is going to be central after the campaign. the one at issue we don't know about is hacking and computer voting and whether there's any effort to undermine that. but write them again that speculation but it's not based on evidence that on election day that would be able to somehow turn the boat. >> host: texas, republican line. good morning. >> caller: good morning. c-span. i just want to say i love c-span. i've been called in since the early '90s when i was in my 20s, and now i wasn't, i was in my 30s, but anyway, i love c-span and thanks for much for c-span. i'm going to keep on the subject. i never liked bush, okay? bush did some underhanded things when he was governor here. he put in the sports authority built for racetracks, for dog

parks, for parking lots, from walls and all this kind of stuff and actually make people homeless, okay? so i never liked bush. i just thought he was crooked and i thought it was always about the money for the bushes. i think he stole the election and i think they stole it from al gore. those are my thoughts on that. >> host: thanks, katie. >> guest: that sentiment comes really from the argument that we have to remember, the governoror of florida at the time was his brother, jeb bush. and so not only did the bush family have a lot of clout in florida, but the republican party was quite powerful. and so there was some sentiment usually among democrats -- >> "washington journal" live everyday at 78 eastern on c-span. relief is recorded portion out

to take you live to a discussion on improving medical care. it's hosted by u.s. news and world report. >> we are not calling this event health care of tomorrow. the new name underscores the industry's commitment to develop being a robust continuum of patient-centered care. of course, that's no surprise to all of you. as hospitals have become the hub of the networks that reach into many corners of the community from urgent care clinics to ambulatory care facilities, nursing homes and rehab centers. our gathering here that reflects that. as you evolve we will evolve. another exciting change we've made, children's hospitals have long been a focus for u.s. news and issue we have created a separate children's hospital track. we've also established a children's health care of tomorrow advisory council and we think this distinguished group of leaders for offering advice

and expertise for our new pediatric spotlight. would also like to welcome the many children's hospital executives who are speaking this week. the hill from the children's hospital of philadelphia, cincinnati children's, children's national, texas children, stand for children's and nationwide children's, among others. and, of course, would like to thank the standing advisory council made up of experts from the nation's top adult hospitals a special thanks to them for their insight and suggestions. would also like to offer a very big thank you to the premier sponsors of this event, athena help, microsoft and siemens. i'll be your mc the next couple days making sure the trains run on time and that you all are aware of the many sessions and networking activities as you all can participate in. just a couple of housekeeping notes. we are live right now on c-span2. later today to confine this session on c-span's website,

c-span.org. wi-fi isn't up to all of you on the network renaissance conference and the password is u.s. news hot. you can follow us over the next three days on twitter at u.s. in hot and we encourage everyone to treat live in hashtag usnhot16. you can also find us on facebook, linked in, youtube and instagram. u.s. news reporters are also coming defenses so please visit usnews.com/hot to keep up with conferences coverage and get a summit of those sessions. videos of our keynote sessions will be posted. tomorrow morning we begin bright and early right that you with several exciting breakfast roundtables and they will have a full day of panels, workshops and case studies. and don't miss our keynote luncheon which features what promises to be a fascinating discussion about how technology is transforming health care. at the conclusion, please join us upstairs in the lobby bar for

a welcome reception sponsored by southwestern medical and roadmap. and now let's begin our program. it gives me great pleasure to introduce our first speaker here ryan kelly, editor in chief content officer of u.s. news. under his leadership u.s. news has undergone a remarkable transformation. board a weekly newsmagazine, u.s. news is not a global digital disinformation company that provides people with the knowledge, date and a they need to make life most important decisions. as you well know many of those decisions concerning their health from choosing a doctor to a nursing home, joint insurance plan to a hospital. and brian has made usnews.com and much read a website for millions of those health conscious consumers. in fact, over 30 million people now visit usnews.com each month and more than 5 million are seeking our health rankings and advice. ladies and gentlemen, please join me in welcoming brian

kelly, editor in chief content officer of u.s. news. [applause] >> thanks. welcome to washington. sounds like a punchline these days. i'm not sure what i mean by that. let me start with a prediction. i believe i'm going to protect three things will happen here. a week from, well, six days from now, tuesday, i predicted that something very interesting will happen. [laughter] how's that for safety? i predict whatever happens on tuesday will not be over. we will be dealing with the consequences for a long time. and i predict that on wednesday life will go on for all of us. i'm one of those stalwarts who believes american democracy will survive. we will see.

[laughter] but i believe that the businesses that all of us are in will also survive. however, they will be unaffected by whatever it is that happens, and i'm not going to predict whatever it is that happens. but it is, in fact, one of the reasons we are here. we talk, the theme here is health care of tomorrow. we tried to be forward-looking at the moment, maybe the most forward we can look is about two months but we look as far forward as we can. it is clear one aspect of this that's clear we're going to talk about this a little bit, i've got great panel is coming up, like you cannot separate health care from the federal government. we understand that. we need to understand what that means. we're going to try to help you and do our part to move that forward. but there's so many things going on in the health care industry right now, the traditional roles of hospitals is dramatically

changing. the system increasingly rewarding better care, preventive care rather than the number of tests and procedures. we are living with a. it had to learn new competencies and rethink age-old practices. we've also witnessed unprecedented disruption comfort of new health care providers both proven and unproven. we struggle with that. who's good, who's not. massive consolidation, the adoption of new payment models, a mandate for greater interoperability. it's already shaping and industry in an enormous and far-reaching ways. i've got a lot of problems in my business, but we are not here to talk about that. be here to talk about the problems in your business and i look at what you've had to grapple with and maybe i don't feel like i'm in such bad shape. medicare continues its push towards value-based care, 30% payments must be tied to those models and 50% by 2018. good luck with that. cms released its new star

ratings for hospitals. i know somebody else in the rankings business but i'd hold off on that for a while. only 2% of hospitals earn the full i star score. we'll have more to say about that later. cms is expand its bundled payment program for cardiac care hip replacement. not insignificant. and in another part of the world there's been airbrushed and cyber attacks on hospitals and health care systems. we've got some people that dig into that a little bit more. a negative health care, humana all of this mixture they will pull out of many of the exchanges set up by the affordable care act. story to be continued. last but not least cms is changing how physicians are reimbursed. we always want to keep some emphasis on physicians because that is where the rubber meets the road in this industry. we try to do that here as well. over the next few days the hospital executives and other leading experts that we've assembled will help you

transfers this rocky landscape. some look at the big picture or provide a new perspective on what to expect down the road. others will go deep into specific issues and give you guidance and lessons learned from their own experiences. you will have many opportunities to network and share best practices with your peers. you will find many of them confronting the same problems and challenges you are. u.s. news has called the hospital industry closely for nearly three decades. in fact, this year is the 27th year of our best hospitals rankings. as we continue to expand our role publishing consumer health of data and advice, in addition fairly recently custom products for hospital executives were constantly seeking out the best measures of success. to that and we're convening a low-key them on friday morning which i will moderate. no one told me that. wait a minute. we will wrestle with the best practices for accessing hospital

quality safety and performance. with the controversial star rankings front and center we want to bring together the key players from the assessment world for a lively and we hope productive discussion about what works and what we can do better. joining as a be some of the nation's leading hospital quality expert from harvard, johns hopkins, northwestern, yale and more. maintaining our tradition of transparency we will also have a session on our own rankings and ratings come at a chief of health analysis will outlined our plans for the 2017-2018 rankings and beyond. our goal for this conference health threat to bar remains the same come to create a forum where the best minds among providers, payers and policymakers come together with a shared mission of improving consumer health. i'm proud that hud has evolved into a hostile but civic form that allows a broad range of health professionals to make

progress on solving the key challenges that we all face. there are few subjects we cover at u.s. news that are more important. i encourage you to engage in the many formal and informal dialogues among the industry professionals, policy makers and medical experts that we've gathered in the nations capital. thank you very much for joining us. [applause] >> and thank you, brian. and now i am so very pleased to introduce dr. craig venter, widely recognized as one of the preeminent scientists of the 21st century. as most of you know, craig pleaded critical role in the sequencing of the human genome, paving the way for numerous new therapies and treatments. to the venture institute craig is continued his groundbreaking research and over at synthetic genomics inc. is developing other innovative technologies to benefit people, the vibrant and industry.

while craig is a visionary, is also a throwback to the great scientists and disposed of the past. encircled the globe by boat to study the remarkable microbial diversity of the oceans, a voyage of a gilded which discovers for genomic research. he has export extreme environments from polar ice to deep-sea thermal vents, producing still more impressive findings. now as cofounder of human longevity he and his team are searching for ways to extend the human lifespan. please give a very big hand for craig venter. [applause] >> thank you so much. very kind introduction. it's a pleasure to be here today to tell you guys a little bit about what we are doing the human longevity to increase the healthy lifespan.

so if i could start with the first slide. this is a picture of human longevity in la jolla, california. started about two and half years ago based on the premise that we need a very large number of genomes with associated phenotype and clinical data to make sense out of the genome. we are trying to change the paradigm from what it is in health care today to being very active, defined the change to be proactive. so we only see people without obvious symptoms or obvious disease, contrast to most of you see people that at least think they are sick. so we're trying to use the genome to make it much more predictive and future but right now we're collecting all this data to see if we can even take that interpretation further. the reason for this is, looks

like it applies to a fair amount of us on this, if you're between 50-74 and you are a male, 30% will not ever reach the age of 74. if you're a female, 20% will not reach 74. the key reasons for early, premature death are cancer and heart disease, roughly two-thirds of the reasons, slightly higher cancer rates in women, slightly higher heart disease in men. so if each of these became predictive early detection and prevention, it would have a tremendous impact. does this sort of the survival curve and how it's changed over the last century, over half the population, 1900 never live past the age of 57. we are getting past the '80s, and there's no clear-cut upper

limit as well as to all these tools for trying to expand what we call the healthy lifespan. so 15 years ago we published the first version of the human genome it cost $100 million to sequence that. it took nine months. we had to build a $50 million computer to analyze that. and so it wasn't a highly replicable event, but just a few years back sequencing technology changed dramatically to where it was under $2000 a genome. and that computer the cost $15 million you can buy a card for your pc for $100 that does almost the same amount. so the changes are in technology, the changes are in distributive computing come and the third key component of machine learning. i'll show you we put these components together but we are precise, the main sites in la jolla, california. we have a site in mountain view

and a site in singapore, mainly for attracting key people. we seek was a little over 35,000 genomes completely where we have phenotype and clinical data on those. many people thought genomics would not be a big data problem but we are about 4.4 petabytes of data right now just of a, c., g. just in 2012 you can index a copy the entire internet with about 12 petabytes of data. so you can imagine with over 1 million genomes, the data problem is going to be enormous. a while ago we published a paper on characterizing the first 10,000 genomes to see what they had in common you're one of the biggest surprises was all the common variants and the human population saturated after about eight, 9000 genomes.

so the things that other people have been measured associated with disease, we all basically share. so the key thing is to come up with the rare variants or accident associate with your unique traits and with the cost of disease. but also having all this data allows us to do unique analyses, for example, he could find how much we have to sequence to get extremely accurate sequence coverage with a very low false positive and false negative rate. i think we've achieved that now and we have the first sequence that is clear about david. so one of the things as we sequence the genomes, on average we found about 8000 rare variants. that's out of your 6.4 billion letters in your genetic code. that's an average.

i was just on a chelsea handler show giving her urging him report. she actually had 15,000 rare variants but a very mixed ethnic and genetic background. up most of what we are building a database that is these rare variants, which makes it a lot easier to analyze things going forward. we can also do billions of data points and we can ask which is like are the sites in the genome that cannot tolerate communications and become compatible with life? you see one of these downward spikes, it's a place there's a mutation at that site in the genome, it's incompatible with somebody being alive. these are very important kind of findings because we are finding certain rare variants in the population disappear with age. that means if you have those, they die out with you prematurely.

there's lots of sites we can look at, just look at the whole collection of transmembrane proteins. apartment sits in the membrane can take very few mutation because it would change the charge and the protein would pop out of the membrane and the nonfunctional. so what do we do with this data today? it used to be you had to have large families with this orders that decades and decades to sort out. today we need a single patient, for example, from the children's hospital to sort out a rare disease your it helps you also have their parents, called a trio. is the case from san diego. it's a very rare disease called delevan centered nobody at work out what the genetic basis of the ones. if you look at the mri of the brain to concede the brain is quite a bit disordered. and this child also had tumors

covering his body. so when it was going to be a multi-genetic disorder. it was are interesting in looking at his parents of genomes and things pop out immediately. wherever you see these orange bands, that's where the parents have and exactly the same genome sequence. this helped us that they are very closely related to each other. in fact, they were first cousins, but they grew up in a small village in mexico with lots of inbreeding, to the point that now these chromosome regions are identical. the impact of that is if one of them had a rare -- on the part of the genome, now those turned into disease and that's what happened with some of these neurological development disorders. also yet another rare variant in the -- associate with our

finance disease and, therefore, might link to the tumors. it's very interesting, we make the point that these apparent that this mutation. so it's only in the child's genome. so in addition to all the information you get from each of your parents of genomes, we also have several hundred, several thousand spontaneous communications that in some cases like this can cause a rare disease. with cancer with the most comprehensive genomic-based cancer program in the world. we sequence the entire person's genome it we sequence the genome with the tumor for extreme high culture we sequence the rna from the tumor to understand which tumor communications are actually expressed. we isolate the t cells from the tumor and sequence the entire t cell repertoire. we also characterize which of

those t cells match up with mutated proteins. so, for example, he is a patient with hpv 16 cost head and neck cancer. we found 25,000 communications in his tumor. by doing both the genome and the tumor genome we get a total mutation burden which is turning out to be very helpful. without 315 communications and protein coding regions. so these great the so-called neo-antigens. if you think about that with tumors uk these vacations that create proteins that are not part of the normal human repertoire. that's what you can find intact immune system the immune system attacks these proteins and generally will kill the tumors. if you have an inefficient immune system or suppressed, then tumor growth can take place.

but we are constantly having communications in cells, and clearing those with a good immune system. for example, it's not a problem in washington but here we get a lot more sunshine. if you could sit in the sun for about an hour you can get as many as 10,000 communications in your skin cell genome. the fortunate thing was a scam, we replace it on average every two weeks. that does to the acumen it's in your house, that's you. [laughter] that's why there's always more coming now matter what you do. so we are constantly shutting that skin -- shedding that skin. but other cells are now so easy to shed and that's why our immune system comes in. this individual had communications -- in his communications.

we found hpv 16 present in his microbiome, putting them in a situation where it would be more likely if we didn't have cancer that if he developed it. but the neo-antigens give several targeted biggest targets are not which drugs will work, which was won't but they also give us the ability now to develop new vaccines specifically for that individual and their cancer. we're just starting this program now between human longevity in usd, during our first test this fall. what we do uniquely is we validate it making sure there's a t cell clone that does recognize that mutated protein which we think will greatly increase the efficiency we set up our own clinic because the health nucleus support large-scale genotyping where we do wife write a test they didn't see the list of them here.

everything from sequencing the genome, the microbiome the measuring thousands of chemicals. and going through quantitative mri imaging, ct scanning, and i will walk you through a few of these things. arche instrument that is what he found is that three t. mri. we have a ge, and a new siemens three t. mri and the resolution from these is amazing. but they keep change in this space happened just in the last two years. scientists working with dale landers at -- develop a new imaging analysis that just looks at the water differences in tissues. it allows as you'll see in a minute, blood vessels show up readily with -- excuse me. tumors light up like light

bulbs. it's called restrictions spectrum imaging. is a case of a tumor totally thought to be healthy, individual came in just for the health nucleus. we 585-centimeter tumor on his breastbone. you can see in the image on the right it literally lit up. his tumor was removed within a week. it was a stage one, but it was just at that stage where it started to penetrate the tissue. this is just the size for the start to be dangerous but detecting an early, he would help a week after discovery completely cancer free. if he waited another year or two, the outcome would've been totally different. the straight mri imaging now allows direct back doses of prostate cancer just in the mri with any contrast media.

if there's a few cases that was published by our radiologists and his colleagues at uscg. you can see in these images on the cover images were shows up bright yellow, that's where the tumor area is and it totally correlated with the pathology our removal of the prostate. so they can actually get -- right off the mri and as little as 20 minutes without any contrast. here's another word that makes it even more clear-cut. you can see the bright yellowish orange region that totally corresponded to where the tumor is. the nice thing about these mri images, taken now be lined up with a cool images for biopsy in the area where the tumor appears to be instead of just taking a random biopsy. we are now diagnosing late stage

prostate cancer in about 10% of the males over the age of 50, many of them with completely normal psa and had no idea that they had prostate cancer. these are the types of images that we get from the brain i can with no contrast media. so we can tell you how good of shape your brain is in the blood flow. occasionally we find things like this. we find aneurysms in the brain, so two women in their 30s had these aneurysms. usually people discover them when they pop and they bleed to death. ..

they are in a dangerous stage because they can twist and women quite often present in the emergency room with massive internal bleeding because of these. one of the exciting measurements is to get metabolic measurements right up the mri and we can measure the amount of in your liver. normal is 4% or less. we've had people in now as high as 38% with completely lack of awareness that they had any metabolic disease whatsoever. at that level, they would be up for liver transplants within a decade. there is a disease called mash. it is not necessarily associated with alcohol use. nash's non-alcohol-related liver

disease. i was on a 30-mile bike ride with one of the world's experts on oregon and we were 15 miles through the ride and he told me exercise won't reduce your organs that he said you couldn't have told me 15 miles ago? [laughter] the only thing that will is calorie restriction. exercise helps with calorie restriction, but it is very dynamic and it can change quite dynamically. so we do a variety of thing for brain and marrow testing using the mri we get these incredible images using another tool developed called the required with the volume of 20 different brain regions and it's very easy to diagnose alzheimer's disease with this technique. i'll make you all experts here.

if you look at the one that says normal and the one with a yellowish clay and that there is to us, that is the hippocampus. that is where changes show up first. if you look at the one with alzheimer's disease, you can see out kind of shrinking around the brain, but that little yellow area has shrunken tremendously and there is going to round them comes about as we're quite often shows up first. we are now at the point combining the human genome with this type of mirror imaging where we can predict the future appearance of alzheimer's in terms 20 years before somebody has to. it gives a lot of time for development of new preventative medicines. we find a variety of different types of brain tumors. this is just an ngo month right on top of the brain. here is another type of tumor.

the main problem with these is they tend to bleed and cause strokes beard we do a lot of unique cardiovascular testing from 40 echo to ct scanning to people wearing these little strips that records their ekg for two weeks and that has been responsible for a lot of our discoveries. the 40 echoes, they are just really incredible. you can see all four chambers of the heart. you can look down and see the heart of speeeight you can see if there's any blood regurgitating. none of the physicians in the health nucleus use a stethoscope anymore because the techniques are far more accurate. this is the ct picture. this is my heart. we actually used space-bar h.r. classes just to remind them that the ceo has one.

[laughter] but we can see the blood vessels very accurately and quantitatively. and so these tools really give a something that is quite unique. the two-week remote heart monitoring has really been amazing. he discovered a number of cases of episodic nature of fibrillation, some for as long as eight hours with people completely unaware they were having it. individuals at very high risk for stroke putting them on an anticoagulant certainly change their risk profile. a few individuals had complete episodic heart block where their heart rate would go to 20 beats per minute and somehow they were completely unaware of it. i think i would notice if my heart target going that slow, but maybe if i was dozing off a wooden. they were a risk for sudden

cardiac death. they are now on pacemakers. we get these beautiful pictures that measures quantitatively the amount of visceral. we can measure the muscle type, et cetera appeared green is the fact you want to get rid of that is associated with disease. we can give you these nice quantitative numbers if you really wanted to know if your left leg weight more than your right leg for example and what your different body parts contribute to it as well as the skeletal enjoying condition. one of the biggest problems we have and it's quite surprising to me is males by almost a two to one ratio over females want to go through the house and lives. to me this is very straightforward knowledge is power. if we find something, for example, these tumors are easily

removable and they are afraid get the answers. do you have the answers on how to convince them to go through. for the same reason they don't want to go see their physicians either. our age range is quite broad from relatively young to as old as 99. some people still want to live longer no matter how old they are remarkably healthy individuals. the challenge is putting data together. taking the new phenotypes and see if we can match it to changes using machine learning pearson of these are obvious. we see polycystic kidney disease, liver disease. we have now had five individuals with great way to spend a day or days and we found a chain

duplication punching that seems to correlate with this. you can see from mr. b. of a a long way to go between the straight single gene disorders, which looks across the genome. there's still a pretty discordance with what the phenotypes find entire. we have a long way to go to make the genome predicted that the level we wanted to be. out of the first 209 people, here's a partial list of the kind of things we've discovered. essentially all of these hot been actionable and treatable. there's only one case a very deleterious wife under changes in the brain that probably worked to reverse full but even by proving the cardiovascular system there is some improvement

in cognition with that person. these are all people that buy any other definition or healthy and we were using 12th century definition of health. if you don't appear to have sent tons and you feel okay even by the u.s. health care system, yuri hulsey person. this data says that 40% of you are not. the data i showed you on the death rate prematurely from heart disease and cancer says you're not. we're up to about 1.5 million new cases of cancer diagnosed each year. those people just didn't come down with cancer the night before. some of them have had it for weeks. some for months, some for years. if we can detect it earlier, we can be removed if. we are using machine learning. i can show you if you are with

machine learning because it getting exciting and i will show you the potential as these databases get bigger and bigger we can make associations within it a novel findings in the genome. we started by wanting to predict things about people including eye color, hair color and faith. we have planned in fact we are better at predict people's eye color then they weren't finding that. we use the toilet imaging to get a precise color and it turns out people's eye color varies by as much as 14% from high july. most people are unaware of that. we can convert eye color pretty well. getting quantitative skin color is complicated because some people go out in the sun. some people use a lot of makeup. there's a lot of different things with it that the correlations are getting pretty good with that.

we can predict age. we can predict all the different features. because some of these together in the genome report that you get when we predict your height, your weight, bmi, eye color and hair color. on the chelsea hitler show, her genome predicted rate of 166 pounds. she used an extreme obscenity at me when i pointed that out. i said look, you just haven't achieved your genome potential. some of us have exceeded her genome potential. but we can actually also predict other things. men and women lose chromosomes that they age. they lose their y chromosome. women use their x chromosomes. "-begin-quote it safely measures to you and your link and find associated with age that are pretty quantitative. we can measure the number of

chemicals that clearly do appear to correlate well with changes in age. we set out to see if we could on top of all of that measure what you look like. we did a clinical study, made 3-d images of their faces, sequencing the genomes and did a lot of other components. we also predict voice. just from the digital voice from the digital voice print, over the telephone or any other themes became pretty accurately determine the sex, the age and the height of the person. the high surprise to us in his correlations, but it somewhat correlates with you overall volume. donald trump would've never been able to fool people with the simple types trying to be his own press agent a few years

back. so we take these 3-d images. resubmit them because of the 3-d photographs are somewhat harsh. we have taken this into our machine learning algorithm looking at thousands of bits across the genome. here is their current version of the phase prediction that seems to match relatively well with the 3-d photos. this is just the genetic code. we don't put in the actual eye color predicted for these punches graphically difficult to get it right. here is another case of the mail, the 3-d photo in here is the genome prediction. here is an african-american male because ethnicities such as a key part of prediction that works extremely well and here is his 3-d prediction.

so we can combine all this data at your height, weight, eye color, hair color. approximate photo of you that the photo on the own can identify one out of 10. we also measure blood type, your exact hla type. with your y chromosome you can be linked on the internet to a surname very quickly. the point of all this is if you think an government and others will tell you your genome can be de-identified. we can identify you from your genome. so be careful where you place a period [laughter] if you're part of a study and

told that you can be de-identified in the study, it is truly not possible. we treat people's data highly securely. nobody can run the algorithm find anybody in our database to try and determine their identity and i think that is the key issue. we are combining all these things. they are all improving with machine learning. think about all the different symptoms of measurement that a gift for disease off the mri. the exact diameter of peoples spinal column and some people have a narrowing that it should mandate here so we can predict in the future those who are much more likely to have lower back pain simply from those markers associated with a narrowing in the spinal cord. at the earliest stages it's just getting exciting. we return the results to people

on ipads or you don't have to carry around a couple thousand pages of paper and we make a 3-d "avatar" out of each person with the baddie 200 camera system. it seemed kind of "avatar" they use in the movie. in the movie they will be animated and help you up for your own data. if any of you are interested in learning more you can do to human longevity.com, health nucleus.com. that is my e-mail address if you want to make an appointment. so, thank you very much. [applause] >> thank you so much, craig for your amazing and they did into the future. we wish you the best of luck. i would like to bring to the stage three others seemed health care leaders. first we had tom daschle,

founder and chief executive officer of the daschle grew. a few people at such a profound understanding of issues animating the health care debate at tom. a senate majority leader, tom established himself as a leading expert on national health care policy. he has remained deeply involved completing the senate and now heads the daschle grew up while serving many influential policy bodies. tom also co-authored the book getting it done how obama and congress finally broke the stalemate to make way for health care reform. he continues to be a key voice in health care in america. please give a big hand for tom daschle. [applause] also with us today as redondo miller. in may, the 11th president of the johns hopkins hospital. she previously served as senior vice president medical affairs

for the johns hopkins health system as well as professor and vice chair for clinical operations in the department of medicine. they've made education a major focus of clinical career. she chairs the council on clinical and quality issues and positions. as she covered she plans to continue caring for patients or she said they will keep grounded and help you remember why i'm here. please join me in welcoming, redondo miller. next we have at this gene was, presidency of the carolinas health care system. after distinguishing himself, he took the reins of one of the largest nonprofit health systems earlier this year.

he will also serve as the next president of the american hospital association. in a recent interview, the new bern and the current health care climate to try and play in a rubik's cube. just when you think you have everything figured out, so much was then resets the game. we look forward to having his is. ladies and gentlemen, please welcome james woods. [applause] leading our discussion this afternoon as u.s. news editor brian kelley. please welcome him back. [applause] >> thinks, margie. when i started in this business, somebody told me the great slogan of showbiz, never follow a funnier comedian. i have a corollary of now, never follow a certified genius. i think we just saw the future of health care. thank you.

we will see you next year. that is fascinating that we've got people in the trenches here and that's also what we want to do. we have 30,000 feet and we have grass roots. dvd introduction. i want to start with some probing questions. tom, you have been the minority leader of the senate twice each i believe i'm not sure when that's replicated. what's the better job? >> i have some time to think about that. been in the majority is a lot more fulfilling. >> we are going to walk through this. eucom from a health system in north to as. eucom to north carolina recently. cowboys panthers. who is better? >> philadelphia eagles.

>> and now we are in camera so close i can panthers. my wife is a steelers fan, so we have -- >> that's why they paid the big bucks. you know how to navigate. one of the great hospitals in the world the day after the election. are you anticipating a surge of people looking for psychiatric care? >> well, nonpartisan aside, i think we will be ready. i'm not sure i know the answer but i will also say we had some riot thingies all tomorrow while ago so we will be ready on that front as well. >> it's a crazy world out there. if you think about what we've got here, people with enormous expertise, but was also carefully chosen them. were donned a has a first-class institution can actually map

her. the president of dha with industrywide and tom have pretty much has the whole country. i think we can cover the bases here. i want to ask each of you in sequence here when you look at your piece of this, a couple things that are working that make you feel good about where we are and then i will ask you what's not working. let me start with you. you look at the hopkins system. what makes you smile when you come to work monday morning? >> what makes me smile? i think it is the renewed focus. not that it hasn't always been this way, but a renewed focus on the patient enough the center of all we do. everything from designing our care models to messaging and trying to make kerry easier to access her patients and

customers it that makes me smile. >> answered. >> tom, fix the country for us. >> the two most permanent powerful forces today or take knowledge you policy. technology we've seen a clear demonstration of the unbelievable things happening technologically. the application of technology and big data is very, very exciting. all the innovation we see through technology has got to be on the shortlist. on the policy side i think the one remarkable thing we've seen is the improvement in the number of people insured today and the protections people have as a result of policy. we haven't seen as much movement as a stain on the technology side, but we've seen that by now both of those two things primarily. >> i would add one clearly in the field.

i see a real commitment to quality. they had her and i was just received and 34,000 or $300 million. likewise we were just renewed 13,000 instances of harm eliminated and about $76 million of cost you. we have a tremendous amount from the quality from but i feel the field as a whole is committed and on the path to that. >> what is on the downside? >> on the downside, if you step back and look at dac look at the aca partly to address access. 20 million people access to insurance. if you look at the nation possible you have about one third struggling financially. you've got one third in the middle there plus maybe a little bit of a key been invented about one third doing well. and most two thirds are particularly concentrated around

areas of rural communities and safety net communities. my concern is that we have access taking we are entering a period where we have access in terms of providers in rural america in safety net areas. >> what keeps me up at night is the rapidity of change. i think we are going in the right direction where patients. if you're a hospital just trying to manage all that is coming at you rapidfire. i think over the last two or three years, just as my own is to titian, we wrestled with launching a new electronic medical record at our hospital and across the system. we had a cb 10. we launched accountable care organization. we have quality metrics shine to perform well.

it is just rapidfire non-of change. i have no doubt we can do anyone of those well. >> if i could go back to my policy assertion a minute ago, the downside is the degree of politicization around policy today and the constant confrontation. we've got to find ways to make the numerous civil again. we've got to find ways to come to some conclusion about the role of government and health care. as you said in your opening, one of the big challenges. once you do that we have a whole range of issues around fee-for-service and moving to a different payment model. mr. alanis i propose we need to be in connect to it. we are two we are to say that yet today. we don't have a health care system. we have a collage in their silos

and no work better together. >> we will come back to that. i promise you guys we will tell you what to do wednesday morning next week. the quality question in the u.s. because we have a little bit of experience in that. if you can't measure it, you can't fix it. we've had a lot of them as assigned data and the government with the five star rating just made a move in that direction controversial. each of you, give me your sense of quality measures, are they working, where do we need go with that and what is it doing to your institutions because both you guys are very much involved in that. >> yeah, you can count the number of quality metrics we have to track on a daily basis. 400, 600, 700. the question is they don't know half -- some of them it's hard

to replicate. some of them are useful to the consumer and another provider. what we thought through and got an initiative that says one of those metrics that really matter. part of that distilled it to 11 metrics that matter. such as obesity and diabetes. the field is overwhelmed by all this quality matcher experience some of them were, some of them do not. we've got the 11 that were hoping to start a conversation with insurance companies, government to say whether these can be coalesced around so we can and will fight and make it meaningful to the people we serve. >> i would echo a lot of that. i think we are at an intermediate stage with their quality metrics. the good part of measuring quality is that it is truly called us to focus and make sure that we are heading all of the

cancer screenings for our patience. make sure chs in copd carries top notch. it does cause introspection and examines processes and outcomes. we have uncovered issues are corrected in our patients are better off. having said that, some of the metrics are not as secure as we would like. some of them end up being a documentation issue or doesn't capture the essence of quality. i like your idea honestly about trying to focus, pick the top once we can all really sort of huddle around and make sure we get those right rather than trying to do a scattershot approach. >> question for both of you guys because you serve the radio patient populations. one of the issues is the notion of risk adjustment of status. i can't even say with a straight

face. whatever you call it, people say there's a deleterious effect. penalizing hospitals and actually taking money out of their pockets. is that happening to you and how do we fix that? >> that is a long answer. the socioeconomic adjustment is really critical and there's a lot of work done on that. we try not to worry so much and those types of metrics. we are focused on the social determinants. this concept if you look at our communities, it's amazing and how under the surface communities in need but issues have been, they make their voices known.

but we've tried to do is look at the socioeconomic factors using things that caught fighting. we know when charlotte their six different zip codes that have three times the ed use of the rest of the population. we are trying not to focus on the methodology and metrics for trying to figure out how we bring better services to those in need. >> are you guys affected by this? >> yes, we are. our institution has two missions. we are in east baltimore, a buried in a city you population number founded in 1889 to serve that community. at the same time, we pride ourselves on being innovative, high-tech and attractive nations across the nation and across the globe. we have two very different patient populations. we aim to serve both. embracing population health around our hospital is very important to us and having socioeconomic adjustment is important. no method is perfect.

i'll be the first to say no method is perfect. it does allow hospitals to embrace local populations and make sure we move beyond our walls to deliver appropriate care. >> should the federal government be in this business? what are they doing making consumer ratings? >> i think when it comes to establishing value, which is the goal of people in government and the private sector. we want higher value. they are reaching the goal. they are really the wild west. there is something out there that is frustrating and confusing and it is. we need to simplify and many decision-makers that government can all play a role in universalizing what the metrics are to be his outcomes-based,

performance-based. have you ultimately describe the metrics and quantify them? government has a role in doing that. >> i want to talk about.yours. doctors are where the rubber meets the road. plasterer conference we had dr. burnout. sort of a two-part question. what do you see because we seem to be putting so much of a burden on doctors. we also put tremendous burden on hospitals. is this your same hospital burnout? you guys fixed the entire problem with all some more which is on your shoulders. you fix the entire problem of charlotte, north carolina. started out as intel knew what you see from your folks and what do we need to do about that and maybe we'll talk about the institutions and are we asking too much of the industry?

>> i would expand that to all care provider burnout. nurses and pharmacists and physical therapists as well as something we are wrestling with. the medical records for instance create such good characteristics to our care. the ability to electronically prescribe medications for patients. the ability for patients to see results all good. but it decreases productivity. it hinders the human touch of an office visit, they need to be click event. physicians are also burdened with other administrative tasks, trying to make sure the coding is correct for meeting this regulation are quality metrics. we are seeing some significant or not and disillusionment. as the tuition is launching joint medicine initiative the next several. how do we bring back the joy of the real reason of why we all went into medicine.

>> he said is so beautifully. the joy of work is some in-laws sometimes with all the regulations and everything people have to deal with it the simple thing we've done recently is to have both a call stories of how we affect that another teammate wife or a patient's life. i'm receiving videos and e-mails on a daily basis in a feed that back to the organization. that alone is connecting people with a purpose and sometimes be found that it helped. the second thing we've really focused on his behalf of our strategic initiatives about 80% of that or co-led by physicians. when we change clinical distant emr something for that nature, they feel they have a voice in not change. i think that it's been helpful in putting compensation models.

also reflecting back to them and the nurses and the organization what is special about what they do everyday. >> let's talk about the institution. population how whichever witness over talking about but it's vastly expanding the mandate of what institutions are doing digging deeper into pathologies than other aspects in the community. the readmission matcher ask for one which penalize you if you are not taking care of that. do you collect hospitals are asked to do too much? >> as i mentioned in my earlier comment, the direction is the right one. i worry about the pace at which we are trying to do all of this. i do worry about that. every single movement, every single initiative does have value. we are spending our time trying to figure out how to become a hospital without walls so to speak. we want to take care of our

local population investing in community health workers trying to really holland and penalties due care models to keep it for a while and out of the hospital. that is what we want to do but it is a lot to tackle and it's not clear that we have the appropriate resources to make of that happening. that's a challenge. >> i want to put that question to you. the national policy perspective, do you think we are asking hospitals to do too much? >> we're asking hospitals to do things they are not prepared to do. we've got to recognize we are all in this together. when you talk about population health, that's especially true. we can ask a hospitals to drag the entire challenge. when we look at what is really required is a far greater understanding of the social aspects of good health. but attrition the last x and

health monitoring of the things that are done in a classroom or work place for a community in addition to the hospital. we have to realize it's a much broader responsibility than just a provider or just a hospital. we can't ask them to do things they are not capable of doing in some cases we do that today. >> this euro amount they spend 15,000 pages of regulation between now and the end of the year will get one final rule every week. are we asking hospitals to do too much. on an uneven path if you think about it we are writing regulations that conflict with regulations written that don't sound right. the one thing i'm noticing and i'm getting back to the members of the feel of his plea slowdown. even with ach regulations, if you're trying to do the right

things in terms of court may care, you need to get an exception for fraud and abuse which were read for and anything was fee-for-service and physicians were necessarily aligned. you've got to get hospitals like they are now. not only do we go through this journey but also trying to navigate conflicting regulations if we could just solve that, even when you file for exception, that is only for the system requested. the whole regulatory burden israel and is confusing and it doesn't have to be so i think you ask if we are asking hospitals to do too much. in some ways with respect to that, we are. >> fix that for us, tom. >> first and foremost, as i said earlier, we are to sigh about. we are not as engaged as we need to be.

on a monthly regular basis what would please me as for any administration, the sooner the next one to bring in the leaders of each one of the factors in favor of focus this month on the regulatory environment. how can we do a better job of adapting to the changing transformation we are in. there isn't enough of that inclusiveness and the willingness to listen and adapt as we go on. technology is moving faster than policy and we've got to bring those back and to sync with technology that can only happen with better inclusion. >> if i could add on to that, you are on the money. over on putting providers together incentives between hospitals and physicians. i would love to bring other stakeholders to the table. and really have a conversation because there's other stakeholders we need to engage

in the work as we move to population health. >> is it too late for you to get into the race? is there a filing deadline? >> will come back to that. health systems. this conference was called last year that time the on. we made a concerted decision because it got to expand the boundaries here. you have a system throughout the state of north carolina. how does that come together? how is that working for you? where does that go? >> with large provider of care in the carolinas where 47 hot close throughout and 6017 and. what we have done well as a system is the first curve conic

tv. the revenue cycle will do extremely well. supply china do extraordinarily well. all of our hospitals and systems work well in that. but we step back and look at is how do you really leverage together so we have building up in different places than we want to make sure the capabilities are coordinated, outlined under management platforms because what we know is they make this transformation. it's a technological build and the platform alone is scary resource intensive. we figure out how to use the same thinking in terms of spreading fixed cost on the first curve and apply that to more integrated functions that that level. >> is for the record, the president the hospital it take baathist said.

so we are little younger in our journey towards being a system. we cannot either 60 or so we are at the point where we develop a lot of shared services, purchasing together the system. things that we are embracing now, which of the six hospitals is the right place. do we need to have six long cancer programs or should we consolidate those? what is best for the patient where we can standardize care instead of duplicating it throughout the system. we also expand the notion of system not just horizontal alignment of vertical alignment, too. we have a home care group in our system that allows the deliver care to patients at home. we have a community physician that her. we are looking beyond just a typical acute care hospital. we have a lot of talented allow us to do well in population

health. >> specifically of the specifically of a little bit familiar because i live in washington d.c. in a deliberate family members many times. several hospitals limited close to my home. it's been fascinating to see how do you translate the expertise, the excellence of hopkins street community hospital? >> we have a lot to learn from hospitals. it's been a real partnership for us. we are engaging the frontline phoenicia furball mid-atlantic hospitals and believe it or not with actually learn from each other and each has some need to bring to the table. that's how we've been approaching it. >> has been in the system six but i think in the audience we have to do roger gray who is chief physician executive. the third month i was barely took all the cf mouse and

brought them together for equality day including patient admits that metrics as a group of men deployed by now. whether you are managed facility where your office will be in for me that has created versus a deadbeat dad but i talked about earlier. that's where you get excited as we are coming together in ways we can continue to build on. >> i think that's another nice outcome of equality movement. we set our goals for quality much except the system level. every stakeholder has assayed with a target should be a new monitor from the corporate level. we hold each other accountable to make sure we perform well. >> he said this consolidation is inevitable. where does this go five years from now?

>> you will see a resolution. we are going to see a lot more applications in health we haven't had before. tell a health and telemedicine is a good example. the extraordinary new rules that technology can play in health delivery is a lot of the infrastructure in the state of south dakota, we have a lot of small hospitals. they have relied on a black mark on it to get the between their hospitals to provide services that not been able to before. if we can fix the interoperability challenges, that can help make connectedness even more consequential. also we've got to recognize the scope of practice that will involve. it isn't going to be physician driven in a bunker. we will see greater roles for nurse practitioners, physician assistants and other providers. pharmacists as well. everyone has a role and we had to embrace those changes in

roles not to struggle with them and sometimes they have in the past. >> we try in this conference to be forward-looking even though it's hard to figure out what's going on next week. that is my last question. i want to talk about looking over the horizon in terms of technology, medical breakthroughs. but things can change either the actual medical clinical outcomes or the structure of your business. what d.c. is promising coming over the horizon? >> if you go back to 1950, and other medical knowledge in the world -- 350 years. now somebody entering medical school by the time they are done, the medical knowledge in the field might have doubled. we are an extraordinarily exciting and innovative time. i am fascinated by the concept

of predict it analytics. we are here and there so much opportunity. i think there is 15 million in the country that have that. if you come to the carelessness to the carolinas sprayed down with 40 different variables and we could predict with 80% probability whether you are going to be back in a year and we could intervene in that patient care. those are the technologies that could look over the horizon that allow us to allocate resources better in this particular case we have an advanced clinical team that identifies the patient, follows the patient and their 40% less cost per episode and 15% less reignition. those types of technology is really helping us in ways that we can even imagine at this point. >> a couple things come to mind.

leveraging technology to meet patient in their care where they want to receive care. for instance, internet technology, mobile technology, reminders to take medicine or how to intervene and chronic conditions. doing this work at the home. elderly help us move forward. focus on precision medicine. for instance, not every disease manifests. some depends upon your genetic makeup. some of it depends upon your socioeconomic environment. it may depend upon behavioral aspects to your health. being able to harness the aspects of that we know we can tailor the therapy to the patient based on how the disease manifests in that individual patient. >> first of all, i think you'll see some breakthroughs and

cures. now we've got the cancer moon shot. i think there's real opportunities for breakthroughs and who knows how close we are. two areas we have the greatest need in progress is some quality care. and both the beginning and end of life we have real issues and real challenges. i'm excited about the commitment and the private addressing those better and more successful way. >> what about the data side? we put a lot of energy and money in to it. it has consequences on the pros and cons side. is that a key part of the future for all these institutions? >> i do. we just finished a lot of our electronic medical record across our health system.

even beyond our health system the regional information exchange is. the chesapeake region information system where patients allows us to access data from all the hospitals in maryland so they can pick up on utilization patterns and fine-tune our efforts to help their patients. >> is it working for you? >> the verdict is still out in terms of the billions of dollars we spend on meaningful use of that interoperability how that has really helped. if i looked a carolinas, we have 20 million transactions daily in our emr so that is an untapped resource for can tenuate to learn about how to make and deliver care better. it is a testing. health care in general has been a little bit late to the table in terms of i.t.'s.

i don't yet know we've got the value of some of it that of it that we will in the future. >> is the government government have to drive back? >> it has to be a public-private partnership that will get this done right. who was this information. once you establish ownership, how it can be handled. we think of this as the national challenge and national question. the government will have some role in what it would be. >> let turn to the entertainment portion of our program. we will look at politics. we promised everybody we would give them kind of him what to do on wednesday morning a week from today. i think it's only fair for you to start off here. please tell us what is going to happen and what we should all do about it. >> i think it is fair to say the race is so close right now that

those at the presidential level and the senate level that i don't take anyone can predict how this will all play out. whoever is the lack of it, they can call the leaders of the party and say let's meet mira are talking about what we can do together. [applause] >> really not too late. this guy knows how to make a deal. we know that. let's be honest here. i'm joking because they have to because otherwise i'd be crying. from a practical standpoint, what are the dealmaking possibilities and how to assess sort itself out. where's the house, the senate. you know the whole scenario. give us and a ray of hope here.

>> we will see the expiration of the chip program. that is broad bipartisan support. nature is a community health program in committee health centers. we don't extend beyond that. we've seen enormous progress in 21st century cures. we can just find an offset for it. there is just some really great opportunities that i talked to members on both sides of the isle who are not in leadership. they say we can do this and we have to keep everybody's feet to the fire. spend more time in washington so they can actually get this done. they come back on tuesday and wednesday is. the five-day workweek used to be the way we did those.

i hope we can go back to that >> it's a big country. picking up on that, you said before there is bipartisan potential here. there is a cam on aca. this just a tremendous opportunity on research and telemedicine, health information technology and a whole array of things that right now enjoy support. it becomes the polarized confrontational round that we will have to get through. even though it's only 6% of the insurance market is in trouble. we've got to fix it in the aca is part of that repair job with got to do. radio lacked to us. >> one of the areas i think we could have across the aisle agreement on his page or a halt.

overwhelmingly they are dealing with behavioral health issues. they moved the health care moved the health care forward and that will be an opportunity to get some collaboration. >> i know this is not your day job. you want to weigh in on this? >> hideaway had the front and provider perspective. i matter who wins the election i'm a pc see on the policy front, i remain very optimistic that health care will continue to evolve in our country can continue to go down the right path. i talked to the top yours, nurses, health care providers every day. their hearts are in the right position. they are there to make health care better. whoever wins or loses, i think we'll be fine. >> next president next wednesday. her forehead.

>> bring everybody together and see which you can agree to. even if it obtained small initially. we've got to figure out a way to put the election in politics behind us and try to govern for a while. i'm amazed. i have to travel internationally and it's amazing how consumed the whole world is by what is happening here and they'll want to know is this real? they could make up what is actually happening in reality. a couple of quick things to tell. >> "avatar" next president to make sure you garner lots of feedback from providers and also other stakeholders engaged in the health care business. i would tell them that we have to advise in order to make these

changes it does require big-time investment in the last thing i would tell them if it takes time. the changes we are looking for are not done in the order of months or even a year. we need a horizon of years to affect the kind of health care delivery system system we wanted our country. >> last word. >> things have been talking about. behavioral health. 40,000 suicides every year here. how do we fix that? how do we do better and work on quality metrics should be a noncontroversial issue. how do we gauge with a noncontroversial issue. the tape was named that are not aca, put them on a list and get to work. >> with got the right people. i want to please thank our guests for some terrific insight.

hot pack [applause] >> thank you. we can agree that was a spirited conversation. thank you oregon site peek at your institutions as well as how the future might shake out. we look forward to examine issues in depth in her breakout sessions tomorrow and friday. now, here is more thoughts about the evolution of health care is the president of seamens south america north america with the log pioneering approach of delivering good dances. they hope to in providers deliver better outcomes and on a special note, we appreciate your sponsorship of this. if it is with us since day one is one of our premier supporters. let's give a big hand to david.

>> thank you. >> thanks much. >> a couple disclaimers i didn't know about this east into thing. i didn't get my hair done. sorry about that. although i didn't have much to work with anyway. also glad another disclosure,.third venter is a great top. now that i got that out of the way. it was great to be here they were brought based diagnostic company focused primarily and also a service provider in i.t. provider and we are pleased to announce a lot of talk about this earlier from our panel in the population health business between a new arrangement that we announced about two weeks

ago. i really want to congratulate the honor roll list. great job and congratulations to all of you. it's a great achievement. we are pleased to his dad there was equipment never one of these or some type of solution and hopefully that in some small way we help you with your performance. congratulations and on a serious note, it's absolutely great two-part with you. congratulations. ..

that's trying to better outcomes and satisfaction with your patients at a lower cost your we understand and appreciate that as an recession, as health care supply and we think it's to partner and collaborate with helped assistance to ensure that this is a sustainable. we believe it's a collaboration between the two of us to make this happen. we are big believers and we are committed to helping increase outcomes and low-cost as a company. so what i want to do is share some collaboration and partnership examples that we are doing globally to address this and help imparting. so that financial partnerships, i will share with you some examples, operational partnerships and clinical partnerships. just a few examples to share some ideas around collaboration and some of the success we've

had with institutions like yours. from a financial standpoint we are all constrained come hospitals and health systems are resource and capital constraint and we worked on innovative business models in partnership with health care systems to help free up capital resources so you guys can invest we think it is appropriate and deploy your resources where necessary. just a couple examples. every hospital, most hospitals i should say in the u.s. and outside the u.s., pay exorbitant fees on software licensing. especially high-end software licensing. oftentimes these licenses are not used so he stuck with a capital piece of the. we have implemented in many times with our software high-end software licensing a pay for use model, the page ago so to speak. hopefully free up capital so you can deploy those monies and use those dollars in other areas. also smart based risk contracting. when hospitals employ new

capital equipment, whether to buy and laboratory diagnostic system from us or an mri, we said key performance indexes in place so we ensure we have cost savings goals in place before the equivalent arrives and before the installation arrives. if these goals are not achieving cost reductions we will share the risk with you. this way we are tied to your success together. these are a few examples of how we're trying to address the cost burden from a financial perspective. we are all trying to do more with less, right? trying to increase efficiencies as a hospital system. we've come up with several different models around out of the box model to help with efficiencies and wanted to share an example from outside the u.s. in latin america we did this in a pretty novel way. it required a bit of technology as well as a business model. são paulo, brazil, that a large imaging center that has a fleet of 67 mris and the challenge

was to which will hard to find qualified technicians to run these mris official and effectively, and also when they found a technologist they were extremely costly from a salary perspective. that was their challenge and we work closely and we partner with them on a technology solution that we created our first remote command center. so all 67 of these mris are actually controlled remotely from a remote location. obviously, as you can imagine help with a staffing piece of it since everything is done in one location. we increased, we standardized protocols and increased throughput as well as result of this new operating model. the first time we did it in são paulo, brazil, and again just another example of innovative business models but we would not have done this without the partnership of the imaging center in são paulo. it was a true win-win partnership to make this happen. from a clinical perspective,

there are more conflicts procedures on the rise. whether its orthopedic surgery, oncology, neurovascular, cardiology. and we believe technology and begin partnership with health care systems we can make these complex procedure simple. i'll give you one example. we heard the doctor talk about this or erase talk about 40 ago but this more complex heart procedures that are not available to some outside and some in the u.s. you are very familiar with -- tricuspid valve repair. left atrial appendage closure. michael powell prepare and replaced them. all these procedures are complex although great advancements in the field, right, and minimally invasive, they're still complex, they're still a cost burden. there's an opportunity to improve outcomes. there's an opportunity to improve procedural types of the first time we are crossing the chasm as an organization and

getting into the therapy business. were parting with clinicians. clinicians and many other is patients and medical device companies to work on making these comments procedures simple. a lot of it is focused on pre-procedure plenty. you saw the doctor talk about cardiac ct. were regarded as cardiac ct solutions to ensure that your right pre-procedure plenty. and then in the procedure itself to optimize into procedure guidance. all of these procedures require imaging but yet we have to work with clinicians and medical device companies to better understand what's important and what's needed, what specific guidance do you need as a physician to ensure these procedures are done the right way, but more important to improve outcomes to reduce procedural time, hopefully reduce cost and help with the adoption of these therapies. just an example from a clinical innovation standpoint and begin a requires a collaboration between a supplier like us, and medical device company or device

companies and clinicians that work in your groups. so just some examples, we are on a tight timelines are moving fast. just some examples of partnering together to achieve our common goal which is focused again on that outcomes and satisfaction for your patience at a lower cost. and i will leave you if you don't mind with a quote. from our actually founding father, ideas alone have little work. the valley of innovation lies and practical implementation of that implementation can be difficult to let's collaborate and do it together. thank you very much, everyone. take care. [applause] >> thank you again david. snake about so many potential partnerships. round out this afternoon session is lee rivas, resident and lexis-nexis. over the last decade lee had spread worked on big data and

analytics across a variety of industries and most recently has been overseeing the health care i.t. side. clinical solutions work with providers to improve outcomes by bring evidence-based content into the care process. ladies and gentlemen, please give a big hand to lee rivas. [applause] >> thank you for the privilege of speaking today. and so i speak to you from a perspective of having spent last 10 years at the intersection of data and technology in several industries with the last five years in health health care lexis-nexis and with elsevier and a plan for solution and a clinical decision support and patient engagement tools.

i also want to share that the first 10 years of micro i spent as an officer in the u.s. army, tanks, nothing to do with health care. the reason i share that with you is today i'm going to show you a few examples of other industries with equal societal missions as the omission and use army which was protecting u.s. citizens serving our nation's finest soldiers. i'm going to talk about th the . auto insurance industry that has a great mission of helping consumers receive their pricing. uncle to talk about the law enforcement industry have been high that i to how his health care similar but different. so just a quick primer of we in the did industry like to call the five c's. let's quickly defined what is big data. you've heard several times today this concept of massive data to you heard the genomic these, you heard about the number, amount of data coming into your system

are clearly there is a big data problem in health care that traditional i.t. systems can't handle or as otherwise cost prohibitive. the second problem is what we call velocity. this is the rate at which data changes in your system. daily, hourly, by the minute. the third problem is also unique to help her, it's variety. so different forms updated, not just numbers, it's a numbers, text, images, video and so on. once you get all this data, veracity. can you believe the insight from the data? and the last point is value. so we heard this great listening to the roundtable what value do you get from the data comes out of your systems? so let's talk about the first example, the u.s. auto insurance industry. this is a $200 billion market.

the primary purpose of an insured is to issue their pricing to u.s. drivers. so that you the safe driver are not subsidizing the risky driver in the premiums you pay. this is really interesting industry that had very similar dynamics. let's take it look at a couple things that happened. the first is there are over 14 million collision claims per year. so you have the volume problem. 250 million claims over five years, so have evolved and variety problem, how to get all those sets of it all the time. which is a typical look back for an auto insurer. the data is constantly changing. i'll go over some steps laid on the rate at which people change addresses, change jobs, last name, et cetera. and there is more and more regulation regulating their pricing for consumers. the last piece is costs are rising the cost of repairs is rising every day. we did research and look at the

cost of a windshield to think about when she'll today versus 10 years ago. a windchill today has a rain sensor, temperature sensor, and an alarm center. call it a midrange car. the cost of a midrange honda accord when she'll today is double the price it was five years ago. to lots of data. it is constantly changing your more regulation, costs rising. sound familiar? so let's talk about how this industry has started to solve the problem. the first and most important is by aggregating data set. you heard in the roundtable today one example of this exchange concept. lexis-nexis aggregation 99.5% of all u.s. auto claim transactions into one database. so you can drag and psychologically over time on a u.s. driver. the second is taking demographic and even dated, taking other sets of data not just one company but from several. i typical incher will collect

motor vehicle records from the dmz. incident data, the crash data. on the data over time so the person u.s. more time with one policy is much less risky than someone who keeps changing policy. and then using news sources updated. so it's happening in this industry this thing called -- user driver data that is real-time data installed in cars at your choice. i personally wouldn't up at the rate at which you accelerate. the rate at which you've decelerated do you drive on paper what types of roads? a time of day do you drive? all of these data points help solve a problem of pricing risk. and back to the societal mission, the mission of this industry is to issue their pricing to u.s. consumers. let's talk about another industry before we get to health care. u.s. law enforcement. the mission of the 18,000 local law enforcement jurisdictions in conjunction with federal agencies like the fbi is to

protect u.s. citizens, find criminals, find missing people and solve crime. 15 years ago, 20 years ago an officer who would rely on feet on the street most static databases to try to find that people. today, the problem is not completely solve, still complex but there's an interesting things happening. a few data point. 319 people in the u.s. -- 319 million people in u.s. 1.2 million violent crimes unfortunately. the average person, back to this velocity problem, changes addresses, moves 1144 times in a lifetime. and back to this theme around resources, u.s. clinicians did resources deployed to different geographies. there's 800,000 u.s.-born police officers. that's one police officer for 400 people. i'll add one more point.

there's 18,000 law enforcement jurisdictions so here's the problem they have to sal. i grew up in alexandria, virginia, not too far from your. if you don't in a 10-mile radius you will encounter several jurisdictions. d.c. metro, capitol police, george washington please, go over the memorial bridge and you see the arlington county police, the virgin state police. guess what. these jurisdictions if they don't have an official record a criminal record on individual, a bad guy passing through their jurisdiction, there's no way to track this individual of reconcile the person that in one jurisdiction is the same person that committed an incident in the other gestation. sound familiar? the problem we're solving for you here. so how has this industry started to solve the problem? the first is by using demographic and other sources of consumer data from databases that aggregate this data over time. the second is by sharing data.

so i.t. companies, back to the theme of technology, are helping local law enforcement agencies share data and link data with the common identifier recognizing individuals, is that same individual another individual in the same jurisdiction to solve the crime. and third just like in health care, continue to use alternative sources updated. so in this industry one new source of data is social media monitoring. another source of data competing cameras installed in many u.s. cities, biometrics and so on. one quick story. a year ago i was at the initialization of chiefs of police conference and i sat with the captain. using data and analytics, predictive data analytics this department with limited resources but able to deploy the resources at the right point in time to solve one of the major issues which hi is gun related crime. the great mission of increasing safety for everyone. so let's bring this back to health care.

so let's do a quick primer on numbers that you guys will all know. this is about the volume problem. 319 million lives, 35 million admissions, 106 million outpatient visits, and 929 million physician office is reduces the volume, variety, a bunch of problems they can do when. let's talk about the unique nature of health care data. so problem number one is the date is in multiple places. even if you want emr system the data is in multiple places. inside the hospital, different venues after across the continuum of care you have data in many, many different places. and it is more complex. so insurance is probably the most simple as example. law enforcement, different types of data, and data is not just numbers. it's also the content in your system that used to make decisions.

it's typically not standardized in your system or to have technology to extract the right content at the right point in time. a day is more sensitive. you heard mr. daschle talk about this. the data is definitely more sensitive similar to law-enforcement but different from insurance. and last regulation is constantly changing on the use of patient data. so very different problem. was obvious to require more innovative approaches to using data. i was very happy to hear talk about the comments of help because one of many ways to assess some is likely of being readmitted in any period of time or editing communication protocol are become as a celtic these are stress associate with financial distress with support systems, even simple things like do you own a car to get to where you need to go?

what we have done at elsevier and lexis-nexis is take the nomination of demographic data sets combined with clinical data to do a couple correlations and help you all assess some of propensity to come in for treatment or be readmitted. just a couple examples are going to go quickly through these. one thing we that you can see in the bottle of private index. this is the rate of prime within a given geography. we use zip code in this example, related to prescribed medication adherence adjusted for age and other factors. a second example, the one it's obvious at a stroke of the industry our industry is used income and educate us to determine its. not surprising there's an inverse correlation between someone's education and unlike that of them come into a department. the third and last is the

average cut of new addresses in the last month sorted by age is an indicator of someone's likelihood of being readmitted. so these are just a few examples of using these data sets. there's 100 more chart i can show you in using those data sets to help predict somewhat propensity to come in for treatment or be readmitted. so imagine if we take these data sets plus all the things you talk about today, the first bigger talk about genomics, talked about demographics, all the content in your system and you are able to standardize that content and the data in your systems and develop real use out of the data. is a couple closing thoughts. i've been in the industry to help industry over the five years in the previous five around big day. i believe that leveraging data the right time and place can drive real insight in this industry. this concept of contributed to come unhappy heard this example today of the exchange at least in one state. to me that is the future of

david in health care. the third is using longitudinal, so demographic data over time can be highly useful in predicting patient risk and assessing someone's likelihood of adhering communication protocols. and the last is use the content in your systems. world is not perfect. there's lots of data that leveraging the content and standardized that content will lead i hope, we hope, to improving patient outcomes. thank you for listening. [applause] >> thank you, lee. the power of data seems limitless. it's good to hear how can be harnessed for improvements in patient care. not just a quick reminder to please join us tomorrow morning at 7:30 a.m. for breakfast right back to industry. there will be several roundtable discussions on topics such as managing the transition to risk-based payments and

effective outreach after patient discharge. your program lists the very many topics. our breakout sessions fall at 8:45 a.m. and i'm it will be hard to fit which was to produce i suggest you review your programs touched the cup again plan and remember our special keynote luncheon tomorrow at 12:15 p.m. featuring athena health and microsoft. you don't want to miss a. and now join us all in the lobby for our welcoming reception. thank you, and i will see you there. [applause] [inaudible conversations] [inaudible conversations]

>> coming up at 5 p.m. eastern here on c-span2 a conversation on whether libertarians should vote. scholars from the libertarian leaning think tank, the cato institute will discuss whether libertarians should vote their conscience, vote strategically, or not bother to vote at all. that discussion gets away shortly 5 p.m. eastern lie there on c-span2. right now it's a look at the state of the presidential race in north carolina. >> chirla observer.com this is the headline. campaigns converge on north carolina in the final week

before election day. joining us on the phone from charlotte is jim morrill a reporter for the charlotte observer. thanks very much for being with us. white house kill line become such a battleground state? >> guest: it's really turned from a red state over the years to a purple state and part of that is due to demographic changes. he got a lot of people moving down from the northeast and a lot of millennials moving to urban areas like charlotte and raleigh and the triangle. and it's just the politics have become more moderate i guess. used 11 urban-rural divide with a lot of the old jesse kratz, people used to vote for jesse helms, used to be democrats are not republicans and a lot of them in rural areas and in the urban areas are pretty blue just like across the country. >> host: with the president making two visits to the state this week, donald trump back in north killing on thursday. what is the message and you would be appealing to?

>> guest: well, i think donald trump is appealing to the people that he has to appeal to that most of his rallies but, in fact, he's having a rally in rural come a rural area near charlotte that is in the same arena where is already had one rally this year. he's going back to his stronghold which is rural north carolina, again is those jesse kratz turned republicans. who are the base of his support. president obama's going to chapel hill which is in the heart of the triangle which is a college town. a lot of young people there, young voters. he's also going to fayetteville and charlotte fayetteville also has some college presidents and, of course, a military presence and and large african-american presence in charlotte. we don't know what the venues are yet but this is a big urban area with a lot of that he cared by 1000 votes four years ago. >> host: what do you think

about the overall turnout in north carolina? >> guest: turnout is high. there's about 10 million people have already voted. the people that look at this stuff expected there to be about 60% of the voters of the overall voters voting early either by absentee ballot or in person early voting. and so what the patterns are showing us so far is democrats are a little under their 2012 performers, republicans are livid over the 2012 performance. and independence, unaffiliated voters, are up like a third of from what they were in 2012. so i don't think anybody is quite sure what that means uzbek jim morrill, based on all the analysis we've been following with regard to the electoral college, the general sentiment seems be kill line is a state hillary clinton would very much like to win. for donald trump it's a must win state your do you agree with that? >> guest: that's been the conventional wisdom. if clinton wins it's really a

flip of 30 electoral votes, right? 15 that she would have gotten and 15 that he would not have gotten, which could be significant. although lately you hearing that is the path to victory. maybe it's not as important, but we like to think it is and he certainly be a lot, both candidates and their vice presidential nominees have been all over north carolina. so it's been a really busy year for all of us. >> host: north carolina voters making a lot of choices not only for president bush of a hot -- a hotly contested governor's race and the senate race. >> guest: death. nobody respected the senate race to be that competitive at the beginning because in the kratz a couple democrats who were more prominent turned down the race, and deborah ross who was kind of a little-known legislator from

raleigh became the nominee. she's run a strong race and it's pretty competitive, a lot of polls show up within the margin of error. we had a poll last week they came out children within two points of richard burr, senator byrd the republican. we have a very competitive gubernatorial. >> host: give us a sense of the demographics of north carolina. when the returns are coming in, what will you be looking for to determine trends on the presidential level but also in the closely watched statewide races? >> guest: i think i would be looking for turnout figures in the urban areas in wake and mecklenburg county, raleigh and charlotte as well as winston-salem area and queensboro, and also the world l returns to see what the turnout is in those areas which is trump country. i think those are the areas and in the suburbs, too. the suburbs are tending to be more blue than they normally are. that would be a bad sign for trump.

with a lot about suburban women, so suburbs will be an area to watch post we look for your reporting online at charlotte observer.com. jim morrill was a political writer and reporter for the sharp observer, thank you very much for being with us. >> guest: my pleasure. thank you, steve. >> c-span's "washington journal" live every day with news and policies used that, in fact, you. coming up thursday morning, republican campaign and election lawyers and christopher clark, president and executive director of the lawyers' committee for civil rights under law will join us to discuss the integrity of this year's voting process, the topics rig the voting systems, oubowed out at the booth and vor id issues. ..

>> >> why is there some government rather than no government? for some us tonight we will ask about a very specific act of the policy which is neatly voting. to say yes libertarians