Services that were provided by the carriers themselves. And then over the last decade, we have seen some new trends where there were these passive disease Management Programs, those were something where maybe somebody had a couple of chronic conditions or something in the mail, or maybe by email, and frequently unfortunately these went into the garbage, but these were disease focused. And finally, in the last few years, we have seen Holistic Care through new Population HealthManagement Programs. These are focused on the individual, and have a holistic wellbeing based in meeting the individual needs. These could be provided by either a vendor or the carrier depending on what type of hybrid model is actually used. Lets go forward another slide. Okay. As we begin to delve into these frameworks and how they are changing, and how best to understand the marketplace, maybe the best place to start, is how are we defining Population Health management today . At the lowest necessary cost, it really includes a proactive application of strategies and interventions, were defining cohorts of interventions cohorts of individuals and the interventions we would like to apply, and were looking across the entire continuum of Healthcare Delivery. So to achieve this fullspectrum of Population Health management, we have to look at the success of our care coordination and Management Programs. Lets move forward to the next slide. And a couple of other presentations, because ive had the privilege of serving you over the last year, we talked about the quadruple. I will not be labor those pieces today, but if you look at the hexagon here that speaks to program navigation, this optimizes the use of programs and resources that track the impact and Ongoing Program management pieces. So what does that look like, and what does that mean . Lets go forward another slide, because now we are getting really close. This is the power of a strong employer who is a leader in their community, and all the potential places of impact. If you look down to the bottom, the policies and programs, being an employer that preserves the city and the county, there are physical environment influences that you have, not only for your employees, but the places you live. Theres also the health factors, the socio and economic factors because of the income, the incentives, and Educational Opportunities that can be provided. Ultimately, Health Outcomes are actually driven by you as well, since you are financing healthcare because of the Clinical Care that we can influence, and how it is delivered, and how we can address healthy behaviours. So through these frameworks, we can finally get started with what is happening in the marketplace. Lets go forward another slide. Okay, we will bypass these goals because they are a bit of a simplification for the prior goals that we have already addressed in a prior slide, some of the pain points where these vendors and carriers have begun to focus more energy on their resources, are what does my plan cover . We have all heard about medical surprises where we saw sought that we are seeing an in network physician, maybe we did go to an in Network Delivery system, but maybe the anaesthesiologist was out and to the surgeon was in. Who will help them member through that experience so theyre benefits are fully realized and they are not left holding a medical bill . How do you find the right doctor what is the right doctor look like . Is there a centre of excellence for this particular condition that i have, or maybe there is broad variations in care. Finally, what are the Treatment Options . I have to have surgery. So when you look at the way employers engage with consumers in the market today, it is much broader than this when we talk about the vendors and the carriers and what theyre able to do now. The current lever points increased when you start to include digital and these Life Solutions in the navigation space. To give you a really simple example, for a point solution, what if you have a member who does not have responsibilities back to the job, that they have the luxury that they can drive across town, find parking, and see if physical therapist . How can it be communicated to this member who has chronic low back pain that there is a virtual physical therapist that they can receive care right in their home for low back pain, or maybe for knee pain . That is a really simple example. Of course, this is the ubiquity of our Smart Devices now. It is possible this could reach a vast portion of your population who we serve. On the other end, live, how can i connect to human being who can understand what the issues are while im having a struggle and navigating the Healthcare System so one more click. Because of those two solution points and various hybrids that exist there, there is a new way that we can connect our employees and our population to all of these employer resources. I will give you another example because this is a pain point throughout the u. S. Behavioral health. Perhaps that when a member has acknowledged, they have cut through that wall of shame and they have said, i have anxiety and i will get treatment for this, however, every time they call a therapist, either no one returns her phone call, they never get through, or the therapist is no longer accepting new patients because they are completely full, or now theyve changed to cash only. What about all the Virtual Solutions . Visiting with a therapist online , all the Cognitive Behavioral Therapy solutions that are online, all the other interventions that are Available Online provided by employers through some of these niche vendor solutions. By the way, the more talk, the warmer it is getting in the room have you all notice . [laughter] we will move on to the next slide. Well go through a couple of clicks here. Theres a couple of takeaways that i thought would be useful for you, and it is more then the detail, it is hoping im hoping this is what you will really remember. There were several key points and shared understandings that we had to share before we could get to the slide. The first take away is there is a lot of vendors who have come to the table and also carriers that believe that they can do better in the Member Experience and how people experience the healthcare today. Because of the low barriers to entry and the problems of venture capital, have taken on this onus that they believe they can do better. What i will hope you will remember is everyone of these members, none of them endorsed by us, by the way, these are simply examples, provide a scope of services for various pain points that we probably have all experience ourselves and we also hear from our populations, but that scope of services is dynamic in that a lot of these vendors are wanting to expand the scope of their services, but this is where some of these vendors stood, so if you absorb the feedback from your populations and you did the surveys, and you knew where those pain points were, then by asking the question, what are they, and what are the possible solutions, and what are the best practices. This could be a Guiding Light for your strategy going forward. In addition to these vendors that are listed here, keep in mind that Health Plans Offer multiple care coordination and management models which vary across the spectrum. This includes both of those domains that we originally started talking about a few slides ago, which include the live and the digital. I will now give you some specific examples from this. I will stop and pause just to see if theres any questions. Now we will go through a couple of examples. And first i will draw your attention to that blue sphere in the centre of the page. While it does read telephonic care advocate, it could read simply care advocate or simpler, and advocate. That could actually be a human being or some type of technological solution, or an intervention. The goal on this slide is for us to think about what could happen differently if we looked over the art of the next two years, how would we like this to change and then i thought maybe the best way to walk through this is come up with an example. Lets think about a member, we will go back to that one where there is some confusing medical bill, and the employer, because they are not satisfied with maybe the adjudication process, and theres a lot of feedback coming to the employer, that theres conclusion around medical bills and how to navigate the appeals process, or maybe the medical bills dont even realistically reflect what has actually occurred. And through this intervention, theyre connected to someone who is proficient experts in helping get this matter resolved. Another example, a member has decided they have done their Due Diligence in trying to lose weight and they have decided it is time for bariatric surgery. They dont know whether those benefits exist, or if they did, if there is a particular centre of excellence that is recommended. Through provider upward optimization tools and navigation tools and through this intervention, the employer has the opportunity to influence a different way and go upstream with how the employee is actually going to interact with the Healthcare System. The provider example might be that a referral for a special type of therapy, maybe immunotherapy that we have already about, the providers will say, who provides that type of service and to this type of spherical tape influence that we have here. They could be referred to a place that is in network and consider the best in class. Those are two life examples. On our next slide, and it is our final slide, as we walk away and open this up for discussion and for the carriers to come up and talk about how they are addressing this today, theres various approaches you could take in acknowledging these pain points. One is, the approach is it is health centric. You work with the carriers to work on the pain points that you are getting into, your strategy accordingly. On the other extreme, approach number 3 this is a complete carveout where this is handed to a vendor and some of the processes, maybe it is utilization management, Care Management and a bunch of the other processes and services that we referenced on the other pages, are simply put in the vendor spot and somehow it interfaces with the vendor ecosystem because of interoperability. I will stop there and see if theres any questions. I have some experience with this over my 32 years in practice, and it all makes sense i see these different approaches its just there is chaos in terms of each health plan and all the tries to find vendors who understand the change. We just heard that blue shield opened up the hospital system, so how does that information how quickly does that information get transmitted to a vendor in this situation, and then to the subscribers, and that is a major change. There are minor changes that happen all the time as we look at our benefits packages in terms of transportation and nutrition support. It all looks good on paper, but when the rubber hits the road, i guess, ill get back to comment that was made earlier about where what are the outcomes from pilots on maybe more contained, smaller programs. Yeah, it has taken a while for me to be able to actually in the last two years, i have been studying this on a weekly basis so i could convey these ideas. There is a massive onslaught of information, and it is very difficult to distill that and receive it in a way that it is actually actionable, but it is not too much information and thats why these companies have come forward. To get back to some of your pieces around what is actionable here, many of the vendors and carers are willing to put performance guarantees in place around what they can form and the medical trends they are willing to guarantee. There are outcomes, there are publishable materials no love to share that. That will be another 20 minutes to work through those. I can tell you that it is not just coming from the vendors but that is actually validated through independent Consulting Firms. Weve done that with some of these vendors and we would look through various cohorts to see if they had that are outcomes and whether the medical trend was affected by it. That is my highest level answer. I appreciate that. We have already had experience with some vendors and outcomes, claims for dollars saved, or whatever, there is no doubt, in my mind, that Member Satisfaction is very high when they can talk to somebody or have the tools available. The question is, we are trying to restructure the way we approach Healthcare Delivery. Where does this impact on quality and cost and accessibility, and even sometimes the published outcomes that come from some of these vendors are a little tainted by their own desire, you know, they are forprofit, quite frankly. Give me a list of nonprofit vendors who are there to improve Healthcare Delivery to low cost, and maybe i will be a little less suspicious. Understood. We could certainly come back and talk about our own independent actuarially where it is validated, or where another Consulting Firm is paid to evaluate this from an independent standpoint. I will share with you the average health plan in the u. S. It is 15. The highest in the nation happens to be kaiser. And these solutions that we are talking about our up above 75 and higher. It is a dramatically different experience. Were talking about cohorts, so of course, they will be experiencing this differently. Thank you so much. I look forward to coming back and exiting this conversation. I will turn this back it will guide the carriers. He will come up next. Thank you. We will have blue shield come up hello. I am with blue shield of california and i am the account management for the city and county of san francisco. Today, well talk a little bit about our Management Programs which we have revamped and relaunched as of january 1st, 2019. We took the programs and all of the other programs that were sideload, and integrated them into one Holistic Care approach. So previously, you were in disease management, then you might have had utilization management over here, and behavioral Health Management and pain management. No we have integrated all of that to make it seamless for the member. We have two types of Care Management dependent upon which program you are in, so for access plus, we have shield support. It is a comprehensive all acuity Management Program that features member focused, clinical support from nurses, social workers, Health Coaches and Behavioral Health clinicians. It is designed to engage the one to two of the population who are at risk or who have the potential to be at risk. We do have a performance guarantee around that. We focus on Care Management, care coordination, and ensuring that the member has a holistic, all person focus for support. So, identification. Hyo do we identify the members and understand who needs the help the most . It is a data driven criteria based on authorization, medical and pharmacy claims, and then wellbeing assessments and direct referrals. Members can self refer to show support if they would like, but we do have a comprehensive outreach program. So we look at their predictive risk and all of the things that go into that. Risk progression trend, and then we look at all of those identifiers in order to outreach to those individuals who are either already who have a chronic condition, or are at risk. And for the trio members, we have shield concierge. Shield concierge is a more Inclusive Program for trio. It is a white glove service. We have specialized and specially trained Member Service [please stand by] mentality. Its all on us, not the member to get the care they need, or talk to somebody about their Current Health care crisis or that of a family member. So identification for shield concierge some of the what is the word im looking for if you have cancer, catastrophic injuries, diabetes, lgbtq health, opioid use, pain management, all of those things are triggers for us to outreach to a member. And then on july 1st of this year, we also launched an enhanced program that is a digital experience for members. It is individualized based on their health care needs. I didnt put that information on here, but thought i would offer it up. And that is designed to treat the whole member and give them an individualized health and wellness pass. Its based on, if i log into the program or access it from my phone, and i put in my scores and my Blood Pressure and things like that, it will help and then any other identifying factors for a health care condition, it will create an individualized health care and wellness path for that member and give them access to several different applications that are housed on our app, so they can be successful in their wellness journey. Thats it. Any questions . I guess in both populations you identify a pretty low percent. And so im assuming there is some you have quite a laundry list. Its identical for both groups. The percentage differs a little bit, but are they stratified, so if you have cancer you move to the top of the list . You know, anticipating a certain percentage in that youre going to support in this. Certain things like Behavioral Health, unless youve already killed yourself, may not be at the top. Right