Operating system that currently talks to any software, whether it be epic, and it now is running 3 million cancer lives for the past three years, across the pathways, across the Delivery System and we know in real time. We have built a Software System that actually takes 10,000 cancer protocols and provides for the doctor in real time the knowledge of which cancer protocol to give to the patient in real time. Its now in 8,000 oncology practices. With regard to technology, it is the job, actually for us is to actually make this Health Care System, where he makes money where patients dont come into the hospital, where we actually have patients at home, i call this icu at home, which means, eye see you at home. You need icus at home. And then this whole world of machine to Machine Technology is upon us. Its right here. So i partner with verizon and at t and i built an Electronics Company that could have boxes that could talk to each other. Blood pressure machine, pulse monitors, scale, we have now adopted this and now we went into every hospital that has 6,000 medical devices. Went into the hospital connection box. If you got an icu in the hospital and you got the same box in the home, which is called the health box, you can then create an icu at home, we have patients, the patient that you spoke about, this elderlily day, youre absolutely right. We can put a pulse scale on at home and know whats going on with her in real time and we have created a telemedicine device on the internet where you can have four or five way videoconferencing, so if you look at this from a systems perspective, if you now can manage a patient from the home, the clinic, hospital, and through a supercomputer do the genomic analysis, we do 1,000 genomes a month. You then have an engineered system for the nation, which then says, frankly, you have the ability to create what i call norads of health care. You now have the capability to create a building with three cardiologists, ten oncologists, one pediatrician. You can manage an entire city. So is this going to happen anyway, or is there something we should change about the laws to make it happen faster . So whats preventing these fee for service. So the issue is to actually create what i call outcomes based, value based care and change the Payment System. We created the co council, bank of america, mckinzie, and the single largest barrier now is the disincentivizing care. Visavis fee for service actually, ironically. So if you can then say your job, mr. Provider is to keep this person healthy, we can measure the outcomes in real time. If you keep this patient healthy, this is your payment per month, and at the end of the year, if this patients healthy, heres your bonus. And whether the patients in the hospital, in fact you dont want the patient in the hospital, the patient is at home, and thats where we need to change the providers of this nation and thats what well be announcing after this event, this cancer collaborative, with the nations of the world, we have the unions also with us, and we he have the united Food Workers Union whos also participating in the audience with us. This is what this nations going to need and this is what we think is the potential is not the potential. Were actually doing it. The opportunity is not to opportunity were actually doing it. The obstacle is the Payment System. Ironically, Medicare Advantage was the best system you had. It is a system thats being penalized because they dont understand the actual system. [ applause ]. Well, there are its interesting. Were doing more and more of this, paying to keep people healthy instead of paying for procedures. But there are and there are incentives in this Health Care Law to do it, but theres no mandated pace to get to everybody doing it. I dont think it makes sense to pay for anything else really unless you have some hugely expensive thing that cant be covered by the size of the pool people are involved in. No question, in a much more mundane world than the one you just painted for us, it also works. It works everywhere, not paying for procedure but paying for people to be healthy. Do you agree with that . Yeah, i would agree. I think we are in a i will speak from a very practical point of view. Were actually on the ground treating thousands of patients a day, millions of patients per year. Were in a period of transition from the fee for Service Environment which is absolutely pervasive throughout physicians offices and Imaging Centers and kind of every health care node that you can think of in the system toward a system where there is Accountable Care and payment for health, but its going to take a very long time. We all need to be realistic about this. The conditions have to exist in a particular community in order to enable that. Now, we have some examples in our own organization where this has been very effective. So, in Northern California in a farming and Light Industrial community in modesto, california, weve actually been running an Accountable Care organization now for over two years. Its been very successful. Actually reduced the incidence of the hospitalization of the population there that has participated in this program. And actually weve done just fine as a hospital provider because, you know, weve been able to earn incentives, as you mentioned, through Better Health outcomes. I think that is a model for the future. But i think we all ought to be realistic about how long that will take. Meanwhile, theres some great innovations taking place among the providers. You know, putting in place these advanced clinical systems to even capture the type of data that were capturing, that just didnt exist six or seven years ago. You mentioned government policy and incentives. The incentives for adopting these clinical systems has been very effective in our own companys case in total were spending about 1 billion in advanced clinical systems and the government incentives are making that it possible for us to do that by offsetting about half of that cost. Although the interoperability and sharing of data doesnt yet exist freely, there are other great things that are happening. So, you know, were just in our company weve avoided hundreds of thousands several hundreds of thousands of unnecessary tests, unnecessary because they were duplicates. Weve all been in hospital environments when a physician walks in and is looking for a result of a test that he or she ordered and the result isnt there, what do they do . They order another test. And were able to avoid that. Were able to avoid medication errors. Maybe the wrong dose or even the wrong medication or at the wrong time being given to patients. So these are really important innovations and improvements in safety and quality in hospitals that are being driven by this technology. Everything patrick described is possible and i think it will occur. But i think we need to give it a little time. Let me ask you this i know you can say whatever youre going to say but i want to follow up on this. Your position is, i take it, that if we completely stop paying for performance for health care, then the government wouldnt have to do much more to end the siloization, if you will, of Electronic Medical records. Then there would be literally no incentive in the world to not share a medical record with, you know, appropriate privacy protections for the patients but is that what youre saying . Correct. Thats exactly right. I think we have completely disincentivized the system and, in fact, perversely incentivize it. You hear with all due respect, you hear directly the incentives are getting the money to actually put in systems that actually dont talk to another system is a perverse incentive that the government has actually funded. So, and i think when we talk about the time i want to emphasize, not the time, that this is not some hypothetical. We actually are installed, as we sit and speak, as you said, in 50 practices 155 systems, 3. 3 million lives, were capturing 40 million claims a day, 3 billion vital signs, its being adopted by the nhs as we sit and speak. The Software System that is intelligent is running 70 of the Emergency Rooms of portugal. Its running the largest hospital brighten in the united kingdom. Running the Largest Cancer Center in brazil. So, this is not some hypothetical. What it is a will of us actually integrating a platform that gives you Actionable Knowledge if real time,ny www. Any time, and it is evidence based. But it also needs to incentivize the provider to give the best care. And the marketplace will do that if you actually provide and you will sift out. You hear problems like Accountable Care organization and i will challenge anybody, how can you have an Accountable Care organization when in no real time can you actually tell who is accountable for that patient . The im has shown if you have surgery and youre elderly, you see just as one person, 27 health care providers. An elderly person has 19 medications. Who is accountable . So, you cant have Accountable Care organization when you cant measure who is accountable. Then you want to give this thing a valuebased care. Valuebased care is outcomes divided by cost. If you cant measure outcomes in pathways in real time, how can you know whether youre giving valuebased care and you have no idea about the cost in real time. So we have now built a system that can measure outcomes in real time and costs in realtime in st. Johns hospital, a patient walks into the hospital. The minute he walks into the hospital, we know exactly where he is, what doctor is touching him, what is being used by the minute, what it is costing him. So, if you can measure outcomes in real time and cost in in real time and cost in real time, you can give valuebased care and create Accountable Care. But the accountability gives you outcomes for health and thats how they will actually be bonused. So thats a system that ive i dont think is hypothetical. I think its actually real. We just need the courage and organizations like yourselves to actually be the voice but youre saying it could be done within the existing Legal Framework or we need to at least change the Payment System rules . And the way im approaching it is im working then exactly as sue has talked about with the fortune 500 companies and with the unions and thats what were announcing today, the bpc council, the ceo council, we will be taking the selfinsured and in that context build a collaborative of providers across this nation, install this system, but on one condition. This collaborative will also work with the underinsured and the underserved. And now we will bring evidencebased 21st century care Cancer Patients whether in South Central l. A. Or beverly hills, and these doctors can do what they do best, i. E. , provide the best care. [ applause ]. Let me just say and in theory, we should be able to bring it to any country in the world, right . Correct. If we have one of the things that our foundations involved in is this remarkable effort the Rwandan Government has asked us to undertake. They want to be free of all foreign assistance in their Health Care Program by 2020. So, they we worked with them for years and dr. Paul farmer partners in health to design a program they can afford to run that will provide high outcomes for them. And its basically build a good hospital in every region of the country which we have now completed doing. Have one good Cancer Center in the country, which we have now completed doing. Lot of people think poor people dont get cancer. The rates are fairly consistent across the world. And then do a network of clinics and then train Community Health workers, which is why i had this nightmare experience i mentioned to you because its really the same in america, you know . But if you have the technology, it should work. I mean, weve got 19 american medical institutions working there training these people for 7 overhead. Im very proud of that. Lowest in history. And theyre going to be free of, i think, all foreign assistance. But they will only have really good care if they are hooked into a Global Information network that will enable people the thing that kills me, like in ethiopia, so there are all these people in the world that you dont think about that are still dying unanimously. Nobody ever knows they lived. Nobody ever knows they died. There is nobody that keeps such records. And so, im very interested for the rest of my life, the stuff i dont do here, about how to apply these technological possibilities to places like in patrick is from Port Elizabeth in south africa. If you get sick in South African cities, youll be fine. But out in the bush, there are still people who are dying alone. Im. Im working with the Global Health initiative in ethiopia and were doing these kinds of things for africa. But its true. So the point im trying to make if we did this in america, it would have incredible Ripple Effect across the world by just building the infrastructure for people to access. What were you going to say . I was just going to build on pats aspect, bringing it a little bit back to the states. 70 of our revenue is Medicare Advantage. And it has just transformed the organization over the last number of years from because of guaranteed issuance. We have to take everybody. Were not an insurance company. Were a Clinical Company because we are highly incentive to keep people healthy. I mentioned to you about the individual i visited in south florida. The reason why we have nurses going to their home, checking if if he have ramps or checking in they have nutrition, ensuring theyre not depressed is because were responsible for their health. We are paid an overall fee for their health and they stay with us for seven to ten years. And so, getting back to patrick, i think its the integration of the technology with a reimbursement system that motivates people to take responsibility for peoples health, not just the information side of that. To me, what is done for our organization is transformed our organization to be innovative about being responsible for peoples health. And i think if you change the reimbursement system, you will bring that innovation as what you were saying before. I want to comment just really quickly on one thing and that is in rest of the world. Some of the things youre talking about, patrick, and in terms of some of the african nations, could, in fact, happen faster because they dont have a legacy system like we have. We dont they dont have to defend the fee for Service System as we have here. A lot is self pay. In fact, the percentage of self pay thats what governs so much of the Health Care System over there. So, in fact, pilots that were trying to do at ge surround some of these activities that youre talking about. We should be able to do those fairly quickly in some of these developing countries. In fact, you are. In bangladesh and. Ge is there with the handheld ultrasound. They have leapfrogged. Bangladesh doesnt have land lines, they have cell phones. Let me comment on that. For me it was pretty inspiring when i learned about what ge is doing. That is, we have a hand held ultrasound. For those of you who experienced ultrasound, you have to go into the hospital or go into a system and you essentially, you know, you have to book an appointment. Theres a lot of things about the system that just is. Ge came out with this hand held ultrasound and now has it connected. So now, you can just imagine as it relates to prenatal care and as it relates to decreasing the morbidity of infant death, its a remarkable tool. And were doing that in a lot of developing countries to be able to help this because in remote villages they all have phones and theyre all connected, but they dont have the tools. And we feel like this is something you can train people to utilize very, very easily. So, as it relates to possibilities of bringing technology into these developing countries, getting the connected world actually utilizing these in these remote, remote villages, its happening today. I have to agree with you with that. Here, we have the legacy systems. We have to break through. And i know you say its happening already, but i have to agree with you, its going to take a little bit of time because the policies dont allow us to do what we like to do state by state. Were still breaking down those sort of barriers that we have to do, unless you fund it yourself. No. Way were addressing, mr. President , is were going state by state. Im working with the governors, so were going through this, unfortunately, state by state. But let me just to make sure everybody understand, we had a little bit of a we got off on a little techno speak, the reason that Medicare Advantage works and the way theyre talking about is it was conceived as a way of paying people to take care of people on medicare and to get a premium for doing prevention, for keeping them well. So, the idea was theres a fixed price list here. Thats the medicare payment that lets say i would get at my age for me. Im enrolled in medicare. And if i sign up with you, you are going to get this to fix me when im sick. So, well give you this to keep me well. In the beginning, there was a lot of controversy about it because in the congress, there was almost 100 agreement that there should be more