficiency and quality of health care. >> and we have got dr. george isham who's the chief health officer and plan medical director at health partners in minnesota. right? >> right. >> okay. and your role here? >> so i have been since -- for some time, the medical health officer and plan medical director of financing system in

minneapolis/st. paul in minnesota. i also co-chair the roundtable on population health improvement at the national academy, and that's another perspective i bring to the conversation on population health. >> okay. and i noticed when i was reading about your bios, all of you have been involved very much on the metrics of health care defining quality and figures out how to measure it and able to speak -- your experience is both very granule how do we know if we're doing the right things and what are the goals trying to set and do they mean something and a larger topic of population health. and not everybody here is in health care full time. i think when you come to the term population health, people often confuse it with public health and the traditional -- fighting tb, or whatever the modern equivalent is. isn't the same thing and yet we don't have a common definition. so i think all of you have an internal population you're

responsible for or employees, members of your health plan. but all of you are engaged in a larger sense of coming to terms with what is the health of population, who do we become healthier? why don't you each use your working definition? start at that end, george. >> well, you know, the common usage talking about sub populations such as employee groups or groups that are cared for by a health plan or patient clinic population, those with diabetes and so forth. and the formal definition is the health outcomes of a group of individuals including the distribution of such outcomes within a group. and those are primarily length of life, its quality and, as i said, the distribution within the group. total population health sort of a little addition to that would be geographic population, like the health of the people in city of washington, d.c., for example.

>> all right. and for horizon, what is your -- >> yeah. it is a multifaceted, right? so dr. isham's definition certainly resonates with me. when we think about it, we think about all the four of us are individuals so they -- all the end of ones, each of us individually and then how we map to certain areas so it might be to a geography. in the case of horizon, we're all about new jersey all day every day but there are broader populations. thinking about our population, we look at persons with a certain condition like diabetes and that group. so, as individuals, we might be young, healthy 20-somethings and part of the population, as well. it might be around high-risk behaviors, preventive services. so really, think about population health as not just

forgetting about the individual identity and who you are as a human being. that's still very much alive and well with physicians like us and with the health systems we work with. that said, we then look at and are able to take -- pull together certain groups of persons to say how we're doing with that particular group within -- as george said, a subpopulation within broader population and so simultaneously. i like the word simultaneity. you as an individual what your conditions, concerns. social behavioral, health and then how you fit into some population which may be around a clinical condition, which may be around the need for certain preventive services which may relate to who your employer is. that's kind of how we view it. >> at dow, what is your population? >> we are, as i mentioned, focused on our employees because those are the people that are driving the success of our

organization, and their health matters. and we think of health as a classic definition of the world health organization, sort of the optimal state of well-being and not merely the absence of disease. we think of health as a very positive construct on a continuum, and we also think of all the people that are on our health plans so that's bigger than our employees. in fact, our employees are only about 20% of the people on our plan so our dependents and retirees and the community we operate because that influences the health of our employees and their families. >> traditionally, as in many things in our economy, we've thought in very short-term ways. it is hard to think in a society where people are changing jobs

and changing insurers and changing -- the investments in health may not bear fruit for decades, even in government, right? it's hard to get the cbo to score a diabetes prevention that might not make money or save money for 30 years out. we think in much shorter windows. how are you -- either how is the system enabling you to think in longer terms or how are you getting around the system that's encouraging short term? maybe you have a very stable workforce, but it is still a problem for -- you may have a -- i don't know the longevity in the workforce. maybe you're more stable than the typical one. but how do you get people to think of this long term? because you understand it but not everybody you work with might understand it. start here. you have the closed -- >> so, you know, i don't think that we really said we're going to think long term versus short

term. we're looking at both. and one of the most important things for us to do was to understand clearly how health benefits the individuals and the company. and what we have done is create a line of sight to each of the corporate priorities. how does the health of the population impact the safety performance, our workers' comp? how does it impact our engagement and job satisfaction and all these other human capital metrics which are very important? and, in fact, it impacts our ability to reattract and retain talent and one of the most tangible symbols of how we value the individual people in organization. and so, it really has a very broad value proposition, in addition to, you know, keeping healthy people healthy and helping others get healthy helps us to keep our health care costs

in a lower level. and so it actually is connected broadly to a broad set of the priorities of the company, and we make a sustained investment in that to achieve those outcomes. and we're measuring the health of our people, and frankly, we do see benefits on a shorter term basis because of the connection to all of these other priorities. >> as a health plan in a rapidly changing environment, changing incentive, changing rules, how is population health changing? how do you think of it differently? how do you act on it differently at a blue cross plan? >> yes. we are again simultaneously looking at what we're doing intrayear. we're not for profit and not for mission and many appreciate. that said, we have in my view taken a very positive step toward -- we have a,

fortunately, very stable population. though there's some change. so working with the clinical partners and group and north carolinians here from the public health. what's 365 times 24? i know it's over 8,000. so fortunately most of us are not spending the time in doctor's offices or with their health plans or health systems so we're increasingly thinking as cathy said about the community and how do we reach our members? our patients? our customers? people. really i like to think of person-centered care. person-centered care, not patient-centered care. who do we work with employer growns, communities, taking a broader view of health and well-being opposed to sickness care construct, and i'm pleased to say we're making some progress there. >> minnesota's a state's that's further down the road in terms of integrated care, and you're having some exchange problems at

the moment, but you're sort of a model in many ways. the rest of the country is sort of a few years behind a lot of things that happened in minnesota so can you build on what you have heard here about sort of ethos and approach? >> you know, we have been thinking about not only high quality care and more recently the cost of care and the health of the people that we serve. and to your question about, you know, the mobility of the individuals versus the interest in place, you know, most businesses and most communities you set down roots and live there and you can move and most people don't. and they're invested in that community. with respect to health care, there are factors that drive that outcome of a long life with good quality. good health care is critically important to that. but experts would estimate only 20% of the impact comes from health care.

the second is health behaviors. whether i smoke or not, whether i'm active in terms of exercise, which i want to be more of, and whether i follow good nutritional practices and don't abuse alcohol. that's the top in rank order from the cdc, and they have a priority list of encouraging both personal behaviors. but then more than half of the factors dependent upon the context or community in which we live. and that's -- >> social determinants. >> the social determinants. those factors have us more interested in how we play a role in linking those kinds of interventions to personal interventions because we want to see everybody thrive as individuals, but collectively, we also rise or fall together. there's good science to suggest that. so, that's -- the sophistication of thinking about it not only immediately, in terms of what you have control of for your personal life and what you can

do tomorrow for your employees is only half the story. the other half is thinking and learning about this more complex pathway. >> let's talk about -- several of you mentioned diabetes. every employer in the room is dealing with this through their health plan. it is -- talking about diabetes 2, not the -- the more preventable, not always preventable but the one we do have more control over and it's huge. it's hitting younger, more people and related to obesity epidemic. let's just talk about it because it's a thing you can get your arms around diabetes. there are warning signs. some of which are personal behaviors. let's talk about the intersection of how do you, you know, what is population health and your three spheres dealing with this prevalent, expensive and often preventable disease? what are you doing and how has it changed five or six --

because we have begun thinking about workplace wellness, incentives differently, privacy barriers and challenges to get around, but there's also some more incentives to get it right and a more of a conversation about getting it right. what are you changing? what are you able to do now that you hadn't thought of a few years ago, or thought of and hadn't been able to get around and overcome obstacles? >> yeah. diabetes is a great example of a chronic condition. we know that the majority of the money we spend goes into chronic conditions. you know, some estimates 75%, 80% of the dollars that are spent. so focusing on a chronic condition is important, and our focus has been moving upstream. and we want people who have diabetes to get optimal care, but we really are looking at how do we stem the tide of this epidemic that we have been living through in our lifetime. so we have really been advocates of utilizing the national diabetes prevention program because it's an evidence-based

intervention. it's got a package out there that you can count on. we have used that within our company on a widespread basis. it's available to anybody who's on our plan and opportunity to participate in the diabetes prevention program. in addition, we have worked in the communities where we have a significant presence of population to create sustainable system change and looked at the availability of these upstream actions that can identify and intervene before somebody becomes diabetic and facilitate their progress to not becoming diabetic. and honestly, we are seeing some pretty good results. >> can you give an example of how what kind of behavior change you are seeing and what -- very specifically, what are the triggers you're pushing to get somebody to the gym or make them stop eating whatever they shouldn't be eating?

>> if you're not familiar the national diabetes prevention program it was from cdc and nih. >> 11 years now. >> it's been out there a number of years. widely researched, highly effective program. and what happens is you measure the impact on people's body mass index, their weight and their behaviors. they're really focused on better eating and activity levels and so collecting those metrics is how we're measuring the progress in that program and what we're getting. so, as far as our general health programs, we have a variety of things that we are doing for prevention in our population broadly. we were just now speaking about only the diabetes prevention program, but we really provide a health advocacy model. we focus on a culture and an environment within which people can live quality, healthy lives and that by being at their workplace, it actually helps

them live a healthier life than if they weren't in our workplace. >> and in your -- how does an insurer, each of you, get somebody to do what they know they should do but often don't get off that couch? what can you as a health plan? >> that's really hard. talking with will and david at breakfast about behavioral economics and irrational decisions we all make around our health, myself included. on a positive level, the metaphorical cloud and the rain falls down and creates the data lakes. we mine those data lakes from the cloud to the lakes. and we're doing okay. we have in our -- what we call the value-based programs, medical home, acos, 6% lower total cost in diabetic persons with diabetes, but they still have diabetes. hemoglobin a1-c and hardly tells the whole story. i had a resident and said, dr.

peskin, the patient's doing well. i go in. the guy has one of his legs is amputated. he has a caretaker. he's legally blind. i said, we're not doing okay with this person. i mean, you told me a story that sounded like this guy's okay. just because the blood pressure is okay today and the hemoglobin and a1-kr. we're doing okay by taking information and sharing it with our clinical partners and they, in turn, are driving toward metrics, right? health effectiveness, data set, medicare, star, total costs. but we still have so much more to do on tackling the causes of diabetes, the behavior change, and we've -- i'll admit we have a long way to go. >> so the total population approach would suggest that you want your doctors to practice the best evidence-based medicine that we know has them giving advice to the people with diabetes.

so that's step one, number one. >> to do that you promoted in minnesota the quality improvement training and standard approach for all payers and all providers and the second thing is you want to promote programs that address the key behavioral issues that lead to diabetes and so we have obesity and nutrition is a tough nut not to crack and we haven't made as much good progress there but with the control of diabetes and measurement standards we have managed to improve the consistency of clinical practice across the state and cut the rate of complications by diabetes by over 30% in the entire state population. so we're not talking about a pilot or one clinic. we're talking across the board

through approaches and then what we need to do is reach out which is what we are doing now to educate children and schools about healthy eating and behaviors and we need to partner with public health in terms of minnesota with respect to smoking and other risk factors and would be factors and those four buckets of health care, behaviors, social economic factors and vierltal factors and encourage people to be active in their communities are all part of the solution both the immediate solution for people with diabetes an the solution in terms of people and risk. >> here we are talking a lot about health and the slide and the graphic and title says leaders in health care investment but we're really talking about leader in health

investment. as george has pointed out health care is a piece of the solution. >> normally it's after you have gotten sick. >> right. what we really want to do is achieve health so we need leaders in health investment including health care. we're focused on health. >> echo that the upstream you talked about is so important one of my good friends is a well regarded family musician in new jersey and he says, you know, the wiser i get the more i'm convinced that what i can do for people is when i talk to them and encourage and coach and change behavior which is really hard and it's not just mds and dos it's even medical assistance and our models taking on more responsibility operating at the top of his or her certification

and license and that culture of health is opposed to health care is really aspirationally where we're headed. >> another buzz word in health care but it's related to this activation is patient engage. it it's one of those terms hah can mean a lot and it can mean nothing but you do -- to create or encourage health or build on health you have to have a partnership right? if the patient goes hole and just sits on the touch and eats buttered popcorn, not to pick on popcorn but that's what popped into my head, they're not going to be healthy. i have three members of my family that exercise and one who doesn't so i know that, yeah, i mean, he is not as healthy as the others so in terms of how all of you come at this -- and sometimes about patient engagement and oh yeah we have a

website they can make their appointments online without having to be on hold. i think that is convenience. i don't think that's patient engagement necessarily so how do you -- by patient it can be someone healthy as well and trying to preserve their health. how do each of you think about the tools that you have to get the patient to understand the individual to understand that i have to do this. i have to own this. going to the doctor and listening to something doesn't doing anything if you don't then behave differently or keep behaving in the way you should be behaving. >> it's a very important question and the answer is having a thoughtful strategy and the strategy for us has several components. we have a strategy a corporate health strategy whereby we are looking and it's ult m components of that.

it's poll southwest airlines sy so we have policy related to smoking for example. so policy pays a role. >> is there also high wrer premiums for people that smoke? >> on life insurance there is. so policy matters and the second thing is how do we create a culture and an environment and we have had for many years a healthy work place index which is a measure of all the factors that can create an environment that facilitates healthy people. that's access to healthy food at the work site. access to opportunities to move and exercise. it's looking at the stress in the environment and opportunities where peers innuance your behave wror ior tg

a culture that talks about this and leaders give it air time and speak to it and then individual and health assessments in counseling and coaching so all of that is a part of this strategy and looking at the way we designed our benefit plans that facilitate that and then i mentioned the community so we'll look at the community and how we as a company can participate in achieving a healthy environment in the community so we have our work place environment as well as the community and we can use our philanthropy and more targeted and intentional ways to impact the health of that community advocacy is another mechanism by which we can facilitate policies. and how we can get everybody working on shared goals at the community level so i'm trying to illustrate that we have a strategy that's ours and a strategy of engagement at the

community level and it does take all of that to get that behavior change. >> and what are your tools to get that engagement? what is patient engagement or consumer engagement mean to each of your plans? >> well, you know, it's integrated and this particular strategy also has to do with place in terms of where your, where people are achieving care and the approach to care and the states that surround them as well so you have to talk about gn an individual approach which is being sensitive to the culture and the people involved. being able to help them learn and their capabilities reach out in a way and being culturally sensitive in terms of where the messages are coming from because people have different trust

depending on who is saying it and whether they're different for the people receiving care for example. and for example and i'll give this example in terms of a screaming strategy for places where transportation is an issue and socioeconomic factors or other factors compressing the care so that the distance between recommendation and receiving the services in the same visit will increase rates and then tracking your performance by a race and socioeconomic status and turning your quality improvement tools into two diagnostic tools so you can figure out what approaches to use. that will be on the delivery side. very much matching that up with the population approach and then the program that kathie was talking about.

and wellness programs. and 26 clinics with employers. that kind of outreach to make it more accessible so they don't have to take time away from work and increase the productive but also the access of the ability of people to engage. for example example and though we are not a delivery system increasingly we are working in a very collaborative way with our clinical partners and with our purchasers so that's a very important and profound change. we can do better in this area. and in one section of that book he talks about participation in 401ks is like 85%. participation in wellness programs is like 25%. >> that's exactly -- >> we're not doing something

right and again i'll reference in other books how to change when change is hard. and switch and we have to figure out a way to smooth the path so that we are able to see groups of folks going down a better path and using the 401k versus wellness and we're just not there yet. one positive example getting into the communities. one going to diabetes and one getting usual care. this is a very high performing group so usual care is pretty good. so the peer coaching group that got better results those are the kind of things we are moving toward thinking differently and getting a better health outcome. is it moving star me tricks?

yes but overall we still have so much work to do. >> there's so much talk including the talk right before this panel about the potential tech and i forgot the number of health and fitness apps but all of us together couldn't count them in a week, right? is there anything that you're using with the populations you serve that is actually, that you're investing in and you see this is a tech tool that is making people stay healthy or controlling there, the conditions they have better. is there a there there in your world. >> i have to say at this moment there's no silver bullet from a technology perspective that we have employed that we said this thing has changed everything for us. we do have fortunately a much higher participation from our employees in our overall health

programs. it's 90% worldwide. and we have done things differently than most people so to the words of our first speaker today we have to think outside of the box and our approach is is we don't provide financial incentives for people to participate at all. and participate in programs and the difference is that our approaches have made something so valuable and the experience so positive that people will always want to come back and will always participate and earn their trust that everything that we're doing and offering to them is truly in their personal best interest and behave and act with integrity that we attach this to other things in the company that have had high participation rates so we'll be very

successful and to use a marketing mind set and create value to create participation. >> the interesting thing about tech is that at harang gets ward business school the experts actually asking the question, what are the factors that drive health? the experts will overestimate the personal impact by a factor of technology and personal care by a factor of 2 to 3 so we as human beings want to believe that we are in personal control of our mortality when in fact we need to collectively work on factors that actually help us determine collectively where that mortality moves. those are far more important than we would estimate. now having said that we got a lot of apps and technology that we're deploying to try to help people track their activities

and motivate them to change their behaviors but the science isn't in on that. we have a lot of faith in that and conducting studies to figure out whether there is in some of that. on other in terms of programming in the work place, we have some good data about impact for companies and company productive. >> and the ones exercising or playing soccer anyway, do you know whether it's making people do more or they're just enjoying tracking what they would be doing anyway. >> i do see some selection. i wear one of these things and normally around 58. and a little bit nervous up here but just a personal observation and sort of their selection

going to the gym anyway and we're working with our clinical partners on directional data exchange and we have been looking at a variety of -- application of tools and technology and some of our groups and patient portal and it wasn't exactly an app. and we've seen or observed or done yet that is very profound. the proverbial game changer as it relates to a wearable or something like that. our keynote speaker earlier had some insights an ideas on that but from our perspective we haven't seen anything that's been profound. >> it's time to wrap up and my closing thought i shared with them on the phone is when they first asked me to do a panel on health care investment i thought

it was people buying companies. i thought it was about vc or consolidation and getting bigger or getting smaller or whatever and i figured out who was in the panel before our phone calls and it's a different kind of investment. it's an investment in the population. that one way of getting these costs maybe not down to the way we really love them but a way that we can manage better does have to do with thinking differently about what is health care, what's health and how to investment hah we have come to call population health so thank you for joining us. ♪

>> good morning. i'd like to begin by thanking the u.s. chamber of commerce and the u.s. chamber of commerce foundation for organizing the summit. today we have got the business community and the health care community and we have the policy community that all together here and we don't often get together and we need to do more of this. it's important for the future health care. i take a few minutes just to introduce who we are. so it's a $4 billion not for profit health care system and we're comprised of about 500

clinics and sites that obviously provide advanced medical treatment throughout north carolina, south carolina, georgia and virginia. we treat more than 4 million patients annually in those sites. not for profit. just to know that i, i have been with them for 18 years and in the last four as the last ceo. so today we're here to say we're here to talk about important topics. i describe it this way that we're redesigning a plane at the same time we're flying it. now think about what i just said. redesigning a plane while we're flying it. so why do say that? let's take a moment and look at the state of health care. as you all know the health care industry is in the midst of dramatic evolution. the affordable care act had a

profound impact on insurers doctors and hospitals. the national imperative is clear. we must improve the patient experience and improve population health and obviously reduce costs. we must do this at a time that demand is on the rise. we have a rapidly growing senior population that needs the most care today and we have a group of americans for the first time. just with the experience the number of people entering our system has grown over six years since the law was passed. so for example we operate across those four states that did not expand medicaid. for example our position office visits are actually up from 3.8 million in 2010 to over

4.1 million in 2015. no problem. i forgot one important point. we must do this at a time when the payments we receive from insurance companies medicare and medicaid are stagnant and declining. an don't forget our payment structure is changing from one based on volume to one based on value. patient outcomes and satisfaction rates are important factors in our revenue stream and we're all being held to much higher quality standards. we're also sharing a risk today and our ability to treat patients efficiently and effectively will allow us to succeed financially. so all of what i just described adds up to a challenging business environment. but i want you to hear me. we are up for the challenge. we are up for the challenge. so i want to take a minute to

explain the approach to flying and redesigning the plane. this is an important aspect with what we have been doing. so first we focused on treating the individual rather than the disease. this means offering new access points to consumers by expanding office hours and providing off hour visits to better accommodate our patients busy lives. it means using new technology to our advantage but offering online scheduling options and and patients can e-mail providers. review their lab tests and schedule an appointment and refill their prescriptions and i'm sure today many of you are participating in hospital and health care systems that offer these services and if they're not perhaps today you may come and join us. we conducted a study that showed

how our consumers wanted to be tre treated they value respect as much as effective quality care. that's a very important insight. people want to feel respected whether they're in a hospital or a clinic and we work hard to honor that wish by training our doctors and nurses to empathize with compassion that delivers the reremarkable patient experience that they deliver in a very authentic personalized way. second we have invested heavily in health care technology and we are big believers that health care technology is important and we value it and we may be one of the minorities when it comes to this issue. we have invested 600 million in our electronic health record and we believe it's a great investment. it has helped eliminate errors

and contrary to popular opinion it's increased the amount of time our providers and nurses spend with their patients. we put -- so for example we put technology in the hands of our nurses and they go from room to room patient to patient to discuss how each person feels, what the treatment plan is for that day. recordkeeping happens in real time with the nurse and the patient together and in our case 76 of a 12 hour shift is on direct patient care in the patient room so the industry average is less than 40% of a 12 hour shift on direct patient care. this also helped with the patient experience and helped with falls inside our hospitals

and it's been good for nurse morale. they get to do what they always wanted to do. take care of patients. physician burn out and nurse burn out is a unrecognized threat across the country. besides recognizing physician wellbeing as an important priority earlier this year. you may be surprised to hear that on average one physician a day commits suicide in this country. think about what i just said. one physician a day commits suicide in this country. and a recent survey showed

nearly 50% of doctors reported feeling burnout in 2015. 50% so i would tell you burned out physicians, burned out nurses are probably not delivering the highest quality care to their patients. that's why it's so important to make sure our doctors and nurses are in good health. so we have developed a home grown program to help our providers address burn out and develop the skills they need in this new health care environment. since launching in may of 2013 the program helped more than 600 health physicians and 300 nurses regain their commitment to the pursuit of medicine. and let me share a story with you. and brings the program to life. the physician that completed our program wrote to me and i'm going to read the text to you. says thank you you saved my

career. what's really important is you saved my marriage, my relationship with my kids and most likely my life. thank you from the bottom of my heart. this program is reengaging physicians and nurses and getting them back into why they got into health care. these are challenging times and every hospital and every health system across the country faces the sail challenges that we do. we're making progress. they needed to achieve the triple aim. as you know we operate in an environment by the federal and state level. the rules and regulations are sometimes contradictory are written two decades ago from

health care systems that frankly no longer exist. for example, current rules of regulations make it risky for doctors and physician assistants to collaborate on care. it bars hospitals from sharing an electronic health record with certain outside physicians. it creates financial disensign tifs to follow best practices and bars hospitals from making specific recommendations about which skilled nursing facilities to consider after discharge. even if we know and there's data that shows that certain ones deliver higher quality care. this crazy patch work of rules and regulations should not serve and bars patients very well. we need policies that eliminate obstacles and make it possible to deliver the affordable high quality and affordable care that

is expected of usful we need to update an modernized set of rules and regulations that support the collaboration among hospitals and doctors and care that is essential to improving the quality of care. so we support reforms and the kick back law and so we can do the following. to improve care coordination. allow collaborative arrangements to coordinate care when a patient is discharged. and provide assistance to patients to maintain their health if they return home and we believe in it so much that we'll be working with american hospital association and the next congress to address these opportunities. we also believe there's room for collaboration among come petd

tos. especially back off this function such as revenue technology and human resources and purchasing and in addition to back office functions we believe that we should look at sharing in some clinical investments with competitors and not duplicate efforts. duplicate spending. we believe that we could save millions and millions of dollars. money that could be reinvested in unmet community health care needs. quality improvements and population health but today we are prevented from doing this under current antitrust laws. which we have written more than 20 years ago and looks nothing like the one we have today. and we need to achieve a national imperative on improving quality and efficient sys and the cost curve we have to be bold and innovative in a new way

to deliver this care. we need policies that allow for this innovation to take place. and health care systems to better serve their communities and higher quality and at the lowest possible cost. meaningful change and could not move forward without these policy changes. in closing i want to leave you with a message that success is possible. quality can improve and savings can be achieved. firsthand experience with this. by working with our team members and our employees on health promotion and wellness initiatives we put an emphasis on each team member and their disease prevention and disease

management and healthy living. we creative incentives to go to high performing doctors with their care. screening are up. emergency room visits are down. hospitalizations are down. annu annual physicals are up. costs are down. let me repeat that. costs are down. the money we spent on employee health and wellness this year is 10 million below our forecast. quality can improve. consumer health can improve and we are proof that it's possible to be in the cost curve. thank you to the u.s. chamber of commerce. chamber of commerce foundation and i look forward to taking questions from the audience. thank you.

>> do we have questions? >> yes. i will. it's a program right now that we designed that's a three day program and it does -- it's a quick look at what really happens and how do people see you in other words as a individual practitioner so how do you believe you see yourself. how do others see you in your clinic? how do patients see you? and then we actually get into behavior patterns that even drive success or drive people away. and drive chaos both in a clinic and in a practice and at home and we look at the whole life and right now we're looking at how do we take that three day course and bring it to where we can take it in a shorter period of time and still get similar

results. yes. >> great job. with the comment that you made about having your employees go to high performing, high value, what's been the backlash, you have a large medical staff i'm sure so those that aren't on the list of being the high value, how have you dealt with that political fall out. >>? we put a stake in the ground. we put a stake in the ground and what we said we were going to do absolutely what we just layed out. we offered incentive with lower co-pays and lower out of pockets for our employees and members to select those doctors. we had some questions but what the beauty of it is we've had physicians now working with physicians to help others get to that list of where you'd want to be.

that provide open access, high quality care and efficient care for our team members. others yes. >> the movement from pay for services and pay for performance and value and i don't want to get too technical but just on value though how do you really measure the value of services in your group? is it subsequent patient surveys? recitivism or what? >> the first thing we did was something very simple. in our group we measured how quickly one of our team members

could get inside and get an appointment for one of our doctors. we opened up access so the first thing for us was did the patient, did the consumer see it as value? those are the things we focused on so for example these video visits we have primary care offices that run like urgent cares to keep the lower price points lower options so that if you think about that we directly focus value through the eyes of a patient, through the eyes of a consumer and through that we obviously have a scorecard that we monitor looking at how many visits can we reduce. can we get people in the right place at the right time at the right price. that's how we're looking at value. >> persons access quality

curtesy. all the quality measures and stuff we pay attention to, so the parking access curtesy we're like 4.6 and the quality measures were .6 in materials of what the person perceived. >> i talked about our electronic health record and we have 700,000 active users utilizing our electronic health record today. because of the access points our doctors and provided are encouraging our patients as they come in. if you want to stay connected 24/7 the best way is through the he welcome tronic health record. we have people e-mailing questions and that constant visit and inside the electronic health record and all of that is there for convenience and a lot of our team members to not only selecting our providers but to really engaging the way we needed them to engage.

thank y'all. ♪ >> what do you think of these avatars? thanks so much to katie and hillary and to the whole team for not only these avatars but for this important conference and for bringing up some of these important points in health care and i'm thrilled to be here and give you the entrepreneurs start upper speck tif so our bodies are radiating data. since the beginning of time your bodies have been radiating data. but for the most part we have ignored these data until something goes terribly wrong. you wake up with a sore throat

or achy back and then you start paying attention to taking your vitamins and rest and your cholesterol levels are through the back and the data that your body are radiating will make you realize i need to start paying attention to my diet and my exercise but more recently we now have loads of gadgets and sensors and gizmos that could help us collect the data that our bodies have been radiating since the beginning of time. analyze it ourselves and make improvements to not only our wellness but our health without even talking to a health care provider. this is a profoundly different model in health care where wearable sensors are taking us. and it really dove tails on con ses. wellness empowerment and patient empowerment. we'll touch on these in the next

few minutes. if you can take this data that the body have been radiating and make the most of your body and your find. so starting with wellness empowerment this is prior to things going wrong. you're all familiar of course with the activity trackers and the fitbits and jawbone and some that are not. it's been ground breaking to get people thinking about collecting the data from their bodies but these activity trackers are just scratching the surface with where wearable sensors can take their wellness. stress is one of the most important tractors that people are wanting to see in wearable sensors. now we have trackers that can simply connect to your waste band all the way up to head bands that can help you with your medication process and all of these stress trackers are

able to identify what makes you anxio anxious, what makes you stressed and what are those triggers and how you can improve that. i like to call this quantified mindfulness. think about the challenges that can be improved. if all of us are able to reduce our stress with challengers as simple as these. the other is sleep. you may have noticed there's a lot more sleep trackers and sleep apps out there. everything from a free app that you can put on your arm or pillow all the way up to more expensive sensors that can identify your sleep patterns. these products are telling you which nights you have good sleep, which nights you're losing sleep and again the triggers that can help you improve your sleep. i like to think of this as sleep mindfulness. what is interesting is the irony is that all of this technology

is what caused us to be stressful and lose sleep and now we're turning that around and using technology to bring us back to mindfulness. that's okay. it's all about behavioral modification. sensors are changing the way we live our lives and joe an brought up a point this morning saying there's so many sensors on the market now how do we make headsor tails of them. and a bufshlg of tables that will compare and contrast all the sensors that are out there. this is one table about sleep sensors and devices so you can just chick on this website and identify which sleep sensors, stress sensors and health trackers may be nice for you. patient empowerment is the second leg of this stool or the buzz word of course is the consumerization of health care. the bottom line with the

consumerization of health care is really disrupting the balance of knowledge between health care providers and patients. so for all the physicians out there watch out, the patients want to know as much as you do about their health care. and interestingly in a recent survey, 60% of smartphone owners in the united states use their phones to manage health and this is still in the face of privacy issues and potential hacking issues and customers and consumers want to learn about their health and collect those data that their bodies are radiating. either to help their own health alone or in collaboration with their health care provider and there's a variety of different types of them out there. for instance we can now just snap on a sensor in the back of our phones and come out with an ecb of our heart health at home without having to go into the physicians office or the hospital and use the incredibly

expensive equipment and wearable sensors that can collaborate with with our health care practitioners so doctors out there to you or don't you recommend the types of technologies. our recent studies show on the right hand side on the wind 40 to 50% said they're recommending digital health and mobile wearable sensors to their patients but when their patients have asked have your doctors recommended any sensors? 4 to 5% of the patients have said yes. there's a back here that's causing a slow up tick of these senators to help the health care practitioner. so the reason could be there's no approachable intuitive and

the patient would be much more likely to go out and try these product ifs they had actionable outcomes and they were easy to use. well, now i get to talk a little bit about my company. so we developed priya a personal fertility sensor. it tracks a woman's core body temperature identifying the subtle changes that occur just before ovulation and then when she is most fertile it sends an alert to her smartphone. the form factor is an intervaginal ring just like all the rings that have been on the market for decades. you may have heard of nuvaring. they have been on the market for 25 years and they're drug delivery systems for women. a woman inserts a nuva ring and she has contraception medication delivered to her and removes it at the end of the month. we put a medication out and put

a continuous temperature sensor in. she wears it a month at a time and does more than wait for the notification to be sent to her phone and yes it can be sent to her partner's phone as well. so this is truly predictive personalized digital health medicine and it's also a subset of the empowerment story which is women's health and women's empowerment. it's a very interesting time to be a woman in this day and age in history. and looking at the health care market specifically the global women's health care market is scheduled to grow at 4% over the next few years and the global market for women's health devices is forecast to grow at almost $2.5 billion in 2021. some of this has to do with the fact that women are waiting later in life to get pregnant so some of this is fertility treatments and fertility devices but this is also due to the fact that women hold the purse strings in many families and

women are now demanding that the health care system pay attention to their specific needs from a health care perspective. i was just recently asked to write a story for ink magazine that focused on the challenges to surpass the stigma that women's health is a niche market and build a business that benefits half of the population. i have ully been in meetings when someone in the audience realizes that our main product is an intervaginal sensor they raise their hand and they say but that's for women. it's just for women. well that's half of the population and our product can be used for women trying to get pregnant as well as women trying to avoid getting pregnant so that's a pretty big market of the slice of the pie in women's health. so looking at different types of health care perspectives as not a niche but a large market and luckily the important players are paying attention. although our product is a direct to consumer product we now have pilot studies with with both

aetna and kizer. so sensors i believe will really accelerate personalized medicine. the promise of personalized medicine has been out there for, since before my career in bio tech started 20 or 25 years ago with gneomics and we have been making progress but it's been slow. how do we accelerate personalized medicines? we have use some of these sensors. what we have done is the impossible. we have transmitted core terrible from inside a woman's body to her smartphone. not to expensive property or hospital equipment and to the phone she is walking with every day. this is the raw data we collect. this is lee weeks worth of data

from a woman and we're collecting rhythm. that's what your core temperature does every day. this is one of the more personalized parameters of your physiology. you each have a very specific rhythm so using core continuous temperature we can predict a multitude of many health care challenges. did you know that a couple of days before you start showing symptoms of the flu, your temperature patterns shift. this is before you show a fever so we would be able to identify this shift in temperature and let you know that an infection is on the flip side and the extreme side. if a patient were wearing one of our sensors in the hospital an alert can be sent to the nursing station saying this patient is looking like they may have hospital required infection or

sepus and treatment can be started two days earlier. or cancer treatments. there are numerous studies in the literature that show when chemotherapy is administered based on your personal rhythm the outcomes are significantly improved and the side effects were reduced. it's simply the fact that they have no way of measuring the rhythm right now so they administer chemotherapy when it's convenience. so this is an example of using a very simple sensor with a very simple vital sign called temperature to really overcome many of health cares challenges and we heard diabetes mentioned a few times today and there's a multitude of glucose sensors and insulin pumpsful here's a few where 20 years ago this would be impossible. we're now wearing a match that identifies a person's very personal glucose blood sugar

levels and then alters their medication based on their personal glue koes levels and this is for children as well as adul adults. so we're taking care of the whole spectrum of pashs with personalized medicine using sensors. so whether it's inserted or implanted or ingested or worn like the glucose monitoring contact lenses, these sensors are true personalized medicine and what's next. how do we get to health 3.0. i have a couple of opinions so i'll give you my top three but these are just opinions i'm sure everyone in this room had their thoughts on how to get to health 3.0. number one we must desilo the data. the health care industry

collects an enormous amount of data and it's by physician office, hospital, health care administrators. this is not allowing us to get a full picture of the patient and a full picture of the patient population. we now have big machine learning and data analytics that can help us predict health care's challenges but we must desilo the data to integrate all of this data into the big machine learning algorithms. less than 50% of physicians in the middle of this diagramment how are we supposed to integrate a patient's own face of health? but it's starting to happen. they're collaborating to develop population management policy.

this was announced a couple of weeks ago and ibm and apple have been consolidating the data coming from the apple watch so we're getting there. this must be evidence based. we know that the practice of medicine has always been evidence based but when you talk to the technology companies who are being integrated into our digital health care space now they have never had to run clinical studies or rigorous at a at a analysis to show that the book is working for expected so the rigorous data that is needed to use technology for health care is required and one example of the company that's spear heading this, they just closed 15 million dollar round and studies all of these digital health technologies to identify which are showing the claims in

evidence that they say they are. it's starting to period happen. they did a study on the apple watch. it compared the apple watch. the fitbit and determine which one is the best heart rate monitor. pretty pacic stuff right but people are using these digital health sensors to identify issues with their health care so these types of rigorous studies are required to make these digital technologies evidence based. so kudos for publishing these types of studies and finally collaboration is key. as i mention the health care side, the technology side, all need to sit at the table and

viable options and it's starting to happen. i won't read all of these and google and apple, nokia, mattel, all of these companies are now partnering with the top health care providers and research centers to integrate and bring together the right people at the table. but vision is essential. intellectual property for instance. tech companies are used to talking about open source and sharing data and used to keeping things quite close to the chest. there must be flexibility when talking about integrating data and technologies with each other or competition and phillips and qualcomm collaborated which is going to require phillips to branch out from their closed phillips system they had. and start sharing their data from their interesting sensors or devices and put it very well.

the last thing a pair like united wants and don't have anything to do with each other. but the vision said the diabetes program that they have collaborated on and nothing to do but it's about the customer. so the vision with digital health must be shared between the health care companies and the technology companies for these collaborations to be successful. so in closing your body is radiating data and now those datas are in your hand and my clicker just lost itself. so the question is what will you do with the data to become the best person that you can be. thank you.

i have 1:28. anyone? >> count all the data that you're getting. the biggest issue in a scalable way and this goes back to virtual health in the future is what to do with that data and then how do i with on demand have access to what someone can tell me to do with with that data? >> axable outcomes. that's why our product is getting so much interest. not only are we collecting temperature data and showing it to a woman. okay you're ovulating in two

days. either take one action if you're trying to get pregnancies nba or avoid that action if you're not but we need more analysis of the data and to be honest the issue there is the fda and of course we have to stay in friendship with fda but a lot of these avoid becoming diagnostic and walk down the medical device path way and here is some information about your heart health. as long as there's no diagnosis they don't have to walk down the fda path way. now it takes a little bit of time but as long as the fda keeps progressing on the digital health side of things which they

are. and you can can can check your heart health and come out with an ecg but they don't want to say this is what you need to do next because that becomes diagnostic and then goes down the fta pathway so the challenge is the balance with fda and whether these products want to stay as a consumer product. >> from all of your research and looking at this where non-obvious things have become so an example is i was talking to a company a couple of years ago and people that filled out forms in pencils were higher credit risk. it was not something that was obvious or intuitive so are you seeing anything like that coming out of all of this aggregation. >> interesting weight loss a

couple of research studies out now showing that weight loss when people are wearing multiple different trackers, weight loss have more to do with the people you spend time with versus your own food intact. why are peel eating when they're not hungry? that's the basis of weight gain is you're eating when you're not really hungry and the correlation is the input that some of these are putting in and the people that we spend time with is effecting their weight gain so i thought that was an interesting one. there are more and more studies coming out from our research that shows that there are changes in swrooen expression based on the rhythm based on chemotherapy and other treatments and temperature. we call it the forgotten vital sign because temperature is making a big impact on a lot of the health care treatments and

diagnosis. >> do we have time for one more. so how are you tracking any of that information, are you able to really say, you know, there's differences. >> our product won't go down reimbursement. aetna and kaiser would like to offer our product at a deeply discounted rate for their members because from a insurance perspective now consumers are choosing their own insurance company, specifically, based on what they can provide. so, i think, the insurance companies and the larger employers are starting to offer these at deeply discounted rate.

aetna and apple just announced a collaboration for their wellness program a couple of days ago where all the aetna employees will be receiving a free apple watch. so that's a significant impact on allowing these folks to purchase a -- own a product that they probably could not purchase on their own. [ applause ]

>> good morning. my name is christian garcia. joined up here by three health care executives ranging from the payer and buyer side. and we'll be talking about talking about half care delivery system reform. in order to kick things off, just some introductions here. >> good morning here, i'm from aon. they're the largest provider,

health and benefits consulting in the health and administrative services. my role is the -- national practice leader for our consultant group here in the u.s. i'm going to represent the employer view in the context of the stake of the game that the employers have. >> i'm chief consumer officer. heard a little bit about it earlier with our president and ceo. i will tell you, i am the least clinical person on this stage today because i have a background in bank and i spent 25 years with a company that was called ncnb, nationsbank, that company was a $1 billion business and we grew. i share with you only to make one point, and that is that banking went through major transformation over the last 25, 30 years and through that transformation created opportunities of better access,

24/7 banking, created opportunities to better understand the segments through consumerism and segmentation. you've heard about consumerism already this morning. i will also tell you in my role as customer strategy executive, is health care is, likewise, going through a lot of major transformation within the industry. when you look at the health today, a patient can come to us and have very easy access into our offices through online meetings, with the doctors they can look at their prescriptions. they can find out and make appointments through online at the activity. it's not only consumer focused, but spending a awful lot of time looking at consumer research. and using it to really conform how we're using that business. how we're looking at the consumer, how we're using that information to inform our strategy.

>> david moraleless nonclinical person on the stage. we're -- i oversee many of the product development, medical malpractice and reimbursements and i'll talk a lot today about incentives and how we're driving delivery incentive. i was commissioner. and led a lot of constructions and changing regulatory incentives of provider and payers. >> what does that mean.

>> run on average per employee in the cost. that's going to be shared with employees but 9,000 cost per employee for employers themselves and $2,700 employees are paying on average to buy the insurance coverage. for those employees, not only are they -- not only are they paying the premiums payroll deduction, they're picking out-of-pocket cost, so employees of these employers are spending about $5,000 apiece on average for health care during the course of their year for themselves and for their family. so it's significant cost that continues to rise and, you know, they're looking for ways to get and manage cost better and achieve better out comes for their members. and i think what we find is the company want to and need to be

bolder in the strategy to help manage cost and drive out comes. one of the shifts that we're seeing is on one hand continued commitment to the idea of well being, physical, social, emotional and financial well being. at the same time, we're seeing a little bit of a change in emphasis around employer strategies, try to focus as much on the provider cost and more so than they have in prior years. and i think that -- part of that is driven by the fact that there is transformation going on, the provider system trying to clinically integrate better. the movement that we talked about better paying for volume to paying for value. i think it represents an opportunity for employer sponsors to look at all the locations that they have significant membership and how did they take advantage of and drive some of the transformation that's occurring in the system so they can deliver health insurance at lower cost and

better out comes to their members. >> as we look at value care environment and strategy, first it really starts with the consumer, how did we begin to define the consumer. and i'm asking you to follow along with me, so we have a view of what the consumer looks like, that nonpatient consumer, those are the individuals today that are not welcome into our acute facilities or our clinics, 55% of the population that's not engaged whatsoever, it begins how do we begin to tell our stories and consumers long before they need us and build a strategy to connect with those individuals, that second bucket which is the more traditional bucket is the patient consumer bucket and that's the bucket of patients that typically will go into the key facilities and the clinics and what we have done in that bucket is to better understand that patient population, but more importantly we've identified six segments

within that patient population. within those six segments some of them are highly engaged, some of them are unhealthy and not engaged with our organization. it goes across social economics. it goes across gender, geographies. and from that information we're better informed of what we can do and how we can better engage our patient consumer. the last bucket of that consumer population is something very interesting, we refer to them as client patient. so kind of go with me here and you know my background is financial services, so in financial services a client was an individual that we had a very indepth relationship with, that was an individual that was typically advocate for the organization, they referred customers to the organization and you had really deep relationship with that individual with very high scores. when you think about the con n continue um of the consumer,

what we vuld to do, are the patient consumer to get that to that point that we are actually identifying client patients. what would a physician have to look like. how would a physician have to communicate in their authentic way to consumer if that was ultimately the goal. when we survey our patients consumers, what we found are some things that are not going to surprise many of you. there were really three major things. the first one was all of our patients were very interested in access and access was defined by 24/7 access that was defined by where they were located, it was defined by how you alu me to engage whether it's electronic engagement or some of the form. we have over 600,000 of our patients that are on my chart, they're using electronic means to communicate ultimately with their physicians. 60 of the 600,000 are actually over 100 years old. the notion that people aren't using