And booksellers will be interested in going deeper on the subject of tonights talk, please use the link on the live stream page to purchase your copy of the long stick the long fix. Doctor vivian lee is us science and healthcare administer. Among her leadership role, she has served as the inaugural chief scientific officer advice dean of the medical center. Prior to that she was vice chair for research in the department of radiology. For 6 years served as ceo of utah health and dean of university of utah school of medicine in salt lake city. During that tenure she was elected to the association of American Medical College council of deans and administrative courts and a member of Advisory Boards of Massachusetts General Hospital and the university of Pittsburgh School of medicine, the Harvard Business review, journal of the association of medical colleges and other publications. Speaking of other publications vivian lees first book was on cardiovascular mris, not for the faint of heart. In the 15 years ive been on this job that is the first intentionally terrible joke i ever told in an introduction. At any rate, this brought us together tonight, the long fix, following americas healthcare crisis, strategies that work for everyone. Please join me in welcoming doctor vivian lee. Thanks, really wonderful to be with you tonight and looking forward to a healthy and hearty set of discussions and i want to acknowledge we are living in some very complicated complex times and i want to thank you for joining me in this event tonight. I want to spend 30 minutes or so and welcome your questions. For this time of empirical knowledge that i thought i would talk about, a series of three questions. First, why i wrote the book, i thought i would talk about how it is structured in the main premise of the book and of the 12 chapters i thought i might dive more deeply into two or three topics depending how much time we have so let me start with why did i write this book . I wrote the long fix, there was a series of presentations that i made to medical students when i was the dean of the medical school at the university of utah and the first year medical students, relatively new to healthcare and i wanted to share what i wish i had known before i had gotten it to healthcare, to answer the question about how healthcare works and particularly to prepare them for how they could make a difference and be on the practice of medicine for the experience of working within healthcare itself and many of the questions i wanted to answer were the same questions i got where i now work which is out for that Healthcare Company and where i have met a number of really talented, great engineers, product managers, researchers and the like and they were trying to understand how this complex system we call healthcare works. I think we all know in the news, there are many components, we know about the rising cost of medication, the lack of insurance for some americans in this country but what we havent heard so much about our solutions. As i have worked in healthcare for two decades and traveled around the country and been around the World Learning from others, the chance to share stories of new and different ways of providing healthcare and paying for healthcare are working successfully. Sharing those Success Stories i found i was able to weave together both narratives, reached an increasingly clear sense of how we can extend those solutions into a National Strategy for healthcare. That is why i wrote the book the long fix. I wanted to write an optimistic book that actually offered solutions, something we very desperately need. It was called the long fix because of our conversation that i had with mike leavitt, secretary of health and Human Services and former governor of utah, on the fact that he thought the trajectory of changes in healthcare took 30 or 40 years at a time and that there might be we might be in the middle of one of these cycles. Since the covid19 pandemic i feel there is a greater sense of urgency about tackling these problems so im hopeful that the long fix might not be so long and might be a quicker fix. Im optimistic about that. Turning to how the book is structured and what i talk about in the long fix, i start by laying out the fundamental premise of the book which is the central problem in healthcare is not so much about local healthcare but really about how we pay for it. It is the economic or Business Model of healthcare. If i were to prioritize just one thing that i would say we need to focus on based on changing the economic or Business Model, not so much who is paying for healthcare, we can talk about that if folks are interested in the queue and day, discussions about should there be medicare for all for example, it is not about who is paying for it on an individual level it doesnt matter tremendously but from a policy perspective it is more important for us to solve what it is we are paying for in healthcare. Specifically what i mean by that is how the Healthcare System is focused on paying for action, procedures, what we call a feeforservice Healthcare System, created a completely different set of incentives than healthcare and if we do that, where that is happening, it is more in prevention, primary care, incentivize hospitals to gather instead of being in conflict as mortal enemies. You have systems paying for Better Outcomes. In the first section of the book, how the Healthcare Industry would act very differently in this model. Delivering value to patientss in terms of normal procedures as we have in the Current System. I start with how hospitals can learn from other industries, airbags and manufacturing plants and aviation history of the Critical Role doctors play in how the Healthcare System works, type a, the intrinsically motivated personalities can and are taxed for the cost of care, and changed patients, might actually move into the center of the universe of the healthcare business because their health would be paramount, driving the Business Model of healthcare instead of the way it is today which is what is at the center of the universe in healthcare because they generate all the actions in the fee for service world. The other exception on the physical industry and date and technology sector, tell stories and reflect on what they could be doing differently if they were competing at lower cost. I focus on symptoms that provide big picture needs of how the Healthcare System could work differently, the perspective of who the biggest payers of healthcare in the country, the healthcare bill for half of all americans but in this case instead of talking about medicare or medicaid i talk about the military Health System and the va and use those to shed light on how government run healthcare could pay for Better Health outcomes and produce better results at lower cost and i close with the chapter that summarizes the action plan and each chapter, stories with narratives and each chapter ends with an action plan for what individuals can do or what physicians can do, and policymakers, that is the structure of the book and the content of it so to transition into a couple of ideas in the book and see how much time we have, let me start with the one big thing and over the course of researching this book i interviewed 100 different people in healthcare, executive patient advocates, Community Workers and one thing you could change in healthcare if you could wave a magic wand, two thirds said the same thing, what i also believe which is they would change the Business Model of healthcare. The current model we would refer to as fee for Service Model, paying for action. The current model, Healthcare Providers and hospitals pay for doing things to people. Laboratory testing, imaging studies, regardless whether it includes health. The Health Systems really incentivized to do more things to people and documents they are doing more and more things so they can charge and bill insurance for them and instead we should be expecting as consumers or individuals to pay for care but improve health or whether it is likely to improve health even if that means not doing much of everything, that is how we should be thinking about the Healthcare System but a fee for Service System as we do and when i say that i mean private insurance payments, the government is predominantly paying on a feeforservice basis although that is starting to change, predominantly a feeforService System what that means is the Healthcare System generating fees, imaging centers, like Cancer Centers and we donated the kind of things during this covid19 pandemic, is essential for Public Health and primary care, if you are wondering why our covid19 response, the best Healthcare Facilities in the world, we havent invested in the things that we have not invested in. What has been laid out for that we havent managed to do that come we have a 3 trillion Healthcare System, the only way to do that is to be more things for people. I believe most physicians and most clinicians are trying to do good. Are trying to practice the best healthcare they can, they have to acknowledge they are incentivized to air on the side of over treating or over diagnosing, and this only supports that or incentivizes that. Doctors who are incentivized to do more and more people, people paying the bills, pay the insurance companies, they limit the spending and the perceived over doing place barriers, that means denial, the mri radiologist, the only way the Insurance Company can manage the cost, i dont think that is authorized or necessary. They put into barriers things like prior authorization, the amount of paperwork the physician has to concede for that to be done and paid for. It is a barrier that is put in but it generates an enormous amount of work so you have doctors and hospitals, denying and putting in more barriers, what i call 1 trillion tugofwar and at the end of the day generates administrative waste and we spend 8 of our healthcare dollars on administration whereas most of our european counterparts at 3 , that is a huge amount of waste and when we cant resolve the dispute we have balance going so the money that isnt paid for falls to the individual, the patient and that is how the Current System works and as you can imagine also generates an enormous amount of other kinds of waste in the system so much so that approximately 25 to 30 of all healthcare in the country, 3 trillion is considered waste so when we have discussions how to extend health care to all those who are underinsured or uninsured there are clearly opportunities in terms of being able to recover those wastes and redistributing that for every one. The implications of this backwards Business Model, flying into the head wents of capitalism is instead of competition and innovation working towards better Healthcare System, our capitalistic tendencies are focused on doing more and more even if it is wasteful. We need to think about how to evil of our Healthcare System into a model where we have capitalism driving us forward and many of us have been thinking about this for a while and one example of success is in a Pilot Project or what started as a Pilot Project and expanded in Medicare Advantage. Most of us are aware medicare helps seniors in this country and a subset of medicare, a third of medicare patients, a special model where the government, medical groups and says to these medical groups we are going to pay you differently. Instead of paying in a feeforservice way, patient after patient after patient in order to get paid we will give you a certain amount of money to care for all the patients in your practice for that year and that is going to to pay you more or a little less, give you a fixed amount of money and it is up to you to spend those dollars to keep patients healthy and we are going to track how you are able to keep the patients and keep them healthy and these medicare patients are dissatisfied. These Medicare Advantage programs that include miami and stand at 70 clinics across the country, leon health, a fixed amount of money to keep people healthy, in completely different ways of medicare clinics, what happens as if they keep people healthy, what medicare gave them for that year, they will have that profit and if they end up having the patient go into the hospital and emergency room multiple times then they lose money and it is there money, they can go into a deficit from doing that. The examples across the country, the doctors spend a lot more time, they know these seniors who have multiple medical conditions need quality time with the clinician, they spend 30 minutes to an hour with each patient. They have onsite pharmacy, shuttle services, yoga classes as part part of the falls prevention program, it is more than enough savings for that, they are keeping seniors healthy. These Medicare Advantage models are incredibly promising in the preabca15 era. They are paid every month regardless of what is happening, they stay open and functioning during this covid19 crisis where so many other feeforservice clinics layoff doctors and nurses. That is an example of a new model or successful model, others including family members, recognize they look for clinics for these services. The second topic i want to talk about which i havent been speaking about much as i have been talking about this book is a very important thing to me which is the issue of safety in healthcare. It may be surprising to you, weve heard a lot about the struggle of hospitals financially, relatively empty ward and clinics aside from covid19 patients but when hospitals are fool, with these issues, they are not the safest places to be. 20 years ago, the institute of medicine, National Academy of medicine, one that i am a member of, 20 years ago they put forward a report called 2 areas human, the estimated 20 years ago 100,000 americans each year were dying for medical mistakes. 100,000. We just crossed 100,000 lives lost to covid19 this year, enormous, devastating loss that every year the National Academy was estimating 100,000 americans would die from medical mistakes and since then the estimates have been revised upwards. You can imagine if you do a death certificate research project, there are no medical mistakes on the death certificate so it is difficult to uncover so new research is suggesting 250,000440,000 people each year die from medical mistakes in this country and that would make it the third leading cause of death behind cardiovascular disease and cancer. If you are like me, these statistics are really shocking because when you think about hospitals, places that are sterile, clean, organized or places that you go to heal, in this chapter i talk a little bit about where, how some of those mistakes arise, what we could do to address some of them. One of the most common causes his medication errors, research has estimated every time a hospital administers the medication there is a 25 chance of one clinical error, sometimes a relatively minor error until medication is given more or less than 30 minutes from when it is administered or less effective but probably not devastating but there are times there are significant and serious errors, and the names of many of these medications are confusing. For example there are three medications. One is called cellular, arthritis medicine, one is a seizure medication in the third is called and this happens all the time. The fda and the institute for safe medication practices publish online dozens of these lookalike and felt like names for drugs and what they recommend, if you have multiple confusing names that we as physicians, three of those letters when we write up a prescription, put three of the letters in uppercase just to differentiate them from other names. It is absolutely ridiculous. There is a clear obvious solution to that that the fda could prohibit pharmaceutical companies from making names for new drugs that sound just like others that are on the market. Theres nothing about the biochemical makeup that is reflected in these brand names. That is one reason why many medical mistakes happen. And others interruptions and distractions. May not surprise you to hear distractions. In the book i talk about a rather tragic slip, a patient in seattle, in the hospital, on average nurses are disrupted once every two to five minutes, emergency room doctors are interrupted every 6 minutes on average in the study and it is a stressful environment to begin with, many things are going on and so i talk about some examples of how systems have adopted best practices from other Industries Like the Aviation Industry who face the same problems decades ago and created rules, no chatting, no distractions and checklists. And they are certainly improving practice for reducing mistakes and especially in the operating room. There was an excellent book that describes some of those practices and finally the third area of medical error or related issues that i mentioned for the third p