peter mcallisterd michael , and sue siegel. welcome. good to see you. [applause] in a nutshell -- and i really mean in a nutshell -- because we cannot transform health care and make the world better if it is dollars put in a key, i would like each of you to explain the pledge you have made to this group and to the clinton foundation and why you are bringing what you are bringing to the table. the welcome, we are a presenting sponsor for this, and part of the reason is because our mission is to improve the quality of life of

patients in our care, and this gives us the opportunity to partner and to build something that is bigger than ourselves. the way we will do that is through collaboration with organizations like this as well as others who are committed to looking at things differently and who are committed to having a different outcome that moves us beyond where we are today and improving the status of the health of the nation. i will do anything the clinton foundation asked me to do. i have been having a wonderful year traveling over the united states watching communities get activated. i think people are starting to realize what is possible and that it is in their own hands. activating communities is the biggest job this country has. >> what do you mean by that? >> do not wait for washington or some higher authority to tell you what to do. the knowledge is there. you will find in your communities people who understand what has to happen to help overcome some of these plates that are overtaking our

nation right now. we can stop obesity, violence, the precursors of diabetes. it is local action that is going to make the difference now. >> you said in the sweet spot of anding at how health care insurance is at a very interesting nexus. >> yes. the commitment we have made as part of the program is for the very first time -- it started a couple of weeks ago -- we are rolling out a platform to 750,000 seniors around -- it is a concept of risk/reward programs around getting behavior modification programs. we have talked about the system. we know we have system issues. we really do not have much of a health-care system. we have health care sprinkled all round. we have to work on the system. we are committed to doing that. we believe integrating health care is a critical answer to that, but you also have to get

people to change. the commitment we are making this week is to take this program to 750,000 people, prove its worth, and launch it from there. >> as part in ge, you have done some extraordinary work showing that communities can change. what is ge bringing to the table? tell me about the project. >> our chairman and ceo in 2009 decided that we had to take health care into our own hands. we could not wait for anybody to tell us what to do or to have anybody structure legislation or anything else to make things happen, so we embark with a $6 billion commitment through healthy imaginations to provide better health for more people. one of the activities around that, which essentially our chairman said, was go and show that this can not only happen internally at ge but also can happen externally in communities. go pick communities we can collaborate with in private

public partnership to make things happen in health care. since then, we had 10 self insured employers joined up with this initiative. we've had 19 hospitals in different health-care service organizations. we have of course the political and company types of individuals, in terms of policy making, and what we have been able to do with this kind of collaborative over the last two years is quite remarkable. there's a report that claims there has been $200 million in savings alone as it relates to emergency room costs. in addition to that, there are surveys that show that because of the coordinated care that has been put into place in cincinnati that in fact the great satisfaction of consumers -- the rate of satisfaction of consumers, patients, are increasing dramatically. we would like to repeat that

with the clinton foundation and our partners on stage here to do it nationally. >> it is interesting watching every one of their head. you and i have had conversations in the past that verizon, while many people did about it as a phone and broadband company, increasingly sees itself as a health-care company. >> verizon has a commitment to something we call shared success. this is going beyond sending vaccines to bangladesh and getting a video of the episode so you can claim you did some good to society, but rather really engaging in products and services and changing society for the good and at the same time being part of that. that is a foundational principle at the horizon. one of the things we think we can do is do things that will facilitate this health-care transformation we all see beyond us.

we know there is an electronic component to it. we know those things have engaged to reduce costs, improve quality and all other aspects of our life. why can we do the thing to remove the barrier there that can help accelerate the ecosystem there? among them, regulatory barriers, making things easier to be compliant with hipaa and what not, making services available everyone engaged. we are all in on health care. we are all in on helping everyone drive the change. >> i want to remind everyone that we will take questions by twitter. if you have a question, please raise your hand. i will see you through the lights, and we will get your questions. thank you for your opening statements, and now a real question. i would like to start with the elderly and move back. there is a trend now, and they think it is the smart way to go, of letting people age in place. not putting people in hospitals.

not putting people in nursing homes, but making the home a so thatart, wired home people can live a robust life and frankly, slide out in place. millions of seniors that are our customers. we have a program called medicare advantage. we have a holistic responsibility for everything that happens with these folks. if you look at what happens in the old medicare program, people are admitted to the hospital -- readmitted to the hospital, one of five, within 30 days after being discharged. we have learned that it is also these -- often the social setting, and their support mechanism, not their status that has them bouncing in and out. we build an integrated approach both on site, telephonic, and everything from transportation to food to whatever it takes. we go to homes and assess the status.

it is incredible. hospital admission rates in the population are down 1/3. readmission rates have been reduced by 26%. it is all about having that ability to get them to the right place at the right time, make sure they take their medications, make sure they understand doctor's orders, make sure they get back to the doctor in a timely way. it is really a lot of blocking and tackling, but the impact is huge. we have emerging technologies as well where we will be able to start monitoring people. i can easily see a day where we will see a productivity gain that will be mindboggling in scale to be able to keep up with these people in their homes because they do want to stay there. >> other than your orwellian fear that someone is always watching, there is a way to monitor pills, refrigerators. >> one of the interesting things -- kids do not live with parents anymore. we get all excited about the social network phenomena, but the social network phenomena for the elderly boils down to the

real social network, not the virtual ones like my mother and sister and brother and neighbors and so on. one of the simplistic things you can do is enable the kid that is two states away to figure out what is going on at home. i've got just one example of that. i'm wearing a watch that i call a dick tracy watch. you push the button, and you can talk to somebody. electronic has accelerometers, and the ability to determine a fall and determine if you are walking well and so on. imagine if you give permission that your family is good to know what you are up to -- it is not everybody. it is your family. maybe it is not the kid you do not like, only your 3 favorite kids, right? but imagine that your kid will know that you have been up and around just because your motion

accelerometer can help record the movement. a wandering alzheimer's person in early stages, knowing where you have gone, where gps tracking has gone. if you think of them in the context of your actual, physical social network, they make perfect sense. >> two things -- nothing excited me more -- i love the running cms. it was a great job, but nothing is better than this trend you are talking about. there was a lot in the affordable care act that will help communities that want to do it get people out of nursing to their back communities. tremendous success in a lot of projects. there also was a very important paper just out in a british medical journal this year, a randomized trial in the u.k. where they took seriously chronically ill people, but the kind of thing peter was talking about in their homes with nurse visiting. they had a 15% reduction in

hospital and a 45% decline in mortality in the first year. >> what is interesting is that every one of you has outcome measures in your brain. no more is this like "it feels good" or "i think it can work." these are measurable changes that improve quality of life, decrease hospitalization, decrease morbidity, and allow people to age in place. >> increase joy. >> and increase joy. for people who say they do not need big brother in their home -- i will put the insurance people in the hot seat. no one likes you guys. we need you. >> i like me. >> how do we learn to like you and trust you with our information? we like you. >> we have an awful lot of data. we are in an interesting spot to be helpful and useful.

first of all, we are properly incentivized to do all those things. because you are given a premium and you want the best outcome you can get for that. you are going to look for the best productivity, the best possible services, the highest quality at the best price -- all those things are all there. it happens it lines perfectly with the needs of people. we are in a great spot to do that. we have wonderful data resources. they are beginning to be used better to help. this is where our industry will change its image over time. this whole concept of the data -- we tumble a huge database every day, and from that, we find gaps in care across the entire system. in one month this year, we found 400,000 gaps in care based on what we knew should be happening with these patients, or at least the data told that

it was not happening. we sent out 800,000 messages. it is helpful. it is useful. to the extent that over time people see that coming from our industry, i think we are in a great position to help. >> building on what michael said, we have the luxury of treating almost 8 million patients a year. that gives us a lot of data as well. we have been focused for years on care variability. looking at where we have variability on what should be done and looking at how we can move closer to that being done on a regular basis. we continue to do that while also looking for ways to drive down costs. there is, we agree, some degree of waste that exists in the system, and looking for ways to improve quality while also reducing the cost of care. we have been working on preventable be a missions since the end of 2009 -- really, the beginning of 2010.

>> does the data show it is working? >> and to us. our commitment has been that for those patients that require hospitalization -- we want you to come to us. we will deliver care that is consistent and scientifically sound while you are there, and we will continue to move in that direction, but we have also put transition coordinators in the hospitals. we also have software to look at patients who might be likely to return either for health reasons or social reasons. and then working with partners on the post-acute care and discharge space to work with them in their homes, in their communities to actually address those gaps so they do not return if that admission could have been prevented or avoided. >> when you look at the property, the portfolio that , veryl electric owns

interesting stuff in the healthcare space, is there a way to make the american home a smart home so that an elderly person, a young person, a doctor, the family, the hospital become integrated with that? >> you bet. her first all, on the whole notion of five is c, travis see more and more is becoming a currency -- >> don't you think that privacy is an illusion echo by the time you post your results on facebook, isn't it over? people -- the whole notion of getting your genome sequenced was just, oh my goodness. we had to have the protections in place to have people get comfortable. the same thing is going to happen with the data.

a more we educate consumers that using data that is simply presented to you and i way you can interface, i suspect that will really empower us to make decisions on our own. bringing it back to what ge brings to the table and really ,ooking at this, first of all we have a joint venture with intel, which is all about care innovations in the home, and that is to have remote patient monitoring and being able to actually continue to make sure that the person who is aging can be monitored in a way that is much more cost effective and much more efficient to the system. you start thinking about everything ge has in its portfolio -- you imagine the dispenser into refrigerating knowing exactly what it should be dispensing based on holistic things that have been measured .n you and hold -- sensors

everything will be tied in overtime. you think about that, and people say, no, it cannot be true, but it is coming and a lot of it is here already. "> look at the cover of "wired magazine and the cover of "fortune" and it is about robots and science. tohave a question over here read if you would stand up your name. and insuranceital company, do you guys share data specifically? or does one affect the other not, and how can that be a model to everybody else? >> good question. how do we share data, and at a time when electronic medical records are not necessarily a home run -- >> i will start. i argue that they eventually will be a home run. implementation is hard and it slows people down in the

beginning, but eventually it is the right thing. there is a huge investment going on in terms of wiring the system. i think there was money in the stimulus bill to push the ball down the field, which was useful, i think. that is getting better and better. we have all sorts of mobility capabilities today where not only individuals but for providers and others can get real-time information. it is crucial to the long-term solution. the only way you get that is bi-wiring and all. the money is going in there, it , there is better venture capital money in the space. i think this will eventually emerge and be ubiquitous. right now we're struggling to get it moving. you will continue to see a lot of effort and money spent on it. should hospitals and insurance companies make each other's data available? i can see the downside.

what is the upside? don.n, then >> we are putting out an electronic health record and implementing that across the system. second, there should be some sharing of data. there should be sharing of information that helps us to be more aware of what is going on with the patient fire to them coming into the care, how they are being managed when they are there, and what is happening after they leave. there is increasing accountability being assigned to us both by governmental payers as well as the marshall payers. also, by having an information, it is more complete and allows us to make decisions that would be in the best interest of the patient as well. we have to figure out ways to open that. the way we do it right now is archaic. we rely on people. you have case management working across the boundaries to share the information. we have those with people, and

people internally as well. and we will get to a place where we have an electronic platform that is more real-time and accurate and actionable. >>' what does perfect look like with insurance companies and hospitals sharing insurance data, and what does the person need to know to access that? let's talk about how important this is. you cannot get better at golf if you don't know where the golf ball went. we have to pull the information , because of the good happen in this hospital and we don't realize that something happened in the other one with the same patient rate -- with the same patient did his about learning, not about punishment or reward or anything. it is just about learning. haitians should have access to everything about them. it is theirs -- patients should have access to everything about them. it is theirs, not hours. when i was in practice in

pediatrics, i was lucky to work at a place that had one of the first electronic records, and one day on my desk i got this report on my use of x-rays. i was using x-rays eight times more often than my chief, and she was better pediatrician than me. i went to her office and i said, what's going on? i was wrong. i miss learned a lot of stuff. if i did not have the data, i could not have improved. 10 or so years ago i was part of a committee called ptac, presidents technology and information advisory committee. ift committee said that only we could share medical information in a reasonable way -- and the answer you're question is no no, although snow sharing actually happens. -- is no, almost no sharing actually happens. we basically said that if we

could only get the health information technology in healthcare to be similar to where it is and banking, just similar. number one, everybody would be dramatically healthier. two, we would see tens and tens of billions of dollars. three, we would invent a dramatic new kind of science. other than that, it is probably not worth doing . [laughter] $700 billion of savings available if we can only leverage the kind of information we have in meaningful ways. i think advertising is looking to embrace the privacy thing. let's give people choice and give the tools that allow us to give people that choice. for those people worried about privacy, let them turn things off and let them know who look at their records and let them decrease some of that sharing where it is appropriate. at the same time, for people who

post their gynecological information on facebook, that whole generation is more open to that. but i don't think you need to tell people to give up on privacy to achieve great sharing. data beinglk about the threshold of making things better and taking the great leap forward, and we could talk about what that means with regard to privacy, and we all define it somewhat differently peopledo we either ding for poor behavior -- cigarette smoking, poor food, lack of exercise -- or how do we reward them for doing well? --uld the insurance company what role should the insurance company play in incentivizing people? we have a regulatory restraints, but it is emerging and getting better. whacking people is the wrong direction. we are better off incentivizing them.

hut is the whole thing with mana, it is a behavioral modification tool -- >> behavioral modification that has a monetary component to it of it. that is part finding ways to get people to change their behavior and have it be sustainable. we lost programs are all over and they tend to work that people tend to revert back when you stop them so you don't get permanent change. the key is finding sustainable behavior change and using any number of techniques and tools to do that. we are all motivated diet whether we want to admit it or not. i was smiling and thinking about what is really motivated the culture of health that ge is embracing. it has to do with a number of things, and that it is not just dated-driven. if you are going to consent a certain behavior, you have to

provide the tool sets, you have to provide -- we all know this -- health is local. why is it that weight watchers has worked so well? number one, it is local. your social environment, it is social, so you have local and social. and the metrics are pretty defined. as we think about this whole notion of data and being able to take that and and empowering everything, at the bottom of all that is this whole notion of consumerism and how it is really taking over health care. we are no longer the passive patients. we actually want to know what is going on and help us understand which choices and which decisions we can make. it is not just about the data, it is how it is presented, how it is actionable, and how we can do something about it with tools that are accessible to us . >> for the number of physicians appear now, doctors find change the toughest. his vision's find -- physicians

find change the toughest. consumers believe they have some chit in the game and they have a voice. physicians may be taking kicking and screaming, but changes on the way. donne of the things that mentioned it is using the data to recognize differences in the way you are practicing compared to your peers. the more we expose that and the become engaged and that in setting expectations, i think physicians will embrace the level of change that is necessary. >> we have a question out here. would you please stand and say your name? my nighttime job is making sure that carter here does his homework and cleans his room once a month -- >> i think you have been a pretty good job. am a primary day i care physician and i care for my patients in the hospital and when they get home. when they get home, i need a

physical therapist, i need a i need anst, assessment of their well-being, what is going on in their home. pretty soon it sounds like i have every way, every blood pressure, every meal they have eaten coming to me. the amount of data that comes to the primary care physician is overwhelming. and yet the primary care physician is practicing as a little silo. team-based care does not exist as a rule. i am curious from the panel standpoint, you will be taking this issue kicking and screaming, but we had -- because we do not want to give up control but we are overwhelmed by the amount of data. how do we handle this amount of data, how do we move the physician community forward? the model un i knew about practicing medicine is so youquated -- the model that and i know about practicing medicine is so antiquated it is

unsustainable. >> we can get there, and learning how we all now practice interdependency -- no longer the hero that saves the day, but i'm interdependent with others to give care. that is what works, and we know that. on the data side, we have to be smarter than we are right now. we are through an almost festival period of data right now. there are 1500 variables. -making.azy hopefully we can narrow down the measurements that matter, the data that we really want, and make your job a lot easier and do the right thing for the patient. the whole history of technology is that at first it is overwhelming, and later it is in the fine. it is the later stage that we don't have clear visibility to. there is more power in your hip pocket now and then what put the apollo -- more power in your hip pocket now than what put the

apollo astronauts on the moon. it is because we have a simple interface and a screen with it trade ever rising, we have a platform and the whole point of it is too simple fire for all the innovators out there the hard parts of solving the position's question. i am pretty sure that you don't want 4000 glucose readings a day coming to your desk. instead you want them to go in a secure way to a cloud where the decision triggers are made based on their particular condition and their particular combination of conditions that maybe you helped tweak and set, maybe with some input from the patient themselves, so that you wind up with the alert. maybe you don't even want that. maybe it goes to the sister and the daughter and the neighbor down the street that says something is wrong with betty, could you stop by, her diabetes seems to be out of control. it is not that we want positions more in the loop.

we want the physicians to do the part that we are good at and get us out of the stuff that we are bad at. physicians fundamentally have been consultants for 70, 80% of what we do. consultancy becomes a service over time. we have a question here in the first row. >> i am superintendent for the coachella valley school district. i thank you for being here in the eastern coachella valley rate although we are further east am a that is where the real work is i represent some of the poorest of the poor in our nation. any percent hispanic, 90% on free reduced lunch. we have an obesity album in our district have a but we have taken individual responsibility forwe had 18,000 ipads 18,000 students. you talk about data, it comes down to education with the data and how we can change lives and eating habits and nutrition

education. i am proud to be here today with you, but i want to know how u.s. healthcare providers and insurance companies can work with us. i have 18,000 students ready. each one will have an ipad from preschool through high school. however we going to use that data? how are we going to get the information out to them? how do we -- i want to partner with you. ,> this is a generational shift from the aging in place and elderly to the future face of america, and partnering with young people and data. frankly, what are we going to do now to teach health and wellness to a generation that, until recently, was almost going to be skipped over? kelvin? >> we have saint christopher's hospital for children, which is in philadelphia, and we are establishing something there that gives some of the things you are mentioning. the center will be called the center for the urban child.

what that focuses on are some of the other determinants of health and wellness and bringing people together through a collaborative partnership to vote become aware of it -- to both become aware of it, educate others, and then be able to address the specific circumstances and situations that will help them to live healthier, more productive lives. >> are you optimistic that it is doable? how would you partner with kids like us who are impoverished but wired? , we are very optimistic about what it will become, and what it will be able to produce. in terms of connecting with the wired, that is another opportunity for us. to be able to have things that are communicating how you are doing or what your goal should be and how your are performing against that to create dialogue will be essential as we move forward. theych kid needs to know

are not alone. one of the great opportunities is for a child to say i have this problem, who else has it, what have you done? communities of shared effort can do think that no individual separately can do. i am thrilled to it here i school system is getting involved here. to have the school system mobilized, i tell you, either do you can really crack this. >> we have a question in the front row. i appreciate the discussion i'm hearing in terms of how you integrate technology companies companies and bring solutions into play, particularly when you think about chronic disease in our country. but one thing that is missing for me is a discussion about the role of pharmaceuticals, and particularly the relationship between pharmaceuticals and physicians. how do you reconcile some of that? we are a country where disease management is too often about a bill, not about managing your health. i would love your perspective on how you are engaging with that. one stepould take that

forward, tell me if i'm wrong, because i want to to make the switch to preventive health tom and preventive health in this country gets short shrift. we are accustomed to going in and getting fixed. how do we harness the data we talked about, engages students, and get away from this idea that the doctor is a hero because he or she made me better when the whole idea is to avoid becoming ill to begin with? look, we are in the midst a flu epidemic and we cannot get people to get flu shots. talk about preventive health. don, we will start with you and go down the line. >> balance matters here. bellingham, washington did tremendous help -- work on chronic disease care. disease went down, function went up, and when people take the right medicine at the right time, things can get better very -- things can get better. maybe in the bathwater?

you are absolutely right. learn that and un get away from that, but when people take responsibility for their health, you will see pharmaceutical use declined because they are less dependent on things to keep their cholesterol down and blood pressure under control. >> we don't always wanted to decline -- want it to decline. most people over 65 have chronic illnesses, most of those are treated with some form of medication, and compliance is a big deal in terms of keeping the health status height -- emma the right medication -- the right thing for the right time. we know all the drugs the somebody is buying. we don't know if they are swallowing them, but we know they are buying them to read -- they are buying them. i don't know about your parents, but i can predict a few things. if you go to their home, they have a pile of pills and they're always in the kitchen.

interestingly, they're not in the bathroom. they keep them there for whatever reason. , because weings have the holistic view of the individual individual, we can have some clue as to whether these things work together or not. from a school perspective, you need to seek me out later. we have interesting things that can me. on ipads relative to websites -- >> at the end of the session, come on back. peter. all of this requires innovation. we have ideas of what the answers may be, but everyone who is a doctor and a scientistwhatever might be the ironclad rule, that this cures cancer, one in 100 of those make it to the real world actually working. we need innovation into big areas. one is in getting people to answer the question. you need to tell people what

they -- what you want them to innovate around. we need innovation. now that we have ipads for kids in schools, how do we use them to make things better? last week verizon announced a $10 million challenge, and we are hoping other people will do a similar things for the explicit purpose of coming up with answers to questions exactly like that so that we can , were that out t separately partnered with the duke to do the science around information technology. we have a lot of science around pharmacology and medical procedures, but we don't have a lot of science -- there is almost no science in computer science, oddly enough. we don't do any hypothesis or experiment. people just build an app and make sure it works. we want to foster the science of what works and figure out how to drive those things. these are the kinds of things we would love to work -- we are working with coachella valley.

that is one of the big reasons we are moving the project we are with the clinton foundation to drive these answers. >> can i get the microphone to the first row? chelsea? ?ould you stand > >> how do you think that nursing education, armistice, pedagogy should change it so that the next generation should not -- does not grow up with the same practice constraint that many of you have and many of the questioners have? how to not only those pedagogy 's change, but the support of computer science and engineering and educational had change sopedagogies that out teachers and doctors and innovators thinking more holistically? see what everybody thinks. i think it requires a systematic change.

one of the most interesting things happening now is at stanford, at the school of global health. created something for to nova and she decided she wanted to hear from architects, systems analysts, wanted to hear from legal. she had it guys in the er, she in the community. when you take people out of their own ecosystems, they see the fallacies of what other people are doing, and then she brought them together. in that moment, i thought therein lies the new medical school. we have over 50% of women. i happen to think that will make a difference rate this idea of sharing information -- that he or she has the right to her own data is the paradigm shift. i'm old enough to believe that the doctor-patient relationship is sacrosanct. what the doctor says to you is

confidential and goes home with you and does not go to a cocktail party or in systems unless somebody wants it. but i also believe that prominent people have to have the human genome dumb -- have the human genome and done and put out an public, and i will do that this year. , andve to share data other we have to protect the individual, and then we have to say to the patient, the consumer, this is your life, this is your show, and you have to drive this baby, and i am your partner in doing so, and that to me is the great dr.- patient relationship. i think that is the doctor of the future, with all the data and computer stuff around it. we alsof the things have to address is creating a team-based construct. i find it interesting that what we do vaguely in medical education and clinical education is you are educated in your school, and your silo, around , andparticular doctrine

then at some point you come into a healthcare environment and one of the challenges that we continue to confront is how do we work together as a team so that we can tackle this together? the more you can get this team- based philosophy in education and training, the better equipped we will be to say what are we trying to accomplish here, and how do we bring out different skills to that, and how do we work together constructively to address it? >> we will take this one down the line. >> teams are important. one of fundamental changes to address families in the educational system. , andown, be quiet listened. young people need to understand how immensely valuable and important that is. there are technological skills and prevention skills. cdc had a report this year. there is a drug that cuts rest cancer risk by one/three, reduces diabetes by nearly 50%,

or cuts depression. it is better than most depression pills. it is walking 30 minutes a day, four days a week. i was not trained on that in medicine, but it is something we ought to put on the screen for young people. >> i agree. >> i worry that we are training the wrong kind of doctors. grandma interesting you say that. i have the same concern -- you say that. i have the same concern. i think that screening for young physicians is upside down. hat do you really think -- >> i know. [laughter] generation hasm the potential to overwhelm the system. we know integrated healthcare is the best, and the highest

quality, but then you have to thereurself, and then are things like radiology where you have incredible capability, and i talked about productivity earlier, the digitization of the pictures, someone sitting in one place and being highly productive in multiple locations, and you think about all that and you think of what is coming out in medical schools and realize that it is not real good and what it will be -- i am not one of those convinced that we have a great dr. shortage everybody talks about. if you take a snapshot of today's world and move forward, yes, but if you change things, you may not have the shortage because of the productivity possible. a systematic change, and i think this was alluded to already. the institute of medicine, when you look at what they are trying to do in changing the taxonomy, first and foremost, the foundation has to be laid in place. when you say something in one discipline of medicine and say something and another, they need

to be defined. they are trying to do this through the digitization of in thend that is not textbooks yet because it is so new, but it has got to get into the textbooks over time. there was breast cancer and lung cancer and liver cancer, and we all believed it was only based on organs. it was organized because of the way we do surgery. it sort of makes sense. when you think about the disease per se, it is probably a solid genetic factors. it is at the molecular level. that is the first element that has be put in place for the education system, not only -- we don't have to have doctors become computer scientists, but i think the whole notion of this convergence of data, the digitization of data, the quantification of data, and how it relates to outcome has to be something that is better understood. i also have to agree, and you mentioned, both nancy and don,

that first and foremost you have to have a doctor listen. that relationship still has to remain. >> a learned skill. we have a twitter question which i think is really -- cuts through a lot of what we're about, that is, can we cut downtime in clinical trials? $2 billion to get a drug from the lab to the market. fda requiring a lot of drugs and manufacturers to go through a lot of hoops. the question is, is the way we construct trials wrong given today's immediacy? and the fda is involved in all the electronic things we are talking about, too, so the proper role of trials is a real big question, especially when you get to precision medicine. if everybody gets a position cocktail or medicine that is particular to their particular disease, we will need to one

million -- 200 new drugs the year, not 10 or so. we need to be up to the pace of the creation of medicine and up to the pace of the creation of devices that do the things that might be able to do. i wanted to restate your question. i think you are asking if we are putting the emphasis on the le whenquabble -- swabb it comes to medical education, and it comes down to yes, we are teaching people how to save lives rather than protect lives and enable wellness. we need both, but we are sort of 99-1 on the save life hero mode and now for healthcare training, and we need to get a plurality that moving in another direction. second to president clinton. >> i want to make a one sentence statement and then ask a question. i think we are going to be compelled to consider whether the fda has the capacity to properly examine and approve in

a timely fashion all the drugs and all the medical devices. i think that they are being forced to choose, and they are in an environment where they don't get in trouble if they say no. that.e point we all want we don't want them to give us bad devices are bad drugs, but i think there is a lot of evidence, particularly on the device side, that we have been so slow that it has hurt the american economy, and secondly, it is undermining the ability of people to maximize a variety of devices for healthcare. you can comment on that if you want. i have a monday in question. talked a lot about management of data in a very sophisticated way. pennsylvania is one of the few states in the country that requires hospitals to report both what they charge for various procedures and the results they get. the results tend to be better, at least for surgical procedures, as they do more. the one that you more do better. not surprising.

the prices have nothing to do with the results. it could be because the cost of care in wirral areas are higher than urban areas -- in rule areas are higher than urban areas. could be a lot of reasons. do you believe that every state in the nation should have a reporting system that measures prices and results and that would enable us to dig down figure out how to improve quality and reduce cost? and should those be posted at? >> that was the monday night -- stion?undane que [laughter] go to check your car seat, you don't check with the carburetor costs. >> transparency sets you free,

and we know that when consumers and patients have actionable information, they make great choices. i will use a drug example. you take these seniors that are in these private medicare , they have a drug benefit associated with that. when they get transparency, and they get it every single month -- here are the drugs you take, what ye costs, -- what it costs -- when they know that, they are incredible buyers and seekers of the value. that is one of the things we wake up every day trying to do. how do we get more transparency about what we do, what hospitals do, and it is very, very powerful. state law everywhere -- should there be a federal requirement? our hospital man has not said what he thinks. [laughter] -- come on, kelvin.

isone of our core values transparency. we advocate that on multiple levels. it is necessary outside that, and we have advocated for that information to be made available. the question when you get to the charges gabon and the cost is making sure it is an actual reflection of what the costs are. it becomes a bit of work that needs to be done, but with overall outcomes and how people are performing, we have advocated for that and continue to do so. >> augusta urban versus rural situation and why cost would -- addressed the urban versus rural situation and why the costs would vary so much in are to theding the hospitals data they are producing? are you penalizing the hospitals as well?

reasons.re a lot of you hear that technology is driving that. it may be availability of services, consultants in the care as well. factors thatot of can influence the cost of care. in terms of overall accountability, yes. we have the internal data, going to what we have, and we look at that to see how we are doing in comparison to what our targets are, how we are doing relative to how verbal hospitals within portfolio, and we work on that internally. and we have hospitals in pennsylvania, and there is an opportunity to do that, but it has to be done in the right circumstances with the right data that is adjusted in such a way that it is comparing apples to apples. i have to say, who does this? large self-insured employers had help in this situation. ge has put cost calculators into place for use across the employee base. you to take as

look, when you are making a decision about where you want to go for medical care, to actually understand it. sometimes you cannot get it as easily, but our group has dug in and try to make all of those prizes transparent so that we understand our cost. clearly you will make a choice as a consumer as to which is more affordable. >> am i correct that in the ge system, if i have cardiac surgery, i can see what hospital has better outcomes, how much is is going to cost me out of pocket, and i can make the decisions accordingly? >> yes, and we're doing it hospital by hospital. >> i want to emphasize the important of all payer data. the next estate we should take is to it -- the next step is state databases. it has to have the outcome data, and that is a challenge. we can trivialize this and study little things that don't matter or we can get smart on things that does matter to people and measure that. it would be transformative. payers --r of the big

i think there five of us involved -- had begun to put out data together into independent party so that we are not seeing in each other's business. once you get into an independent place, you have the effectiveness of the database and you don't have any business issues to go with it. there is some progress. baggett, youth dr. want to compare apples to learning-nd other non- motivated expeditions for why hospital x gets better results and charges less than hospital y. but how can we speed it up? pennsylvania is one of the handful of places that requires this to be done for everybody, and only so many people can work for ge. what should we do to accelerate this? >> i think the main thing government can do in that space is try to find some laser kind of regulatory assistance that makes -- that liberates people

to figure out this data and publish it. i am not saying private data, but for example, even is oftend data difficult to legally publish. >> the president is right. the building is doing this, state by state by state issue, one more patchwork world the data that does not interconnect, does not move things forward -- does it take a bunch of the very brave governors to say this is what we are going to do, and you ran met down -- ran it down the legislature's throats? not everyone can work for ge. has to be a way to move the data and small data and transparency at the same time. y, what we little wonk are fries short of a happy meal here. wonky.ot very

no authority to set up a so-called qualified entity talking about taking the data. we need congress to mandate the medicaid share its data instead of holding it. we need medicaid to follow on that and we need courage on the part of the private insurers and hospitals to say, let's leap over our shadows and get the data together. it is scary but we will learn a on that note, i would like to thank all of you. resident clinton, thank you very much. have a great break. we will see you in a few minutes. [applause] >> now a discussion on mental health and addiction. they will talk about the lack of funding and stigma that up -- the company's mental health illness. this is one hour, 20 minutes.

thank you. i imagine you are getting a a little weary, and it might seem as if we are changing the subject, but we are actually not. let me begin by thanking the clinton foundation and the health matters initiative team for including mental health in this year's discussion. i think that is critical. i know that president clinton think so. i want to take a few minutes to try to frame that issue in the context of our overall discussion. 1999, i had the opportunity to release the first ever surgeon general's report on mental health. and then i was asked by the ifector general of the who,

i would come to geneva and present our report before that body in may 2000. it has not been that long that we have really started to discuss mental health at this level. i have to say that our major recommendation and -- in our report was for parity of access to mental health services. that was 1999. it was not until 2008 that legislation was passed -- it was actually signed by president bush in october 2008 for parity of access and mental health services, and that president obama issued an executive order that resulted in, among other things, being part of the affordable care act. let me begin by defining mental health. weant to do that because almost immediately get to mental illness.

but i think that mental health is really critical to think about. in our report, after a lot of debate, we define mental health reform of theful mental functions -- successful performance of mental functions, such as this one is able to be productive in his or her work, to develop and maintain positive relationships with other people, beginning with families, to adapt to changes in one's life and environment, and to deal with adversity. .ust think about that being productive, developing positive relationships with others, adapting to change, like come upnts for example with adapting to change and dealing with adversity. we saw 30% rate of depression in new orleans after hurricane

katrina. mental health is that. it is being able to deal with these life challenges and circumstances and to be productive. it should follow that mental disorders, mental illness, represents alterations in those oneal functions such that is unable to carry them out because of rude disorders or thinking disorders or behavioral disorders. mental disorders follow immediately from that definition of mental health. but i want you to think about that, because i don't want you to take your mental health for granted. that is what we do. we take our mental health for granted and therefore we are not sympathetic when people have mental illnesses, because we have not thought about our own mental health and we have not thought about the fact that we could lose it.