Michigan. The system, through its federation of insurers covers one out of every three americans. I think that it is a very important statistic. It is something nobody else does. It serves every zip code in the united states, meaning in every zip code in america, someone has a blue cross card. It is one of the most trusted brands in Health Care Conversations on health care and his involved in health care reform, so everyone has access to quality, Affordable Health care. Scott has devoted his career to improving the health of all americans. Through parts of that identify Health Issues and challenges and provide insights to improve the quad of care across america. Scott was named president and ceo of bcbsa after serving four years as Senior ExecutiveVice President , including two years as chief operating officer. Prior to that, as an exec at a Vice President for system development, he was in charge with new Business Strategy and the bc Bs Technology evaluation center, which is renowned for evaluating the safety and effectiveness of emerging medical treatments. During scotts tenure, the Blue Card Program was introduced through this National Program which allows blue plan members to receive Health Benefits while traveling or living in another part of the blue service area. Our nationwide membership in the system has increased from 65 million in the beginning to 106 million members today. Scott was at the helm of many important policy debates including the implantation of the Affordable Care act. It was his vision to use available data to develop insights about what is happening in Health Across america, in driving solutions on health care trends, like Millennial Health. Before joining bcbsa, scott served as president and ceo of chicagobased prudential Russia Health plan. He also led health inc. A missouri based pho. Hes a leader with a strong commitment to corporate responsibility. His also driven to be cynically active professionally and personally. In addition to serving on numerous blue cross boards, is a Founding Member of the National Business group, the Health Institute of Health Care Costs and solutions, board member of Brain Research foundation, an Advisory Board member of paragon biosciences. He also serves on the Leadership Council of the Health Care Management association, the deans Leadership Council of science at purdue university. The Washington University school of medicine counsel. He has also advised the white house policy and programs and services affecting our older citizens and was a charter member of the American Health information community, commission to advance Health Information technology. He also serves on the ceo Advisory Board for building a healthier chicago. Scott earned a bachelors degree from purdue university, where he is a proud boilermaker, and holds a masters in Health Administration planning from the Washington University school of medicine. He also holds an honorary doctorate from purdue. I would also like to introduce our moderator today, and awardwinning Health Reporter at ww to bj at newsreader 950. Previously she was a medical reporter for major stations in miami, chicago and boston. She has received multiple awards. A and a Michigan Association of broadcasters and to American Heart Association awards. Deanna holds a bachelor science degree from michigan and earned a doctor of podiatry degree from the Williams School of medicine in chicago. She completed residency at the Phoenix Community hospital. It is my pleasure to introduce them. Lets give them a warm welcome. We look for to their conversation. [applause] deanna good afternoon. Im thrilled to be here with the detroit economic club. Thank you for having me and scott. We are going to be talking about the vision for the future of health care. A lot of people i talked to over the past few weeks found out that i was going to be meeting with you today. They all had questions that i should ask you. One question kept showing up over and over and over. So lets start with this. Im sure it is something you have never heard. They want to know why is health care so expensive for consumers and business as in our country . Scott thats an easy question. I will get to the question. But i did not get a lot of applause when you said im a proud boilermaker. [laughter] so i have to go on record. My daughter did not see the light and she is a proud spartan. [applause] you have to do something to get the audience on your side. Ok, why is health care so expensive . Health care is unique in that the consumer of services is typically not the person paying for the service. So you have a strange dynamic in that environment. You have organizations, whether it is the government or insurers like the blues, who are paying for the service, but the manufacturing plant who are the physicians and hospitals delivering the service. So you have lots of disconnects. And lots of missing checks and balances. So that would be. 1. The second point is, we built the Health Care System on a piecework basis. That is, the more you do, the more you get paid, so we have created incentives for delivering excessive care, so long as that care is not going to do harm. So we have a scenario where providers are in scented to deliver more care. Patients have no buffer not to accept that care because theyre typically not paying for it. And payers are afterthefact trying to manage the care in a remote basis. So that drives the price up. Second, what is more important than health . Nothing. So we invest as a society, i believe appropriate lake, lots of dollars in innovation, in finding new breakthroughs and ways to drive better value in the system. And those innovations and breakthroughs have a price attached. We have also increased life expectancy, improved health outcomes, we have eradicated diseases. So we have done a lot of good things with those dollars. The logical question is what can we do to make it more affordable . The evolution there is to move our Health Care System to one that is less focused on inputs and more focused on values and begin to construct relationships between payers and providers that are focused on the outcomes of the care received, rather than the inputs. In fact, Blue Cross Blue Shield of michigan is one of the leaders of that movement, about 5000 physicians operate here on a patient centered medical home, an environment where the primary care physician begins to manage or take ownership of the full spectrum of care of the people who are part of his or her practice. We try to do that across the country. In fact, in our system alone, 70 million americans get their care through some form of a valuebased care arrangement. The goal there is to focus our reimbursement on approving the outcomes that our patients receive. And it is showing results. We have had diminished remissions to the hospital, diminished emergency room utilization, increased compliance with chronic disease treatments and protocols. We have a whole host of activities beginning to show positive results. Long answer to a short question. Deanna will a lot of Companies Offer incentives so if you quit smoking or lose weight. Are they worth businesses investing in . Scott i believe any investment you make in your employee or Workforce Health is a benefit. I think the lifestyle things, losing weight, reducing smoking, all have positive outcomes. The jury is still out if the investment in those programs is still paying out in a real dollar benefit. But i think if you factor in the noneconomic or nonhard economic factors like reduced sick days and parter to be measures, i think it is an investment we should all be making. Deanna about a year from now, we will be having a big election and health care is always a big issue. If you were running or advising a candidate scott the former will never happen. [laughter] deanna lets say you were advising somebody. What are some things that would make a Good Health Plan and what are some things as voters we should be looking for . Scott im a big believer in building on what works and not just tearing things up for the sake of tearing things up. Or i advising candidates, i would say we spent, as a nation, a long time working on, debating and implementing the Affordable Care act. I would build on its successes and look at the fact that as of this moment in excess of 90 of americans have Health Insurance today. So i would look at ways to close that gap and get the last 10 . I think the number i saw this morning was 7. 5 , but how do we close that gap without disrupting the care that the rest are receiving . There are a number of Public Policy initiatives we could do that would improve lower costs and improve our ability to access care. I would encourage candidates to look at the issue of pharmaceutical costs and promote the idea not just in pharmacy, but in the entire Health Care System, of transparency, allowing patients, employers, insurers to have a real line of sight and understanding of what the components of health care really cost. And therefore identify where the opportunities are for improvement, so how are pharma drugs priced . Lets get some transparency. What are the real developmental costs. Real costs. So we can have a better discussion on how much we can afford to spend in that regard. As a society. We have to develop Public Policy initiatives on high cost drugs. We now first drug that exceeds 2 million for treatment. We have to, as a country, figure out how to deal with those particular issues. We have to improve access and lots of communities. We have to ensure our rural hospitals survive. There is no shortage of agenda. The answer to your question in this regard. As a priority, i was a focus on building on what is working today, as opposed to disrupting what is working today just for the sake of disruption. Deanna ok. There have been some major Health Issues in the news lately and i kind of wanted to get your take on them because we are talking about the future of health care. And also how does the blues combat these things . Here we have, five people that died. Over 450 people have been hospitalized with respiratory illness. What do we do with something that is newer, or something you dont have a lot of data on . Scott the issue of how to deal with vaping, i put in the broader category of how do you deal with lifestyle issues. Then we as a society, or we as the blues. As dan said earlier, we are in every community. What makes us unique, the unique qualifications of our programs are People Living in the communities in which they operate. So when we make decisions or policies to decide priority issues, it is impacting our neighbors and our friends, our families and communities. So we are very committed to a community activities. I put all of these things smoking, vaping, nutritional issues, all of these into the category of social determinants of health. We as a blues system fail very committed to take the resources, the insights and information we have and try to work with local communities to solve those problems. We want to be certain that peoples genetic code is more important than their zip code as we look at how to address health care issues. We take the data and information we have two work with policymakers in washington and in state capitals, so they can understand the depth of the problem. So they can understand the communities that are impacted with the problem. And then we try to work with those communities to actually take our resources and staff to invest in those communities and solve those problems. It is vaping today, opioids yesterday and opiates for a long time. Deanna the measles outbreak, vaccination rates. Scott the best way to deal with it is with information. We are blessed with a Data Resource because of 107 million members in every zip code and every demographic. We are blessed with the data that provides us great insight, so the trick is to take that for the people who can really make a difference. Deanna when we think of health care, people often think of the elderly as the ones who are the sickest, but i saw a report that say the millennials are not the healthiest. Can you talk about that . Scott sure. We have done 27 different kinds of reports on various Health Conditions, given that we are in this beautiful stadium, i would say one of those that hit the headlines earlier was a concussion report. The latest one that we did was on Millennial Health and we were very surprised that we found the millennial generation, which will be 50 of the workforce in 2020 is at this stage the sickest generation of any other cohort group. It relates seven of the top 10 conditions are Mental Health or Emotional Health related conditions. Generally stemming from detachment issues. Lots of virtual contact but not enough human contact. We are seeing chronic conditions arise, things like high cholesterol and high Blood Pressure that we would expect to see in people 25 years older. It is an issue of vital importance. We have taken that on his omission to address this issue. We have had listening sessions. Because the data only tells you so much. So, we went out to 11 communities in the u. S. And spoke to the millennials and ask them what they were looking for. Interestingly, people of my generation, seniors, are very concerned about privacy and data. Not an issue for millennials. What they want is a compassionate medical professional who is willing to treat them as a whole person, and look at their conditions in the context of their life as opposed to treating each disease condition independently. Which is kind of like the patient centered medical homes that you are doing here in michigan. They are very free to share information. They will seek sources anywhere to Seek Solutions to their problems. Theyre really creating human contact and they are creating the ability to interact and communicate with people. So 11 cities in november were having a national culmination event in philadelphia where we are bringing leading experts in Millennial Health together where we can begin to embark on a campaign to try to address these issues. Im counting on millennials to support the Health Care System in the future to take care of me. So we need to be sure that that generation is as healthy as they can be and should be given their physical age. Deanna do most of them even have a primary care physician . Scott no, i would say that the number of millennials with a primary care physician is markedly lower than the seniors, but they crave that and they are looking for that connection. I think that might be one of the shortterm solutions to make that connection. They are much more comfortable but with virtual care programs than other generations, so we have to find that sweet spot where we can get connected to the Health Care System. Deanna what about Artificial Intelligence and the future of health care . Scott Artificial Intelligence and Machine Learning have a wonderful opportunity to do a number of things. First, in underserved countries around the world, Artificial Intelligence can serve as an extension and do screening that may not get done because of the lack of access to medical professionals. I was at a conference recently, where executives from google were talking about working with Artificial Intelligence to do retinal scanning in india, which is underserved from an ophthalmologist standpoint. And found that the scanning and screening they did compared to human screening was actually better in the plumbing rescreening. If you multiply those kinds of activities in various areas, you can envision a time when we can get trained radiologists, pathologists out of the basement and to the bedside, and have a lot of the screening work done by machines. And have that medical, Trained Medical professionals over read and actually get more involved with the more complex matters leaving routine matters to machines. So i think theres a wonderful opportunity for us to be more efficient and effective and to free up our medical professionals to