Transcripts For CSPAN Industry 20240705

The opinion that matters the most iyour own. This is what democracy looks like. Cspan powered by cable. Leaders in the Health Industry add policy advocates assess the current state of the u. S. Health care system. They talk about health care affordability, innovation, Prescription Drug prices, and the need to increase accessibility. This is from the Milken Institute future of Health Summit in washington, d. C. Welcome to the Milken Institute future of heal summit. We are delighted to have you join us and look forward to your participation over the next few days to kick off the event, please welcome executive Vice President of health at the Milken Institute, esther crawford. Welcome to the Milken Institute future of Health Summit. We are delighted to have you join us and look forward to your participation over the next few days. Please welcome executive Vice President of health, esther krofah. Good morning and welcome to the 2023 future of Health Summit. Whether you are here in the realm or watching online, we are delighted to have you join us. Gathered are hundreds of leaders from across the health sector, representing government, philanthropy, care delivery, academia, research, the investment community, and more. Anthropy, care, delivery industry, academia, research. Patient advocacy. The investment community. And more. We come together because we recognize we can do more collectively to achieve Better Health for individuals and patients than we can do alone. I have engaged with many of you across our work at Milken Institute health throughout the year, and what i have found to be the Common Thread is partnership. Collaboration across disciplines and sectors is not just good practice, it is essential for government and industry, academe, mere health care, delivery systems, nonprofit, retail and more are leading the way in forming new partnerships to address growing domestic and Global Health challenges. Our theme for this summit is closing the gap. Better health for more people. This theme is particularly timely as we more fully emerg from the covid 19 pandemic and survey the landscape. We see widening inequities in health here in the United States and around the world. The trends in the United States are particularly stark. Despite spending more than 4. 1 trillion on health care, the most in the world, Health Outcomes are on the decline. The washington posts recent analysis revealed Life Expectancy is the srtest it has been in two decades. 76. 4 years. Taking us back to the mid 1990s. In 25 of our counties people are dying at a higher rate than 40 years ago, particularly in the nations interior, the miest and the south. The gap in mortality between the rich and the poor isrowing significantly wider. Taking one step further, people in both the poorest and wealthiest communities in the u. S. Live shorter lives compared to tir peers in canada, france and japan. An epidemic of chronic illness is our greatest threat. Heart disease, cancer, diabetes, Liver Disease and obesity are among the primary reasons for poor Life Expectancy in adults. Age 35 to 64. Compared to other high Income Countries and this is despite the tragic deaths related to covid 19, the Opioid Crisis and gun violence. Life expectancy, however, is Just One Health outcome. Unfortunately, the Health Burden on communities across the country is also taking an economic toll. Increased povert unemployment, inadequate housing, violence and more. At the same time, we live in the golden era of science and technology. The breakthroughs and rapid pace of innovations in medicines, vaccines, diagnostics, new modalities of care, delivery and application of technology should be boosting lifespan and quality ofife across all communities. The challenge and the opportunity i pose to you tod is how do we close the persistent gaps between innovation, access and outcomes . How do we innovate our innovation to reach more people . Though we me to the table with different perspectives on how to close the gaps, we are united by a sense of urgency and a common goal for Better Health, for more people. I have seen firsthand how bringing together crosscutting sectors in medical research, Public Health, food systems and healthy longevity enables us to live to develop better, more holistic solutions. And as we look across the lifespan, we must also consider how to maxize the quality of life for an aging population by 2031, in six people in the world will be aged 60 years or over. While this shift ian aging population began in high Income Countries, it is now low and middle income couries that are experiencing the greatest change. To elevate and prepare for an aging population, an ongoing area of priority for the Milken Institute. I am pleased to announce today the new aging innovation collaborative. This collaborative. Thank you. This collaborative is led by the Milken Institutes future of aging and established with a 3 milliocontrave auction from the National Investment center for Seniors Housing and care, which includes the contribution of the intellectual capital and fellows at nexis insights. Joining me on stage now is ray bruin, president and ceo of nec. Bob kramer, founder and fellow at nexis insights and cofounder and Strategic Advisor of nec. Susan barlow, cofounder and managing partner of bloomin capital and board chair of nick. And diane tice, senior director Milken Institute. Future of aging. Welcome. Thank you so much. Thank you, esther. As chair of the nec board of directors, i first want to say how pleased we are to provide the seed capital for the aging innovation collaborative in connection with the Milken Institute. But nick, representing the Senior Housing and care industry, shares the milken view that public and institutional private companies propeing health care, housing a and communities as our as our for our aging population are not adequately prepared meet the opportunities and challenge is preparing for an aging population ia priority. The Milken Institute. Improving access and choice in housing and pport services for older adults is next mission. Were excited for the aging innovation. Collorate mission to identify Scalable Solutions and then fast track their implementatn. Time is of the essence. Thk you r the opportunity to collaborate. Im excited about the impact we will have working together. Thank you. Thank you, susan. Id like to thank all of our sponsors for making this event possible. I hope that over the next three days you will walk away with fresh ideas, new solutions and examples of how to implement them on the ground. I encourage you to move beyond your traditional areas owork to explore new areas and potentially form new partnerships and collaborative efforts. Thank you very much and i hope you enjoy the conference. And you fully acknowledge the participation of the following organization whose generous support makes this conference possible. We thank the following media partner for their participation at this event. We thank the Milken Institute Strategic Partners for their year round support of our work around the world. Please welcome the panel to discuss closing gaps in health and health care moderated by cn medical correspondent maggie terrell. L right. Well, hi, everybody. Excited to get started. This is going to be a really fantastic few days with some really fascinating looki panelsoming up. Im ally delighted to get to have this panel ofolks rlly spanning all aspectsf the health carsystem and to to start this conversation. So im going to introduce everybody. And then i thought maybe we could start by kind of setting the stage and framing the question that well be talking out this morning by having everybody kind of tell us where theyre coming to it. So to my left is dr. John rue, president and ceo of geisinger, herr. We have amr ali tauzin, cofounder and coceo of guardant health, and dr. Ashwin vasan, the commissioner of the new York City Department of health and mental hygiene, hubertus von baumbach, the ceo and chairman of boehringer ingelheim. And ange williams, president and ceo of united way worldwide. And angela, why dont we start with you. Tell us about sort of a little bit about your organization and how youre coming to this question were talking about day. Thank you. Good morning, everybody. Its good to see all of you. Youreautif, smiling faces. I am so pleased to be this president and ceo of united way worldwide. Many of you have probably heard the name but didnt ally understand the scope of our organization. We have 1100 local united ys operating in 37 countries here in the United States. We cover approximately. 98 of communities. En i think about our organization andur areas of focus around health, education and economic mobility as well as climate and disaster relief, what really strikes me is that have an asset that i want you all to know about, and that is to one onehich is health care, mental hlth, social Services Call center, united way. About of tse in the u. S. And it is the ngle most important tool th you all should recognize and know abou and engage with, because w touch 20 million america a year that call us for support for health care resources, to be connected to cariver resources and so forth. Here it is. So we are a Research Driven pharmaceutical company. We develop, we research, develop and bring to the market the products we produce. On the animahealth side, as well as the human side. Weve been doing this for almost 140 yes now, so weve been ilding an organization that is rather diverse and the target we look after, whether its oncology, whether its depression, whether its cardio, metabolic diseases, lung insuffiency. So we rather broaden to have about almost 10,000 people helping us to develop those new products, really excited to able to touch patients around the globe with our organization and pretty much everyajor country that is cessible to us and without hoping to be able to contribute to the cause which we all share around. Its great to be here. Thank you for having me, esther. And the entire milken team. And good to be with all of you. Im ashwin vasan. Im the Health Commissioner of new york city, a small city to the north where we face many challenges. You know, our department has a 200 year old history of really improving and protecting the health of our residents and facing whatever challenges come our way and responding with innovation, with aplomb and our work has influenced not only national, but Global Public health. And im very glad to be here with representatives from the private sector, from nonprofits, from other Public Sector actors, because if one thing is clear and that covid brought to bear was that when we are aligned, we can do pretty impressive things. When we have common goals in health, we can do impressive things by unlocking our respective strengths. So im very excited that this is the focus of of this several days here and that esther led us off with the discussion on Life Expectancy, because believe certainly and we are putting this into practice in new york, that that is indeed our common challenge. And we can unlock a new generation of collaborati in health if we all agree that this is something we want to work on together. And really, im here t italicize. Im cofounder cochair of garden hped advance health is a prision agnostic cpaign. Named work wh the Mission Clean curing cancer and bringing more time to cancer pients. We do blood testing acrs ntinuum of car weave blood tests for advanced Cancer Patients where we tl e physician patients wh kind of tatments gointo work for em, wh kind of trement is not going to work othem anymor about 20 ofll advanced cancer patient united stes are getting mane by ung our blood tests. And then we have blood tests for ncers rvivor if theiriseases comi back or not. And most recently, a blood test for colon caer screening and coectingur mission to th topic of this panel. So when you think about, for stance, colon cancer screenin where 60 million of people who should be screened are not getting screened, although we have a lot of solutions for the including colonoscopy and othereans. And when you look at underserved patient population, when you look at people of color, those arthe people who are more noncompliant tthe cancer risk reenin takingwo days off to get through coloncopy fees or having access to some kind of seice sa in order to get prevent table colon Cancer Screening, we bring a new optionality. Yohave a simple blood test. We can go where they work. We can go where they leaveo get this Cancer Screening done. And the and decrease their mortality of colonancer. Excited to be part of manner and you yeah im excited as well itgreat to join everybody today big thanks to the milken team for having me a little bit about geisinger we are system in central and northeastern pennsylvania. I think some folks we are what you might call a provider, meaning we are a payer, but also a provider. I think were operating in both worlds and that allows to build and focus on Clinical Program so that sometimes dont happen in our industry because the incentives dont quite line up. And so in our world, for the portion of the population that is both our patient and our member on our health plan side, we have an awful lot of flexibility to focus on programs that simply improve health. We dont have to worry of a food program, for example, as a billable event or not. We could just do it. We still have the half of what we do where it resembles most others in the health care industry, where where youre or still partnering with other Insurance Companies and as an insurance company, also partnering with other delivery systems. I think a big part of our focu especially over the last handful of years, has been building clinical capabilities of Clinical Programs and trying to bring those into settings that meet people and communities closer to where theyre at. And oftentimes thats either the home or the work environment, Community Programs or even clinics. You know, if you walk the halls of geisinger, youll hear us often talk about moving care. One click to the left. And i put at in quotes, because what it means is, folks that were seen in the e. R. And maybe hospitalized, is there a way to discharge them from the e. R. And send them home with proper supports so that they dont need a hospitalization instead of seeing them in the e. R. . Is there a way to have access be so fast that they could be seen in a clinic instead of Specialty Care . Could you take care of something in primary care instead of even an actual visit . Could it be a virtual visit . Could it be prevention that gets ahead of an issue altogether . Thats what we mean when we talk about one click to the left. We know that theres always place for very sick people inside the hospital. So were going to continue to develop those programs as wel but to the extent were able to get ahead and move things further upstream, thats what were trying to do. And then i think preventiois one of the common themes i think i hear from all of you in ho you approach this topic, and i guess im curious. J one ill come right back to u. What are the roadblocks in reaching that more universally to getting more people into the sort of Preventive Care setting where youre not then seeing people really farther downstream . Yeah, i think there are a couple things i would say. The big one, id start with t payment model. You know, we have a payment model in this country and you all have hea it. I know im talking to preaching to the choir here, but the payment models tend drive re further downstream, especially if youre in a traditial fee for Service Reimbursement model. And so i think sometimes and food is just a reay good example. Theres no cpt code for food programs, so how to invest in that really those whbear the risk, those who have sort of a lue bad payment environment where theyre looki at total health, total of re. Those are the folks have a natural incentive to Pay Attention d invest in food programs and i think in the absence of those kinds of environment you have a set of incentives th make it really tough to invest in those upstream tivities, whether in food isust one example. But this is true for housing, transportation or even primary care or services in the homer even lonr physician visits for seniors who may have multie chronic morbidities. I mean, these are all examples of things at become possible in a prepayment or Population Based payment model that are not possible in a fee for service model. Hmm. And emily, sorry. Do you want to jump in the . No, im gesting. Well, you know, talking about gardens and the services you guys provide. I mean, the whole idea is. Oh, well, not the whole idea. T much of the idea is prevention and so what are the roadblocks that you face in terms of Getting Better uptake . So at high level, you look at, for instance, how much we are spending on in our health care in this country, about 4 or 4. 5 trillion outlay, which about 3. 1, 3. 2 trillion of it. Th goes to treating the sick or delaying the symptom in a proactive or reactive way. And when we look at how much of that is getting spent on promoting health or preventions or wellness, its about 1,000,000,000,000. And when we look actually how the Health Care Cost is gng, there is no future that you can imagine unless you see that the center of gravity goes more toward wellness and preventative investment. And we believe by 25, 2040, we are going to see a much more balanced kind of investment by in terms of barriers to get to that point. Maybe ill just give an example of what we do. There are billions of dollars that have be invested by private sectors and Academic Centers around having these blood tests for Cancer Screening. But we have issues on the last mile of bringing these innovations to reallyatient care. What do i mean by that . So innovations are there. You know, for instance we expect our tests to get fda approved sometime next year. And in terms of coverage, cms has National Coverage determination, but there is government funded gueline committees in the United States called United States Preventive Services task force that they go and grade all the preventative measures, not just for oncology forever. Everything very broad scope, but they are heavily on their funded and their level of funding has been flat during last five years. So typically, lets say for breast cancer, the guideline recommend nation updates happen every eight years. The last time that it happened was eight years after the previous guideli recommendation for quality Cancer Screenings. The guidelines typically get updated every 5 to 6 years. So you could imagine you have all these investment to test that for regulated re and coverage. But because government fded task force do not have the means to look at these innovations, many would not get access to this test because many of the commercial payers wa for the task force to render the judgment before they give access to the patients. And the solution is really through a significa and private Public Partnership and raising awareness around these matters, because some of these last mile issues are generating the mainroblem in the gaps that we have in health care in this country. Hmm. Ashwin, you Just Announced a new initiative, of course, to raise Life Expectancy. Tell us about how you focused in on the priorities there. And you know what some of e challenges are going to be to actually reaching some of those goals. So some somethings wrong in the richest city, in the richest country in the world. If the People Living in it can expect to live longer, healthier lives over time. And that we arent having our children in a world where they can expect to live longer, healthier lives. And when we saw the data from 2020, this is our Vital Statistics data that hadnt been calculated. We were busy with the pandemic. We saw this at the beginning, at the end of 2022. And it was stark. It was alarming. New york city lost 4. 6 years of Life Expectancy in 2020 alone. And while some of it came back in 2021,e are still two years behind where we were in 2019, and the United States istill on the decline and is three years behind where it was in 2019. And as a society overall, we flatlined in the last decade, more or less. So something is wrong with the way that weve structured the incentives, the way that weve structured, frankly, our safety net in our society. If this ishe case. And so im very pleased to be about prevention here because it will take a fundamental shift towards investing in the things that deliver on health. And so what we said as city is, can we organize ourselves around a common goal . Can we set out a Life Expectancy target for our city and organize public, private,onprofit philanthropic sectors to drive towards those goals . Can we start to have a conversation within the part of at least the local budgeting process of how we spend against health and can we do this over time and embedded into our our citys planning through law. And so we launched health nyc last week. Thats the name of the initiative to do exactly that, to organize our city and thats the role of government, right . Set goals create guardrails, strategies, but then allow our Civic Infrastructure in new york city and frankly this country to to start to deliver and. We think its ambitious. We know its but we definitely didnt want to be at the and just allowing this to happen. And so thats why we out the goals that we did. Where did weind the goals we looked deeply in our Vital Statistics data at three things. What are the overall leading causes of death . Whatre the leading drivers of premature deathelow 65, which in new york city and the country predominantly impacts people of color, black and brown people in particular, and excess death. So where are the lasmile problems . The the vulnerable communities that are being left behind. But that we learned in particular during covid must be centered in our Population Health planning from the beginning. And so across the leading ivers of death overdoses, suicides, violence, chric illness, diet related illne, widening black Maternal Mortality covid remains on list anso forth. We are going to be deploying packages of strategies across those three buckets. How we reduce overall risk . How do we reduce premature death, and how do we target in our programs around excess death . That doesnt mean theity of new york is going to be delivering everything, but it does mean at we can outline a road map and a framework for all of the many partners who would create our Civic Infrastructure to help u he rate us. Where does the pharmaceutical industry fit into this idea of evention . I mean, the idea, of crse, from the drug indusy, i think, is that by using medicines, you can prevent worse outcos. And so thats a value sing proposition to the industry, to the whole health ca system. Of course, pricing ialways in the limelight and inflation act has drawn many challenges from the drug industry, including from boehringer inlheim to the drug pricing provisions there. So how do you make that Value Proposition especially as you look across the United States where we spend more on medicines than any other country with access . How are you thinking about that . Maybe. Lets start from where the colleagues on the panel have pointed out, and lets look at prevention one more time. I think theres one element that we see understanding the pattern of pathologies of disease is that might make quite a significant difference. And its about education, educate, getting the population about how diseases develop, how they can be prevented, take metabolic diseases, food plays a role exercised place. And then you start getting into continuum of early diagnosis. We heard that and bringing that then together at the end to provide pharmaceutical intervention to those that have progressed to a stadium that then needed will allow these systems to be more efficient. But the more we can prevent of patients actually progressing to the stadium, of needing a pharmaceutical intervention, i think the more robust we can build the systems and my collgues have all alluded to how important it is to, make sure that prevention keeps patients actually healthy rather than in a state of disease. And thats speaking for my company. Thats what weve been trying learn from many social entrepreneurs that we have been engaging over the course of the last ten, 12 years. Th started developing models that will help us as a company to actually bring that element of education out of prevention, to to a broader population of patients whether its communities that are underserved. But also, you know, every one of us we can all learn how to prevt a disease. If we learn what we need to do to do so. Sohats a large role. Now, access is something that we as an industry obviously also play an important role. Now, my plea there would be if we do all the elements and like you pointed out, as you said, we need to bring these goals together. If we put efficiency in our systems and if we make sure that the patients that really benit from the drugs and that we can then an outcome for have access to those drugs. I think the overall gap is going to get smaller. Angela, one of the things youve talked about is building resilient communities. An you know, one of the i think the themes ve heard about already here on the panel is the idea that covid really focused in one singular goal and that it really chang some of the ways people people work. Tell us about ho covid provided potentiay a different model or a way of focusing more on the real local Community Level in your work . Im going to slightly if your question a differently in that as im listening to my panel federal fellow panelists, i keep thinking the fact that my vision for united way is to really be that platform in the ecosystem that people are willing to use and to leverage. And the reason i say that is that we have proximate relationship with individuals that live in communities and i said we cover more than 95 of communities. The u. S. , were the only organization that does that. So when you think about what impacts a community what impacts that individual or families and when you think about you want to educate those families or you want to move the needle with respect to a particular issue, then we are there and are able to take those innovations to be able to educate folks, to be able to move the needle in a way that none else can. But it can only be done as has already been said through partnerships so for us working, we work with Community Health workers. As ive already mentionedwe have a two on one hotline. The other thing i can share is our partnership with aarp, where just this year alone, weve been able to connect 12 new caregivers, unpaid caregivers to at least 3 to 5 resources to support them in their work. Were the ones that when people call, we can get them to for transportation or to get to a primary care visit or when they say they need food. We register people to get access to medicaid or we register them to get snap benefits. So when i think about this gap that were talking about, when i think about the the ingenuity thats on this panel in terms of what the companies are innovating and how we can, again, sitting in this country with all of the all of the assets in place, we should be able to mobilize in a very intentional way to make things happen. So with respect to your question around covid, yes, we were able to with the calls working with local governments to even disperse arpa funding for families, making sure families had meals, transportation or telehealth, helping to enable them, telling them whe they could go for the vaccines, helping them get their vaccines working to make sure that as we educate people and talk to talking with them, were doing so in a way, in a language that they understand being spoken with by people that look like them, that understand cultural nuances and on and on and on. So i am just im still encouraged and hopeful for the u. S. I know that there is a way that we should be able to solve for all of these problems that are not insurmountable. I just got off the plane from ghana yesterday, and i take a look at what i see there in the other african countries, ich we operate. And then i come here to a panel today to discuss this. We have so much richness in this country. We should be able to do it. I think the problem is, one, the will to to Work Together. How widespread right now is to. And and the 211 service that you mentioned how widespread is that right now and what are the sort barriers to geing it really that Everybody Knows about it and everybody can benefit from it . So whats really interesting is that two and one has been around now for several decades. The united way operates about 60, a little over 60 of them across the country. We contract with states or will contract with cits, or sometimes we operate them on our own. But believe it or not, with as i said, we take 20 million calls a year. We dont get it receive any federal funds. We literally, as a nonprofit, are raing the money to do the work. And what i think people miss out on is i can tell you on a daily basis, what are the uptick in calls in a community or zip code and trends that are happening . I call it the canary in the mine. For example, we were getting calls a new bill for the federal government that baby formula was off the shelves in grocery stores. And so when you think about the power and then when you talk about even ashlan was talking about data. So we actually have a National Data platform. And again, we have all this data that we sit on. But were a nonprofit trying to figure it out without much support. Send it to me. It sounds like great story idea generation. I would appreciate to know about it. Ashwin does does new york city used to and what we do and the united way is a fantastic partner to us and i think angelas spirit is exactly right. We have to if we have common goals, if we say we want to increase Life Expectancy, as weve done in new city, if we say as a part of that strategy, we have to deal with whos dying too soon and from preventable causes, then we have to go into communities and we to build the kinds of programing that will catch disease early, that will get people into care early, that will help folks navigate a really complex social and Health Care System. And and that starts with our community organizaons. We learned during covid, the height of covid, that government haan obligation to get its resources into the hands of the organizations that are closest to communities that need it. The most and that have the credibility to actually get people into lifesaving services. So we built a program called Public Health corps, new york city Public Health corps, over 100 Community Based organizations, not the ones that ordinarily get government contracts that have the administrative capacity, but small, sometimes five, ten person organized sessions. We got incredible amounts of federal emergency dollars into their hands to do Community Health work, to do enrollment into care, to do vaccination, to do distribute ofpe. And so what if we can do thatn an emergency . If we can do that when were awash with extra dollars from the federal governmenthow do we organize our systems to do that during pcetime . Number one, we need a goal. And i think life expectan is that goal. And the inequities underneath it redressing. That has to be a focusing effort. And then number two, its about dialog and alignment. How do we come around together and say whos in the best position to deliver . And what we find that its often not government. It may not even be some of the privateector representatives here. It will be cmunities that can actuallyeliver on what we all need. Well, that idea of alignment i mean, john, you were talking abouthe idea of food sort of as Preventive Care. It can work perhaps in a system like yours where the payment incentives arehere to maybe capture that value down the line. But we have such a fragmented system in the United States, and i wonder, you know, and maybe ill direct this to the to the industry folks on the panel in raleigh and hubertus, are is our system set up to be able to enable the most people to benefit from the Incredible Technology esther was talking about in ourntroduction . Or do you have the pressures . I mean, i was at cnbc for nine years covering the pharmaceutical industry. I saw where the pressures were to make your prices as high as possible, to be able to make as much money as you possibly can from your products, particularly in the United States. How does that, you know, result in who gets your medicines o yo benefs from your tests and whoever wants to take that one. Okay. I guess im the first. Come on here. I think we all share one goal and that is getting medicine to those that need. If we develop medicines and they dont reach the patients that n benefit from them, we dont deliver on our purpose. Having said so, t complexity of the system is high and the mplexity is driven by many players and what might seem to be higher price at the level does not necessarily mean an income. Equal income othe basis of the industry. So cnging e priclevel th lel of the patient needs to involve like its been mentioned many times before ny more players and just that of the industry. Havingaid so, i would likto go back to a point i tried to make earlier. We need to improve the efficiency of the system, which will then at thend render a higher and better outcome outcom should be what is bei not cost. Because if we can compare ouome and efficiency of a treatment, we measure it against the benefit that it brings to bring a depressed patient back into a working environment, to allow a Heart Failure patient actually to walk the stairs in the house again, pticipate in a in a in a community life. Contribute to it. I think currently we are lacking the ability to really look at the value and are bng driven mainly by the cost. And that i think veils aittle bit the discussion out the ility e necessity to drive efficiencies of the system. We as an industry, we understand these patterns. We understand how to meare outcome and were willing to contribute to it. But as i said in many of the other points, we nnot carry it alone. We need do this together with thgoal to close the gap, impre health of patients. Ani like the idea of lets measure, lets measure le on as the ideal that we all wt to deliver on. And im sure we all and will all be able to improvehat. I woullike to also make a comment about this matter about the pricing like as as our on our panelist mentioned, a lot of the parameter that goes into pricing determination by the is all their level of investment that goein that specific asset to make it excessive for the patients. Obviously. So if we go back to the exam for that, i mentioned that the innovation line which is approved takes like 5 to 7 years to become access for patients comprised with consider all the cost of, you know, five, seven years of sitting on a specific asset into at the end what the pricing should be at least to recover those kind of investments. So if we Work Together, we bring efficiencies in the right way into our system, the Economy Dynamics of product access would be very different and we can have more. I Affordable Care and healthier population. I think another parameter that we should discuss about maybe this closing gaps on equitable care is the trust in the system. When we are talking about even during the r d, during the Clinical Trials in ord to bring our test, our intervention our drugs to the communities, the underserved patient. They need to feel they were part of the trial. They were part of database and they were part of the trial. So doing an equitable of r d, equitable way of clinica studies and enrollment is very important and it can be done. We can do it together as aligned as we are coming it. Its work, its hard. Weve done it in our 20,000 patients study we are proud of it. 2 of people that reenrolled and the nonwhite kind of section. But it was not easy. But we know its doable. And as wind as we commit to it, that level of trust can get also improve as was thinking about the sort of the paradox were talking about here, one of the examples i think that came to mind of something that rlly sort of portrays what were talking about is perhaps the sickle cell, crispr gene therapy that we may see come to market as early as december, if the fda gives it the green light. One, i wonder, how do you look at Something Like that . And e idea as ameer ali was just talking about, you know, sometimes new Technology Takes 5 to 7 years to actually reach many people. This will be an extreme example of that. Perhaps because these therapies often cost like 3 billion a year just for the therapy and effects, you know, primarily african population. How do you look at geisinger about perhaps covering and providing something that. Yeah, we were actually just talking backstage about some things that done historically together with. Folks like guardant, i, i think the world is a little more open for us. Gets to your question because we have this payer lens as well. So re able to actually view a given or a given clinical condition more longitudinally. I thk thatelps an awful lot versus being confined into sort of episodic eluation where it becomes really difficult to figure out is it sustainable to support some of these technologies, medical advancements if its the right care and theres no other treatment, of course thats the right answer. But you also i think we a society need to think about how do you make that sustainable . And what weve tried to do at geisinger is evaluate thgs through that more longitudinal lens, sort oa popular asian based, Community Based, multiyear time horizon. And onwere able to do that. I think, with regard to a specific patient who may need the drug. I think it gives us a lot of flexibility. Weont have to argue with the payer, for emple, because half the timehat payer is us. And so in that world, were able to invest in those capabilities. Think the other thing to note here is that how we how we figure outhat are the rit clinical situations to use a drug or an intervention. I think theres an awful lot of variability across the industry. How certain of these technology are used and what weve tried t do. Were big bievers in trying to create care thways, reduce unwarranted ad variation and by doing so, were ae to make sure that any Given Technology by any given medation is really focused. Those who can benefit most. So i think this question of approach greatness, of use is also a deep consideratn for us. Hmm. Im gointo askou a hard question, which is to you in one system that has this sort of unique model does what doing their work in places that dont have that model where youre the provider. I think it does. I, i dont know the payer and the provider need to be one in the same necessaria. As i mentioned the other half of what we do, we still partner with other. And as a payer we still partner with other provider entities and independent physician groups. But you could still introduce like what were talking about, whether its introducing care pathways, you know, what might be the most appropriate for that crispr therapy, what populations, what situations would that be appropriate . And i think those kinds of things you can introduce, even in terms of arms length dealings between payer and provider, youre either in a, you know, value based Payment World or a collaborative one where youre passing data back and forth. You have the information to better manage the patient member. Whatever the case may be. I think those things are doable even if youre, you know, completely integrated. That provider world. You mentioned amorality you mentioned trust. You know, we think about life, expect and see i interviewed rob caleb, the fda commissioner, several months ago and he was mentioning he thinks one of the main reasons Life Expectancy is declining is misinformation and is maybe an upstream part of it. You dont look like you necessarily agree with that. Id be interested to hear your reaction to that. Maybe ill ask you that and then offering my queion. What do you think about that . No, no, im thinking about the link misinformed is certainly a massive issue in terms of our engagement, our own health. So at the individual level and ma no miake, health is a choice. But i think in this country, weve ve organized it as an individual choice. And what were saying inew york city is its acally an institution and oice. Its a its a crosssecr choice. And have to make choices. You have to organize yourselves. But its hard to organize the actions of communities when were were basically, you know, an information ecosystem where the foundational elements of health are being debated. You know, i think one othe biggest challees with the pandemic and i dont want to rehash this, but is that from the get go, the the fundamentals were being argued. So it put ople in positions like mine at a at a huge competitive disadvantage in terms of getting a positive meage out there, how to take care of yourselves when the when sarscov arrived. And so we built we built at the new York City Department of health a an entire misinformation unit which whose sole focus was to look at where which communities were being disproportionately targeted with hyperlocal, factually incorrect messaging around, the vaccine or how covidr so on, so forth. And what we found is that we were able. You know, target our resources, outreach, communication, even advice, even media buys to those communities by doing things, other languages and disproportionately investing in this. But we are government is very much, you know, starting a different point than the Tech Industry and that actors in this space so do i trace it to Life Expectancy certainly when it comes to the pandemic we lost lot of lives due to misinformation. The question is, is that going to have bleedver into other partof our life. And you know were watching overdoses in particur very closely to seehether there is a misinformation ecosystem growing around the were watching Mental Health and suicides very closely to see whats growing around that. And so unclear but it is its great that hes lifting that up because its a challengfor all of us. We are definitely the Health Ecosystem that we all are a part of is is very much fighting with one arm tied behind our back against against the tech, basically unregulated tech apparatus. Hmm. Angela so when i am hearing the conversation and i am thinking very simplistically and what comes to mind for me, two, maybe two and a half things rst being education and educating the individual in order to allow them to make the healthy choice, but then access us. And so when you think about that word access, i think underneath that are several things that that comto mind. And when i think about our access our System Access means do have either insurance or do i have the economic wherewithal to even be able to pay for Healthy Services or basic items food or shelter some of the social parts of access to health care. I also when i think about access, think about institutions and systems that have been in place for decades. And we are in a postcovid and a complete new era. And yet were still operating the same system. And d why cant we reinvent it or retool what exists now to meet people where they are. So where can they have access . Where can we bring the support to them . Where are they . Where they dont have the access . What we saw during covid was. Ll, lets talk about precovid. Doctors said in order to treat you, i have to physically see you in my office. Covid happened. Oh, i can see you on your phone. Thats not a problem. So where are we now . Postcovid. Are we in a hybrid situation or . Are we still like, yeah, lets go back to the old way of doing things. So what we have to really do is again and go back to my whole do we have a will point to to make a difference. But access means how are we defining access and access for whom and how and how is it paid for . Well, and you mentioned why cant we . I guess my question to you is why . Why cant we . And you mentioned the will as part of the problem. Where is the well lacking money . I mean. I can actually sayomething. We are i was so glad to hear eser. And others mention the unsustainable trajectory. We are on in terms of health care, spending. Health spending we. And now theres a movent to say, how do we liberate these dollars om thi system thats incentivized not to deliver on health . And how do we start to divert it towards the things that we know will deliver value food as medicine, housing, transportati and so forth . But what did we do durin we brought extra systemic fus to bear in an emergency an built a whole lot of stuff outside of the apparatus of Revenue Generating health care. So can we start to get real about creating new financia system for social for health that rely on an extra ordinarily complex and baked instead incentives to deliver the tngs that angela works on every day that i work on, every day that all of us work on. But at the same time, its its real orthogonal the way we pay fohealth care and delivering on health. And think we need to have an honest conversation with ourselves after the pandemic, whether were barking up the wrong tree and whether we can liberate new dollars for health that actually go into the things that deliver the best roi on health as measured by Life Expectancy or as msured by however you want to measure it. But but something that is beyond control and absence of disease and by barkingp the wrong tree, do youean going to systems we had precovid or what is barking up the wrong tree mean i mean we hava dominantly for Service Healthcare system in this country that will always have a volume incentive. We can creatnew financial inruments, new payment models to try to shift that slowly. Its been years weve had value based payment for a while. I dont see the value coming out of that movement. I dont see the entire system shifting in the direction towards health. Hmm. Right. Theres islands of excellence in a sea of. In a s of, you know, need. So im saying. And especially the covid experience taught us we can build p up clinics, we can build Community Health worker programs, can deliver on Digital Health solutions when we liberate those dollars from this real tightly wound system with, a set of financial incentives that are really hard to unwind. Yes. So i love the rm liberate dollars. I think thats exactly right. Getting to the question about telemedicine, i think its a really good examp. You know, what cnged after the pandem or as we entered a different phase, the pandemic. You know, that was no longer a billable event. So it gets to ashwins comments about fee for Service Medicine and sort of being in Population Based payment versus a fee for service paymenta virtual visit only under Certain Circumstance as por to covid was ever recognizeds something could build. Cms say medicare and other paye would typically follow the medicare payments system dung covid, all ose things were lifted. You those dollars to use ashwins rm. Theres a lot oflexibity, but those fxibilities shifted back and reverted. So to yo questn about, you know, at happen and why are the virtual visits a little more challenged now . Now youre back, a frawork where its got to fit certain scenario, reos and otherwise those arenpaid for. Can any of this be changed witht some huge government intervene option . Can the system evolve without trying to reach some agreement in congress, which seems you not not easily doable, but thats up for anybody. Maybe can start so that you know. Yeah, we can debate some of the big changes in terms of Health Care System in this country. Universal health care, which is what it is. And, you know, some of the big moments. But what i can tell you is even within this Health Systems, there are ways to bring some meaningful change as long, probably private partnership happens effectively as long as the right set of awareness is feel. I give you an example like you know in terms of some of the funding and money issues, there are some quality scores that we ve in our Health System for providers on Health System that on those quality scores, if theyre showing some kind of improvement, there could be some Medicare Advantage benefits in terms of the claims and the fees associated with their Medicare Advantage just with putting the right quality scores for Health Systems and they follow it very closely and very tightly, we can nerate some kind of behavior changes. And in fact, by some quality scores, which are not up to date. In fact, we can this sense in this this incentivize these Health Systems to go after some innovative approaches that can put that quality score atisk. The point is i think even this current Health Care System, there are ways to make some improvement instead of just waiting for some kind of big disruptive changes. Mm oh, go ahead. We often talk about health as in a series of moonshots like aspirational targets, but we to see something thats out there that we use a host of other sectors which is industrial policy. We have industrial policy for health care. We have industrial policy for microchips. Weve used it for big infrastructure throughout history. And what does it mean . It means government setting, super short and it bigger than any of us can achieve on our own. Setting some financial, even liberating some capital or creating some capital. T who does a lot of the work . Its the private sector. Its philanthropy, its nonprofits, its the Civic Infrastructure filling in that space towards a common vision. We dont have an industrial pocy for health because we havent about what we want. What are we solving for . What are we actually what is the Common Health project of this country . Were trying to lay it out in new york city, but we need the rest of the country to also follow. And i think thats the kind of Government Action we need as the only government representativ i feel like i have to speak up for government. Its not that we need to do everything. In fact, sometimes we shouldnt do it too, that we should do a lot. But what we do need to do is set out a vision that we can all get behind, that we can that that says this is best for society and we do this all the time. We select winners and losers and we select common when we see that theres a a threat. The chips act was the latest example, bill, of when we see a National Security threat, we step in, we intervene with clear action. Well, this is a threat. I think those data show thats a threat to our our project. Thats a threat to our democracy. Thats a threat to our society and its future if we dont step in. So going to be on the government to set a target some goals and unlock an industrial policy of help that we can all behind and that only then will we start to ship some of these in centers towards health and not just, you know, when you just said what you said and then said thats a threat. It reminded me of the conversation around climate and and we see how things are just taking place and the impact of climate change. And yet what is it . We almost need a psychologist, this panel because what is it about Human Behavior at you can phrase face imminent threat to your wellbeing and still stay stuck there a cycle lets just do that. Thats a great question. I think maybe to add a couple of thoughts. Yeah, innovation is going to be one of the keys to answer many of the challenges ahead of us, and thats based on your proposal to have an industrial policy behind it is something we need to keep in mind. How can we keep patients out of hospital . How can we improve their lives quality not only in the sense feeling better, but actually making more productive and thus directly also reducing the cost of hospitalization e. R. Oms were a big issue. The earlier diussion people need to go there because the right interventi with the outcome, its going toelp the system. So lets not lose sight of what innovation can actually add to the system. Thother thing wneed to understand our data. We need to share it. We need to be able to use that transparency in an unbiased way. I think thats another learning curve ahead for us . We still it in pockets. We should respect the ownership of data, which is usually with the patients. Thas who belos to them. But making transparent to everyone, getting unbiased view using technology to mine these huge lakes, oceans of data is going to be one of the key drivers to efficiency i. E. Liberating dollars within the system. Im absolutely sure about. And were getting down to our last few minutes, so id li to ask each panelist and ill start with you, joanne this is the first panel of a three Day Conference filled with really fascinating conversations. What what do you want to leave people with to spur more conversations about this topic in parcular . I think maybe a couple of things. One, i think were getting a flavor just how complex weve made our Health Care System and i think inherent in that is maybe weve made it challenging as a result, there is still good. I was going to mention this earlier. You know, if you look at just even some of the work thats gone on over the last couple of decades around readmissions, by hang that be a focus, by having government kind of anchor that as a quality measure, i think our readmission rates across the industry are significantly lower. So thats a you know, there are bright spots in the middle of this mess that weve created. But i think over the next couple of im looking forward to just digging into each of these issues and i in our world, you know, if you havent noticed already, i think payment incentives, i really do believe its one of the Biggest Challenges to creating and getting on a better path. I also think its a big challenge equity in health as. Well, because the payment incentives around fee for Service Despite favor commcially insured populations which tend to be better financially and as a result you know you wide the inequities in health care so i think the payment component something that i think is near and dear to us but also something we would argue should be near and dear to Big Conversation around the challenges of health care. I really should. Maybe i would start with sharing a t of optimism about the future of health care, the of innovation is really working well. There are room for improvement but innovations a very strong on diagnostic side therapeutic side across the board intervention side. Lets figure out how could we Work Together to solve some of the access and some of those last mile said we talked about that last milis generating a lot of these gaps in equity and the only way to make it Good Progress is through partnership. Its a very noisy world. Nobody can do it alone. We need Public Private partnership, amplifying information even if we can not misinformation and making sure that together we can solve this issue. Thats the only way to get it done. I have a lot of hope that were at a moment to take some of these structural challenges in the way organized health and health care in this country. So even though those data you are concerning the data we saw in new york city alarming i see a moment of great opportunity and hope and when we launched health nyc last week it was its a hopeful vision its a hopeful vision that can aln around common project that we can somehow break down some of these silos and areas we live in and, and get behind a project that is as amir said, bigger than the ability of anyone of us to achieve on our own. And that means a unprecedented level of cooperation, collaboration, alignment in places just like ts. Right . Bringing together all aspects of our really complicated but really Innovative Health care apparatus in this country is essential. And so i come i hope you will leave here after days with more hope than not. And and the sense of a moment, a moment in time. Because in a year from now, if were here and were lamenting the same data, but we havent taken any of the steps, reorganize ourselves, then we will have potentially a moment. I think we have a chance, particularly in the next 12, 24 months. Who knows what happen in washington thereafter . I think we have to seize this ment now and define a new common project for for this country, because we deserve to live in a society that is healthier. And and with the expectation that will live longer and better lives. Well, thats tough to follow. Now, i mustay so i would fully to that shared goal. I would also like to share with this room and everyone beyond it is that theres great breakthroughs ahead of us on the therapeutics side. I think weve just seen the edges and that innovation will rise. The tide for everyone because it will improve the system last one point. I can best speak for the country i know best that the discussion we currely have and what we understand does not improve the system. More regulation does not help the system to liberate the dollars, to improve access to, improve delivery, improve outcome. I think we need to create more space for everyone to be innovative and as i mentioned many times before, we need to learn to speak with each other not so much about each other. I thats another big key there. Thank you so my charge to each and every one of you is this given your sphere of influence and your seat at the table. I want you to commit to thinking about the one thing you will do in with someone else to move the needle, in american healt care. All right. Im. Im ready. You give such a good point to end on. But im a tv reporter. We use every last second. We absolutely. So i see we have 4 minutes and 7 seconds left. So i want to ask one question. You guys were very pithy in those last responses, and i didnt that. But i want to talk a little bit about innovation. I mean, weve talked a lot about the problems with getting to that innovation. And i think each of you has different of innovation in spaces where you are and he maybe coming back to you what is area that you see the most promise in for advancing technology now one space that comes to my mind id be curious your thoughts on it is the glp one obesity drugs space. Is that something that barringer is heavily invested in how will that change things metabolic comprises of many comorbidities so we will be addressing with those mechanisms a whole universe that is, as we understand, better and better day by day, linked multiple together. If you were to ask me what im personally most excited about, i think mental disease is going to be a field where the next five years we will see significant breakthroughs that will change the trajectory of patients. I havent seen any innovion for the last 40 years. Im convinced i have so many follow upsbout that, but im not not going to go there merrily. How about you . I think when we thinkarly detection of diseases in general is kind really helped to move and shift center of gravity in our Health System from treating sickness to promoting heth and wellness. Its beyond oncology. We are thinking about the Early Detection of diseases, alzheimer ah, not a lot of intervention because cannot detect diseases at the right time. And just that Early Detection disease would foster a lot of innovation. 200 therapeutics say the reason there are a lot of advanced cancer drugs, lets say for lung cancer, is because majority of people g diagnosed. Late stage lung cancer. Now, imagine a world that vast majority of people get diagnosed with three cancer years or early stage disease, just the day the biological and incentive that diagnosis at early stage would generate, we are going to see more intervention and more therapeutics, more medical devices to manage diseases at early stage to restore that health. So im very excited about what we could see within the next 10 to 20 years. John how about you . Yeah, i think well have to, whether we like it or not, find better ways around chronic disease. So i think metabolic is one there are many, ny others. I think the challenge will be because our system is set up and the Payment System specifically is set up, address episodic interactions and disease by definition is longitudinal. And so there you have a disconnect i think the other is to the extent we have existing intervention tions around chronic disease, they tend be very labor intensive and there simply wont be the human bodies around to sustain those models going into the future. So i think lot of trains entering the station, if you will, that point to, were going to need a different solution around chronic disease, ashleigh. Two things care delivery. And again, going back to covid experience, we brought care peoples homes to peoples street corners to, pharmacies to, you know, to police stations and fire stations. I mean, we used the entire Civic Infrastructure to deliver care in an emergency. We have to learn from that as well as telehealth. We have to expand our notion of what it means to deliver care. I think in an environment where wearables and and where peoples selfgenerated engagement with their health can match our ability to bring care to where they are, that would be thats thats one area im very excited about. And i hope we learn. Number two is data and hubert said this we have to get better and i think it offers important opportunity to really get past our administrative silos data so we can get into a Population Health mindset using using real actionable data. Angela, final word. Final word. If im just excited to be alive in this with this group of smart people because,m excited about the change thats getting ready to happen here. Thank you, everybody. Yes, we grefully acknowledge the participation of the following organizations whose generous support makes this conference possible. Thank you very much. And lovely