Strain with the recent wave of event cancellations we are extending a new generosity by supporting during this time by donation at the bottom of the screen or by becoming a member. Booksellers as you can imagine are feeling it right now. If you are interested in going deeper in the talk please the link on the page to purchase your copy of the long. Doctor vivian lee phd has been a physician, scientist and healthcare administrator for two decades. Among her leadership role, doctor lee served as a scientific officer in enough refinance at nyu medical center. Prior to that she was a vice chair for research of the department of ideology. She served as the ceo and dean of the university among other roles in salt lake city. Elected to the association of american medical Colleges Council administrative board and also a member of the Advisory Board of Massachusetts General Hospital and Pittsburgh School of medicine in her work has appeared in the Harvard Business review, the Journal Association of american colleges and other publications. The first book was an academic page turner and apparently im told is not for the faint of heart. 15 years ive been on the job and that is the first terrible joke i told in an introduction. But tonight its the long fix solving americas healthcare crisis that worked for everyone. Please join me in welcoming doctor vivian lee. Guest thanks so much it is wonderful to be with you tonight and im thrilled to be part of the event and looking forward to the discussion and i also want to acknowledge we are living in some very complicated and complex times and i just want to thank you all for joining us tonight. For this time of prepared remarks which i thought i would talk about would be a series of three questions. First, why i wrote the book, then i thought about how it was structured and the premise of the book. The inhospitable chapters, i thought i would die of deeper into two or three depending on how much time we have. Let me start with why did i write this book. I wrote the long fix with a series with bradley medical students when i was the dean of the university of utah. The first year that the cost and refresh out of college, relatively new to health care, and i wanted to share with them what i wish i hadnt known before i had gotten into healthcare. I wanted to answer the questions they have about healthcare when it works and particularly to prepare them for how they could make a difference and go beyond the practice and experience of working in health. At the Healthcare Company where i met a number of talented, bright engineers and research we also try to understand how healthcare works and if they can make a difference. We all know in the news or from our own personal experiences there are many composites of healthcare that feel broken. We know about the rising cost of medication, the lack of insurance for some in this country, but we havent heard so much about the solution and as i have worked with health care her two decades and traveled around the country will learning from others, i share different ways of providing healthcare and paying for health care and working successfully. In sharing those success stories, i found i was able to put together those narratives and launched a clear sense of how we could expand this into a National Strategy for health care. That is why i wrote the book along with the. I wanted to write a book that actually offered solutions which is something we very desperately need. Its called the long fix because of a conversation i had with former secretary of health and Human Services and former governor of utah. He felt the trajectory of changes in healthcare took 30 or 40 years at a time, and through our conversation we thought [inaudible] since the pandemic i feel there is a greater sense of urgency about tackling some of these problems and im hoping the long fix might be a slightly quicker fix. Im slightly optimistic about that. Let me now turn very briefly to help the book is structured and what i talk about in the long fix. I start by writing that the central isnt so much about the delivery of healthcare but how we pay for it. Its the Economic Business model of healthcare. If i were to prioritize one thing to focus on it is changing the economic or Business Model. Its not so much who is paying for the health care. We can talk a little bit more about that if the folks are interested. I think it is as much about who is paying for it. From a policy perspective i think that it is more for us to solve what it is that we are paying for in healthcare. Specifically what i mean by that is how our Health Care System is focused on paying for action and procedures that we call the feeforservice Healthcare System. If we do that we talk about what is happening in the country today and find ourselves in prevention and primary care and disincentives highest positions to Work Together instead of them conflict as enemies as i will talk about a little bit as well. Now i can some o again some of s already happening in the country where we are paying for health and paying for Better Outcomes. Thats what i talk about in the first section of the book and then about specifically how the Healthcare Industry itselhealth. Differently in this model where it was motivated like every other industry in the country to actually compete with Better Health is better value to patients in the current system. I start and talk about how hospitals can learn from other industries ranging from manufacturing plants to the Aviation Industry, for example, to make a whole care safer and the Critical Role that doctors play and how our Health Care System works and how to they were intrinsically motivated personalities that can and are to reduce the cost of care and finally patients might move into the center of the healthcare business because it is paramount and it would be driving the Business Model of healthcare is today where it tends to be the center of the universe in healthcare because the solutions are the last to generate the actions and fees in the service world. I died deeply into the pharmaceutical and the data and Technology Sectors and tell the story to reflect of what we could be doing differently if we were competing and i focus on systems that provide the picture on how they work completely differently in the perspective of the two biggest, and players that fit the healthcare bill and the government. In this case instead of medicare and medicaid i talk about the Healthcare System. And how the Government Health care to help pay for the outcomes and actually produce better results and lower cost. Finally i close the chapter that finalizes the action plan. There are stories and narratives and examples in each chapter ends with an action plan for what individuals can do or what physicians can do. So that is essentially the structure of the book. So, i will transition to a couple ideas that are in the book and see how much time we have. Let me start with the one big thing and in the course of researching the book i interviewed over 100 different people in healthcare and Patient Advocates and asked what is the one thing you could change in healthcare, and over two thirds said the same thing, and what i also believe, that they would change the Business Model in healthcare. Our current model is a feeforservice model, i refer to as paying for action. In the current model, healthcare providers, physicians and hospitals, for example, are paid for laboratory testing, imaging studies, obligations, procedures, regardless of the health. As a result, Health Systems and physicians or incentivized to do more things to people and document that they are doing more so they can charge and insurance for them. Instead, we should be expecting, as consumers and individuals to only pay for care that will accrue health, even if it means not doing much of anything. That is ideally how we should be thinking about the Healthcare System is whether it delivers Better Health. But if we have a feeforservice system as we do predominantly now, and i mean private insurance pays a percentage and the government also is predominantly paying a feeforservice. Although, that is starting to change. Medicare is still predominantly a feeforservice system. That is what generates fees like imaging centers, cancer centers. We dont invest in the things we see right now during this pandemic is absolutely essential, which is Public Health and primary care because it really doesnt generate any fees. So whether the response has been if we have some of the best Healthcare Facilities in the world it is because they simply havent invested in these things, we havent invested in the Public Health infrastructure in this country. We havent managed to do that and so with a trillion dollar Healthcare System that is focused on making itself four or 5 trillion the only way to do that is to simply do more things to people. I will stop and say that i believe that most physicians and clinicians are trying to do good in practice the best healthcare that they can but i have to acknowledge that the academics are such that they are incentivized to air on th the se of over treating one over diagnosing and it only further supports that were incentivizes. We have hospitals and doctors incentivized to do more and more people. So the payers, insurance companies, the government, the only way to limit the spending and prestige in that overdoing is to fight barriers. For the Insurance Company, that means denial into saying if a doctor recommends an mri, radiologist for example, if the physician recommends an mri, the only way the Insurance Company can manage the cost is to deny it, no i dont think thats overpriced or necessary. Or they put in barriers like prior authorization which simply means paperwork the physician has to complete for the study to be done and paid for, so it is a barrier and what it does is generate an enormous amount of work so you have doctors and hospitals, insurers and payers putting back and forth a trillion dollar tugofwar and at the end of the day it has waste and we spen spent about 8f our Health Care Dollars on the administration whereas most of our counterparts spend about 3 . That is a huge amount of waste. And then when we cannot resolve the dispute, what happens is we have [inaudible] the money. Fullstop the individuals, the patients and that is what we call surprise billing. So that is how the current systems work. As you can imagine it also generates enormous other waste in the system so much so that today, approximately 25 to 30 of all health care in the country, and again, around 3. 5 trillion, is considered wasteful. So when we have discussions about how can we extend healthcare to all ohealthcare te underinsured and uninsured, there are clearly opportunities in terms of being able to recover some of the waste and redistributetobe distributed ano Cover Health Insurance for people. The implications of having this completely backward Business Model of the feeforservice, what i call flying into the headwinds of capitalism is that instead of competition and innovation working towards a Better Healthcare system, its focused on doing more and more. We need to think about how we can devolve the Healthcare System into a model we have to capitalism driving this forward and many of us have been thinking about this for a while the example of success is any Pilot Project to expand Medicare Advantage so most of us are aware that is the healthcare for seniors in this country and Medicare Advantage is a subset that covers about a third of medicare patients and in the Medicare Advantage program there is a special model where the government contracts with medical groups and says we are going to pay you a little differently instead of the feeforservice way where you see patient after patient in order to get paid we are going to give a fixed amount of money to pay for all of those in the practice for the year and that will depend on how sick the patients are. So if they have medical conditions they will pay you more and if youre Healthy People pay less. A fixed amount of money and then it is up to you how to spend those dollars to keep patients healthy and track how healthy you are able to keep them otherwise there are penalties and these patients can go elsewhere next year if they are dissatisfied. So what is happening in these special programs that include groups like in miami and have expanded across the country they care more about these across the country and in these positions where they have a fixed amount of money to keep people healthy they start to practice and completelincompletely differentm traditional Medicare Clinics because what happens is if they are able to keep people healthy and spend less than a medicare gave them for that year if they end up not keeping the patient healthy and having the patient goes into the hospital and emergency room multiple times they lose money and it is their money they can actually go into the deficit from doing that. I talk about this in the book but there are an many other wonderful examples across the country. The Doctors First of all spend a lot of our time with the patient. They know often they have multiple medical conditions and meet quality time so instead of this they spend 30 minutes to an hour with each patient and have onsite pharmacies and shuttle services. They have classes and their prevention program. In the long run while they spend a lot more money and more time up front, theyve seen more than enough savings to these models are promising regardless of what is happening theyve been able to stay open and are functioning during this crisis while so many of the other feeforservice clinics have had to lay off doctors and nurses. So that is an example of a new model, relatively new model, successful model. When i talk to seniors and others in the family members that recognize they look for clinics that offer these kind of services. The second topic that i want to talk about, which i havent really been thinking about much is a very important thing to me which is the safety of healthcare. It may be surprising to you right now weve been hearing that the struggles of hospitals financially with relatively empty clinics aside from the covid patients, they are not always the safest places to be. About 20 years ago the institute of medicine which is now called the National Academy of medicine, one of the most heralded organizations in the country and one that i am proud to be a member of, they performed a report and estimated at the time that about 100,000 americans each year were dying from medical mistakes. 100,000. We just crossed 100,000 lives lost to covid. A devastating loss. But every year the National Academy was estimated at 100,000 were dying of medical mistakes and since then theyve been revised upwards because as you could imagine if you do a death certificate Research Project nobody looks at medical mistakes, so its difficult to uncover and more research is suggesting between 250,000 to 440,000 people each year are dying from medical mistakes and that would make it the third leading cause of death behind cardiovascular disease and cancer. These statistics are shocking because when you think about hospitals and places that are so clean and organized and in this chapter i talk a little bit about where those arise and what we can do to really address some of them anytime a hospital administers a medication, theres about 20 to 25 chance of clinical error. Sometimes it is relatively minor, less than 30 minutes from when it was to be administered that makes it less effective, but not devastating. But there are times when there are significant and serious errors. One of those cases is because the names of many of these medications can be very confusing. So, for example, theres three medications. One is an arthritis medicine, one is cerebux and the other is celexa, antidepression medication. They sound similar signal could imagine getting them confused. This happens all the time. If you go online and search, you could see that the fda and the institute for medication practices published online dozens of these look like and sound alike names for drugs. What they recommend is if you have multiple names, three of the letters when we write the prescription rate than in uppercase so they can differentiate them from other names. Its absolutely ridiculous. There is a solution to that that the fda could prohibit pharmaceutical companies from making these names for new drugs that sound like others on the market. Theres nothing about the biochemical makeup so thats one reason why many medical mistakes happen. Another is distraction. It may not surprise you to hear. In the book i talk about a tragic case of a nurse caring at the childrens hospital. On average, nurses were disrupted once every two to five minutes. Emergency room doctors about every six minutes on average in some studies and its a stressful environment all ready talready tobe