there are ways, both passive and actively that will build a profile. we have a company that goes out and scours to get all the views, the amazon type of reviews. right now you want to see a specialist, maybe an orthopedist and how do you find that? you go online and put the doctors name in. you get one review. parking was horrible. that doesn't help me. how do you start incorporating data that's already out there on facebook? on twitter. all the important things. how do you do that in a realtime fashion that is scaleable?

that's the key. as we look at businesses, it's always, hey, is this something that the market needs? is this something that can stand on its own? can this scale and become a big company, something that can make a meaningful impact? so many of these companies we see are single apps. they're important apps. they can deliver a lot of value. they can save lives, but how do you then make that into a platform? how do you make that into a company? that's real why it struggles that we try to ferret out early on as we think about is this a team? it's really about execution. we talk about technology, integration, implementation, but it's really a team that makes a difference. we try to find are these people someone that have done this before? can they do this? do they have the network in health care?

a lot of it is still a people business in health care. do you know the right people at these hospitals and payers that can help you get this adopted. >> stephanie, you might have perspective on this. how do you take an app-based business and scale it? i'm thinking in particular about this feature of yours which is really making the match with a human being, somebody who is a coach who can deliver a particular kind of service remotely to the patient customer. >> we're really excited to be able to combine the human touch with technology in a scaleable way. we use a lot of technology actually. we have a back end platform for coaches to log in and manage their clients and look at doing synchronized communications. we use a lot of data to create insights that the coach can deliver, machine learning, for example, on the back end.

and there's a lot we have in the works on the back end to essentially automate a lot of what we are doing. we use evidence-based programs, like diabetes prevention program or other programs. it's not just the coach, for example. one example, we took cardiac patients from, that had an mi or stent at duke. we partnered with duke and astrazeneca to post these. we have increase in pam scores -- patient activation measure. we reduced readmissions. i think we only had one readmission from the cohort. we made it easy for the patients to really understand how to comply with what the provider was telling them was important for their rehab and real write not going back to the hospital. a lot of that was actually a program we built called day by day.

it was the coach and connecting to all the devices and data and seeing it all realtime. you can apply a lot of technology to this. i think we all talk about ai and vr, automated intelligence and virtual reality. those things are early, but they're happening. you're going to see a lot more of that in health care. you're seeing solutions where automated intelligence and machine learning is being applied to adhere to protocol improvement, helping not only doctors but patients themselves figure out what to do. you're seeing virtual reality used for mentality health and cancer patients. i think we are literally -- i was at the fortune health conference yesterday in san diego. it was the first, the inaugural conference. i asked them, when was your first tech conference? i've been going to the fortune tech conference. my background is more in tech. they said 16 years ago.

i said we should mark this day because this is the beginning of the health care revolution, right? the next 20 years i think all this technology is going to create scaleable solutions for health care and bring the consumer to the forefront and patient to the center. >> do you have thoughts whether technology can help and things happening in cognitive computing and things microsoft is working in? >> i'd say there are three areas we've been focusing on as a business. put them in broad buckets. one is patient engagement, a 360 view of the patient which we've been talking about and what are the tools and resources available to facilitate those scenarios, whether it's virtual health or bringing in different sources of data to augment the systems and record in the hospital. there's clinical analytics. what's interesting is i'm seeing a lot of top hospitals we talked to. there is conversation yesterday one of the last presentations about the wealth of data.

you talk about digital transformation and digitizing. health industry has riches of data. how do you get from data to information to insights? we are focusing on cloud services that support advanced analytics and machine learning scenarios where you can build new programs and get and derive insights with scenarios you couldn't before because you can leverage the immensely scaleable, unlimited scaleability of the cloud to load large data sets. we are finding a lot of hospitals we talked to are saying we see applications for the data sets we have. it falls into your space a little bit, too, in terms of them saying we think there are offerings here. i.t. that could be shared out. we don't know what the business model would look like. there's a lot of storming and forming around this.

we have a huge amount of focus. the intelligent cloud. how do we leverage the intelligent cloud for application specifically in health care. a lot of start-ups in this space but a lot of traditional companies investing and seeing how they can transform your businesses with the new capabilities. >> when it comes to making information useful and valuable, how do people get paid for it? we talked a little about sort of, you get an insight, how do you get your money back as the supplier of that insight? ed, any ideas? >> i think that's by far the most interesting thing going on in health care today. it's not the technology. it's the fact the business models are changing. the core business models that are underlying health care change. that's where the flow of money, flow of dollars, how you get reimbursed. there is real interest in changing that. again starting with the 1,000 pages of aca.

for better, for worse, it's there some of the pieces i could do without, but by and large the point was to change the flow of money to figure out a way to get you paid more for doing less and taking better care of patients. what i see now happening is an intent to create high quality consumer experiences because that's actually what will bring consumers to your brand. then actually make sure you monetize that. what i'm seeing are super innovated companies trying to take first dollar risk. this idea of first dollar risk or consumerism, those things will actually end up driving a lot more than the technology. the technology is there to support the business. so you have folks like privia

trying to take first dollar risks without the hospitals. they'll take first dollar risks from the insurance companies and try to charge down stream against the cost of the hospitalizations. you have urgent care chains taking advantage of the fact patients want convenience. you have new york presbyterian who is launching a creative outreach strategy to leap frog other folks in their communities to reach out to patients. for the first time, folks like that who focused historically on the excellence of their service lines are now actually thinking about what does it mean to create an excellent service experience out into the community?

so i'm seeing folks from across the spectrum beginning to think about what does it mean to live in this next generation of health care, how do i need to rewire my own economics to survive, and what investments do i need to make? >> yumin, what do you think about the timing for this? you don't want to be too early. there's a lot of interest in paying for value. is there enough of it actually happening that you can build your business on something? >> we hear a lot about value-based payment and share savings and innovative technologies, yet when we dig into the companies, most our customers want fee for service. that's how it's traditionally done. we are definitely seeing the shift. it's taking a long time. i think it's going to accelerate. we can have this discussion. i tell all our companies, at least have a pricing model and business model thought through. 95%, 99% of the time it's really

challenging to convince a customer, whether it's a hospital or payer or whomever to participate in that. it goes down to your roi question. how do you calculate that roi? what does it mean for that to be applied? what is that time frame? what are you measuring? how do you know that's actually driven by this one program or not? i think it's easier when you have a model where it is a heavily serviced model and you're caring for them across everything. a lot of our companies -- we have a few companies that do that. a lot of companies touch one aspect or a few within health care. it's hard to then give that attribution of that benefit or whatever the outcome is to that company saying, you're in isolation here. this works. you get 100% of that. it's usually a combination of

better service, better technology, better work flow. there are a lot of things that go into getting that roi driven. once again, going into that multiple stake holders. i think fundamental problem, i would love to see a market where the health care market goes toward amazon model. think about all of us as consumers of health care. we are so far from that. we think, hey, our taxes, 20% gdp is health care, right? it's a big portion of what we pay in taxes. we also pay health insurance premiums, we pay co-pays. if you ask someone to pay an extra $200 to go get certain diagnostic tests done, you look at the payer and go, why aren't you covering this? why aren't you the employer covering this? you get into this mindset -- all of us, i'm the same. you go, i'm not going to pay that bill. it should come out of the taxpayer dollars. there is so much built into that.

it's shifting to the consumer starting to get empowered. we actually sold a company that was giving pricing transparency. we have another company that helps figure out the quality measures for hospitals so that you as a consumer can figure out where to go to get the best quality outcomes. you're starting to get there. but the visibility into that is still opaque. it's not as easy as going to amazon saying this is the cheapest one and this has five stars so we'll buy this. we are still away from that. >> there are huge opportunities today in terms of taking costs out. that's where some of the focus is. maybe pay for service, but the service you're getting is different, where it's delivered is different. there's a partner that we've been working with, iris, who does retinal scanning. the leading cause of blindness in adults and most of the time, folks just don't get the scans. 90% is preventible if they got

the scans. this company has put the devices in the physician's office. you skip having to go to a separate specialist appointment which they likely weren't going to get done anyway. engage that with the specialist to do the readout and come back. that's taking cost out of the system. it's avoiding canceled appointments. the wait delivery and where it's delivers is like low-hanging fruit taking costs out of the system. >> i agree. what we are doing is taking costs out of the system. we are telemedicine, enabling a lower cost model for managing chronic conditions, prechronic and chronic conditions. there are two things that are really important that are happening right now that are driving us faster to the consumer side or the ownership by the consumer. number one is cms. they are pushing for value-based payments. they said 50% of payments are going to be value based by 2018. they are not relenting. they are pushing aggressively on

this. there is pressure in the system. they drive a lot of the spend. number two is deductibles for the first time, you're seeing a lot of noise, especially around this election cycle about essentially wages are flat. deductibles and premiums around 63% in the last five years. the average consumer -- there was a study that came out a couple days ago, 50% of consumers in the u.s. cannot afford a $2,000 deductible. you're really seeing for the first time real financial pressure on the architecture of the system. consumers, if they're having to spend money out of their pocket, they're going to become more vocal. these two trends are pushing the system. the question is how fast will it change? >> what do you think as far as the role of cms in moving some of this stuff along? >> cms, everyone takes signals

from them because they are the big dog pair. when they say they'll put their muscle behind telemedicine, most others will follow. most folks will take what they do and try to improve it in some way. at the end of the day though, i think to your point, short savings, right? short savings are a half step. i see very few people who are super serious about short savings, per se. most folks into that are into it for one of two reasons. either they're into it because they want to improve quality to patients. they want more patients. that's one reason. the other reason is because it's a step on the way to global risk. for those people, they want to go as quickly as possible and bypass the whole share thing. why don't you give me the whole dollar instead of 50% of the dollar? that's the other major model as that begins to happen. i think cms' role is singular in terms of how they want to pay. they are unrelenting in how they are actually putting this out. with that saidthey are adding

an awful lot of regulatory craft to the system. there are 21,000 pages of legislation since the ac was legislation since the ac was passed. i've read through a lot of it. it's depressing. i don't know if anyone else read through the regulation. it's mind blowing. i think what i'm concerned about is the unintended consequences of value-based reimbursement as defined by regulation. it would be a lot easier if value-based reimbursement were defined by getting other economic actors out of the equation. having good care from a provider that i trust and i get the outcome that i want. that would be easier as opposed to all these quality measures and cost measures, and thousands of pages of regulation, which candidly suck up an enormous amount of innovation just fire power. everyone i know who is smart is

focusing on how to keep their head above water. not as much innovating the core systems. anyways, long story short on cms, i think they are playing the role of singular. my hope is they can peel back on regulatory pieces of it. >> yumin, is there enough of a market so if cms signals and regulations can be navigated, do you see your companies navigating the market? >> i hope so. even with the regulations, there's going to be innovation, there's going to be companies. we need it. there is no way we can sustain 22%, 25%, 30%, it's not sustainable. at some point, something's going

to give. i think it has to be a combination of things. i think cms is not only a signaller, they can move markets. a lot of times when health innovation happened, it's been mandates. emrs are going to be prevalent. emrs take off. meaningful use, all these different things come out, you

know, it's always, you know, an it rags of the previous so it's not that crazy. that's not the theory. that's the status quo. you have a slide of all the different files. i'm surprised it is that organized actually. and you cannot get rid of fax -- i think health care is single handedly keeping fax machines alive. it really s i recently tried to fax something to my insurance company and i couldn't find one. i asked my assistant, we got rid of it five years ago. nobody is using them. yet, that's -- we have a company that pulls medical charts from hospitals and faxes it back to the insurance company. right? we have a company that specifically is aiding and abetting this, you know, proliferation of faxes which i'm horrified with. but that's where we are. so as you think about oh, yeah, digitizing and mobile and ipad and apps, there is this big 95% of hk is still driven by paper, pencil and emrs. how do you pull the right things from the charts and put night digitized format? we're in that transition period. hopefully we come out with lower costs, improving quality and better consumer experience. but it's a way to get there. and the timing once again is the issue, right? i don't care who you are. there is no way you can say we're going to get rid of faxes by x.

it just, you know, the government can say that. >> actually, faxes were specifically protected as a -- >> i think so. >> they're protected as a special class under hipa. >> exactly. >> health care keeps the industries alive. when the government comes in, they say we're going to get rid of all paper faxes starting 2020. that will move the needle. can we get there? probably not. i think there is it government mandate that drives health care now. that won't change. that being said, we're still very positive on innovation. even despite all the different things that have happened, there are innovative companies coming in. a lot of technology coming in, a lot of services coming ncht once again, these aren't revolutionary in the fact that you have a new business model.

you have a any integration. you have a new work flow that helps get these adoptions happen now that weren't possible, you know, five, ten years ago. >> in our discussion we talked a lot about what tech can do for health care. we're at the limits. one of the things where we're still going to need humans, we're still going to say substituting an algarythm or approach to this particular problem may not be the way to go. do you think about that when defining your own business and sort of what the objectives are? >> absolutely. health care is all about the human, right? empathy and compassion and all the things you all practice every day if you're a provider or pairs, this is the essential.

there is no -- so we -- that's why we do pride ourselves on the human touch and we use a lot of technology and we get asked a lot of questions like how do you scale, you know, why don't you adjustment use ai in bots? get rid of the humans. we're not going to get rid of the humans. you can't really form a long term relationship with an individual or really get at the root of their motivation or behavior change without a human element to it. you can use automated intill jens. you can use bots and a lot of technology to augment the human relationship. and that enables scaling. but the human element is essential. >> i think it's going to end up -- i mean, for much of this is going to end up requiring a shift in how we think. the human is at the center of the decisions. but i think that we're going to see computers helping humans and

humans helping computers. you're not going to be able to tell the difference if we do this right. people will do well what they do and computers will do well with what they do. but this is going to happen over a long period of time. we can't, for example, these days actually even deal rationally with the care. we don't know how to have -- we don't know how to make decisions. we're not equipped with the mental frameworks. we're the oldest generation. we're just going in the oldest generation with new technologies to help support. but the intersection of the -- those kind of human decisions with technology is going to be how health care is going to be driven. i think it's inevitable that's going to continue to just push

forward glacially. i think we know where it's going to end up. the question is what is the path? it's all in the timing. >> it's interesting. to me, it's almost like back to the future. we want to get back that human element of the doctor-patient engagement. it's about having the technology in the background not the foreground. the issue is physicians are in front of the emr typing. so we really have to be focusing on it as an enabler to allow the humans with their intellect to do what they do best and make them more efficient. that has to be the design point that we go forward. >> right. >> you mean you're going to get the last word here. >> great. >> there is a dchotomy of technology and service. there are certain things you just don't want to deal with human beings, right? you want the answer, the price. just tell met price. don't give me the run around. tell me this or this. which one is better. you go on to web md. everything is cancer. you have cancer. everything that you put in will lead you to cancer.

i actually had cancer last year. i can laugh about it. but, you know, when you are a consumer of health care, when you're in that seat where you need the care, right, a lot of care is as you said, mental and emotional, behavioral health. that can change the outcome. that can change the outcome of how you interact with people. and we can -- we have a company that can show you that by dealing with the mental and behavioral issues for someone that has gone through a medical traumatic event. we can change the outcome and the readmissions, medical spending. and so, you know, someone -- when you're faced with your own mortality and your health care, you want the person, you want to

know that someone is caring for you. you want to know that you're in good hands. and you go back to the basics of what is health care? it's human to human. it's community. it's beyond sick treatment. it's really the health care of that person before. they get sick, during the treatment and afterwards. right? that's what we want to strive to do with health care. you want to be there before that person gets chronically ill. before and after and we're doing end of life care. you want that human touch. i think technology has an important role to play. we absolutely focus on that human element. >> thank you very much for a wonderful panel. i hope you guys enjoyed it as much as i did. here on c-span 3 tonight wab house hearing on self-driving cars. then a discussion on the impact of consumer debt in the u.s. and later, a look at what the justice department is doing to stop corruption and fraud between corporations and foreign governments.