What an incredible morning. The insight that dr. Manual provided regarding the intent, results, and the future of the Affordable Care act as well as integrated care and how our industry is moving to a valuebased system was fascinating. Equally intriguing was the description of our complex and evercheesy Health Care System by our esteemed panel of ever i trust their years of practical experience and i trust that they have certainly confirmed the complexity of our Health Care System. Which it isd in changing in america. Im going to take a little bit of view on some of these which it is changing in america. Comments, consistent with complexity issues of the day, consistent with things we need to change the system to make it better, but a slight difference from a quality perspective. Representlth care approximately 18 of our gdp. Rys i think it is a to say the health care as an industry is perhaps the most important part of our economy and growing fast. That was something that was confirmed with all speakers today. Because of this, we have been Building Health care around the , a concept that came 10 years ago of what we needed to do within a society within health care to it increase and to increaseth care, quality, to decrease costs, and improve the visit and the accessibility for our country. What we learned this morning is that we have made tremendous progress with this initiative and that the next massive shift will continue to be towards out youbased health care. Getting paid for products and services on the basis of how well they achieve the triple aim. After reflecting on what we have heard today, i think you can come away with a few impressions. Is that in this question country we have massive issues with both cost and accessibility throughout health care. But we do not have those major issues as it relates to quality of health care in america, and that is an area where i take exception to some of the things that have been said, not only this morning, but when you watch the news or when you talk about health care in a general setting. We sometimes lose the focus of quality ofonal health care that we have in our country, and it has remained constant from a highquality perspective. Sometimes that gets to live the size and not talked about at all. The fact is america has the highestquality health care in the world, and certainly the best technology to impact positive outcomes. We heard a lot of talk during the Election Campaign of our highestquality health care in the world, and certainly the systems and comparing our systems to sweden. We heard our system compared to morocco today. Andisrespect to sweden morocco, but i have never heard a patient say i would like to get this procedure done in morocco. [laughter] never. Granted, a lot of these countries that we were talking about during the election , Health Care Coverage for all citizens, and that is great. The other thing we were talking about is that is not free. For those of you who studied business at pepperdine or anywhere else, you learn day one that everything has a cost. Who had ather ninthgrade education always said nothing is free. Our great system has come at a cost. Is up to us to again continue to drive quality at a lower cost and making it accessible to all. Always been a caring nation, and the notion that we have allowed people to perish because they did not have ,nsurance is frankly nonsense and you heard both cedarssinai and mayo clinic talking about a number of their procedures and their care is given at no cost at all to the patients. In fact, with the formal care act, they get paid pennies on the dollar for a number of procedures they do every day. Most of our hospitals and care centers are not for profits. OfMental Health, 95 Community MentalHealth Centers and these places take care of 90 of our severely mentally ill are not for profits. They are charitable organizations that would never turn away a patient who has no insurance, and a lot of people who do those services are here today, and i want to thank you for what you do for our patients, and our Health Care System. Granted sometimes you may not get the highestranked hospital in the country to take care of you if you do not have insurance, but there is always a place for insurance in america four care in america. This is true today. I suspect it will be true when a new Health Care Program is an announced in d. C. Andver, it is also true very possible that a major procedure could bankrupt you in our system, but that an uninsured person will be taken in during a crisis, but cannot afford preventive care. This happened before the offender the Affordable Care act and it happens today. We must continue to strive toward the triple aim as an industry, and we are. Another fallacy is that the Large Pharmaceutical Companies are the primary reason for escalating health care costs. Total pharmaceutical costs in health care represents about 15 percent of the total cost. Even if drug inflation rates went to 0 , it would not change the overall escalating cost of care. I am not advocating that there is nothing that can be done to the pharmaceutical industry, and examples plenty of where costs are way too high and we need to address those issues. But we cannot take any of health care one silo at a time. Example oft me give you an what happens when you concentrate specifically on pharmaceutical spending. On spotlight is focus is on spending, yet spending on pharmaceuticals may need to increase to achieve overall reductions in the total cost of care. When patients stay on their meds, you will see an increase on drugs spent. Peopleif they see having 96 adherence rate, they will be spending more on pharmaceuticals. What you have to look at is the total cost of care. It has to reduce the higher costs. Recently we did a study that determine if you are putting pharmacies inside these Community MentalHealth Centers, and you are taking away the ability for them to leave the center and then go get their prescription. Severely mentally ill patients will fill their prescription at least 20 of the time. Pharmacyis a integrated in a center, severely mentally ill patients take their meds 96 of the time. That is what the study from the said. L of managed care the net savings for the population for america because of a 40 reduction of hospital stay, 18 percent reduction of er visits, amount to over two 400 million in savings on the basis of 500,000 patients. I do not understand the world the word trillion, but i understand what 400 million and the impact to this topic to this population is. So that is what i want to leave you with. The fact is lets not look at silos, lets continue to Work Together to work for total cost of care, and lets make sure as a society and a health Care Industry continue to reduce costs, increase access, and improve health. So with that, we are going to talk about technology. And the Technology Impact that is having on the quality of care in our system. Todays panel is pretty exciting. We have heard talk about earliercine in conversations today, and last year there was an entire symposium on data and technology and the impact it is having. Today we have three great panelists, and we have a moderator that comes to us as panelists last year, kathleen grave, who has that history of making sure innovation is impactful. She is one of the designers panf is currently now part of the Watson Program with the weather channel, revolutionizing what we do with technology. Please welcome kathleen grave. [applause] ms. Grave thank you, and what a great morning it has been so far. I am looking forward to putting this panel on board. I want to introduce you to telemedicine. What do we mean by this . What is the difference. You may hear telemedicine and telehealth used interchangeably. Telemedicine includes all kinds of health care provided by communication and information technology. Telemedicine is more specific to the engagement of the interaction between the provider and the patient and the medical services that are provided. It is patientClinical Care delivery highway of remote services. It can be critical, emergency care, and it can include technical and diagnoses remotely and often for critical conditions. Between the doctor and the position and the patient or a consulting team. Telemedicine provides access longdistance and remotely to expertise and experts with experience in specialists that would not be available in remote areas of the world or to remote provinces. The American Telemedicine Association likes to give an example of telemedicine, and that is the medical peer that was provided in the monitoring of the astronauts in the early graham, and that continues today. Militaryed in remote deployments to keep the troops say. It provides three areas of patient care, focused on instrumented, interconnected, and intelligence solutions. Medical data and transmission and access radiology, imaging and this gives us insight that is needed to drive the information for the patient from the details of the data. Also Remote Monitoring of chronic care or special circumstances, so in congestive heart failure, one needs to get the regular finals of the hydration of the patient. Clinical concentration is the third for convenience to allow for it to happen regularly. The use of electronic information in telecommunication technologies to support is now common and it is coming to provide longdistance Clinical Care of patients and education, public health, and health administration. Technologies include videoconferencing, and the internet is a very common practice. It includes forward imaging, and wirelessia, can medications. Theres no end to the innovations happening around this area of health care, and we are going to see it expand fold in the next few years. Insights e data the fingertips of the providers to transform the Patient Experience. We had as muchve information at our fingertips to take care of the triangulation of information shared between heyer, provider, and patient. With the transformation to include telemedicine and Global Health solutions in patient Care Management, we had the increase access to improved highperformance Health Care Systems, improve and improving decisionmaking, enabling access of all levels while reducing cost, and minimizing the patient insurance. We have the opportunity to extend patient care on the office for convenience, outultation, Remote Access, in provincial and rural areas. It can be focused on patientspecific management or riskmanagement for populations with chronic care or problem needs. Our disease, diabetes, all depending on which Care Management programs are created. Access to a specialist is available outside the metropolitan areas so when providers graduate from college and decide to stay in cities, they can provide Remote Access to patients who need that in the provinces. It provides support to those doctors that are remote. It reduces travel for patients who might need frequent visits, checkups. Enabling flexible learning options for a physician to consult patients, training, Care Management programs, bringing together a team of specialists to discuss a specific case management, to give feedback come to bring in other non clinical roles are experts who can contribute to that augmented information based on the environment of the patient. One common master view of the information needs experts can now contribute from all facets of their expertise. Onis my privilege to bring the stage three panelists who experience asir well as their perspectives to answer some questions about the industry and its growth. There is this models and applications of telemedicine. Mr. Ferguson is the chief executive officer of doctors on demand with two decades of experience in mobile technologies. Been a founder to be a Senior Executive at paypal, a highgrowth committee. He has a commitment to put customers first by delivering the best possible products, a value that resonates with doctors on demand. Before joining doctors on demand, ferguson transferred pay paul into a technologyfocused company, and serving as the chief product officer. Prior to joining paypal, hell was Vice President hill was Vice President of a company that enabled consumers to make komen payments quickly. He built a vast network over 250 applications operated in 250 countries. He also worked as general manager at a company where he developed personal Financial Management market software. Hea manager at yahoo, created the finance website and drifted a friday a payment services. 1. 7lped consumers manage billion in loans. Hill holds a that first degree from vanderbilt. Lets welcome him to the stage. [applause] mr. Ferguson panelistd palace is came into a roll through his acquisition of one company, a citybased company. He served as ceo. The Company Expands access to health care in rural america. Team have built his company from scratch, treating 50,000 patients across the country. He was the president of and aure Health Care Company that he started and led. These endeavors have grown from two employees to over 150 employees while improving and a company that he started and accs to health care and markets. To 22 health, he was the director of planning at centerpoint hospital in st. Louis. New model for outpatient Mental Health programs across three states. Prior, he began with mckinsey and company as a is a analyst, where he focused on initiatives for Large Organizations inside and outside of health care, and he served as the hospital he received a bachelor of science at the university of aylvania, a bad bachelors, at a masters of business administration, and he does not sleep. Lets welcome him to the stage. Our last panelist is mr. Lew silverman. He has a record in Health Care Services companies translating a passion for transforming and if its for solutions in a successful organization. His experience and holding ,ompanies that enable quality and serve as a catalyst for industry change is at the heart of his business. Committed advance care to working with Hospital Partners and their bedside teams to bring promise of outcomes to Telemedicine Services to the patients we serve. Prior to joining advanced icu care, his experience with Innovative Health companies informed advanced icu care. Pursuing a strategy of building organizations designed to deliver success and investing in reinvesting in its clients, staff, and infrastructure to ensure continued innovation and on going sector leadership. At priors tenure companies, is companies were named to the Forbes Magazine list of best Small Companies for a total of 15 consecutive years. Silverman serves on the board of directors on a variety of companies, public and private. He earned his mba from harvard b. A. From amherst college. Thats welcome him to the stage as well. Lets welcome him to the stage as well. [applause] we will get started with a bit of a round of introductions and perspective from each of our panelists. Ferguson we can connect you to a wardcertified physician in 49 states, soontobe 50, as soon as arkansas passes some legislation here momentarily. We started out in the direct Consumer Market in 2014 launching our first product as a solution for lack of access to urgent care. It grew really quickly and quickly started to work more partnerships with Large Insurance Companies like United Health care and humana as well whoelfin short employers offer doctors on demand as a part of their health care design. This has fueled our growth, and weve gotten into dental health. A team ofilt psychologists and psychologists psychiatrists who work with primary care physicians to help provide a suite a solutions for consumers who are seeking on the direct market and as are part of a benefit that may be offered by their employer or health plan. We are excited about the future of telemedicine. It is an incredibly exciting tailwind for everyone in this room. Everyone plays a role and can benefit from it. Unlike my previous industries, it is not a winner take all marketplace. There are applications for providers, payers, consumers, and there are so Many Solutions out there that are focusing on specific cases that are driving innovation that is going to lead to brandnew designs for health plans as well as changing the way consumers think about becoming consumers and this marketplace. Im happy to be here and look forward to this conversation. Good afternoon. Thank you again for inviting us to share some of our experiences with you. Now six years in the making, focused on schemes we have seen from the cedars and mayo clinic, leaders that we heard earlier today. Our focus is on innovating for the Mental Health population. We are the nations largest outpatient psychiatry provider, and we have a team of about 200 psychiatrists who work for us, and we partnered with them using a system so that those physicians who can treat patients who are otherwise not able to access care. We found patients are seeking services that pri