uniformly, all the students that i work with just want their lives to go back to normal. that's their goal. their goal is not necessarily to even see punishment, they just want to go to clasds, go to school, go to the cafeteria, not see their perpetrator. they want someone to acknowledge that what happened to them was wrong and they want life to go back to the way it was. so if restorative justice helps in that, particularly in identifying there was a wrong and supporting them in that then i think that could be an option but it's something we should be careful about. >> [ inaudible question ] addressing the cause of the wave of sexual assaults we're seeing and i know this is well beyond the charge of this panel but

you're all in the weeds, you've done this work for so long for a long time and for -- and done it quite well so i'm wondering what you think, if you think that there's anything that you've seen that you would like to suggest as a best practice for schools and going forward on the prevention side or if you have a thought to share about what might be causing an increase, if there is an increase, in these waves of sexual assault on campuse campuses. >> i'll take the opportunity to -- because i'm probably the person on this panel who's spent the most time thinking about this. since i started in 1995. so, you know what i would say is that the best practice that i

would like to see every single institution do is to develop a coordinated community response team. and that's almost a term of art these days because it's used by the office on violence against women for many of their grantees. it's a grant requirement. but it's -- it's not -- it's just a well-functioning committee, you know? in the parlance of academia, it's a well-functioning committee, working group, some -- a body that is expected to last essentially forever but that is charged with making sure that it has its finger on the pulse of what is going on in this area.

and that gets you so many things. and some of them have to do with response, right? but some of them have to do with prevention, at least the way that we all think of it. but i actually am totally convinced by the public health approach which says that prevention -- it's all prevention, right? . there's primary prevention, secondary prevention and tertiary prevention and it's all prevention. and therefore if you're going to have a really comprehensive prevention approach you need to have all of the people at the table who are doing the primary prevention -- everyone can't do everything, right? so you have to have the people who are doing the primary prevention, the people doing the secondary prevention, the people doing the tertiary prevention. you have to have a table at which they can all gather on a regular basis to make sure they

are coordinated and that there is clear community buy-in for whatever it is that they are advancing. and, you know, college campuses -- we do committee work all the time. i mean, we don't do anything without a committee it seems like, right? so this should be a really actually easy thing for us to do but it's actually been something that i've seen a lot of resistance to on college campuses. so that's part of the reason why i press it at every opportunity i have that. because, you know, even in terms of policies or in terms of investigations if you have a policy that someone has just written and put on your web site, you have a dozen people

who are going to get involved in implementing that policy if you ever have a case -- and you will have a case i mean, look at the statistics, you will have a case. and so if you don't have community buy-in to that policy and if nobody knows what that policy is, the moment they try to implement it, the wheels fall off. and so it just leads to all kinds of bad results. so, you know, we need a committee. we all need a committee and it needs to be a good one that is invested and that does its work. >> i guess the only thing i would add is that i think it's crucial that schools think about this as an issue of public safety and public health but i also think anti-violence efforts have to be part of a larger anti-subordination project and obviously that's going to look

different on each campus but i'm worried about the ways in which the framing of the issue as purely an issue of safety and health allows us to forget about the fact that it's not unsurprising there are high rates of violence against women at schools where there are almost no women on the facultfa at schools where women don't speak up in class. and those are in some ways harder questions but you can't solve one without the other. >> and i completely agree with that but i would also add on a completely different side of it, affirmative consent needs to be part of sex ed. i have students now who are working on a project for training for high school students and i'm inspired by this because i think we can't wait until they get into college, that's great. but i think reframing what sex is supposed to be and what affirmative consent is will largely help the students by the time they get to our campuses.

>> i'd like to see an understanding that this isn't a -- something that happens here but not over there. or in there place but there's not a problem here. that this is more systemic than that and i would like to see us keep this rooted in diversity education as an educational issue because if we can't get to effectuate culture change and we're processing cases i don't think that's enough. >> thank you. i want to thank georgetown law for having this platform. my name is kimberly kennedy and my e-mail address, just in case after i ask this question, is kennedykimber kennedykimberly170 @gmail.com.

i really feel for young people who have to go through sexual assault or anyone. i'm a victim and i'm saying that i'm a victim and not a survivor because i'm still going through the process of it being investigated. but there's a -- as the panelist says, the wheels fall off when you make these clients and when you're an individual and my -- and i was on the job and it was my superintendent, i was working in the construction field so it's a man's world -- a male-dominated industry. i feel that ha the advocates are not around. i don't know if i'm just going to the wrong places. wait lists and when i talk to

some -- certain organizations you get victimized again. then people look at you like, you know, it was my fault but i do not ask for any of this. i said no, it was plain. so i don't know if it's because of the large company, and i want to know how can i advocate for myself? what can i say. on the media? i would like to let my voice be known. what can i say and what i shouldn't say because i don't want to say the wrong thing for myself or either the person who -- who's my predator. so if someone can help me because i'm doing research on my own and i'm not a lawyer. there's good information on the internet but you also have to know where to go and there's so much information you want to know what should you retain and what you should use and what you shouldn't. so if someone can send me an

e-mail on information or who i can find to represent me because i'm going to lawyers and lawyers and lawyers and do you have $15,000 or just going to the right place because when you tell your situation, your incident, you're retelling your story, you're retelling your story and you get kind of tired of all of that. you just want to know where to go. >> i run the domestic violence clinic here at georgetown and i will give you my card before you leave and i'm happy to help you connect with local resources and john if other people have additional -- >> the nonprofit i work at does sexual harassment at work cases so i'm happy to connect afterward. >> and if you're local, there's a law firm in d.c. called katz, marshall and banks that i would put at the top of your list. if this happened in a workplace,

they're your go-to firm. >> i want to thank you for having the courage to say somethi something. >> so i guess i'm going to push back a little bit on what i thought was alexandra's call for more sort of uniform process, that what we have to do is we have to think about this issue as part of a larger piece of better process on university campuses and i was struck by all of you how very different the process requirements are. so as a matter of constitutional law, due process a fluid can september. nancy and i talked about this. but the amount of process you're due depends on the liberty property interest at stake, right? but that's very different in these kinds of contexts. but as a lot of us vohave been

saying, suspending students is different than throwing them in jail so maybe we have a different amount of process there. this we need to remind everybody so we don't always go to criminal law. but when it comes to sexual harassment at the workplace, most employees are employees at will, the process that needs to be implemented in the vast majority of employment sexual harassment contexts is very different than any university campus when people have jobs for life, right? maybe faculty members are entitled to more process because they have something more precious than the average employee because they're not at all faculty members at will and i think we're doing everybody a disservice when we sort of project the idea, a, that process isn't costly, because process is costly to the people who have to go through it, the victims, and process is costly to the schools that have to provide it, that's just an

unfortunate truth. but it's also clearly the case that there are different levels of process that will be appropriate in all of these different contexts and that just makes this messy and i think we're all well-served by recognizing that messiness. restorative justice is a great idea, too but as an administrator i can also say oh, my god, we need another option? what's my dropdown menu going to look like? and i think we have to own that, right? those of us who want to do something about this issue have to own that there are going to be lots of different processes that are going to be appropriate in all of these different ramifications of sexual harassment. >> can i say something to that? so i agree we can't have a single process for every disciplinary issue because that depends on whether you talk about faculty, staff that's unioniz unionized, student versus student or university versus student where i'm comfortable with the clear and convincing standard.

but what i would like to see is the same process for someone who is raped by a classmate and punched in the face by a classmate and that seems like -- i would be curious to know if you're not comfortable with that uniformi uniformity. >> i think that the -- >> i guess i'm not sure i am because i think the victim responses to those things will be different. i think there's an embarrassment and a sort of dignitary harm associated with sexual assault that isn't necessarily there -- i wouldn't feel at all weird -- i wouldn't feel at all like jane stanford person described if i was punched in the face by a classmate. i just kind of wouldn't. i don't know, like the feminist jock in me would feel like "i'm a man, i'm a guy, they treated me the same way they treated the guys" which would be very, very different than if i was sexually assaulted. and i'm not sure that that different isn't one that the

process should take into account. that there's a vulnerability and there's a sort of shame associated -- we don't like it but it's there with regard to sexual assault victims and i think the process may have to be sensitive to that. and it doesn't have to be sensitive to that if i'm punched in the face. >> i would say there's going to be limits to what you can do because of title ix. but this is why you need a committ committe committee. >> i agree with that and it shows how difficult it is to have folks educated, to have the conversations about that messiness. and we need to have people on all sides of issues in terms of advocacy and what are limits of that. >> and an example of that would be that a number of universities are using the preponderance of

the evidence standard in faculty discipline cases and have changed their rules very recently. harvard law, university of wisconsin, e et cetera." there are a number of universities where universities do use preponderance of the evidence for a title ix investigation finding. but then they use clear and convincing for purposes of a disciplinary hearing in sanction and that unhappy marriage is something we're trying to work through and also includes other domains like research misconduct." >> we can probably do one more questi question. okay, i want to thank the panel and everybody who participated in this incredible discussion. thank you so much.

[ applause ] let's take a five-minute break. every four years, the presidential candidates turn from politics to humor at the al smith memorial foundation dinner to raise money for catholic charities. at new york's historic waldorf-astoria hotel. >> i must say, i have traveled the banquet circuit for many years, i've never quite understood the logistics of dinners like this and how the absence of one individual could cause three of us to not have seats. [ laughter ] >> mr. vice president, i'm glad to see you here tonight. you've said many, many times in this campaign that you want to give america back to the little guy. mr. vice president, i am that man. >> it's an honor to share the dais with a descendent of the great al smith. and, al, your great grandfather

was my favorite kind of governor. [ laughter ] the kind who ran for president and lost. [ laughter ] >> now, al, you are right, a campaign can require a lot of wardrobe changes. blue jeans in the morning, perhaps, suits for a lunch fund-raiser, spooa dinner, but it's nice to finally relax and to wear what ann and i wear around the house. [ laughter ] >> watch the al smith memorial foundation dinner with hillary clinton and donald trump tonight at 9:00 eastern on c-span and cspan.org and listen at 9:00 p.m. east we were the c-span radio app. now the annual u.s. chamber of commerce health care summit with experts in health care technology, doctors and health administrators. it's just under three hours.

♪ wide open spaces, she needs new faces ♪ >> good morning, i got wide open spaces up here and i'm glad to see very few down there. welcome. good morning. thank you for joining us here at the u.s. chamber of commerce for our fifth annual health care summit, health forward, part part of the chambers foundation future state series. my name is katie mahoney, i'm the executive director of health policy at the chamber. this year our theme is health forward, a very appropriate title as we look towards the coming year. new opportunities to drive positive change in our health care system. we have a wealth of experts who will talk about everything from personalized medicine to how employers are investing in population health to what the next five years may look like. before we dive into the rest of the program, we'd like to thank

novant health for sponsoring and thank byayer for serving as a co-host. we're thrilled to have blue cross/blue shield and fti consulting as our partner level sponsors. we appreciate their support and yours. we're lucky to have you here today. it seems like just yesterday we were working on our first annual health care summit and here we are five years later. looking back we focused on improving transparency and rewarding innovation, harnessing efficiencies to increase value and improve outcome, advancing delivery system reform and optimizing the next generation of health care and this year it's on our app. today's event, health forward, builds on our summit's history of highlighting private-seconder innovation. while the theme is similar, we're focusing more today on technology and data and their role in targeting personalized treatments through custom analytics and digital health as well as assessing the needs of different communities and populations in order to best

treat conditions and manage health. speaking of how far we've come, please don't forget to download that app on your phones, just search for health forward in your app store. within the app you'll find today's agenda and speaker bios as well as great content from our speakers. given the focus of this morning's event, we're honored to have bob pearson president of w 20 kick off with how to accelerate innovation. he has had an esteemed career in technology and health and is recognized as a marketing visionary driving pragmatic disruption in social commerce. at the chamber we take pride and applaud pragmatic disruption and could not be more pleased to welcome you as our first speaker to the stage. bob? ♪ changes, turn and face the strange ♪ >> a pleasure to be here. i come out of the pharmaceutical industry, originally worked for

novart novartis, then the technology industry at dell and today we work with over 100 health care companies, many tech companies and i would say the majority of the venture capital firms so what i did is said okay, let me consolidate thinking of what we're learning from these folks into a 20-minute talk and see how we do here. so three things are driving innovation in business like never before and what we're seeing is this convergence of technology and health care that we all are aware of but i think the future is unbelievably bright for this country. with with big data, everyone knows about big data but what's happening is we'll move from having an app here, a tool here and platform here to really starting to think like an information genome, how do we capture this data through multiple systems so we can use it for the benefit of transforming health? artificial intelligence, machine learning and neural networks has tremendous potential. i'll show you one example in

just a bits but the ability to allow software to understand what is happening in these bodies that we have is going to lead to breakthroughs that we can't even imagine today. and with science we're well into the human genome. that's been going on for a while but there's something that's interesting and i write books on this topic and i think about how science evolves and you have to go back and realize that patients actually matters so when you think of the web or the human genome project or artificial intelligence, they've been around for long time. but what happens is eventually enough areas mature that they collide and when they collide amazing stuff can happen. so let's take a look and see what is happening and where are we today in terms of innovation, one example is this. what if we could combine a semiconductor technology and

pharmaceutical technology? what would that do. well, there is a ceo of a company i met a few years ago, we met and he was explaining what he was doing here and i thought this is amazing, this is something that we can do very broadly. and that is protous digital health. they have an adjustable sensor, a small bio degradable chip that you take with medicine, you can then get through a patch, the kinetics of the drug, you can see the heart rate pulse where the drug was manufactured, everything. just a very beginning of what we can do when we put bio digestible sensors into our body but the thing that's immediate is if you're caring for let's say a loved one 3,000 miles away we can see if they took their medicine. we can call them up and say "mom, you need to take your medicine, i saw you didn't take it at 10:00." what if we can figure out how to edit disease. is there a way if we can

identify genes and have this knowledge on the genome, what do we do with it? we have that ability in front of us that's crisper, so what you're able to do is have a system where scientifically we can find the places where we need to snip, edit and improve the function of a gene that changes the game in how we look at treatment, diagnostics. bayer and crispix they are pew dix have gotten together. we don't need biotech trying to do this on its own, we need pharma and biotech and, quite frankly, health systems pioneering stuff together earlier. because innovation is going so fast that we cannot go in a linear path. it won't work it requires more team work. and the bayer jv is what's happening. what new medical disciplines will form as a result of

technology and health care converging? this is something that there's many things you can think of but i was speaking at the phoenix medical device meeting to 75 ceos and they were featuring new technologies and one of the ones that hit me was bioelectronics medicine it's a new field emerging because of technology and health. and chad bowdoin at the feinstein institute, she showed by putting an implant in the brain and having the brain waves measured and basically using ai, they were able to allow the person who's paralyzed, person is paralyzed, to think and start to move their hand for the first time and pick up a key. and this is by understanding the brain waves, understanding what they're telling us and able to

make that motion go through to have the person do a motion. it's enough to bring tears to your eyes. if we can apply technology and health in different ways, what is it that we can't do? we can change jeanne function, we can change how a paralyzed person sees their life. there's a lot we can do if we partner together more effectively. now next thing what is the promise of virtual reality in health? this is an area where there's a lot of hype with oculus rift and many things, we all think of it for our kids and what can we do there? we will innovate faster to find augmented reality but you're seeing we can train physicians anywhere in the world so we can up the level of medical care worldwide through training, that's huge through the world.

burn victims. burn victims, it's already showing that if you allow people to think of different things. they have scenarios where they're thinking of being in the antarctic and going through cooler areas their pain goes down. it does work. so you can see how do you help people deal with their pain. there's new ways on how you can deal with post-traumatic stress disorder. so things that are part body and mind are starting to be able to -- where we can make an impact through virtual reality and augmented reality. so i look at the line here. it's a matter of our applied imagination. the issue is not is the technology available, the issue is our readiness to think through what is possible, test it and figure out where we can go from there. the immune system, the immune system has been something that -- i mean, i've been in the industry for 30 plus years, we've been talking about the immune system forever. when anti-bodies first came out

they were cute, nobody knew if they would take off and here we are today. and what we're seeing are things like this with the anti-pd 1 immunotherapy blocks the pathway. so we're blocking the patways so the immune system can do its job. the immune testimony is ready to do its job. we have just needed science to step in to show how you can allow it to do its job. and it's -- this is leading to a whole new generations of medicines but more importantly it should lead to our lack of need to use to be sick therapies so early in the treatment of a cancer patient. so there's ben foits go way beyond the initial science. now how can technology and machines improve what humans do? look at an example here. robotic assisted minimally invasive surgery. so you're not doing robotic surgery. you're helping surgeons do a better job through robotics.

so what that means is if a surgeon is guiding surgery. if they're doing it themselves your risk can only bend so far but if you're in there with robotic assisted surgery you can bend in unlimited way there's always kinds of things you can do surgically that you couldn't do before and that's the beginning of what we'll see there this is something exciting for me and i had the opportunity to talk to jeff huber who's at grail and jeff is the guy that -- well, many people were involved but he was involved in building google maps and basically what they needed to get built, whatever that would be, jeff would end up on the project and the project would go pretty well so jeff's so jeff's of cancer and he said i'm out, i'm going to figure this out i

left google and they formed grail. a couple notable people have gotten behind this and he's looking at how do you build search for our body. so in other words you can see signs at the earliest stage and detect cancer before you would see it today in a standardized test will he succeed? i personally believe he will from knowing about jeff and the resources he has but the more important thing is these are doable scenarios to think we could be building the equivalent of google inside ourselves to figure out what's going on what if most of our health data could be integrated? this is something where many of us are involved in this everyday and it's all over the place so at the same time science is

moving fast, technology is allowing us to dream in ways we never could, we're struggling with basic stuff. can we get data to talk to each other? can we get systems to work together i look at it like a data immune system. the insights on houb to change behavior will grow. but we have a ways to go here. our body is an untapped data source. the amount of data coming out of us is unbelievable. the question is can we tap into it? we have the technology athat allows us to innovate and when you think of any disease or disorder being fair game, we only have to look as far in personalization to see how much rare diseases have taken off. i remember a time in industry where rare diseases were something no one paid attention to because you couldn't make

money. now with enough incentives we've revolutionizing how we do in rare diseases. we'll do the same thing with many other subtopics of health as we go. when i bring it back to the chamber of commerce, very conscious of the stage i'm on, this is an unprecedented opportunity for this country. with silicon valley in the medicine chest that we have here, if we combine those two, we are going to lead the way in the world for the next couple of decades. there is nowhere else on earth that has the kind of intelligence that we have in our great 50 states. it's a question of how we decide to use it. and when i look at technology, here's things we know are true as i end this talk. one is technology acceleration as we see it today with increase not decrease. so we're going to be bombarded with all these different opportunities we have, we also know that organizations will struggle with this mightily, mow do i actually change?

are we changing fast enough? what do we do? and they'll also be behind the curve and that's normal but we have to acknowledge it and realize the onus is on us to innovate faster. then if we go to the last one here, this is just being honest political change is the slowest. regulations are the slowest. so we have to think through how do we do this. well, i get back to what do innovators really want? if i am not here talking to venture capitalists and startup ceos and ceos of life science companies, what do they really want? i break it down into this. they want clarity of rules. they're not necessarily saying i want the rules i want for my company they're saying please, just give me clarity so i understand the world i'm playing in. they want clarity of payment. don't hit me later on and tell me that i can't get reimbursed, can get reimbursed. i can't make models on that. give me more direction in terms of how to get a return on

investment. ability to learn together. i've seen in the fda some fantastic innovation that has occurred in terms of trying to think through pharmacokinetics. -- sorry, pharmacovigilance. we're trying to think through the future of social media. we need the fda and the government overall to learn with industry. we need to do a better job of saying can we just all not try to sell anything and just come in and teach each other so we go up to speed at the same pace. that will help us with regulations and everything we do. and the ability to evolve together, we will need new regulations in terms of what we do with this data. what does technology do? if you have the ability to search inside your body what do you do with that data? so if we're learning together it won't be that hard to do. if we're not learning together we'll hit these wall after wall

after wall and the problem with that as you know is that patients are out there counting on us to succeed. they believe we're smart enough to do this and so it stops with us. can we do it? can we take advantage of this unprecedented opportunity to innovate? so i think i have a few more minutes here and if anyone has any questions i would love to take them. early in the day? any questions at all? yes. [ inaudible question ] >> what is the best way for employees -- >> employers who p-- thank you. what's the best way for businesses that provide benefits to their employees to help advance these innovations, because these are important to us from a cost management perspective and health of our work force. >> so this gets into what we

find when we look -- we workout side of health care and when you work with big consumer packaged goods companies and things like that. what they're learning is if you say this is what i know we need people to do, i'm going to tell them what to do and we'll measure if they do it. that's old school. that doesn't work. so you have to do, as i say, go out into the world and say the people we're trying to reach, this group of employees, what do they do online? where do they go? what content do they care about? what key words do they use? what language? what channels do they go to? who do they respect? and then i need to say okay, from there how do i talk like that inside my company? do i bring these experts they revere in nutrition in to speak at our company? do i bring the content they care about into our company? so if we bring the world into them, now we're speaking to them like we are now and we're having more of a conversation. but companies are -- as you know

are very poor at that and they say well, these are incentives, we have to get people do this thing. we'll jam it out, they didn't do it. how come they didn't do it? it's a never ending cycle. so we try to teach people to think of it differently and get outside the normal box. >> thank you for being here this morning, i'm paul kelly with the federal group. these are sbooesing and exciting i innovations you're talking about but there's a great concern about privacy so i'd be interested in your thoughts on what these companies are doing related to privacy and that environment generally. >> yes. you're absolutely correct about that with personally identi identifiable information and where you store information and all of that, the candid answer is i think there needs to be more work done in terms of how we actually make sure we have the right privacy standards,

most of them are fairly top line and basic and what you see are companies intuitively do the right thing. they regulate themselves to figure out what they should do, the most progressive privacy we see is in europe and so if we're over there, you have to be exceptionally clear of how to use data and for what form and all of that. so i think we have some work to do here in terms of what we do with people's data but that's a very -- 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 and store it anywhere, you can protect it at whatever level you want. that's not the problem. it's do we allow people to use this data for any other purpose and is it clear what purpose it's for and are we aligned with the person who we got the data from? and that's where things break down. i think there was another --

either that or you're just 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 in age you can see -- let's say you have 100,000 people you're working with. you can actually see what they're doing online. you can see what they care about. more importantly you can 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're listening to for advice, how your employees and providers are talking to each other so when you look at the actual world of what's happening you can start to say, hmm, how do we shape that? because, again, too much of what we do is to say inside our company we will share information rather than say who are all the physicians in the network we here in? what are they doing?

how do we have a better relationship with them? and that's easy to do because doctors are online, they have an npi number, you can see exactly what they do. and i think of like -- i'll give you one example, i can probably say this. a big clinic that -- a very famous clinic you all know looked at what their providers do versus what they think they're doing and i can assure you that what they do and what they think they're doing are not the same thing so we have to start with how do we impact the people who are prescribing medicine or implanting devices or doing things to make sure that that whole ego system is 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. >> i don't think i can solve that in 30 seconds but i have an opinion 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 look at what we can do in terms of guidelines and the storage of data and what we do with it, it's not that hard. but we get all worked up with is this something going to be misused. so i don't know that is addressing at all -- it's not addressing at all what you said. okay, well, that's a good way to end. [ laughter ] you just raised one of the hardest things out there on the planet, practically, other than saying how do you cure poverty. okay. i'm at the end so i think i should stop and thank you very much for having the time to listen. [ applause ] ♪ he got the action, he got the

motion, the boy can play ♪ ♪ ♪ note? ♪note ♪ ♪

♪ >> hi, i'm joanne canon, i'm the executive editor for health care at politico and we have three people here, all physicians, who are going to talk to us about population health, i'm going to introduce them, i'm going to have them say what they do and i want to spend a couple minutes defining population health because it's one of the eye in the beholder kind of things, we don't have common definitions. so let's start with dr. catherine bazi, she's 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. in that role i'm responsible for our occupational health, health promotion, epidemiologist research, health policy, health benefits, the landscape of health with really the militia

to accomplish better health for our people because that's related to all of our other corporate priorities and when i say "our people" we think of dow people broadly, the employees and families and retirees. >> and then we have dr. steve peskin at horizon blue cross/blue shield of new jersey. >> i'd better know what population health is, right? good morning, everyone, thanks to the chamber for organizing this. i'm a general internist by clinical training and lead our efforts in population health which we'll get into much more deeply at horizon blue cross/blue shield. we're the largest health insurer in the state of new jersey and i jokingly -- somewhat jokingly or seriously say my ford fusion american car is my office because i spend most of my time out in our clinical ecosystems from family doctors up to our 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 dr. george isham, doctor at health partners in minnesota. your role here? >> i have been since -- for some time the medical director and health officer, the largest integrated care system and financing system in minneapolis/st. paul and i bring another perspective to the conversation on population health. >> and i noticed when i was reading about your bios as we talked before you have been involved very much on the metrics of health care, defining quality and figuring out how to measure it so you're able to speak -- your experience has been a granular how do we know if we're doing the right things

and what are the goal s we're trying to set and do they mean something as well as this larger topic of population health. not everybody here is in health care full time. i think when you come to the term "population health" you often -- people often confuse it with public health citing tb, things like that, ar r or whatever the modern equivalent is. it isn't the same thing but we don't have a common definition so all of you have an internal population you're responsible for. an -- employees, members of your health plan but you are engaged in a larger sense of what coming to terms with what is the health of our population, how do we become healthier. so why don't you use your working definition, start at that end. >> well, the common usage talks about subpopulation such as employee groups or groups that are cared for by a health plan or patient clinic populations, those with diabetes and so forth

but population health, the formal definition is the health outcomes of a group of individuals, including the description 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 an -- a little addition to that would be geographic population like the health of the people in the city of washington, d.c., for example. >> and for horizon, what is your -- >> yeah, it's a -- it's a multifaceted, so the doctor's definition certainly resonates with me. when we think about it, we think about all the four of us are individuals, so each of us individually and 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 everyday.

but there are broader populations so when we think about our population, we look at persons with a certain clinical condition like diabetes and how we stratify and measure health improvement in that group so as individuals we might be young, healthy 20 somethings and they're part of our population as well. so what we do with them might be around high risk behaviors, health behaviors, preventative services. so really think about population health as not just forgetting about your individual identity and who you are as a human being, that's very much alive and well with physicians like us and the health systems we work with, that said, we then look at and are able to pull together certain groups of persons to say how we're doing with that particular group within -- as george said, a subpopulation within broader populations so it's simultaneously -- i like the word sigh mull tin nayty,

what you as an individual, what your issues, concerns, needs, social behavioral health and then how you fit in to some population 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 from a physical, emotional and social 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 their dependents and retirees is a much bigger group. and frankly, we think about the communities 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 some kind of 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?

what are some of the -- 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. let's 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 our 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 attract and retain talent because the way we focus on health is one of the most tangible symbols of how we value the individual people in our 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 intra year. we're not for profit but still nomar gin, no mission and many appreciate. that said, we have in my view taken a very positive step toward -- we have a, fortunately, have a very stable population, though there is some change. so working with our clinical partners and working with our plier groups, as my friend ed fisher, i know there are a lot of 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 most of our 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 it as person-centered care, not patient-centered care. who do we work with employer groups, communities, taking a much more broader view of health and well-being as opposed to the 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, but also 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 certainly can move, but 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. those are the top in rank order from the cdc. and they set a priority list in terms of what we ought to be doing in terms of both encouraging 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 one really 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, we've been thinking about incentives differently, there are privacy barriers and challenges to get around, but there's also some more incent e incentives to get it right and 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 an 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 with the national diabetes prevention program, it was 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 facilitating 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 they would be able to 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 our value-based programs, medical home, acos, 6% lower total cost in diabetic persons with diabetes, but they still have diabetes. % better immediate biomarker hemoglobin a 1-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 his a 1-c. 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 information 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, we promoted in minnesota the institute for clinical systems improvement which provides quality improvement training and the standard approach for all pairs and all providers in minnesota. the second thing you want to promote programs that address the key behavioral issues that lead to diabetes. and so we've -- and obesity and

nutrition is a tough nut 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 those approaches, and then what we need to do is reach out which we are doing now to educate children in schools about healthy eating and behaviors and we need to partner with public health in terms of legislation. in minnesota with respect to smoke and other risk factors in the workplace, you know, that can be complicating or cofounding factors. so again, for those buckets of health care, behaviors,

socioeconomic factors and environmental factors, good walking paths and stuff like that 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 leaders 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. >> i would echo that. the upstream that you talked about is so important. one of my good friends is a well regarded family muz in new

jersey, bob, and he says and he's old like me 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 behavior which is really hard and it's not just mds and dos, it's rns and our medical an activitients and our models are taking on more responsibility operating at the top of his or her certification and license and that culture of health as opposed to health care is really aspirationally where we're headed. >> another buzz word in health care but it's related to this activation you're talking abouting is patient engagement. it's one of those terms that can mean an awful lot, and it can mean nothing, but do you, to create or encourage health or build on health, you have to have -- it's a partnership, right?

if the patient goes home 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 i don't remembers. so in terms of how au of you come at there the concept of patient engagement and they say, oh, yeah, we have a website they can make their appointments on line 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 who's healthy as well, you're trying to preserve their health. how do each of you think about the tools that you have in your organizations to engage, to get the patient, to get the individual to understand that i have to do this, that i have to own this, that i have to be part of 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. how is that -- >> it's a very important question and i think the answer is having a thoughtful strategy, and the strategy for us has several components. we have a strategy called our corporate health strategy whereby we are looking and it's multiple components of that. there's policies. so we have corporate policy related to smoking, for example. nonsmoking at our -- on our properties and in our workplaces. so policy plays a role. >> is there also higher premiums for people that smoke? >> on life insurance there is. so policy matters and the second thing that we focus on is how do we create a culture and an environment and we have had for many years a healthy workplace 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 the capacities around communication and the use of -- and opportunities where peers actually influence your behavior so having a culture which really talks about this and where leaders give it air time and speak to it. so there's -- this healthy workplace. and then we have individual health assessments and 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 actually look at the community and how we as a company can participate in achieving a healthy environment in the community. so have our workplace 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 help to facilitate policies at the state and local level. looking at how we partner in a multistakeholder way to 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 to insurers, what your tools to get that engagement? what does patient engagement or consumer engagement mean to each of your plans? >> well, you know, we're also a deliver system, as well so it's integrated. so this particular strategy also has to do with place in terms of where your, where people are receiving care

the neighborhood it's in and tailoring the approaches to care. and actually in the states that surround it, as well, so you have to talk about again, an individual approach which is being sensitive to the culture and the health literacy of the people involved, being able to help them learn at their capabilities and reach out in a way, being culturally sensitive in terms of where the messages are coming from because people have different trust in terms of that education depending upon who is saying it and what they look like and whether they're different than the people that are receiving the 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 for people getting to the clinic because of socioeconomic factors or other factors compressing the care so that the distance between recommendation and receiving the service is in the same visit will increase rates and then tracking your

performance by race did, ethnicity and socioeconomic status and turning your quality improvement tools into two diagnostic tools so you can figure out what approaches to use. that would be on the delivery side. it's very much matching that up with the population approach and then outreach to the employers in the program that cathie was talking about. and wellness programs. 26 clinics located with employers. you know, that kind of outreach, you know, to make it more accessible and likely for people on the job, you know, so they don't have to take time away from work and increase the productivity but it also increases the access and the ability of people to engage. >> a specific example but 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 certainly do better in this area. i'll be a bit provocative here. in the innovator he's description,ing in one section of that book, he talks about participation in 401(k)s, you know, all these business folks out here 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. so the driver in the path of the elephant so we've got to the figure out a way to smooth the path so that we are able to see groups of folks going down a better path and again, using the 401(k) versus wellness, we're just not there yet. one positive example to something george said about getting into the communities. we did a peer coaching pilot

with 100 persons with diabetes going back to diabetes and one getting usual care and 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 the same old same old is not getting us a better health outcome. again, is it mof be certain medicare star metrics, yes, but overall, we still have much work to do. >> there's so much talk including the talk right before this panel about the potential of 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 their -- 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 approximately 90% worldwide. and we have done things differently than most people so to the words of our first speaker today is, we've got to think outside the box. and our approach is we don't provide financialive sentives for people to participate at all. to fill out questionnaires, participate in biometrics and participate in programs, there's none of that. we never have. the difference is that our approaches make 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're here as their health advocate. and we've attached this to other things in the company which have had high participation rates. so we've been able to be very successful. so i would encourage people to use a marketing mind-set and create value to create participation. >> the interesting thing about tech is that bob at harvard business school doing a survey of experts actually asking the question, what are the factors that drive health? the experts will overestimate the personal impact of health by

a factor or technology and personal care by a factor of two to three. 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 weather -- whether there is a barrier in some of that. in terms of programming in the workplace, we have some good data about impact for companies and company productivity. >> are the people who use those apps and the fitness monitors and the trackers are the ones that would be exercising or playing soccer anyway, do you

know whether it's making people do more or they're just tracking what they would be doing anyway? >> i do see some selection bias. i wear one of these things and normally around 58. i must be a little bit nervous up here. but just a personal observation folks that are enamored of the and sort of the selection by going to the gym anyway and doing these things, we are working with our clinical partners on bidirectional data exchange. we have been looking at a variety of -- maybe not quite as much as what georgia health partners. >> minnesota is five years healed. >> application of tools and technology, certainly some of our groups are invested and doing a great job with their patient portal and that kind of information which isn't exactly an app. nothing that we've seen or

observed or done yet that i would say is very profound. the pro verbal game-changer as it relates to a wearable or something like that. bob's got a, our keynote speaker earlier will -- 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 was just reading the headline. i thought it was about vc or consolidation or anti-trust or getting bigger, or getting smaller or whatever. and i figured out who was in the panel before our phone calls and i hope they've been able to show you it is 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 in what we've become to call population health. so thank you for joining us. >> thank you. ♪ >> so good morning. good morning. i'd like to first begin by thanking the u.s. chamber of commerce and the u.s. chamber of commerce foundation for actually organizing this 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. i think it's really important for the future of health care. some of you may not note novant health. i take a few minutes just to introduce who we are. so novant is a $4 billion not for profit health care system comprised of 14 hospitals and about 500 clinics and ambulatory sites that obviously provide advanced medical treatments throughout north carolina, south carolina, georgia, and virginia. we treat more than 4 million patients annually in those and beulahtory -- ambulatory 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. the future of health care.

in these days when you look at the future of health care, 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 i 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 in 2010 has 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 that are newly insured entering our health system for the first time.

so just in novant health's experience, the number of people entering our system has grown over the six years since the law was passed. so for example we operate across those four states that did not expand medicaid. but for example, our office -- physician office visits are actually up from 3.8 million in 2010 to over 4.1 million in 2015. no problem when i describe that, right? well, 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. and don't forget our payment structure is changing from one based on volume to one that's based on value. patient outcomes and patient satisfaction and readmission rates are now important factors in our revenue stream. and we're all being held to much

higher quality standards. we're also sharing in risks today. and our built to treat 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. again, we are up for the challenge. so i want to take a minute to explain novant health's approach to flying and redesigning the plane. this is an important aspect of what we've been doing. >> so first at novant health, we focused on treating the individual rather than the disease. this means offering new access points to consumers by expanding our providers office hours and providing off hour visits to better accommodate our patient's busy lives. it means using new technology to our advantage by offering

online scheduling options and investing in a patient portal where patients can e-mail their providers have, video physician visits, review lab tests and physician notes it, schedule an appointment and refill their prescriptions. 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 novant health. we recently conducted a study that showed how our consumers wanted to be treated. they value being treated with respect just as much as they value receiving effective quality care. that's a very important insight. people want to feel respected whether they're in a hospital or in a clinic. and we work hard to honor that wish by training our doctors and nurses to empathize with compassion that delivers the remarkable patient experience that they deserve in a very authentic personalized way.

second we have invested heavily in the health care technology, and we are big believers that health care technology is very 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 actually increased the amount of time our providers and nurses spends 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. this adds up to more time at the bedside and less time at the nurses' station.

and in our case at novant health, this means 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 effort has also helped to improve the patient experience. it's helped reduce accidents and falls inside of our hospitals, it's reduced medication errors and it's been good for nurse morale because guess what, they get to do what they always wanted to do, take care of patients. third, we invest in the health of our doctors and nurses because we believe in order to have world class physicians and caretakers, we actually have to investment in them so that we can deliver world class care to our patients. physician burn out and nurse burnout is a significant and largely unrecognized threat across the country.

despite the surgeon general rec fliesing physician well-being 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 rshs survey by med scape showed that 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 at novant health, we have developed a homegrown program to help our providers address burnout and develop the skills they need in this new health care environment. since launching in may of 2013

the program has helped more than 700 novant health physicianses and 300 nurses regain their commitment to the pursuit of medicine. and let me share a story with you. one that really brings the importance of this program to life. a physician who completed our program recently wrote to me. he sent me a text. and i'm going to read the text to you. it 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. again, this program is reengaging physicians and nurses and getting them back to flow why they got into health care. so yes, these are challenging times. and we are not alone in facing these challenges. every hospital, every health

system across the country faces the same challenges that we do. we're making great progress. but i believe there are policy changes that are needed if we're going to achieve the triple aim. as you know we operate in an environment that is heavily regulated by the federal and state level. the rules and regulations are sometimes contradictory and in most cases were written two decades ago for health care systems that frankly, no longer exist. for example, current rules and 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 disincentives for care teams to follow best practices, and it 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 patchwork of rules and regulations does not serve the health care system or patients very well. we need to policies that reflect the current environment beat operate in, that eliminate obstacles that currently make it almost impossible to deliver the affordable, high quality and coordinated care that is expected of us. so we need to an updated modernized set of rules and regulations that support the collaboration among hospitals and doctors and the coordination of care that is essential to improving the quality of care. so at novant health we support reforms to the anti-kickback law and the stark law so that we can do the following -- share electronic health records to improve care coordination, allow collaborative arrangements to coordinate care when a patient

is discharged, reward a team-based approach that includes nonphysician practitioners, and an provide assistance to patients to maintain their health when they return home. and we believe in it so much that novant health will be working with the american hospital association and the next congress to address these opportunities. we also believe there's room for collaboration among competitors, especially in back office functions such as information technology, revenue cycle, human resources, purchasing. 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 dhog under current anti-trust laws which again were written more than 20 years ago for a health care system that looks nothing like the one we have today. this is an exciting and extraordinarily challenging time for the health care industry. if we're going to achieve the national imperative of improving quality, we have to be bold an 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 to realize the national imperative to provide higher quality and at the lowest possible cost. meaningful change especially in collaboration cannot move forward without these policy changes. in closing, i want to leave you with a message that success is

possible. progress can be made, quality can improve, and savings can be achieved. novant health has firsthand experiences with this. for example, 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 efficient doctors for their care and the results have been impressive. screenings are up. emergency room visits are down. physician visits are up. hospitalizations are down. 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 at novant health are proof that it's possible to bend the cost curve. thank you once again to the u.s. chamber of commerce, the u.s. chamber of commerce foundation for hosting this summit, and i look forward to taking questions from the audience. thank you. >> do we have questions? >> yes. [ inaudible question ] >> i will. it's a program right now that we designed that's a three-day program, and it does a really quick look at what really happens and do people see you. in other words, as an individual, as a 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 -- that either 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. thank you. 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 at your many hospitals in five states. so those that aren't on the list of being the high value, how have you dealt with that political fallout? >> so what we've -- we put a stake in the ground.

we put a stake in the ground and what we said we were going to do is absolutely what we just laid out is we offered incentives with lower copays and lower out of pockets for our employees and our team members to select those doctors. >> we've had some questions, but what the beauty of it is we've had physicians now working with physicians who 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 to pay for performance and value, i've been on the quality alliance steering committee, et cetera. i don't want to get too technical but you could outtechnical me times ten.

how do you really measure the value of services in your group. >> is it subsequent patient surveys? et cetera? revisits to the -- for retreatments of the same underlying zeerkie ying disease 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 with 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 actually have primary care offices that run a lot 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 ed visits can we reduce, can we get people at the right place at the right time at the right place. and that's how we're looking at value. >> persons access parking courtesy, all the quality measures and all that stuff we pay attention to was like -- so the parking access, courtesy were like 4.6 out of five and the quality measures were .6 in terms of what the person perceived as being valuable. >> i talked about our electronic health record and what i want to share with you is we have 700,000 active users utilizing our electronic health record today. it's because after the access points. our doctors and our providers

are encouraging our patients as they come in. if you want to stay connected 24/7 the best way is through the electronic health record. we have people e-mailing questions and that constant visit and it gets recorded 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 engage them 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 startup perspective. 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 an achy back, and then you start paying attention to taking your vitamins and getting more rest. or your physician calls you and says your cholesterol levels are through the roof. and the data that your body have been radiating are now making you realize, well, 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 dovetails on two concepts. wellness empowerment and patient empowerment. we'll touch on both of these in the next few minutes. but think about what might be possible if you can take these data that your body have been radiating and make the most of your body and your mind. so starting with wellness empowerment, this is prior to things going wrong, you're all familiar, of course, with the activity trackers, the fitbits, the jawbones, the nike fuels some which are still on the market, some which are not. it's really been ground breaking to get people thinking about collecting the data from their bodies but these activity

trackers are just scratching the surface with wearable sensors can take your wellness. stress is one of the most important trackers that people are wanting to see in wearable sensor s. now we have trackers that can simply connect to your waistband all the way up to headbands that can help you with your meditation process. and all of these stress trackers are able to identify what makes you anxious, what makes you stressed -- what are those triggers and how you can improve that. i like to call this quantified mindfulness. think about all of the health care parameters and challenges that could be improved simply if all of us are able to just reduce our stress with sensors 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. but that's okay. it's all about behavioral modification. sensors are really changing the way we live our lives and joann brought up a point this morning saying that there are so many sensors on the market now, how do we make heads or tails of them. there is a website called well, okay kracy which has a bunch 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 sensors and all different types of trackers may be best 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 tisch -- issues, potential

hacking issues. 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 are a variety of different types of end health users out there. for instance we can now just snap on a sensor in the back of our phones and come out with an ecg of our heart health at home without having to go into the physician's office or the hospital and use the incredibly expensive equipment. we can identify our heart health at home with wearable sensors that can then collaborate with our health care practitioners. so doctors out there, do you or don't you recommend these types of technologies? a recent study showed that on the right-hand side in the red, 40% of physicians said they're recommending digital health and mobile wearable sensors to their

patients. but when the patients have asked have your doctors recommended any sensors? only 4 to 5 of the patients have said yes. there's a back here that's causing a slow up tick of these sensors to help the health care practitioner. so the reason could be there's no approachable intuitive technology with predictable outcomes. the patient would be much more likely to go out and try these product if they had actionable outcomes and they were easy to use. well, now i get to talk a little bit about my company. so we've developed priya, a personal fertility sensor. it's a wark sensor that practices a woman's core body temperature identifying the subtle changes that occur just before awfululation and then when she's 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. these again have been on the market for 25 years and they're a drug delivery system 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've simply taken the medication out and put a continuous temperature sensener. so she wears the ring a month at a time and she does nothing more than wait for that notification to be sent to her phone and yes, it 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 market is scheduled to grow at almost 4% over the next few years, and the global market for women's health devices is forecast to grow at to almost $2.5 billion in 201. 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 wrut a story for "ink" magazine that focused on the challenges to surpass the stigma that women's health is a niche market and to build a business that benefits half of the population. i've actually been in meetings where someone in the audience realizes that our main product is an enter vaginal sensor, they raise their hand and say, yeah,

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 so looking at different health care perspectives as not a niche but large market. luckily the important players are paying attention. although our product is direct to consumer product, we now have pilot studies with both aetna and kaiser. they know the importance of attracting and retaining women members into their organizations. and so sensors, i believe, will really accelerate personalized medicine. the promise of personalized medicine has been out there for since before my career in biotech started 20, 25 years ago with genomics, and we've been making progress but it's been slow. how do we accelerate

personalized medicine? we can use some of these sensors. what we have done is the impossible. we've transmitted core temperature from inside a woman's body to her smartphone. not to expensive property, hospital equipment but to the phone that she's walking around with every day. this is a graph of the raw data that we collect. this is about three weeks worth of data from a woman. as you can see, we're collecting circadian rhythm. that's what your core temperature does every day. this is one of the most personalized parameters of your physiology. you each have a very specific circadian rhythm. using core continuous temperature, we can predict a multitude of many of health care's challenges. did you know a couple of days before you start showing symptoms of the flu, your circadian rhythm temperature pattern shifts. this is even before you show a fever.

so we would be able to identify this shift in temperature and let you know that an infection is ensuing. on the flip side, on the extreme side, if a patient were wearing one of our sensors in the september, an alert can be sent to the nursing station saying this patient is looking like they may acquire hospital acquired inception or sepsis and send an alert so treatment can be started two days earlier. or cancer treatments. there are numerous studies in literature that show when chemotherapy is administered based on your personal circadian rhythm, outcomes are significantly improved and side effects are reduced. it's simply the fact that physicians have no way of measuring circadian rhythm right now so they simply administer chemotherapy when it's convenient. this is an example of using a very simple sensor with a very simple vital sign called temperature to really overcome many of health care's

challenges. there are other personalized products out there as well. we've heard diabetes mentioned a few times today. so there are a multitude of glucose and insulin pumps, glucose sensors and insulin pumps.'re aking care of the who spectrum of patients with personalized medicine using sensors. so whether your sensor is inserted like the ring or implanted or ingested, or worn like the glucose monitoring contact lens, these sensors are true personalized medicine identifying your specific data that your body is radiating. so what's next? how do we get to health 3.0? i've got a couple of opinions so i'll give you my top three. these are just opinions i'm sure everyone in this room have their thoughts on how to get to health 3.0.

number one we must de-silo the data. health care industry collects an enormous amount of data and it's typically siloed by physician offices, hospital, health care administrators. this is not allowing us to get a full picture of the patient or a full picture of the patient population. we now have big machine learning and data analytics that can help us predict many of health care's challenges but we must de-silo the data to integrate all of this data into the big machine learning algorithms. patient information at this point is not shared across providers. less than 50% of physicians in the middle of this diagram can with the mrs can share their patients' records electronically with clinicians outside their practice. how are we supposed to integrate a patient's own face of health without being able to share the data? but it's starting to happen.

3m and verily are collaborating. this was just announced a few wes several years to consolidate the data coming from the apple watch. so we're getting there. my second thought is this must be evidence-based. now, for those of us that have been in health care and medicine for many years, we knee that the practice of medicine has always been evidence based. 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 data data analysis to show that the uber app works or that facebook is working as expected, so the rigorous data that's needed to use a technology for health care is required. one example of a company that's spearheading this just closed a $15 million round of financing.

they study all these digital health technologies to identify which are showing claims and evidence they say they are. this is what we need in health care and medicine. it's starting to happen. jama, journal of american medical association actually did a study on the apple watch. i almost fell off my chair when i read this, but i was so happy to read it. it compared the apple watch, fitbit, basis and fuse to determine which one has the best heart rate monitor. pretty basic stuff, right? 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 to jama for publishing these types of studies. finally, collaboration is key. as i mentioned the health care side, the technology side, the fda and compliance and

regulatory sides all need to sit at the table to make these digital health products viable options. and it's starting to happen. i won't read all of these but this is just a smattering of the really exciting collaborations we're seeing. senofi, google, apple, nokia, mattel, all these companies are partnering with top health care providers and research centers to integrate and bring together the right people at the table. but vision is essential, ip, intellectual property, for instance. tech companies talking about open source and sharing data, pharma companies used to patenting and keeping things quite close to the chest. there must be some flexibility when we're talking about integrating data and technologies with each other or competition. phillips and qualcomm have recently collaborated, which is going to require phillips to branch out from their very closed phillips system they have had with data analytics and

start sharing their data from their interesting sensors and devices. jim malt put it very well from qualcomm. the last thing a player wants is ten different one off solutions that don't interoperate and have nothing to do with each other. but the vision by jared jocelyn from verily said on duo, which is the diabetes program that sanofi and apple collaborated on can sell insulin or novartis, nothing to do with sanofi, 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. now those data are in your hands. my clicker just lost it's self. so the question is what will you do with those data to become the best person that you can be. thank you.

[ applause ] i've got 1:28. anyone? yes. [ inaudible ] >> -- count all this data you're getting. the biggest issue on a scalable way, and this also goes back to virtual health in the future, is what to do with that data and then how do i, on demand, have access to somebody that can tell me what to do with that data? >> the next actionable outcomes. absolutely. that's why our product is getting so much interest is because not only are we collecting temperature data and

showing it to a woman, but we're saying, okay, you're ovulating in two days. the action is either take one action if you're trying to get pregnant or avoid that action if you're not. we need more analysis of the data. to be honest, the issue there is the fda. of course we have to stay in friendship with fda. but a lot of these wearable sensors are trying to avoid being diagnostic. as soon as you become diagnostic you have to walk down the 510-k medical device pathway. as long as you're just telling someone about the aspect of their health, you know, here is some information about your