Thank you steve. Good afternoon everybody. Welcome to our dc members and or guests. It is wonderful to be here at the Detroit Economic Club. Organization is long attracted some of the nation his most distinguished thinkers and innovators. It is my privilege to introduce todays participants. Well engage us to the capitated rating discussion about the future of healthcare. The may begin by introducing our guest speakers, someone who ive known for monday years and consider him a mentor and a friend. Scott promises the president and ceo of the Blue Cross Blue ShieldAssociation National federation the source 36 independent communitybased and locally operated Blue Cross Blue Shield companies. Including Blue Cross Blue Shield of michigan. The Blue Cross Blue Shield system through his federation of insurers, covers one out of every three americans. I think this is the very important statistic. What else does this frankly. It serves every zip code in the united states. In every zip code in america, someone has a blue cross card. Its overseeing one of the most trusted brands in healthcare. For the nation his most influential leaders in our field driving Public Policy and conversations on healthcare and healthcare reform. Everyone has access to quality affordable healthcare. Scott has devoted his career to include health to all americans through innovations like the bc bs health index and health of america reports. It identifies Health Issues and challenges and provides insight to improve the quality of care across america. Scott was named president and ceo of the csa in 2000 after surfing four years a Senior ExecutiveVice President including two years as chief operating officer. Prior to that, and executive Vice President , for system development, he was in charge of new Business Strategy and bc Bs Technology evaluation center. He is renowned for evaluating safety and effectiveness of emerging medical treatments. When youre in scotts tenure, the required program was introduced through this national program, which allows blue pan members who receive Health Benefits of traveling or living in another part of the blue area. Our nationwide membership in the system, has increased from 65 million from the beginning to hundred and 6 million members today. Scott was at the home of monday of the important policy debates. It includes limitation of the Affordable Care act. It was his vision to use available data to develop insight about what is happening in the Health Across america. In driving solutions on Healthcare Trends like Millennial Health. Before he joined, he served as president ceo of chicagobased financial rush health plan. He also created and led positions for prohealth preferred healthy misery based be a joke. Scott is the leader of an association with strong commitment to corporate responsibility. Hes also driven to be cynically active both professionally and personally. In addition to surfing on numerous blue cross boards. His Founding Member of the National Business group on Health Institute of healthcare costs solutions a board member of the Brain Research foundation and Advisory Board member of paragon biosciences. He also serves in the Leadership Council to healthcare Financial Management association. The American College of healthcare executives, the deans Leadership Council and Purdue University and the Washington University school of Medicine National council. Scott is also advised the white house and congress on policies programs and services affecting our older citizens and was a charter member of the American Health information community. The commission to advance Health Information technology. He also serves the ceo Advisory Board building a healthier chicago. Scott earned a bachelors degree from Purdue University where he is the proud boilermaker and holds a masters in Health Administration planning the Washington University school of medicine. It also holds an honorary doctorate of science degree from purdue. I also like to introduce moderate today, doctor deanna live. An Award WinningHealth Reporter ww j news radio 950. Previously deanna was a medical report of her major tv news stations. Miami chicago and boston. She is reserved multiple awards for reporting including six emmy award nominations. Michigan association of Broadcasters Award and to American Heart Association awards. Deanna holds a bachelor of science degree in nutrition from Michigan State university and earned a doctorate of interactive medicine from doctor William School college of podiatric medicine in chicago. She completed her surgical residency in the Phoenix Community hospital. It is my pleasure to introduce both scott and deanna. Lets give them a warm welcome and were looking forward to their comment conversations. [applause] hi and good afternoon. I am thrilled to be here with the Detroit Economic Club and thank you for having me. And scott i want to officially welcome you. Thank you. Were going to be talking about the mission for the future of healthcare. A lot of people that i talked to over the past few weeks, found out that i was going to be meeting with you today, they all had some questions that i should ask you. One question kept showing up over and over again lets start with this. Im sure its something youve never heard. They want to know why is healthcare so expensive for consumers and businesses in our country. Thats an easy question. I get the question but didnt get a lot of applause we do said that im a proud boilermaker. I have to go on record, my daughter didnt see the live and she is the proud spartan. [applause] yet to do something to get the audience on your side. Okay why is healthcare so excessive. Healthcare is unique in that the consumer of services is typically the person anchor the service. You got a strange dynamic in that environment. You have organizations both of it is the government or are insurers like the blues who are paying for the service but our manufacturing plant if you will, on physicians the hospitals and the others who are delivering the service. Lots of disconnects and lots of missing checks and balances. So that would be. 1. I think the second. Is, we got the Healthcare System on a piece basis. That is, the more you and the more you get paid. So we have created human sedatives in the system for delivering excessive care so long as it care its not going to do any harm. So we have a scenario where providers are incentive to deliver more care, patients have no offer to except the care clause are typically not paying for it. And payers are afterthefact trying to manage the care and remote bases. That drives price up and second, what is more important than health. Nothing. So we invest as a society i believe appropriately, lots of dollars in creating innovation. An inviting new pharmaceutical breakthroughs new ways in which to drive better value in the system, i hope the zone alarm of some kind. To drive better value in the system and those innovations in those breakthroughs have a price attached from them with also increased live expectancy and Health Outcomes and eradicated diseases that we have done a lot of good things with those dollars. The next evolution, the logical question though is what can we make it more affordable. The evolution there is to move our Healthcare System to one that is less focused on inputs and more focused on value. To begin to construct relationships between payers and providers that are focused on the outcomes of the care that are received rather than the inputs. In fact, the michigan plan here, Blue Cross Blue Shield of michigan is one of the leaders in that movement about 5000 physicians operate here on the 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 and then in fact, our system alone, 70 million americans get their care through some forum of a value based care arrangement. The goal there is to focus our reimbursement on improving the outcomes that our patients received. Ensuring results. We have had diminished readmissions to the hospital and diminish emergency room utilization increased compliance with chronic disease treatments and protocols. We have a whole host of activities that are beginning to show positive results. Long made it through to a short question. A lot of Insurance Companies and businesses offer Wellness Programs and incentives so if you quit smoking or you lose weight, i just wondered how effective are these. Are they worth businesses investing in. I believe that any investment you make in your employee, enforces health is the benefit. I think improving lifestyle having people lose weight, reducing smoking, and those of things all have positive outcomes in the jury still out on both of the investment in those programs is actually paying out in real dollars benefit. But i think in if you factor in the noneconomic or the non hard economic factors like reduced sick days and productivity measures, hes clearly an investment we should all be making and worth making. Suggested for about a year from now, were going to be having a big election and healthcare is always the big issue. If you know running or you were advising a candidate. The former will never happen. [laughter] lets say you were advising someone, what are some things that would make a Good Health Plan and what are some things as voters we should be looking for. Im a big believer in building on what works. And not just tearing things up for the fink of tearing things up. Where i advised any of the candidates, i would say we spent destination, a long time working on and debating and implementing the Affordable Care act. I would build on its successes. I would look at the fact that as of this moment, in excess of 90 percent of americans have Health Insurance today. So i would look at ways that had we close that gap to get the last 10 percent i think the number i saw this morning was seven and a off percent. How to close that gap to get those folks that went out disrupting the care that the rest are receiving area so there are a number of Public Policy initiatives that we could do. I would improve lower costs and improve our ability to access care in that regard. I would encourage candidates to look at the issue of pharmaceutical costs and promote the idea, not just in pharmacy but the entire Healthcare System of transparency. Allowing patients and, employers and insurers to have real line of sight understanding of what the components of healthcare really caused and how therefore identify where the opportunities are for improvement. How are varmint drugs priced. Lets get some transparency into what other costs and developmental clause the real cost, the research costs. How are the spices developed so we can have a better Public Policy discussion about how much we as a society can afford to spend on that regard. We have to develop a Public Policy initiatives on my constructs. We now have our 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 hospital survive. There is no shortage of an agenda isnt the made it through to your question in this regard but i think is the priority, i would say focus on building on whats working today as opposed to distrusting what is working today just for the fink of destruction. So thereve been some major Health Issues in the news lately. I kind of wanted to get your take on them. Were talking about the future of healthcare and also how does a blues combat these things. For example, vaping ecigarett ecigarettes, here we have five people that died over 450 have been hospitalized with respiratory illness. We do do something that is newer and you dont have a lot of data on. The issue of how to deal with vaping, can put it in a broader category. How do you deal with lifestyle issues. How do we as a society we as a blues, as dan said earlier, we are in every community. What makes us unique, the unique qualifications of our programs are our people live in the communities in which they operate. So when we make decisions and policies, when we decide what our priority issues, its impacting our neighbors. And her friends. It is our families is in our community so we are very Community Activities committed to them. I put all of these things be a smoking, baking mating, nutritional issues, all of these things into a category of social determinants of health. Visible system, feel committed to take the resources and the insights and information that we have, and trying to work with local communities to solve those problems. We want to be certain that people his genetic code is more important than their zip code as we look at how we attack healthcare issues. Try to take the data and information we have worked with policyholders carmakers, in washington and state capitals. So they can understand the depth of the problem. And so they can understand the communities that are infected with the problems and we try to work with this communities to actually take our resources and our steps to invest in those communities to solve those problems. His vaping today is opioids yesterday. Unfortunately voip is for a long time. Vaccination rates. The best way to deal with this is with facts and data and information and we try to bring to the communities. Were blessed with the Data Resource clause of a hundred and 7 billion members in every zip code in every edge and every demographic, we are blessed with the Data Resource that provides us great insight into that so the trick is to take that insight and provided back to the people who can really make a difference. Tmac when we think of healthcare a lot of times we think that the elderly are the sickest. But a saybrook class report with the millennials are not the healthiest group. Can you talk a little bit about that. Waiver program called the health of the american. Weve done 27 different kinds of reports. On various health and additions. In this beautiful stadium, one of the ones that get the headlines early on was our customer report that was the ideas. On the front page of the estate today and a whole host of others. The latest one we did was on Millennial Health. I will tell you we were very surprised that we found that the millennial generation, which will be 50 percent of the workforce in 2020, at this stage of live, the sickest generation of any other cohort group and it relates. Six of the 10 percent of the ten top ten conditions are Mental Health or Emotional Health related conditions. Generally stemming from detachment issues loss of virtual contact but not enough human contact were seeing chronic conditions arise like high Blood Pressure high cholesterol things of that nature and that generation that we would fully expect to see in people 20 or 25 years older than them. It is an issue of quite a pit and importance to us. We with the blues have taken that on is kind of a mission of ours. To try to address this issue. Listening sessions. The data only tells you so much so we went out and spoke to spoke to the millennials and asked them what they are looking for speaking. Interesting late, people might generation, seniors unfortunately, are very concerned about privacy. Not an issue for the millennials. What they want is the compassionate medical professional who is wheeling to treat them as a whole person and look at their conditions in a comprehensive in the context of their live as opposed to treating each disease and condition independently. Kind of like the patients in our medical homes that your doing here in michigan. Theyre very free to share information. Those six horses anywhere to try to Seek Solutions to the problems. But they are really craving human contact. In the ability to interact and communicate with people. Eleven cities in november we are having a national combination of pit in phila