Nations distinguished thinkers an innovators. It is my privilege to introduce todays participant to engage us in a captivating discussion of health care. Let me start by introducing the guest speaker who i have known for many years and consider him a mentor and friend. Scott serota is the ceo of Blue Cross Blue Shield, and a National Federation of supporting 36 independent communitybased and locallyowned Blue Cross Blue Shield companies and including Blue Cross Blue Shield of michigan. The Blue Cross Blue Shield system through its federation of insurers covers 1 of 3 americans, and i think that this is a very important statistic, because nobody else does this frankly, it serves every zip code in the united states, meaning in every zip code in america, someone has a Blue Cross Blue Shield card. He is overseeing one of the most trusted brands in health care, and scott is one of the most influential leaders driving Public Policy and conversations on health care and health care reform, and so everyone has access to equality, Affordable Health care, and importantly, scott has devoted the career to the health of all americans through innovations through the bcbs health index and the health of america reports which identifies Health Challenges and issues and provide the insights to improve the quality of care across america. Scott was named the president and ceo of bcbsa after serving four years as the Senior ExecutiveVice President including two years as chief operating officer. Prior to that in charge of the system development, he was in charge of the Technical Evaluation center which is renowned for evaluating safety and effectiveness of merging medical treatment. During scotts tenure the Blue Card Program was introduced and through this national program, which allows blue plan members to receive Health Benefits while travel org living in another part or blue service area, and our nationwide membership in the system has increased from 65 million from the beginning to 106 million members today. Scott was at the helm throughout many of the policy debates and including the implementation of the Affordable Care act, and it was his vision to use the available data to develop the en sights of what is happening in the Health Across america in driving solutions on Health Care Trends like Millennial Health. Before joining bcbsa scott served as the ceo of the chicagobased Prudential Health plans, and also led preferred health, inc. , and missouribased pho. Scott is the leader with strong commitment to Corporate Responsibility and driven to be civically active professionally and personally. In addition to serving on numerous Blue Cross Blue Shield boards he is a member of the National Founding group of the Health Institute and health cost and Advisory Board of paragon biosciences. He serves on the leardship council and the Health Financial association, and the American College of Health Executives and the dean Leadership College for science at Purdue University, and the Washington University national council. And he has advised the white house and congress on policies and programs and services affecting our senior citizens, and a charter member of the health committee, and the advancement of health technology. He 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 School of medicine. Also holds an honorary doctor of science degree from purdue. Id also like to introduce our moderator today dr. Deanna lights an awardwinning Health Reporter at wwj news 950. She was a reporter for medical news in miami and boston. She has received multiple awards for the reporting including six emmy award nominations and Michigan Association of broadca Broadcasters Award and two American Heart Association awards. She holds a bachelor of science degree in nutrition from Michigan State university and also in podiatrist college, and holds a fellow at phoenix hospital. So it is my please suure to introduce scott serota and deanna lights and we look forward to their conversation. Hi. Good afternoon. Im thrilled to be here with the detroit economic club. Thank you for having me and scott. I wanted to officially welcome you. Thank you. So we are going to be talking about the vision for the future of health care and when a lot of people that i talk 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. Ugh oh. And one question kept showing up over and over and over, so, lets start with this, and i am sure it is something that you have never heard. They want to know why is health care so expensive for consumers and businesses in our country. Well, that is an easy question. I will get to the question, but i did not get a lot of applause when you said that i am a proud boilermaker, so i have to go on record that my daughter did not see the light, and she is a proud spartan, and you have to do something to get the audience on your side. Okay. 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 got a strange dynamic in that environment. You have organizations whether it is the government or insurers like the blues who are paying for service, but the manufacturing plant, the physicians and the hospitals and the others who are delivering the service. So you have lots of disconnects and lots of missing checks and balances. So that is point one. The second point is that we have built the Health Care System on a piecework basis. And that is the more you do, the more you get paid. So we have created incentives in the system for delivering excessive care so long as that care is not going to do any harm. And so we have a scenario where providers are incented to deliver more care, and patients have no buffer not to accept the care, because they are typically not paying for it, and the payers are after the fact trying to manage the care in a remote basis. So that is driving the price up. Second, what is more important than health . Nothing. So we invest as a society, i believe appropriately lots of dollars in creating innovation in finding new pharmaceutical breakthroughs and new ways in which to drive better value in the system. I hope that is not an alarm of some kind. To drive better value in them is, and those innovations and those breakthroughs have a price attached to them. We have increased the Life Expectancy and increased the Health Outcomes and eradicated diseases and done a lot of good things with the dollars. The next evolution, and the logical question is what we can do to make it more affordable. And the evolution there is to move our Health Care System to one that is less focused on the inputs and more focused on the value and to begin to construct relationships between the payers and the providers that are focused on the outcomes of the care that are received rather than the inputs. And in fact, the Blue Cross Blue Shield of michigan is one of the leaders in that movement and about 5,000 physicians operate here on the patientcentered medical home, on the 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 her practice. And we try to do that and in fact, 70 million americans get the care through some form of a valuebased care arrangement. And the goal there is to focus our reimbursement on improving the outcomes that our patients receive, and it is showing results. We have had diminished readmissions to the hospital, and diminished emergency room utilization, and increased compliance with chronic disease treatments and protocols and so we have a whole host of activities that are beginning to show positive results. Long answer to the short question. Well, a lot of the Insurance Companies and businesses offer the Wellness Programs and incentives so if you quit smoke org lose weight, and smokeing or losing weight, and how effective are these and are they worth businesses investing in . Well, any investment that you make in your workforces health is a benefit. I think that in improving the lifestyle and having people lose weight and reducing smoking and those kinds of things all have positive outcomes. The jury is still out on whether the investment of the programs is actually going to be paying out in the real dollar benefit, but i think that in, if you are factoring in the noneconomic or the nonheart economic factors like reduced sick days and productivity measures, it is clearly an investment that we should all be making and worth making. So, just over about a year from now, we are going to be having a big election, and health care is always a big issue. If you were running or you were advising a candidate the former is never going to happen. So lets say that you were advising someone or what would make a Good Health Plan and what as voters should we be looking at . Well, i am a believer in looking on what works and not just tearing things up for the sake of tearing things up, and if i were advising any of the candidates, i would say we spent as a nation 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 of americans have Health Insurance today. So i would look at ways to close the gap to get the last 10 or the number i saw this morning was 7. 5 . But how do we close that gap to get those folks without disrupting the care that the rest are receiving . So there is a number of Public Policy initiatives that we could do that 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 in the entire Health Care System of transparency and allowing the patients, employers and insurers who have real line of sight understanding of what the components of the health care really cost, and how we, and therefore identify where the opportunities are for improvement, and so how the pharma drugs are priced. Lets get some transparency and into what the are the costs and the developmental costs and real costs and what are the research costs, and how are those prices 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 Public Policy initiatives on high cost drugs. We now have our first drug that exceeds 2 million for treatment. We have to as a country learn how the deal with those particular issues and we have to improve access in communities and make sure that the rural hospitals survive. There is no shortage of the agenda i guess is the answer to your question in this regard, but as a priority, i would say focus on building on what is working today as opposed to disrupting what is working today just for the sake of disruption. Okay. So there have been some major Health Issues in the news lately and i wanted to get your take on it as we are talking about the future of health care, and how the blues combat these things. For example the vaping ecigarettes and 450 hospitalized with a respiratory illness and we have deaths, and an issue that you dont have a lot of data on . Well, the issue of how to deal with vape iing i put in a broader category of how do you deal with society issues and we as the blues as dan said earlier, we are in every community, and what makes us unique, the unique qualifications of the program czar is how people are living in the communities of which they operate. So when we make decisions and we make policies and when we decide what are our priority issue, it is impacting the neighbors. It is impacti ining our friends families and it is in our community, and so we are committed to the community activities, and so i put all of these things be it smoking, vaping, nutritional issues and all of these categories of the determinants of health, and we as a blue system feel committed to take the resources and the insights and the information that we have in how to work with local communities to solve those problems, and we wanted to be certain that peoples genetic code is more important than the zip code as we are looking at how we attack health care issues. So, again, we are trying to take the data that we have and take it to the policy makers in washington and the state capi l capitals to understand the depth of the problem, and the communities impacted with the problem, and then try to work with the communities to actually take our resources and staffs to invest in those communities to solve those problems, and you know, it is vaping today, and opioids yesterday, and so, unfortunately it is going to be opioids for a long time. The measles outbreak. Vaccination rates. The best way to deal with it is with facts and data and information that we try to bring to bear in the communities and blessed with the Data Resource because of 107 million americans in the zip codes and demographic, and blessed with the data to provide us great insight into that, and the trick is to take the insight and provide it back to the people who can make a difference. When we think of health care, a lot of times people think of the elderly are the ones that are the sickest, but i saw a blue cross report where the millennials are not the healthiest group, and can you talk about that . Sure. We have a program that we all the health of america. And we have done 27 different reports on various Health Conditions given that we are in the beautiful stadium i would say, and the ones that hit the headlines early on was the concussion report on espn, and on the front page of u. S. Today and a whole host of reports, and the latest was on Millennial Health. I will tell you that we were very surprised that we found that the millennial generation which is 50 of the workforce in 2020 is at this stage of life the sickest generation of any other cohort group. It relates 6 of the 10, and 7 of the 10 top conditions are Mental Health or emotional healthrelated conditions. Generally stemming from the detachment issues and lots of virtual contact but not enough human contact, and we are seeing chronic conditions arise like high Blood Pressure and high cholesterol and things of that 2345i chur in the generation that we would fully expect to see in people 20, 25 years older. It is an issue of the vital importance to us, and we have done, we the blues have taken it on as mission of ours to try to address this issue. We have had listening sessions, because the data only tells you so much. So, we went out and spoke to 11 communities in the u. S. , and spoke to the millennials and asked them what they were looking for. Interestingly, people of my generation, seniors unfortunately, are very concerned about privacy and data and not an issue for the millennials, and not an issue. What they want is a compassionate medical professional who is willing to treat them as a whole person and look at their conditions in a comprehensive, in the context of their life as opposed to treating each disease conditioned independently. Which is like the set of medical homes that you are doing here in michigan and they are free to share information and they will seek the sources of information anywhere to try to Seek Solutions to their problems, but they are really craving human contact, and they are really craving that 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 where we can begin to embark on the campaign to try to address the issue, because i dont know about you, but i am counting on the miamis millennials to support the Health Care System to take care of me, and so we have to be sure that the generation is as healthy as they can be and should be given their physical age, physical age. Are most, or do most even have a primary care physician . No, i would say that the number of millennials with a primary