You said of baghdad he and and Islamic State are now trying to be the new al qaeda, how much indication do you see that out there in lebanon, libya, message ishat starting to resonate. Were seeing an alignment with the United States. Have seen individuals, including influential individuals within some of the either oft state some casesnce or in more affinity for the successes that they have had and tactics. Situation. Ynamic the competition and a queue on the other. A concern we have that perhaps to demonstrate they are the leader they would seek to carry that wouldck establish bona fide. Very dynamic situation. I go back to the propaganda points. We focus on the english language propaganda but they are using propaganda and a range of languages across the region. It is not just focused on u. S. Or western audiences. Obviously an area of grave concern for us so we are watching the situation very closely. Lex thank you very much. Is to be ahe prize local Jihadist Group and attack the homeland. I want to thank you for coming us a serious and balanced assessment. Because mr. Olson is a very busy person, and i ask all of you tuesday in your seats while he and i try to slip out the back or . Thank you very much. [applause] you can see all of this evaded event live. We will take you to the Rayburn House Office building where center for medicare and Medicaid Services of in a straighter marilynn tavener has just started speaking, giving an update on the implementation of the health care law. The recent reports have been talking singledigit that is proposed, not final, i ornk it is defined a year two in the marketplace i think it is a good sign for employers. Which i will come back to you in a moment. In 2014 what we did find, seven taxof 10 consumers using credits were able to receive coverage for 100 or less per or 46 and nearly half got coverage for 50 or less per month. Days remember in the old when we would try to present different types of coverage programs. We were always looking to get at the price of an individual if we could say your insurance does not cost more than your cellphone, we thought we might have a shot at it. As we plan for year two, what were planning on doing is building more options for consumers, educating people about those options and helping those first time and newly insured consumers learn about the benefits, eligibility requirements and financial protections. We recognizeime, hereto brings its own set of challenges, unique challenges, which is why we will talk about theuse all the rule in accompanying material about renewing coverage as simply as possible. Is it as simple as we would like . Absolutely not. Have we made a lot of progress cap goes yes. We hope that individuals coming back to the markets will look, will shop, will update their tax credit, income information, family changes and also recognize there are a lot of people who may not have had changes, so it would be easier for them to default to an automatic renewal and we are encouraged by that. The same way most of you and i buy insurance sponsored products in the same way medicaid works in medicare regular and part d. Make it easier for people to reenroll, and groupsly we have a whole we will be going after in the next ranks of the uninsured. We also launched a program called coverage to care. Surprising many of you could have told us, once people became uninsured, many of them did not know what to do with the insurance they recently acquired so there were a lot of questions, and many issuers had done a great deal of education and outreach. We also try to do the same thing working through the office of Minority Health and partnering with navigators and others to try to get material out. As we get into year two, i think we will see more and more of that. Withast area has to do what about the next group who people of people who need to be enrolled 25th team. Are in the process of doing the analysis again about where are the next pockets of uninsured . Where do we need to reach out to get to the next group of folks so that we can continue and march forward on reducing the number of uninsured . Now moving to quality. I have been here almost five years now, and i would say over the past five years we have made a great deal of investment and quality improvement, quality systems, the work that has gone on around meaningful use and Electronic Health records, starting to see results such as the nine percent reduction and harm on high School Hospital acquired infections. We have seen and been able to document fewer admissions from 2012 to 2015. We have seen over 60 of physicians and 70 of hospitals adopt some form of Electronic Health records. These accomplishments have been significant, and wherever possible, and i think more common than not, we have been able to align the private insurers to make sure we are not confusing the markets, whether the market as a consumer, physician or hospital, but we would all agree there is still much work ahead and we will continue to work in these areas. I think what you can look for in from this cms side of the house as we will continue to tie quality measures to those about, not process, and we will continue to take those measures and leverage them within existing payment systems. Work is underway for the medic key medicaid before service many times for the private side of the house, and that slowly being adopted throughout the payment system. You cannd paper reform see as it relates to quality is we will be creating reforms. Medical, health, homes and others. 60 date, we have over 30 acos that have been established at the medicaid program. Interim Financial Results show they generated 120 8 million in savings for the Medicaid Trust fund in the first year while either maintaining or improving the quality rating and rankings for patient care. This is that an early example of the type of work that will expand to state providers and others in the coming months and years. I think you can follow the message around quality and will continue to be outcome oriented. Leverage itinue to to payment strategy and continue to spread it across the entire spectrum of medical care and i will let the private actors private actors speak for themselves. That is good, because we need to be aligned because it is easier for consumers and providers if were moving in the same direction. The third area is cost. We have seen historically low cost and Overall Health care spending. That has continued to 2014. That translates to stable premiums. Kenneth fisher year is being able to save money on prescription drugs and preventive care. It also translated last month or in july into trust Fund Solvency being extended to 2030 or four years beyond what was projected in last years report. In the futurepect on cost . We all know it will continue to be a very big issue for us. While we certainly know there has been a lot of factors. We consider this a time where we can move quickly. So i think the reforms we are talking about whether it is on the marketplace side, and when we talk about the marketplace, remember there is a lot of things we do not have to address again. We have handled preexisting conditions. We have handled renewability. All of us created working together for a whole new world and Health Insurance and Health Insurance delivery. The question is, how do we not take those great things that have been done and tie it to cost improvement, quality. Will expect we will continue to work with employers and consumers to get that done. I think we will continue to look at every opportunity to more importantly select quality and pavement payment. You can look from volume produced to outcome and overall cost as the measure of what is good and what is working. We will partner with states in we will work, and more closely with businesses and issuers to make sure the benefits are aligned and benefit consumers. We will continue efforts in public release of data to help individuals, businesses and employers make the best decisions regarding overall quality and cost of care. Past five years has given us those tools, information to move forward. The Health Care Cost trends have certainly helped that there is still much work ahead and i look forward to working with each of you to get it done, thank you. [applause] thank you. We really appreciate the extra effort you made to be here, and i think it speaks to the dedication we have all witnessed form from both sides of the aisle. We really appreciate it. This serves as the perfect opening to the broader conversation about the future of health care in america. Our goal for this event is to pull together people that are shaping the Health Care System and doing it from different perspectives and different roles him and that is what it is really all about. We are viewing things from a different perspective. It is a nonparking partisan organization focused on creating positive change. We do this by supporting empirical research, convening influential stakeholders and realizing excellence through grants and awards. To have an fortunate exceptional board and Advisory Board of markets and policy leader. Today, of whom are here including our chairman brad wilson. And ceo ofpresident Blue Cross Blue Shield of North Carolina. Brad. Serving almost 4 million customers. Prior to joining lou cross nearly 20 years ago, brad ascticed law and served general counsel to the governor of North Carolina. As ceo thomas he really brings a very pragmatic optimistic view of the future and its really helping his Country Company transform what is happening in North Carolina and playing on the National Stage by contributing to his great thinking. By that, please come up. Thank you, nancy. Good to be here. It may congratulate you and your team for putting this conversation together. Are proudrtant and we to be part of it. Nancy and her team does not give us work throughout the year bringing wellinformed information to all of us so we can make better decisions in the health care space. Let me also begin by thanking all of you that are here in the public sector. We appreciate your commitment and dedication and hard work that you bring to the conversation that we are about to have today. Of us in this room have a certain amount of knowledge about the challenges that face our Healthcare System. A system that is the most expensive in the world. Yet does not deliver the kind of value and quality that we need, deserve and expect in america. Many of us have good ideas on how to improve it. I appreciate the opportunity you are giving us today to share with you some of my perspectives. Two things that are necessary to make health care better. A bigger role for consumer and a bigger role for collaboration. To improve the quality of health care in the United States, slow the rate of cost that pushup health , get morepremiums people covered, all of these things are the essential things we must do in order to get value out of the two point 8 trillion we spend each year, then it is very simply up to all of us to get it done. Why is it up to us to get it done . He cuts we are all healthcare consumers. Were consumers yesterday, consumers today and were going to be healthcare consumers tomorrow. As such, we are in the best position to lead the transformation of health care in our country. So today i want to ask you to do me a favor and put aside whatever your title is. Whatever reason it was you were invited here today. Lay that segment representation aside and look at health care is transformation as a consumer of health care. Said i am the ceo of Blue Cross Blue Shield of North Carolina but i am certainly and definitely at Health Care Consumer. In the past two years i have had rotator cuff surgery on both shoulders. For me fortunately a total of five in order to get to shoulders working well again. So i can tell you, that in of itself qualifies me as a Health Care Consumer. And i learned many things during my experience. Having the best hospitals and physicians in the world, the most advanced medical technology, the best medicines to treat most of the Health Issues we all face, the consumer must play an increased role in his or her own health care. As individual consumers of health care, we must engage in Healthy Behaviors across the course of our lives. We must engage in preventative practices, and we must be fully compliant with the care directives that come from our Physician Partners when we asked them for help and access care. I would submit to you that transformation begins with our own behaviors. By the way tom a the word choice by the way, the word choice, verymer not patient is deliberate. We must think age consumers in their own health all of the time, not just when they have a medical emergency or a Health Circumstances that causes them and drive them into the Health Care System. I think this is especially true when we think about how we will improve health at a time when more than half of americans live with some type of chronic diabetes orke obesity. A very daunting statistic and one that is getting worse rather than better. So looking through the consumer lens, how can we make it better gr . Must makers, we health care easier to understand, all of health care. There is no question about it, we have a very complicated system. If we must assign blame, it extends across every entity involved and engaged in health care, including my own line of work. Insurers have failed consumers by not providing trans timely information about what cost, quality outcomes or how the system really works, offering advice and guidance about how to navigate the system. Lots of people still think the 20 copay is the entire in total cost of their office visit. On changing that. Understanding and navigating the complex Health Care System is certainly a real issue for the 8 million americans who enrolled under the Affordable Care act. Across the system of luke ross across the plans system and country, we have yielded countless questions about benefits, costs and the simple question, what do i do one of our individual Sales Managers in North Carolina tells a story about a community recent tatian she was making and a small town one evening during the aca in rome in time. A few minutes into explaining the aca and coverage option on the exchange, at hand went up and asked this very direct and simple question. Deductible . She decided to scrap the formal presentation and just talk to folks about how the basics of health care worked and how it in her relates to Health Insurance. We are trying harder to make things simpler and more understandable. We have done plenty in there is a lot left to work a lot of work left to do. Many providers are now taking Customer Service into account when it comes to scheduling, billing and other administrative processes that do not necessarily have anything to do clinicaldelivery of care but everything to do with the experience that the consumer patient is having in the clinical setting. This kind of consumer friendly approach is long overdue in health care. It is going to continue, and we to lead it. Tinue another thing healthcare consumers must have. They must have the resources to make the right decision about not just static information or pamphlets of the automobile but dynamic tools and information tailored just for you based on your unique health history. Where you live, where you can go and many other factors. There are Real Progress on this front. For example, we are rolling out the personal set of tools to connect customers for the information they need about their health. We want to get them access to everything they need to make an informed decision and have it right at their fingertips. We conceptthat under the of blue connect. This is not the way health care has traditionally worked. Think about what you do with your smart phone today that you did not do a year ago or five years ago. Interesting statistic, the Federal Reserve tells us 51 of smartphone users have used their and 17 ofbank mobile banking customers have made a deposit using their phones. So the question is, why not go,nd these kinds of on the readily available at your fingertip transactions to health care . There is no reason not to. Think about what could happen if if were at the playground your children and i would dare say no one goes there with the top of mind trying to figure out the closest emergency room that you might need that day because your daughter will need care as a result of an injury at the soccer match. Access to have ready nearby Urgent Care Centers through a Health Care App on your smart phone, you would be repaired to make a wise decision. That decision may be to go to the urgent care, rather than going to an emergency room if it were not necessary where you would endure a long and costly visit. The accessntial is to the information and willingness to deploy. The goal of these kinds of resources is to get consumers the data they need to choose. The ones that offer the best value for the individual consumer. We are working with doctors and hospitals to develop meaningful withre and then coming up data for them. Data leveraging incidents and should is an essential role we are playing to help