And so you constantly gradually fall behind urban areas so that does become a problem in rural areas. Similar are observations on wage index from ms. Peterson or mr. Stover . The wage index relative to critical reimbursement is not as significant as a pps setting. However, the idea that physicians and specially trained nurses and nobody flebomotists and technicians can be recruited to rural areas for less than when they would earn in the urban areas is simply not true. We compete on a National Level for these very, very scarce resources. Same observation, mr. Stover. Yes, mr. Chairman, i would agree with my colleague, ms. Peterson. My last question would be on telemedicine, are you getting reimbursed do you have Behavioral Health also . We do, yes. Are you being reimbursed for Behavioral Health in the same way for other health items . We are. Your goal is to recapture all costs . Correct. And to integrate Behavioral Health into medical clinics as well. Do you have any studies that would indicate how much better people do with other Health Problems if youre dealing with their behavial Health Problems at the same time . Well, its interesting, in our diabetes program, a component of our program is around medical adherence and lifestyle and behavior changes which needs a small Mental Health component as well for behavior change. So were incorporating into that. Were not through with that study yet to be able to publish it. But were offering, now, Mental Health services on College Campuses and schools and one that will continue to grow, and probably our biggest demand right now. My personal belief that even certainly societally if you deal with Mental Health like its every other health issue, the cost comes back many, many, whatever you spend come back, i think, many times. But my personal belief is, even in the health care context, that you deal with every other health issue in a more effective way if you deal with Behavioral Health like its a health issue, rather than youve got lesser reimbursement and less of a commitment, whatever that i hope we can get there. Im glad that youre getting there on your telemedicine program. Any other questions . Senator murray . Senator cochran . No, thank you, mr. Chairman. Would you like a minute . No, thank you though. Lets properly close out here. Well leave the record open for a week for questions to be submitted. We thank our panel for coming and we are going to adjourn until 10 00 a. M. On thursday, april the 16th. Thank you all for being here. That cant be right. On may the 16th. Thank you all. This week, were bringing you American History tv in pry time here on cspan 3. Tonights focus is the atomic bombings of hiroshima and nagasaki. Programming includes remarks from president trumans grandson Clifton Truman daniel. From our real america program, the atom strikes. From 1945. A u. S. Signal corps film that documents a Manhattan Project report on the destruction caused by the atomic bombs. On american artifacts, its a look at the hiroshima nagasaki atomic bomb exhibit from washington, d. C. s American History museum. Starting at 8 00 p. M. Tonight on cspan, its Energy Expert mark millings with mills with a presentation that suggests that oil and Gas Production from fracking is entering a new phase of construction. Heres a preview. This is whats fascinating, unwittingly when the Silicon Valley investors started pouring thousands of dollars into hydrocarbons, the people that changed the game are the guys in Silicon Valley which will unlock even more cheap oil than natural gas in the future. Heres whats going to happen, three complimentary things take place over the next decade. First, we will get underlying improvements in the existing technologies, at least equal to that thats already heard the drilling, the operational cape abilities for pumps, seismic mapping. The aggregate 4 or 500 . That will happen again. Secondly, what will happen is well layer in new stuff, advanced automation. Automated ones are far more economically efficient. Were going to add things like robotics and industrial drones, that will layer into the system. And the third thing is, all of this will be optimized with analytics and big data. It will uberize the entire shale industry. Thats a short portion of tonights Program Featuring mills. A look at Health Innovation in the health care industry. A Stanford University dropout who started a Blood Testing Company and who Forbes Magazine calls the youngest selfmade female billionaire. The Clinton Foundation hosted this event. We have here today i think a fascinating opening panel. I want to bring them out and talk about disruptions in a positive way they have made in health care, why they do it, and how they measure success in terms of people. So let me first introduce our panelists and id like to bring out Elizabeth Holmes, she dropped out of stanford when she was 19 to start this company. A company that is now employing more than 500 people and valued by investors at about 9 billion. Not bad work you will see shes quite young, i met her at Henry KissingersBirthday Party with George Shultz who was 92. I thought anyone with that sort of age span has got a bright future. Since im closer to 92 than her age. It looked like a wise move. Lets bring Elizabeth Holmes out, give her a hand. Josh cushner is the co founder of oscar health, who wants to do something really interesting, which is to reinvent Health Insurance, and how people interact with their annual physicals. I had a highly unusual conversation with the chairman of one of the Largest European Companies who happened to be dutch. I asked if he wrote Health Insurance. He said, yes, i do, but we dont make any money on it, Insurance Companies write it and the government subsidizes people by income based on their need. But he said, we shouldnt make any money on this, we should make all of our money out of traditional insurance lines. I thought, i wonder if theres a single solitary soul in america that would say that. Interesting. This guys got an interesting idea, lets bring out josh cushner. Joe is the founder and chairman of massimo corporation. It was sort of a garage startup that now employs more than 3,000 people worldwide and its production of and distribution of a market leading measure through motion and low profusi profusion. Im of know joe through his commitment to build a coalition to eliminate preventable patient deaths entirely by 2020. He just had his annual conference not very far from here in irvine. Its a fascinating struggle with so far a very good result. And an amazing thing, it will be interesting to know why he thinks he can do that. Lets bring him out. Our last panelist is Jeffrey Selberg this is really import t important. Theyre great friends of mine, and they have worked for years. We can bring debt, the debt we run up every year consume iing down. After years of beating their heads against a wall, they decided that actually all the real structural problems are in health care, combined with the aging of the population and they decided they would be a part of the delusion instead of sitting on the sideline complaining about it. Lets bring Jeffrey Selberg out and thank the Peterson Foundation for what theyre doing. Lets just begin with something elemental. Why did you decide to do what youre doing in health care . Lets ask all of our three reformers in the middle here. What ever possessed you white you were still a teenager to do this . I had the opportunity to spend a lot of time thinking about what i could do with my life to make a difference. And ive always believed that the purpose of building a business is to make an impact in the world and that were all here for that reason. To me, nothing matters more than the reality in our Health Care System, when someone you love gets really really sick, by the time we find out about it its often too late to do something about it and in those moments, nothing matters more, if i could spend my life trying to change that, we could make a difference in the world. Spending a lot of time thinking about that led to the realization that we live in a system in which people can only get a diagnostic test paid for by insurance once theyre symptomatic for a condition. And so the ability to create a preventative karin from structure where people have access to the information that can change outcomes by making it incredibly inexpensive, by making it less invasive could help to realize this change where people start getting access to actionable Health Information at the time it matters, and thats what our lifes work is about. What does it mean to reinvent Health Insurance. We thought we were doing good just to get 10 million more People Health insurance last year some people did. Explain what you mean when youre trying to reinvent Health Insurance. The vision for oscar came about when i opened my Health Insurance bill three years ago and realized i had no idea what it meant. Over educated and at the time was starting a business, and i realized i didnt know my benefits were with doctors or hospitals, had to pay claim, the list goes on. If you think about Health Insurance, in reality of a cost perspective, the idea we had when we set out to make the data more transparent and understandable and relatable, but what weve been able to accomplish, weve been able to take the data weve got in provide People Better access to better care. Primarily because we know a lot more about them. So theres not been a ton of innovation in new york in 15 years. We feel grateful were going after. Health insurance has been sole from brokers to companies and for the first time ever, the consumer matters. Youre marketing to the individual market . Which is about nine or 10 of the total number of people who could buy Health Insurance in the company. To date, we only started about 14 months ago, we didnt start the company because we believed there was a void to be filled, we started the company because we felt people deserved a consumer experience. What we say, we want to do everything we can to be proactive, were paying people to go to the doctor. Were paying people to get flu shots, giving away free generic medicine, free physician visits, being proactive is what were hoping to accomplish. What percentage of your potential market exist . Even in new york. New york has all these new york insurance is generally this whole health care debate, before the Health Care Law ever passed, 80 of the policies in the individual market lasted two years. Or less. Talk a little about that. Theres almost no understanding of who these people are and how they struggle to become insured. 10 of people who signed up for oscar which is a decent market share. The most interesting fact about us which we havent ever disclosed is that 40 of our members signed up for us, because they heard about us through existing members, no pun intended we claim to be the first ever viral Health Insurance company but i think the best way to acquire customers is by having a really good product spending our time to accomplish. Talk about your core business into this awe deficiency effort to try to eliminate every preventable death in the Health Care System in america. What made you think you could do it. I want to congratulate you for your innovation. With this commitment based approach of Holding People accountable, you have impacted 430 Million People around the wor world. Its more important what you do and how you do it, because how you do it teaches others what to do in their own role. Ive been around the medical space for 20 years, i remember when the institute of medicine first reported in 1999 to err is human, and reported 100,000 people were dying from preventable causes in the u. S. Hospitals every year. I was shocked. But a lot of great smart people jumped in, and i thought, okay, theyre going to take care of it. And i went on doing what i did, making nonevasive monitors. A few years ago, the new data came out that showed over 200,000 people were getting killed in our hospitals from preventable causes. Thats when i realized, maybe its time i step up and try to do something about it, i would be fortunate enough to get to know a lot of companies in the medical technology space, a lot of great hospitals and clinicians, a lot of amazing people like you, president clinton. I thought maybe if we brought everybody together, bring in the hospitals, government, the Patient Advocates that provide this powerful voice, when you think about 200,000 people dying every year, its a number that runs through your head unfortunately. I think stalin said one death is a tragedy, a million are statistics. When you think about that one life that impacts the family left behind, it grashs you and makes you want to do something 37 we borrowed shamelessly with your permission. Created this commitment based approach if youre going to come to our meetings, youre going to make a commitment. From my everything nearing background we started unpeeling the problem, seeing what are the things causing these preventable deaths, from hospital acquired infection to medication errors, to lack of monitoring, when people are give en opiods. It stops pain, but also stops them from breathing. Anyone who can use it, to come up with. The last two years weve now gone from saving 600 lives a year, to over 6,000. And we hope maybe next year we can report 60,000 lives saved. Let me ask all three of our innovators before we come to jeffrey its technology that what role does it play in creating the Health Care System we want. And what if any economic imperative actually blocks it from creating the system we want. That is. Are you at all disrupted markets, with noninvasive technology. Whoever thought of an Insurance Company giving you medicine, all this stuff how are we how is it going to come out, how would you measure the success of what youre trying to do, and how much of it does it depend on the whole system transforming itself . How much do you think about the Health Outcomes in america, and how theyre not as good as they are in other countries, but we spend more money . Where is the end of this, and what is the role of Technology Going to be . How do you think other people in your line of work should behave . Where is this going . Weve always Seen Technology as a tool. Its a tool we believe for empowering the individual, because we believe very strongly that the answer is to our challenges in Health Care Lie in empowerment of the consumer and enabling people to take more control over their own health and, therefore, their own outcomes. Whats been interesting to us about our model is, we decided we were going to start billing at 50 off of medicare great reimbursement rates. And thats medicare and medicaid reimbursement rates over time by definition based on the way were billing. Technology can serve as a tool for facilitating change in policy for empowering the individual to then get better access, in our case the diagnostic space, 80 of the decisions that are made in health care are driven by this military data. You can change outcomes and we strongly believe that one of the things this country is so great at is innovation and creativity and applying it toward helping to solve policy issues, in this case our work, without having to raise taxes. I want to come back to you. Let me ask, you made your money and you did a lot of good with your medical device work one of the things you said earlier this week, some of the people in your line of work think if they share information, if we have truly prehencive medical efforts, which will be easy to do. Do it in a way that lowers costs. How do you get people to join . What how come you think you can do this and still be successful and so many people dont . How do we break down that illusion that nontransparency is good economics. Its disastrous over the long run. First of all, with your help, youve been a huge source of inspiration. People want to get involved by what were doing, by coming and helping start the movement sooner or later were going to become victims or recipients of a great Health Care System, that not only has amazing technology, amazing doctors and nurses, but it provides a safety and quality care with dignity. I try to reach out to the ceos and say to them, 20 years from now, after you retired, how would you like to have left this industry. Because if we dont all share the data, we cant get to this patient data superhighway where we can can create al