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Brainstorm Health 2024

D.A. Wallach, Recording Artist; Co-founder and General Partner, Time BioVentures

Brainstorm Health 2024: Lessons from the Music Industry

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Well, thank you very much. It's great to be here following an actual death panel. And um as you heard in my introduction, I'm a bit of an odd duck. Um I run a biotech and health care venture fund in L A called Time Bio Ventures, but this was my previous life. And as you can tell from this photo, uh you should take everything I say today with a grain of salt. I want to talk a little bit about the parallels between the lessons we've learned in the music industry and what I perhaps see uh on the horizon for the healthcare sector. And when I was in college and got my first record deal, we entered the industry at a remarkable time when things were in total freefall. So what you see in this graph here is us, recorded music revenue over time starting from about 1970 the peak is the absolute bonanza of an era that the nineties were as the recorded music industry resold the entire history of music uh on compact discs, people were just rolling in cash. And when we got our first record deal in 2007 this freefall had been catalyzed by the advent of Napster and then youtube and with it, the erosion of consumer spending on recorded music. So you probably remember these record stores, they were progressively going out of business at this time. And a couple of years after we entered the industry, I had the good fortune of meeting the founders of Spotify. And when I saw their product, I was just completely blown away by the potential that I saw in it to get people paying for music. Again, it was such a compelling product that you could imagine consumers going from free music to something uh for which they would pay a monthly subscription. And that's exactly what happened. The old music supply chain was I think to a lot of folks at that time, clearly anachronistic and you'll remember these days, it was basically this very clunky intermediate system to get content to consumers. So you'd go into a brick and mortar record store and you'd sort of prostrate in front of Grand Wizard of music who would query their huge brain for all of the history of records. And they'd recommend to you just the perfect record to get in this example, the Jimi Hendrix experience. And that record typically would have come through one of just a few record labels like capital or Sony that were basically the sole distribution channel through which artists could get their content into their fan base. And Spotify succeeded by dramatically simplifying that connection between consumers and content. And it put all consumers on an equal footing such that they could access the same catalog of music globally for a very low monthly price. And here's the end of that story or at least up until today, what's happened with streaming, which is depicted in green here, consumers started to pay and revive the industry. Health care in some ways has the exact opposite problem, which is that we're spending too much and the amount that we're spending is growing too fast. And most of that spending is on our hospital centric business model. So as you can see from this breakdown of the 4.5 trillion we're spending in the US per year, something between 70 80% of it is basically going to human mediated health care services, be it in hospitals or brick and mortar clinics. And this model, as I see, it is really trapped in an 18th and 19th century factory paradigm where the concept is basically get a bunch of big brains into big buildings and you'll realize production efficiencies. And we have similar issues in education with large universities and in criminal justice. These are all a paradigms that originated in the 18th and 19th century and they're all in certain similar ways failing us today that fits into a supply chain. It might be a little bit of a stretch. But I think it's actually reminiscent of the music industry supply chain that I described previously. Instead of going into a record store, you go into a hospital or a clinic and you're seen by a physician who queries their huge brain which has been stuffed full of information, the whole corpus of medical knowledge. And they will try and identify for you the perfect intervention. And if that happens to be a drug as here, that drug will have come from one of a few large pharmaceutical companies like pfizer, which similar to the record labels are essentially now the distributors for those who really create new medicines, which are the small and mid size biotech companies. And so the question I want to raise is whether we should do to these and please forgive me when I was putting these together. I did not know that Johns Hopkins or CV S were sponsors of this great event. Nothing against either of them. I think they're fantastic organizations just a little bit dated. And so I wonder if we should do to these, what we did to these and if we do, what would the equivalent of Spotify even be, what would streaming medicine be? What I propose? Is that what we need to build? And this includes A I and a lot of the other technologies that people have been talking about today. And yesterday is a single global catalog containing all medical knowledge, all diagnostics, all interventions and all medical reasoning. Essentially the super A I of medicine in the cloud to which people can connect from anywhere in the world and connect to the exact same knowledge just like today. They connect to the same music catalog through Spotify or the same film and TV catalog through services like Netflix. My belief is that this type of knowledge centralization is actually the only way to make medicine modern and I would define modern medicine as evidence-based. I don't see why we should distinguish between medicine and evidence-based medicine. I don't think anyone goes to the hospital looking for non evidence based medicine. It should be personalized with validated algorithms that are universally applicable to patients. Uh everywhere in the world, it should always be up to date. So the standard of care that someone gets in Botswana should be exactly the same that they get in Los Angeles or New York. Uh We should be honest that if we're not giving people the same high quality care everywhere, we're doing that because they're poor, not because they deserve a different standard of care and it should be geography and income invariant again, the same medicine no matter where you are, no matter who you are with that type of centralization of knowledge. I believe we can actually decentralize the care itself. So on the one hand, centralize the information out of hospitals, sort of evaporated it into the cloud and then push down care into the community through decentralized delivery. And I've chosen the village people here, not because I think they should be your doctor, but just to make the point that perhaps people who today have different jobs even outside of health care in the future, when paired with this type of technology streaming medicine could end up being superior as a way of delivering care to even super doctors like house. And so I think in the future, we're going to marvel at the fact that you had to be a genius to be a doctor in the past. I actually think that's a moral imperative because lowering the barriers to medical competence is the only way that we can possibly scale up high quality care globally. What you see here is that the darker countries are those with a higher density of physicians per capita in the US. It's about three doctors per 1000 when you get into countries like Madagascar. Uh it's less than 1/10 of a doctor per 1000 people. So we're not going to fix that by manufacturing doctors in our current paradigm, it's just impossible. I would propose that maybe the doctor of the future is more like an accountant. It's a highly trained specialized person, but not necessarily someone who is educated for 15 or 20 years. And I think there are a million potential configurations of how those sorts of professionals could fit into something like streaming medicine to deliver better care. But this is just one kind of spitball idea. I came up with, imagine that patients get a voucher to spend on choosing a sort of primary care navigator and then hire this person. This is again like the sort of health care accountant character and they're paid directly by this voucher, not by insurance. So take primary care out of insurance, put them entirely on the side of the patient. And then this team, the patient, their care professional working with streaming medicine can navigate the system and choose the best products and services to cure them and then align cost savings with patients, let them capture the savings that they generate by navigating their own care in a thoughtful and cost effective way. Again, apologies to CVS and Johns Hopkins. But a couple of weeks ago, we learned Wal Mart is not going to save us. And I don't think that this is a particularly exciting future either. I would be shocked if 100 years from now, the way we're doing medicine is in minute clinics and huge buildings. And fortunately in my day job, we get to see amazing entrepreneurs coming up with all the little seeds of this future that I'm outline and we're not investors in all or even most of these companies, but I think they're really promising. And I would invite any of you who are working on this, who sort of believe in blowing up the system and starting from a blank sheet of paper to reach out to us. We're super excited to engage in entrepreneurs who are thinking really big and I appreciate your time. Thank you.

Rosie Acosta, Mindfulness and Meditation Teacher, Headspace

Brainstorm Health 2024: Meditation Moment

Hi, everyone. Welcome. It's so nice to be here. I've learned so much even just being here for a couple of hours and I'm so honored to be here. It's so important for us to be able to take a moment in our day to reset, to recalibrate, to come back into our body and our breath. And so I would love to guide you through a short practice so that we can do just that um you know, our bodies, we're just having this conversation with one of my colleagues right outside and we're talking about all the information that we get put in right where there's so much constant barrage of information we're trying to process and our body has the opportunity to digest our mind needs that same type of experience, right? So we don't have those opportunities or those moments where we let our mind just be bored, right? Because we're constantly, you know, one thing to the next. And so I'd like us to take this moment to just arrive here and reset. So find a comfortable position. Sit up nice and tall. My teacher always says the straighter, the spine, the calmer, the mind whether that's true or not. I don't know, but we'll find out. So, instead of nice and tall, have your palms facing or on your lap if that's comfortable or any other position and together, let's take a big deep breath into the nose, open your mouth. Exhale. Ok, we'll do that again two more times. Deep breath in, open your mouth. Exhale good one more time, deep breath in deep, deep breath, as deep as you can slight, hold at the top, open your mouth. Exhale good. If it's comfortable for you, perhaps you can close your eyes together. We arrive to this present moment, just observing what is present, bring your attention and awareness to whatever is supporting you in this moment. Notice the chair underneath you the ground that's holding the chair, bring your attention to your legs and just have the intention to relax, bring your awareness to your lower back, relax your stomach, your chest, relax your shoulders, your arms, your hands, relax the back of your neck, the muscles of your face, relax your throat, begin to bring your attention and your awareness to your mind. Notice the busyness of thought, the fluctuation of thought. Just notice without judgment, just noticing. Now, I want you to begin to imagine your thoughts like slow moving clouds in the sky. Perhaps observing these clouds begin to slow down. And as they slow down, your mind begins to quiet, sometimes the most important thing in the day. Is the moment you have between breaths. Notice your body, notice your breath continue to relax your throat, your shoulders together, take a big deep breath in nice long exhale. And when you're ready, gently lower your chin, blink your eyes open, come back to the space and just notice if there is a shift. So always say this to people. I know that's brief, but it really only takes about three minutes for your mind, your brain to actually start to feel the benefits of a meditation practice. We have 1440 minutes in a day and we can find at least three minutes in those to practice. Thank you so much for letting me share that with you.

Dr. Helen Egger, Co-founder and Chief Medical and Scientific Officer, Little Otter  Kristina Saffran, Co-founder and CEO, Equip  Zoe Tait, Vice President, National Student Advisory Committee, Active Minds Solome Tibebu, Founder and CEO, Behavioral Health Tech Moderator: Alexa Mikhail, Fortune

Brainstorm Health 2024: Youth and Mental Health

Dr. Helen Egger,  Little Otter, Kristina Saffran, Equip, Zoe Tait, National Student Advisory Committee, Active Minds Solome Tibebu, Behavioral Health Tech, Alexa Mikhail, Fortune

Lisa Pahl, Licensed Clinical Social Worker; Co-creator, The Death Deck Dr. Shoshana Ungerleider, Founder, End Well; Host and Producer, TED Health Darnell Lamont Walker, Death Doula; Filmmaker; Emmy-nominated Children’s Television Writer Moderator: Jennifer Fields, FORTUNE

Brainstorm Health 2024: A Better End of Life

Lisa Pahl, The Death Deck, Dr. Shoshana Ungerleider, End Well; TED Health Darnell Lamont Walker, Death Doula; Emmy-nominated Children’s Television Writer, Jennifer Fields, FORTUNE

Doctor Anger Leer. I wanna start with you. We're talking about transforming the way that we talk about death. But can you talk a little bit about what it's like to die in America today? Yeah, thank you, Jennifer. You know, I would go as far to say uh that dying in America today is a public health crisis. Um 80% of people wish to die at home, around 30% actually do. The rest are dying in hospitals uh in other institutions, 60% of people are are dying in pain. Um Our health care system um favors aggressive invasive treatment um for people of all ages and all medical conditions even if it won't help them. Um And this is very expensive care and how it plays out for people is it creates a lot of needless suffering for patients and their families in and around the end of life. And we could be doing a whole lot more to encourage upstream conversation so that the care that people get is care that they really want. They really understand. I think truly honors the life that they've lived. So a lot of the work that we do end well is trying to change that cultural conversation. We know that um doctors in general really fear death. Um How can we allow uh more conversation about mortality to let us all live better every day? Um How can we create interdisciplinary solutions so that uh dying? Uh so that caregiving, so that grief is a little less hard for people. And then the third thing that we really focus on is trying to uh shift media portrayal of death and dying, which we know on film and television is inaccurate to try to include things like medical aid and dying to tell more nuanced stories of patient centered care around end of life. The way that things really should be psychedelic assisted therapy, death duel is all the things that hopefully we'll get to talk about today. And so I, I know that we can be doing a lot better and turn out you are a Du Doas. And when we think about doulas, we think about um someone who's assisting at the birth of a child. Um Can you tell us a little bit about what you do? Yeah, absolutely. I, you know, just talking about birth, everyone knows what a birth duel is. And so, you know, as a, as a joke, usually when people ask, I say well, birth doas bring them in, I take them out um which essentially is what it is. But I'm there as a support. Um I'm there to make sure they get the good death, the death they want. Um you know, everyone wants to die with dignity. I'm there to, to support that there, to support the families through grief. Um And just make sure that the person doesn't die alone. I, I started in this business because I didn't want people to die alone. And um I, I get to be there holding their hands through that process, advocating for them in the hospital in the medical system. Um And a lot of my work I do in uh black communities and so advocating in the medical system is a, is a huge part of the work. Um But all of that, it's a, it's a huge support system and sometimes there is no family. I get to be the family. I get to be the support, the advocates um and making sure that good death or as close to that um happens. And Lisa, you do a little bit of work in medical aid and dying and it's probably a topic that gets a lot of the focus of conversations around reframing death. But I'm hoping you can tell us a little bit about what it actually is and what it means, what it looks like. Sure. So I work in hospice as a social worker and in that space, I help people similar to Darnell. Um I'm part of the interdisciplinary team and sometimes we also involve Doulos as part of that. Um And through my work supporting people. What I witness are these beautiful loving deaths. And then I also witness a lot of pain and suffering and fear and anxiety about what's to come. And so in 11 regions or 10 states and DC, uh medical aid and dying is legal. And what that means is a person who is terminally ill has six months or less to live is competent to make their own decisions and can ingest the medication themselves. They are allowed to control the matter and time of their death. And I've had the privilege of attending a lot of those deaths. And what's really beautiful about those experiences is that we're all talking about the fact that the person is dying. And for me, that's what I see as lacking the most in our culture is we're just not talking about it. And when someone talks about, even if they're exploring the option of medical aid and dying, it means we're talking about what they want in their death, what they want in their life. And a third of people who obtain the prescription, they don't even take it. And so we know that people get relief and reduction of anxiety when they just have access to the medication. Doctor Ar sorry, Doctor Unger Leiter, you mentioned uh just a moment ago, psychedelics that I know that there's been a lot of innovation around um the other uses for psychedelics besides um recreation. Can you talk a little bit about what you were thinking, this is gonna bring to the end of life experience. Well, I can certainly tell you what I hope will happen. Um I think it's important to set the stage in that. Uh currently uh psychedelics are not legal except for two states, Oregon and Colorado. Uh We do expect sometime in the next 2012 to 24 months that FDA will uh legalize MD MA, which is also known as ecstasy um for PTSD, but currently only those two states it's legal. Um But I will say that, you know, for next now, 60 years, we have really solid data showing that people facing the end of their lives, often, not always, but, but pretty often have existential distress when they become more proximate to the end of their lives. And in medicine, we don't really have good tools for helping people through that. The medicines that we do have. Benzodiazepines, opiates really blunt the senses and don't allow people to live fully until they die. And so the idea with psychedelics and what the data has shown that, for example, one treatment uh with a trained therapist um of psilocybin, um which is the active component in magic mushrooms um has a very long lasting effect up to six months of relief of some of that dread and anxiety. Uh Many people who've gone through this experience have said that it's the most powerful day and most meaningful experience of their lives. So there is something that happens as a result of this medicine, of the intention setting of the integration therapy that happens afterwards, which is also a really big part of it. It's not just popping medicine and then tripping, it's, you know, much, much more um and done in a very rigorous clinical and at least in the clinical trials. Um So I think there is promise and I hope that we as a health care system, as a society see this as something uh that's really important for everyone to get access to. In addition to all the other indications for mental health for which psychedelics are shown to be safe and effective. I should have also mentioned that the safety and efficacy piece are there as well for dying people? Um I'm gonna look out for questions if anyone has anything, just raise your hand and Mike will come to you. Um But first Darnell, I want to ask, what is the impact of your work on the families of people who are dying? Does it impact their mental health? Does it impact their grief? What have you seen? Yeah, absolutely. Um One of the first things I do when I, when I come to a client is how they want to die. Um And this is a question most family members don't ask the person who's actively dying. Um So it, it gives them a sense of, oh, it helps ease that. Uh that question that they were all that they were afraid to ask. Um, it lightens the grief. It doesn't get rid of the grief. You know, we can't cure grief. Grief is gonna happen. Um, but it lightens the grief when they know when they, when they questions that they had, when those questions are answered. And I'm able to help facilitate that when I'm able to help facilitate closure on, um, so many levels able to help them in the me, uh you know, talk to doctors um make advanced directives, you know, uh figure out who the proxy is gonna be. These are things that family, you know, a lot of times when someone is diagnosed, people don't know what they need right away. And so I'm there to say, OK, this is everything you need. And so it, it takes a huge weight off of their shoulder. Um and it, you know, I, I don't mind, I'm sorry, I don't mind taking that and, and saying, listen, this is what we have to do. Um when you have time, this is what we have to do. And then I'm, I'm a writer full time. Um and I'm, I'm able to bring that into my work as a death dealer and say, listen, let's tell your story. And so then when the person dies, we have all of these things that some people don't get, you know, in the end, um I'm able to craft, you know, this is what this is what I wanted as a as a kid. These were my favorite memories. This is uh these were my best friends, whatever that is, uh which also comes with the death, the death deck, which is an amazing tool um that I, you know, I able to use as well with some clients. And um so yeah, it, it helps ease that pain and the suffering for the families. Also, I want to turn to the audience. Does anyone have a question? We have it right here. I would just ask that you keep your questions brief and focused and definitely have a question in there. Thank you, Seita Finney with Bayer Consumer Health. Um This is probably best directed to Darnell and purely selfish question for all of us with aging parents, which is probably many of us in the room. What is the best way to have the conversation about? How would you like to die before it's an imminent event? It's a thing. Yeah. Um the siblings to uh go in uh a lot of people don't, you know, to be an effective listener. I, I think, you know, we, we say it but all of us, we aren't, we aren't bad, you know, and to just go in and listen and, and ask the question, I, I come straight out and ask, I come into the room and I just say, how do you want to die? And you know, some people are a little shaky on that at first, but it will start the conversation and, you know, if that's the one they, they don't want to answer, then there may be a softer one that they'll introduce and say, well, I don't know. But this, you know, um, so just go in and just say, listen, I'm, I'm here to listen or talk about you, you know, go in and say, well, this is what I want. This is how I wanna die. And then as you're talking about it, they'll see, you know, it may soften them up to the conversation as well. Can I, can I add a couple of things? Um This is one of my favorite topics is how to have these difficult conversations. And so, you know, we can use media as Sohana was saying, we, there are films, there are podcasts, there is some great storytelling that I was even, you know, part of to be able to use those moments in the film. You know, my mom and I watched this is us. And so, you know, after the episode where they're talking about the advanced directive, I called her up and she had a lot of thoughts and so we have to be creative. Um And then I, I created a game called The Death Deck to help people have these conversations as well. Um So there's a lot of tools out there and um I think we just have to be brave and willing and less denial about the fact that we're all gonna die. And these don't have to be like sad, scary conversations either. It can be an intense set of subjects, especially if the person is already ill. Um But it's really a way if you think about it of like getting to know your loved one better. So approach it with that, that kind of love and curiosity of, I want to know more about you as a person and honor you throughout your life. This is such great advice. We have another question. My name is Tara Bain. I'm with the 100 top hospital program. Prior to doing that, I actually practiced as a nurse and was a hospice nurse and had the privilege of being with people um as they died, which is, it is a true privilege. I'm just curious, Darnell, how do you fit in with hospice? Like, are you totally separate? Because a lot of what you were describing is what I saw when I practiced as a hospice nurse. I think it's really cool what you're doing. I just kind of curious how that all fits. No, absolutely. I, you know, I, I've worked not for a hospice but I've been in hospice there. Uh clients who will call who are in hospice and honestly, the work that I do, I've seen hospice workers do hospice nurses. I've seen people who don't even know what death dealers are. I, I started in this work because my grandmother was a caretaker. She's never heard the term death dealer, but she did everything that I've been doing. You know, I think we've all done the work on some level. Um, but being in the hospice, I, I couldn't tell you what the difference is between what I do and what so many people in the hospice, uh, in, in hospice do. It's an amazing, it is an amazing thing to see. Um, and I, I think, like I said, I think we've all done the work. We've all been there for someone. We've all held someone's hand, we've all held space for someone. Um, you know, even just going and taking the plate over to a sick neighbor, you know, whatever that is. I think we've all done it. We have one more question over here. Hi, I'm a Aris Lazin with Stanford medicine. Um, really important topic that you're addressing today. One of the things I've been thinking about is, you know, knowing the loneliness epidemic that's currently, you know, that we're all dealing with the United States. How does that play in sort of end of life conversations or decision making? Knowing that often people who are at that stage are hopefully counting on family networks and others to support them through something like this. How are you kind of thinking about that challenge? Mhm. I mean, it's, it is a huge challenge, right? We know that most, you know, family members, younger family members don't live anywhere near, you know, their elders. Um And so thinking about who will, I think the question as well? Like who will care for you in those final, you know, days, weeks, moments of life. Um I don't know that we have, you know, major solutions. I think this is something that we need to be talking about as society, right? So how we care for people through illness and through death is how we really should be measuring ourselves as, as a, as a society, we need to do better. Um I do think that we'd be remiss to not talk about the field of palliative care in general. Such that, you know, if someone is in the hospital, I know, you know, this um you know, having a team inclusive of a social worker, physic and a nurse um and a case manager thinking about these bigger questions about the, the logistics and the practicalities of care. But in reality, this is uh a major one and I think, you know, the the field of death doulas while it's been around for, you know, probably thousands, right? Since the beginning of time, it's now called death doula. They are filling a need um filling a gap where I, I just lost my father this last year. Um you know, as somebody who's an expert in this space, I was texting a death Doula friend of mine to get advice because I myself you know, wasn't even well as well equipped as I wanted to be um caring for my father who was dying. So there, there's there are many, many gaps. Um isolation and loneliness uh is, is a huge uh part of that conversation. And I think we also have to just be educating people more about hospice and palliative care and end of life op options. Because uh hospice and palliative care do include that social worker who is skilled at finding resources and helping people with caregiving issues, enlisting the help of friends and family um referrals for death to us when that's appropriate too. So really the education to let people know that these services are available um I think is the most important thing we can be doing. Turn on. Do you have anything to add? Um No, II I would just like to say, I think it's very important you brought up just having those conversations, like those difficult conversations. I think that's what's gonna uh drive us a little bit further and um and really find out, you know, like, yeah, we aren't that close to some people but um having those conversations, you know, how, where do you wanna be? Do you wanna be here? Uh How do you wanna die? You know, um is a great way into a lot of that. A lot of the questions you all may have uh can be answered by just asking that that first question. Uh how do you wanna die and just not being afraid of it. I'm not running from it. And I think those conversations are what give us confidence to make decisions for our family members too. You know, because people are really scared to make decisions on behalf of their family member. And if you have these conversations, you can feel more confident in doing. So. Thank you so much. You really are contributing to a, a big conversation that people are having already, but you're really working so hard to change the stigma around that. So I thank you so much. Thank you for your being here and for this conversation. Thank you.

Dr. Christina Harris, Vice President and Chief Health Equity Officer, Cedars-Sinai Medical Center Leslie Schrock, Author, Bumpin': The Modern Guide to Pregnancy; Fertility Rules; Investor; Advisor, Maven Clinic, Alife, Origin, Reverence Dr. Alice Zheng, Principal, RH Capital  Moderator: Deena Shakir, Lux Capital

Brainstorm Health 2024: The State of Postpartum Care

Dr. Christina Harris, Vice President and Chief Health Equity Officer, Cedars-Sinai Medical Center Leslie Schrock, Author, Bumpin': The Modern Guide to Pregnancy; Fertility Rules; Investor; Advisor, Maven Clinic, Alife, Origin, Reverence Dr. Alice Zheng, Principal, RH Capital  Moderator:Deena Shakir, Lux Capital

Dr. Christina Harris, Cedars-Sinai Medical Center, Leslie Schrock, Bumpin': The Modern Guide to Pregnancy; Fertility Rules; Maven Clinic, Alife, Origin, Reverence, Dr. Alice Zheng, RH Capital, Deena Shakir, Lux Capital

Dr. Christina Harris, Cedars-Sinai Medical Center, Leslie Schrock, Bumpin': The Modern Guide to Pregnancy; Fertility Rules; Maven Clinic, Alife, Origin, Reverence, Dr. Alice Zheng, RH Capital

Hello, everyone. So happy to be here again. You know, last year when we had a discussion on maternal health, it was a special moment for me because I announced my pregnancy on stage and here I am postpartum for the postpartum care panel. So thank you all for joining me today. It's such an important conversation and we have an incredible group of women here uh to address it. So I wanna start with my good friend Leslie, who is known for many things, including two best selling books, one on fertility called Fertility Rules, and one on Pregnancy called Bump In. But we're here today to talk about neither of those things we're here to talk about the thing that comes afterwards, which is postpartum. So talk to me about perhaps what might be your next book? What does Postpartum mean in the context of this conversation? Well, so I'm actually really fortunate I am updating Bump In currently. So it's coming out in its second edition in January and it was published five years ago and I'm really sorry to say that not that much has changed in five years. 80% of maternal mortality is avoidable. And that stat has stood for the five years that I have been writing about this topic. Thinking about this topic. It became very clear to me in revisiting this material that the big gap actually was for most people, what happens in the postpartum period? The unfortunate surprises we all encounter weird hair stuff, you know, sweating incontinence, all of that. But also, um I really, I know you've never talked about this publicly, but I actually revised my book um to reflect an experience that, that Dina had that she's never really spoken about. Um But do you wanna? Sure. Well, I guess the moderator is gonna spend a few minutes talking um, about an experience that happened to me. So I just had my third child. Um, and uh eight days postpartum um was back in the hospital with severe postpartum preeclampsia. Um and almost didn't make it. Um So as someone who, you know, lives and breathes health care, we're here today in the bastion of privilege with access to, you know, many Obgyns on speed dial when I was admitted to the hospital, I was told I was minutes away from having stroked out and having had absolutely no pre existing conditions that would have contributed to that. And if I wasn't someone who lived and breathed health care who recognized those signs, um I wouldn't have made it. Um And so for me, that was just another moment that makes us realize why, what we do is so important. And also, you know, just how many people who don't have those access and don't have those resources are at risk and how much of maternal mortality actually happens postpartum. Um So with that, I, I wanna turn it to you Christina to talk about a topic. Last year, we had a whole panel on the Black maternal health crisis. I don't think enough has improved. It's still a critical topic where black women in America are 3 to 4 times more likely to die in childbirth. And afterwards, uh tell us a bit about some of the work that, that you're doing in the health equity space to address these challenges, particularly in the context of postpartum. Thank you for sharing your story. I think about, you know, situations like this all the time as the only physician in my family and feeling these calls for my friends. And I think how lucky, you know, we are to have me and my family and to be able to answer these questions, but so many women don't. Um And for, you know, one statistic that I think is very important as we think about um the, the challenges that we're facing in the black equity space is the fact that 40% at least 40% of our births in this country are to win in with Medicaid. That's astonishing if you are a black woman, that's 65%. So in our, in my role at J Cedar Sinai. I think a lot about access to care. I think a lot about the innovative things that we'll hear about later and that we're producing to help close this gap. And I think is this gonna be available to the women that need it most? You know, when you really think about these inequities, unfortunately, we are in America, it follows socio economic lines. And if we're not thinking about how we meet the needs of those who don't have access and don't have the means and don't have the education, then we're really gonna miss the mark. Absolutely. Well, you alluded to some innovations in this space and uh we've got a fellow VC here on the panel, Alice who uh invests with a fund that focuses specifically on women's health. And I know, I think a third of those investments are in maternal health. So tell us a little bit, give us some bright spots, some, some things to look forward to. What are some of the innovations that you're seeing in the areas you're excited about investing in and particularly in the, in the postpartum space? Sure. Yeah, you know, we've made over 20 investments and indeed, one third of that is in maternal health and there's different solutions to different parts of the problem. So we have a couple of companies that are in devices um for delivery as well as prenatal monitoring in terms of postpartum care. Four of our companies are delivering some type of care um around that period. Um This includes virtual mental health care, like virtual therapy as well as um do support um attorney Navigators. And actually I'll call out one company in particular called Milly. And we're excited about this company because they have postpartum care that I've actually never seen anywhere else. Um So they actually have a midwife or a model and you get a visit in your home within a few days of discharge from the hospital, another visit two or three weeks later, and this is all before the six week visit, which is all you get in the US and most women, a lot of women actually miss that visit. Um And we know that this matters because over half of paternal deaths actually occur between seven days out up to a year. And another course are actually occur in that period if you add in delivery through the first seven days. So the post random period is really critical to the maternal health experience. And that's why the fund we look at that. Um quite closely. One last comment I'll make in terms of Medicaid is that's a huge part of our investment strategy as well. So all four care delivery companies actually accept Medicaid, one of them actually has an exclusive Medicaid strategy and there are some investors who might ask, how could you make that work, but you can make it work financially and you'd be missing half the market if you don't do that. So, um anyone who's following election knows that women's health has actually made it to the top of the agenda um for, for the US election in many ways and, and related to that, there have been efforts by the current administration to address not only the maternal mortality uh crisis that we have in this country, but also the gap in women's health research, Leslie. I know you've been involved in some of these efforts coming out of the White House. Could you share a little bit about the, the plans coming out of these discussions? Absolutely. I don't think that the core problems are unknown at this point. I don't think anyone uh can say with a straight face that we don't all know that paid leave is a necessary part of the solution and extending the hours, one can access care, which is so critical, especially in the populations. We're talking about, you know, if you can only do it 9 to 5 and you're a shift worker. How are you supposed to access prenatal care? Um So I was actually very fortunate to be part of the maternal mental health task force that HHS and Os and a lot of other various acronyms within government are putting together and we just put out a report to Congress um actually last week and many of the solutions are things that we know. Right. It's, it is paid leave it's better access to a more diverse set of, you know, providers. It's providers that look like the patients themselves. It's increased access to midwives, doulas, all of those. Um But I am actually really excited about the ARPA H as well, the real commitment to research in these areas because the sad truth of it is, you know, as, as we just heard from Dina, we don't even know what causes postpartum preeclampsia. We don't really know what causes prenatal preeclampsia, which by the way, I also had at 38 weeks, I had preeclampsia and help syndrome with my, with my second son. No one really understood why they're either. So I think that, you know, we know that as women go into pregnancy, they're unhealthier than ever. They have more chronic conditions, comorbidities, things that really cause these complications to, you know, be more likely, but we still don't actually know. So, um Arpa, I think it's like $65 million that's been earmarked for women's health research. Uh They tried to make the grant process easier for companies which as we know is a very big barrier for many of these start ups that have very limited resources. Um But to anyone who's building in this space, you know, as someone who's been working in it for a long time, I would really encourage you to take policy seriously. There is only so much that we in the private sector can do without working with government. And there is a real willingness among folks in government right now to work together with the private sector. And if you want to know who those people are, come find me afterwards. I'm happy to connect you. But I would encourage you to have someone on your team who actually is, you know, understands that world because that's the only way anything is really going to change. I just gonna say like, just thank you so much for sharing. It's really an incredible time to be in medicine and thinking about this space for so long. I mean, I'm a physician and in some ways medicine looks very similar than it did a very long time ago. Um But, you know, as I think about health equity, it's truly just patient centered care, like giving people what they need and everybody needs something a little different. Somebody might need a doula, maybe I don't need a doula and we're asking different questions and we're looking at our data differently to understand the differences that are inherent between us and make a difference in our outcomes. Um And then we're taking the opportunity to innovate on that. Um And so I agree, getting involved from a policy standpoint is amazing. Um And so so necessary and, you know, really thinking about how are we designing to solve these very intractable problems? And I'm thinking about health inequities that if it was a simple solution, we would have been done it, it takes everybody in this room to think about something differently and think about how we're designing for everybody um and allowing access um innovations through payer diversity, racial and ethnic diversity and how we're getting it out to the people. Jumping on the policy. I do feel like in this country, it's a tale of two cities. On one hand, you have the White House jumping all in. It's amazing. There's a Arpa Age grant, there's the executive order for women's health. Um Jill Biden is going around to lots of events, speaking about it. And that's incredible. We've never had an administration have this much interest in women's health. On the other hand, women's rights are being rolled back on a number of geographies and, you know, as investors, the way we think about it is no matter what side of the debate you're on. Um in terms of um women's others, reproductive rights, um It's gonna have a huge impact on maternal health. Uh We need to prevent more pregnancies, we need to treat pregnant women better because there will be more of them. Um No matter what going back to, you know, some of the data around maternal mortality, what would you identify as the primary driver in uh in a, in a country where we have so much technology, we have advancements. Certainly there are policy um regresses as well as progresses that have been made. Why is it that maternal mortality has only actually gotten worse. I think we have to think about how we as a country support our women or maybe how we don't support our women. How do we meet the mental health needs? Unfortunately, mental health and substance abuse is one of the largest drivers of mortality. I don't know if anyone has tried to find a therapist or psychiatrist lately. I have a commercial pp, it is not easy. Right. And so for those patients that I care for that have Medicaid, it's virtually impossible. Um And that's a problem because what we know what happens when mental health and substance abuse goes unchecked and then you throw in a newborn baby, I mean, it's literally a recipe for disaster. Um And so, I mean, that's, we have to do things differently. It's I've spoken to thousands of women in the last five years, thousands of pregnant women, postpartum women, women, I, I'm, you know, going through fertility journeys and what's very clear is we not only don't know the basics of our own bodies. We also don't know how to know if something is wrong. You know, you knew that you felt off, you knew you had a headache that wasn't going away and you had the wherewithal to reach out to people and to say, I don't know if this is right for so many women who end up, you know, dying pum because of preeclampsia or something else, they don't even know what to look for, they pass it off as, oh, I'm just tired because the baby's not sleeping and whatever I'm supposed to feel weird because, you know, I'm postpartum and that is simply unacceptable. I had to, one of the decisions I had to make as a writer, everybody wants a pregnancy book. What to expect when you're expecting his soul has been in like the top 100 on Amazon for a million years. And there's a good reason why every pregnant woman wants a book. So when I revisited this content, I had a decision to make. How scary do I wanna be in this book? And I have received notes from readers over the years who have told me actually, like you saying this thing about miscarriage has really like changed my life, you writing about your experience openly. And I have to say like Dina, when you went through what you did, I made a decision. I actually like lovingly referred. It's the Dina page. I had to make a decision and say, well, you know what, even if it's a little bit scary, if I can save a life by putting a page of postpartum warning signs into this book that has been sitting on someone's bedside table for nine months that they trust and they like that is something I'm willing to do even if it does feel a little scary. But women just simply aren't told they're discharged with like a piece of paper and that's all they ever get and then they pass it off because either they feel gas lit, they feel like, oh, it's just not sleeping. They think it's just completely fine and it's not fine. Like if you find your off in this situation, you should always call for help. But again, like I think the asynchronous support telemedicine more flexible formats. It's why innovation is so important. Like Millie, what Millie is doing, I think is so powerful that for this reason, and there's actually a gap between when morbidity, mortality is occurring and when care is delivered. So, you know, once you have the baby, you're home, there's really very little clinical care, whether asynchronous or live. And that's, that's a huge gap in a driver. I wanna we have a few minutes left and I want us to share some of hope here, things that, that we are excited about. Uh we touched on Medicaid. And I think one of the exciting things about Medicaid uh in innovation in general is that when you're looking at a value based care space and you're designing for outcomes, the data drives the innovation. And we've seen much more reimbursement of, of things like doulas, for example, in Medicaid, that was actually are harder to get reimbursements for in a fee for service model. Um would love for each of you to share maybe one or two things that give you hope that you're excited about when it comes to women's health and postpartum care. Um One thing I'm excited about is that in 47 states and more to come, um, there's expanded Medicaid coverage after delivery for 12 months. And that's, that's, I think it's, it's amazing. Absolutely. I will say in the last five years, one thing that has been a positive change is when I used to ask people if they were getting a doula, they would say, what is that? Nobody knew what a doula was. Um And actually there was a lot of misinformation even about midwifery, which I find is really changing. I think like a lot of people understand whether it's because people in Hollywood talk about their doulas or we're just having more conversation. But I think the role of doulas and the tremendously improved outcomes that happen when you have a doula or a midwife as part of your coordinating care team is now something people no longer debate. It is just an accepted fact. And I will say thinking about the mental health task force that just came out in the recommendations. The idea that someone is writing down that six months of paid, you know, maternal care or leave is incredible. The statistic is insane. 25% of working women go back to work within 10 days of having a baby. And then you want me to follow up with my primary care and the postpartum like that's impossible. Um And so, you know, the idea that we will be able to protect our birthing people to be able to spend time on themselves and on their babies. Hopefully, um is incredible and California has made some strides in that standpoint. I know we have a long way to go, but it's so necessary and I will say the fact that we're having this conversation on this stage right now gives me a lot of hope. So, thank you to all three of you and to all of you for your time and attention and I appreciate it. Thank you.

Meghan Fitzgerald, Investor; Founder, Grey Ghost Capital; Adjunct Professor of Health Policy and Management, Columbia University (appearing virtually) Larry Levitt, Executive Vice President, Health Policy, Kaiser Family Foundation (KFF) Lee Shapiro, Managing Partner, 7wireVenture Moderator: Maria Aspan, Fortune

Brainstorm Health 2024: The Health Care Affordability Crisis

Meghan Fitzgerald, Founder, Grey Ghost Capital; Columbia University (appearing virtually) Larry Levitt, Health Policy, Kaiser Family Foundation (KFF) Lee Shapiro, Managing Partner, 7wireVenture, Maria Aspan, Fortune

Meghan Fitzgerald, Investor; Grey Ghost Capital; Columbia University (appearing virtually) Larry Levitt, Health Policy, Kaiser Family Foundation (KFF) Lee Shapiro, 7wireVenture, Maria Aspan, Fortune

Welcome and Megan, thank you for joining us. I'd like to start with just some definitions. I mean, it's so overwhelming this problem. How did our health care system become so broken? And Larry? Uh Well, you stole all of my talking points in my data with your introduction and thank you for that. Um You know, it really comes down to, I think two things. One is price. Um You mentioned that we spend double what other high income countries spend on health care and get poorer outcomes. That's not because we use more health care. It's because we pay higher prices for health care, whether it's hospitals, drugs or, or physician care. And then the second is the structure of our private insurance system, you know that, that we uh deductibles now for people with employer based insurance, average $700 per person. So it's price that drives the overall affordability crisis and then the way people experience it is with these high deductibles. Uh Lee anything to add here. Well, I mean, we're facing a new type of pandemic. Um We've just gone through one in 2020 2021 but the affordability crisis um is a pandemic in this country with, as you mentioned, more than half of those of working age and above not being able to afford health care. And what does that do when you can't afford health care? You're not buying your prescriptions, you're delaying the delivery of care, you're not making appointments. And so all that does is result in you getting sicker and that of course, increases the cost of the entire system. So it's a massive problem that we need to address Megan. I'd like to ask you to weigh in both on the problem and on uh perhaps some of the solutions that you're pursuing at your firm. Yeah, I think, you know, from where I sit, I, I volunteer in the hospital and I also am an investor. I believe there's millions of Americans that are underinsured and unheard. So 40% of adults believe that mental health is not addressed at all and not seen as something that should be, you know, addressed by insurance or um by society at large. That's the first thing. That's a big deal. Second, I would say in terms of being under insured, um as mentioned by Larry and Lee, it's really an access issue. You have 45% of Americans who are underinsured, so you can go bankrupt from cancer care, which you can imagine what a double whammy that is to get diagnosed and then find out you get a $5000 bill and those are people that have, um, insurance. So I think for me when I think about things and how to, you know, get stuff done, you have to find things that can be done at the local level. Everyone can agree that we spend close to 20% of GDP on health care. In fact, you might say we like that for as long as I've been around, it's been 18 or 20% of GDP. But when you start to break it down, I think the few areas I would point to is primary care, a new generation of providers. And can we please address waste and bureaucracy, which I've never met anyone that hasn't agreed on targeting, that we spend about $1200 a person on administration and bureaucracy because again, we like it to be super complicated. And I also think we need more people to enter healthcare. They have to find this field as exciting as technology and finance. So one thing I always say is let's hear it for the trade degrees. It would be so great for someone to stand up and pay for someone school that is getting a twoyear nursing degree. I love hearing all these people pay for physician education, but I think we could really do well to attract more people into pharmacy nursing and just get on the ladder in hospital um in a hospital setting, we can certainly use them over the next 20 years. So I, I'd love for us to find ways to attract more thought and energy into health care. You know, you raised a lot of excellent points. And Larry, as I was preparing for this to the under insurance point, I was stunned to read a KFF stat that six of 10 people, six out of 10 people with insurance ran into a problem accessing those benefits in the past year. I mean, we're at a point where even those who are fully insured can't get health care coverage, like what's going on. No. And it, it's a and we do have to remember, I mean, we focus a lot in our political debates about Obamacare, the Affordable Care Act, Medicaid, Medicare, but most people still get their insurance through an employer and we have not done a lot for, for those people. And, you know, we're here today talking about affordability, but there's also the complexity of the system that makes it so hard for people to navigate, you know, figuring out who's in their network, you know, figuring out what their benefits are, figuring out what the price of something is going to be and what they will have to pay out of pocket ahead of time. And that complexity ends up mattering for affordability as well. Right? If you're stuck with an out of network bill, you're stuck, stuck with a balance bill, you're stuck paying out of pocket because, you know, you couldn't get prior authorization for a drug or a service, that's an affordability problem as well. So what, how much responsibility does big business bear for this? And what solutions are you seeing big business propose or put into place that could actually address this? Well, you know, employers, uh, are footing most of the bill. Uh, you know, employers pay roughly 80% of the, the, the cost of insurance for, for their workers and employers are effectively caught in the middle. I mean, they're, they're a, a they're feeling the burden of the affordability crisis because they are paying the bills. But frankly, they are part of the problem as well. You know, they're not using their leverage, whether that's economic leverage or political leverage to try and get prices down and they've been raising deductibles, I mean, employers, you know, have just been, have run out of solutions. And so the one solution left was to increase cost sharing, increase deductibles and that then exacerbates the problem uh for their workers uh and, and their families. Um you know, and I think, you know, hospitals, pharmaceutical companies have a lot of political power. Um if there's going to be any kind of political or policy solution to health care affordability problems, uh employers have to be a counterweight uh and it kind of has to be in the C Suite because it's ceos that have that uh political capital, Lee, I'd like to ask you to add on to that. And also perhaps uh from your perspective as an investor, like what sorts of solutions are you investing in one of our portfolio companies transparent is helping to equalize the playing field between self insured employers and those who are providing care or otherwise providing them with of services for their team members. And what Larry had mentioned is that we have this um disproportionate knowledge that exists between those who are providing insurance um and those who are paying for the cost of care. And what Trans Karen is doing is helping to equalize that playing field by providing employers with not only better information but guidance to their team members in order to be able to direct them to the best possible care at the lowest possible price. I'm sure many of you have seen a number of the studies that talk about the discrepancy that exists even in a given geographical market for a service like AC T scan or an MRI same equipment, same order. And yet there could be in magnitude thousands of dollars of difference just to source that type of imaging test. And so being able to provide individuals with a better understanding so that we give them the opportunity to leverage the dollars that their employers are making available to them in better ways. And to let those healthcare dollars go further is a benefit. And lastly, what I'd say is, you know, many employers don't have the capabilities to do direct contracting with providers in their area. So they rely on transparent and others to help them do that. You know, if you're Disney and you're in Anaheim, you might be able to have some direct contracting because of the concentration of employees you have there, but very few self insured employers have that ability. So relying on a third party intermediary to help you with, that is important. One other thing that, that I'll mention quickly because you asked about where we're investing. Um One of our other companies Pay Zen, which is based in San Francisco is helping individuals to better manage their out of pocket cost expenses by giving a zero interest loan to those employees. But they're doing it in partnership with health systems because health systems recognize their responsibility and frankly the burden they have. Larry mentioned cost shifting to employees. Well, now with high deductibles and large out of pocket expenses, you can't afford care. How can we use tools to help make that care more affordable? And that's what pays is doing. Megan. I wanted to ask you because you are an advisor on a new fund that was announced this morning, investing in health care. And there was, there was a uh the Wall Street journal covered it and there was a quote in there particularly about how that fund is not interested in doing physician roll up investments, which we've seen contributing to the primary care and just provide our crisis. And I wondered if you could tell me a little bit more about the philosophy behind that. And again, how you're thinking about this as a solution or a fix? Yeah. Well, I think, you know, few investments I've made this year have been in rural health care anywhere. There is a desert and there is not access to care. Um, you know, many don't have the luxury of picking where they can go. So whether it's a pharmacist or an urgent care center is super important as well as I spend a lot of time investing in caregiving. And I think we all know the stats about 50 million people that do that work for free. So huge leverage if you can have access to care in remote locations and you can stand up givers the fund this morning that was launched by Joe Not Tori very much is focused on healthcare services. And I think her view and a lot of the views is um I think 75% of the physicians right now are privately employed, so 25% are still independent. And I think what we often forget is uh many of them are fighting to stay profitable. Uh Many of them have to do paperwork every day, advertise for patients and manage risk and that's become really difficult when you go to school, do all this training and you want to treat patients and you went into the field to make things better. You didn't go into the field uh for bureaucracy. So I think it's more of an interest of where the market is going. Uh and less about a critique on one field. But what can we do to empower the front line and make it easier for people to stay in medicine and do what they signed up to do and that is take care of patients. So obviously, we're in an election year and health care affordability seems like it should be a bipartisan topic. But I wonder if, I mean, it obviously affects all of us. I wonder if I could ask each of you to talk a little bit about what you hope for and what you expect to happen after the November elections in either scenario. Well, I, I would hope for uh you know, some bipartisan consensus on issues where that's possible. Um You know, we've seen it, for example, in the effort to eliminate surprise medical bills uh for patients with broad support from Democrats and Republicans. Uh we've seen it uh around antitrust issues, um you know, dealing with anti competitive practices. Um And even at least among the public, we see it in efforts to address prescription drug prices. Uh You know, the public broadly supports Democrats, Republicans Independents, um the Inflation Reduction Act, uh negotiation of drug prices in Medicare capping insulin co-pays. Um And uh you know, so I, I would hope at least, uh you know, I mean, things are as divided as they've ever been in Washington. Uh But I would hope that we could find some ways to make some progress on, on affordability issues. Uh in a bipartisan way. Uh the marketplaces that were established by the Affordable Care Act have provided a lifeline to so many people to be able to obtain affordable care. Um In 2025 the end of 2025 some of the subsidies for the marketplace are going to expire without further political action. So my hope is is that in spite of some of the rhetoric around the Affordable Care Act, that there's a recognition of the number of people who are dependent on that as, as we said earlier about rural communities and those who lack access to care, those individuals are really dependent on the ability to get these types of policies. And I would hope that we can find ways to continue to support them. Megan, what are you preparing for in November? Um I'm with my peers there. I think the AC A worked, I also think it was ironically both a Republican and a Democratic construct at its heart and it drove down uh the uninsured rate and a lot of people benefited from it. And I also think you can't take benefits away from voters. That's just me speaking from a policy perspective. I'd love to see moving forward and I think there is bipartisan support it. Finally, an honest discussion about the socio determinants of health where and how you live affects your health more than anything. So we can talk about care in the home and all things we aspire to do. You can't discharge someone when they don't have a home, you can't give them care when they don't have the home. So I think having an honest discussion about all the things that drive health care that right now aren't directly seen as health care, uh is inspiring to me and also daunting. So I think a lot is said on the election trail. And at the end of the day, there's a lot more common ground when the rubber hits the road. If I could add, I mean, we uh uh Obamacare was uh as politically divisive a law as we've ever seen. Uh primarily because of the person who it's, it's named after. Um And I think now 14 years after the Affordable Care Act has passed, uh we've finally seen some of that change. Uh So, for example, this year, uh Mississippi, which is one of the 10 states that has not expanded Medicaid to low income. People under the Affordable Care Act came very close to, to doing so. And there's not a redder state than, than Mississippi. Uh And it was really because of that symbolism of Obamacare uh starting to fade. Uh And, you know, Republican and Democratic politicians in Mississippi seeing that it would bring money into the state. Uh And uh and frankly, a lifeline for, uh, hospitals, particularly rural hospitals. Do you see a path forward in our lifetimes for universal health care? And would that be the best fix? Well, we, um, uh, I mean, we're the only country that does not have universal health care. Uh, the only high income country, uh, we've come as close as we ever have. The uninsured rate is at a historic low. Uh, but there's still upwards of 30 million people uninsured. Um I, I uh at least in my lifetime, uh I don't think we'll, we'll get there. Um I think the politics of uh of the, the US are more about incremental progress than uh than big bang legislation. Uh And I, I expect we will continue to make incremental progress but not quite get there just a quick realization though, that the government today pays for over 50% of health care in this country doing Medicare, Medicaid subsidies into the states that, that have that expansion chips programs and the like. So, you know, as we start seeing the further graying of America, um and more people moving into Medicare. Um I think that we'll start to see a realization that um having some of these programs that are able to better regulate some of the challenge we face around pricing and the cost of care um can be meaningful in terms of extending that to the 100 some odd million people that get their insurance through employers. So it almost sounds like you're saying we might eventually get to universal health care as long as it's rebranded or under a different name. Uh Megan, would you like to close us out your outlook on the future of health care? I think the future is really bright if you listen to all these panels, the level of innovation. Um and I think, you know, our front line workers and our healthcare workforce and some of our institutions are, are world class and if you were sick, you'd want to be treated here. I think what we're discussing on this panel is that it's not equitable. Um and access is still a challenge. And I think we're in a position of power. We have the money, we, we have uh the ability to change that if that's something that we want to address. I also think the fertility uh refill rate is is falling below. So we need healthcare workers to take care of us as we age. Uh And the fastest growing segment right now is those over 80. So we all have a vested interest to keep the American health care system. It's the front line. And as we saw in the pandemic, it's the only line. So um I think we learned an important lesson of how important it is. But I'm optimistic with all the innovation. I also think we should celebrate people that solve the mundane. If you solve billing, we should be cheering you on. Thank you so much, Megan Lee and Larry. Thank you so much for joining us. Please join me in. Thanking our panelists.

Dr. Thaïs Aliabadi, OB-GYN; Co-host, SHE MD Dr. Kimmie Ng, Founding Director, Young-Onset Colorectal Cancer Center, Dana-Farber Cancer Institute; Associate Professor of Medicine, Harvard Medical School Moderator: Erika Fry, Fortune

Brainstorm Health 2024: The rise of cancer in young people

Dr. Thaïs Aliabadi, SHE MD Dr. Kimmie Ng, Founding Director, Young-Onset Colorectal Cancer Center, Dana-Farber, Cancer Institute; Harvard Medical School, Erika Fry, Fortune

Thank you all for being here for this conversation. Uh Doctor Ying, I want to begin with you. You're a clinician and a researcher focused on G I cancers and the rise in young onset cases in particular. While there's still a fraction of all cases are increasing. And it's a bit of a, it's a mystery as to why, right? What can you tell us what you're seeing and what we do know about why this is happening. So there is a silver lining about colorectal cancer in that overall and especially in people over the age of 50 there's been a decline in incidents and improvement in survival, largely due to increased compliance with screening guidelines and also improved treatments. But this improvement has not been seen in people under the age of 50 where it has been increasing by about 2% per year ever since since the mid 19 nineties. And in fact, the problem is so severe now that colorectal cancer is actually the leading cause of cancer related death in men under the age of 50 expected to be the leading cause of death in young women by the year 2030. And we do think it's probably some combination of environmental exposures that is causing this uptick, but we don't know exactly which ones. Wow. Um Thank you. We'll come back to that. Uh Doctor Kim, you know, is this something that we're seeing more broadly with all with other cancers? And in terms of, you know, figuring out what's driving this, what are the, the challenges, you know, this is a really concerning pattern that we've all seen someone who's done lung cancer in their past, but now oversee a lot of cancers. This is the epidemic that is smoldering underneath us. We are not noticing it enough and now it's becoming apparent when you walk through our clinics. Now you will see people in their forties and their thirties showing up with new cancer diagnoses. In fact, the American Cancer Society reported that it was the 50 under age group that had the increasing rate of cancer, not the older folks. And uh we did our own study here in Orange County in Southern California where we looked at L A county, riverside San Diego and uh as well as Orange County and Orange County where Newport Beach, Huntington Beach, Irvine is very highly educated uh population. We had the highest rates of cancer in those under the age of 50. So we've got to do something about this. Uh I I've seen patients in my own clinic in lung cancer over 10 years ago who were 4030 years old and it's not because of smoking. So something is happening. Um Doctor Ali Abadi, this is personal for you. You had breast cancer yourself. Olivia Munn, the actress credits you for saving her life for the role you played in her breast cancer diagnosis. In both those cases, they were near misses uh not caught or not detected in mammograms, but caught after you pushed for more thorough testing based on your breast cancer risk assessment score. You know, why was that the case? Why? Um are these things not? Um Like why are we not doing that screening? Well enough? No, first of all, thank you for having me. I've been in women's health for now over, I don't know, 30 years almost. And the first thing I noticed is that women in general get dismissed when they go to the physician, our complaints are dismissed and every time we open our mouth, they tell us we're exaggerating our symptoms. Uh It's P MS, it's anxiety. So that's the starting point of a woman going to a physician when it comes to breast cancer. Uh There's a lot of false information out there. Um I personally had no history, family, history of any cancers and I was still diagnosed with breast cancer. An average American has a 12.5% chance of getting cancer. So if I told you breast cancer, so if I told you this plane had a 12 point 5% chance of crashing. Would you board it? But when you tell a woman that you have a 12.5% chance of getting breast cancer. They're like, it's not a big deal. I don't have it in my family. Even if you don't have it in your family, you start at 12.5. Now, if you add, if you're tall, if you had Children after 30 if you have dense breast, if you've had family history, uh you know, you add these, uh if you're overweight, you add your risk factors and you get a risk score. If that risk score goes above, it's 20% or above. That means you fall into the high risk category and you have to start your imaging as early as 30 not 40. And you have to add MRI to it, which is exactly what I did for myself. And Olivia Munn. Olivia had a negative mammogram, negative ultrasound, but because her lifetime risk was 37%. I added an MRI, all her friends were telling her why is your doctor so paranoid? And you know, with my paranoia, she had three cancer lesions on her right and one on her left breast. And the, you're telling me as we came on stage, the CDC changed their CDC, the US task force because I heard you say it. They, they were talking and they're like the US task force changed their guideline. I'm like, who do you think did it? It's I call it the Olivia task force and I texted her since 2016, the US task force was recommending mammograms at age 50 it was driving me crazy. Olivia comes out with her story mid March on April 30th. I wake up in the morning, they had changed their guideline to 40 every two years and they said average risk this time, meaning if you're high risk, that means you need additional images. I texted Olivia and I said this is an Olivia task force. So thank you for that. Um That's uh that's great to hear. And you know, what are the challenges in detecting these cases early for younger patients, especially since they may not, you know, be entitled to screening at a younger age. Yeah. And the delays in diagnosis for young people presenting with symptoms that we commonly see with colorectal cancer is just a severe problem. There is an average delay of about six months to a year before somebody even goes to seek medical attention for their symptoms. And two thirds report having to see two or more physicians for being correctly diagnosed. And that's because there's a lack of awareness both among people, young people as well as the providers seeing them that colorectal cancer can happen in a young and otherwise healthy person. So there needs to be an increased awareness about what these symptoms are and not a dismissal of symptoms when they happen. Um Either of you have other things to add on what we can do to better prevent. So I have a personal story with my own colonoscopy. I'm 53 years old. I wanted to get my colonoscopy. At age 48. I went to my local gastroenterologist. He said, no, it's not going to get covered. You're going to have to wait. I waited 49 covered, not covered. 49 to 11 months. I get a phone call. We can do you now. Excellent. Had a colonoscopy. It was fine before I turn 51 the guidelines switched to 45. So am I five years late now or did I just get it in time? That's what frustrates me about these guidelines for lung cancer for years. The, the preventive task force recommendation was not to screen for lung cancer. It's because we don't have any evidence or data yet to support it. That doesn't mean we shouldn't do it. We've got to do something proactively through our research, through our clinical trials. Two of the initiatives that we've opened up here in Orange County at City of Hope through philanthropy. Not because the NC I is going to fund it or anything but philanthropic organizations. We opened up a pancreatic cancer screening program where in the 1st 10 patients who came in, we diagnosed a 78 year old sprite lady who's probably going to live to 110. Now, after her cured whipple and we found it. Second is a stomach cancer screening program. If you're of Asian or Latino descent, especially Asians, you come over from Asia, you're getting screened for gastric cancer. You moved to the United States. Now we don't screen it for it. It makes no sense. So we opened up a study now where we're screening our, a API population for this cancer. And the third one I'm going to open this year is a thyroid cancer screening program. Now again, if you go to the task force and it says thyroid cancer screening, they'll say not recommended may be harmful. Well, it's because we just haven't established the level one data or the pilot data that we need to find this. So it shouldn't stop our research and I hate it when people say it's not recommended. Well, no, it just means it hasn't been proven yet. We have to continue to pursue this. And if I may add the age at which to begin, colorectal cancer screening was lowered from 50 to 45. And most young patients getting diagnosed with colorectal cancer are in their forties. But if you look at the statistics, the rate of rise is actually steepest in those in their twenties and thirties who are still not eligible for screening. So a lot of work needs to be done to figure out how to best screen those really young individuals. I want to add one thing which is very important, especially when you talk about cancer in these young patients, make sure if you have family history of any cancers. I don't care what it is. If it's pancreatic, if it's prostate, you're a woman, it doesn't matter. Breast ovary colon, do a genetic test. These genes. I use the myriad my risk test. You can do it at home. You can literally order the box spit in the tube, send it back. They check for 48 cancer causing genes. It's so important because a lot of these younger patients specially have it in their family. They do carry a gene they could carry, I'm not saying all of them, but you don't want to miss at least the ones that carry the gene in my office starting age 25. If anyone has family history of cancer, I do uh order a genetic test on them and you just wanna make sure that's the uh you know, low lying fruit. You don't want to miss those patients, at least in your practice. And you'd be surprised how many people walk around without genetic testing. If you have one family member with pancreatic cancer insurance, we'll pay for it. If you have one family member with prostate, one family member with breasts, under 52 family members above 50 with breasts, two family members above 50 with colon, one under 50 with colon. I mean, almost everyone gets approved. So take advantage of that with appropriate genetic counseling as well. That's very important to have somebody be able explain those results to you and does wanna turn to the audience any questions? Uh just raise your hand? OK. I see you went out there. Um Hi uh Emily Sherbert with Apco worldwide. Um Well, I am the person you speak of. I was diagnosed with breast cancer at 48. Um just had my lumpectomy going through radiation in a few weeks and throughout um I was all did the 86 gene uh genetic testing, it was all negative. My mother had breast cancer though she got it in her mid ff so throughout my whole entire journey, nobody talked to me about my diet. Nobody talks to me about my alcohol consumption or my exercise or any of my lifestyle factors. And I'm convinced that that was a big part of what led to me developing cancer at 48. Um So talk to me about or talk to all of us really about, you know, why is that? Why isn't that diet and lifestyle and exercise? You know, I mean, I saw a surgical oncologist, I saw an oncologist, you know, at all these doctors part of my care, not one of them mentioned diet. I think, I think part of the problem is when we go to medical school and I'll completely be honest with you. I think we can all speak to that. No one sends us to a nutrition class. They don't teach us about diet lifestyle, right? We just learn to treat the disease and we forget about everything else that surrounds it. I agree with you. I mean, processed food, uh, lack of exercise, obesity alone is linked to 13 cancers. So, you're right. And until, you know, we, I mean, more and more we're learning about diet and health and, uh, not smoking and, um, uh, obviously avoiding alcohol but it's a, we don't know, I mean, there's so many factors I don't smoke, I don't drink. I don't, I've never done drugs. I've never been overweight. I don't have family history. I don't have a gene mutation. I got breast cancer. So I think as she was saying there, I was the poster child of an American woman who was not supposed to get any cancers. I got it when I was 48. So there's so much more to it. I think. So when I, when I moved, I was recruited to City of Hope. Just 3.5 years ago, we're building, we just built our second campus in Orange County. Orange County has got the sixth largest county in the country, 3.2 million people. My very first recruit to come to the center is a guy named Richard Lee. He is an integrative oncologist. He's internationally known. He has spent time as on a Fulbright scholarship over in Taiwan, learning about holistic lifestyle, therapies. I recruited him. We started an acupuncture clinic, a massage therapy clinic. We had other programs ready. And we were fortunate enough to meet some donors who were ready to join our mission in just what you say to treat the mind, body, soul and not just the disease, treat the person. And so uh the Churn Family uh Andrew and Peggy Chung gave us $100 million to set up the Churn Family Center for integrative oncology at City of Hope. And what we're going to do with this is basically a drug development institute. But for naturopathic compounds, we're going to test aromatherapy, art therapy, music therapy, tai chi, you know, white button mushrooms. Uh cannabis, actually, he's the first person in the country to get an NC I grant to study cannabis in patients who have neuropathy afterwards. So all of these things you've mentioned is so important. That's what we're going to integrate, not into just those who are diagnosed but also in the survival and cured patient population, but also in the preventative population as well. So I hear you loud and clear. It's the mission of what we're doing. We're armed with resources and brain and smart people who are coming to join us. And we're going to make this a nationwide program. So I salute you there. And I don't think it's a coincidence that breast cancer and colorectal cancer, the two most common cancers in young people are the most strongly linked to diet and lifestyle. We started our young onset colorectal cancer center with the goal to really guide patients after their cancer diagnosis about what they can do in survivorship to decrease the risk of recurrence and have them live healthier lives. And that does include exercise and avoiding red meat and avoiding alcohol and not smoking and all those things that are often too often overlooked. Unfortunately, when survivors are being counseled, uh real quick, we have one question in the back and then Alicia Bazzano from Hopkins Venison. Uh I don't want us to just throw the US Preventative Services task force down the river. There was a reason that they didn't originally do that and it's because of false positives as well. So a lot of these conditions, for example, uh cervical cancer, we've done tons of pap smears on women and subsequently a lot of procedures and a lot of money spent on all those procedures um for women to get their cervixes cut out. And now they don't actually need them cut out as much because we know the, the natural history a little bit more. And there are a lot of false positives. Similarly with breast cancer, there are questions about that as well. So I wonder what your response is in terms of how do you address false positives and um in the future you mentioned MRI. But how does A I play into this as well? I think let's start backwards. Thank you. I think A I plays a huge role, one of the centers that I refer my patients to uh basically as um last year, they implemented A I to read their mammograms. And I was speaking to the CEO of the company and he was telling me that in the past six months, a I picked up 500 lesions that the radiologist missed. So, and even in my case, when my mammogram, ultrasounds and MRI were all negative, I had no cancer but because my lifetime risk was high, I asked for a double mastectomy. And after I did it, they found cancer in the, in my breast tissue, not the uh not this um not on the left where we they were doing all the biopsies but on the right when you know, and it was read as completely benign on all three images. So I think a I will bring a huge value. I think our false positive rates will go down and when it comes to the US task force, you know, when sorry, I'm really sorry. We are completely out of time. I'm sorry, we couldn't get to more questions. But thank you all for being here and for not very much. I think you can connect in the hall, but thank you.

Dr. Michael Curren, Cardiologist; Medical Director, Clinical Informatics, University of Pittsburgh Medical Center (UPMC) Moderator: Chrissy Farr, Second Opinion Media

Brainstorm Health 2024: AI In Action

Well, hello. How are you? Good. Yeah, enjoying the post lunch aspect of this. Absolutely. Always my favorite session, post lunch session. Um Well, who is ready to see a demonstration of some very exciting technology? Chrissy for the day today. It's the first time you don't have to moderate, you could play the role of a patient. So most importantly, she's gonna be playing a role. None of this is going to be real medical history just for the rest. Don't worry about her. She may or may not have some interesting diagnoses that we discover. Um And we're gonna get right to it. So why don't we jump in? That's all right. So we're going to be demoing an application called a Bridge today. So, Chrissy, while we talk about your medical problems here in the office today, I'm going to use this technology. It's going to record our conversation so you and I can talk and then it's going to help me to do a better job of delivering care to you. Does that sound OK. Sounds good? All right. Well, give it a go, I'm going to start the recording and so Chrissy, what brings you to see me today. I hear you've been having some problems. So, um, since I arrived at the Fortune Brainstorm Health Conference, I've been feeling quite a bit of fatigue. Hm. Just since you arrived, just, just since I arrived. And have you had any other symptoms with that? Have you felt short of breath at all? I haven't been experiencing that, but I did wake up this morning with giant ankles, giant ankle. Oh, goodness. Could you put your shoes on, Betty. I had to squeeze them on. Oh, goodness. So your ankle swelled up, huh? And did you have any other symptoms? Did you feel like your heart was racing or your heart was skipping beats at all? Nothing like that. Nothing like that. Just swelling and you're sure no shortness of breath over the past week or two. Maybe going up a flight of stairs, feeling more short of breath with that prior to getting here. Maybe you will be chasing all the panelists around today. Certainly do it. I could certainly do it. Um, and, uh, have you ever had any symptoms like this previously? Um, nothing, no crazy swelling in my, in my feet previously? I think this is the first time. Well, anytime I hear that as a cardiologist, I always worry about it being a heart problem. And I'm looking through your records here. And do you remember a few years ago you actually did have a heart problem where something similar happened it was during the height of the pandemic, there was a lot of stress was going on, you know, being a journalist traveling all over the place all of a sudden, you couldn't do that and you developed something called a stress cardiomyopathy. You don't remember that, do you? I think I somehow blocked, we all tried to as much as we could at the pandemic. So this is concerning that, maybe this symptom has come, this condition has come back. And so I think we should take it seriously. So I'd like to do a couple of tests if that's ok with you. I'd like to order some blood work. I'm going to use the medical terms just to help me document something called a complete blood count. I'm going to get a BNP level going to get a basic metabolic profile. And then I want you to come in and get something called an echocardiogram as soon as you can, maybe this afternoon or tomorrow, that's an ultrasound of your heart. And while we do that, we're also going to order an EKG. Does that sound? OK? Sounds good. And then we'll review all of these test results and talk about what our next steps are going to be. But in the meantime, I noticed something back in the green room when we were coming out on stage here, if you walked in with two big bags of mcdonald's and you opted to skip lunch today. And I'm asking you about that because your blood work, your cholesterol was a little bit high. And that, yeah. You know, I'll tell you, I was surprised but, you know, I understand sometimes it gets all of us. So, you know, we're going to have to talk about that and I'd actually like you to talk to a nutritionist and really start to focus a little bit on maybe cutting out the mcdonald's and think about maybe doing something a little healthier like a vegan diet. How does that sound a vegan diet? It's a lovely diet. Yeah. So with that, we'll touch base again, as I said, with all these test results and then we will move forward. So I'm going to stop our recording now. Ok. And let's take a look at what we had. So how long does this usually take this pod? Yeah. So you're going to watch here on the screen, it will show you how long it takes and what's happening now that the beauty of this model is this is getting ready to prepare communication for a number of different people. Uh From my, my selfish standpoint, I'm going to use it to write my notes. It's going to write my note for me at the same time. It's generating a document for my patient for you that's going to be in more layman terms that you can review and have at your, at your disposal and you see it's already completed additionally, what we'll look at is some pulling from this unstructured data, some structured data elements and recommend some ICD 10 codes to me just based upon the conversation that we had. The last thing that it will do is it does support actually multiple different languages. So you actually heard that introduction a little bit of before we came out a little bit of French. And we do this, a bridge does support multiple languages. So if I have a conversation with a patient in creole, for example, that will translate for me into an English document and it supports multiple languages within a single conversation. So let's take a look at what we got here. So I'm just gonna focus on the desktop here and here's the output of my notes. So I'm going to make this a little bit bigger. So it's a little bit easier for us to see. I'm just going to slide this over. Give us a nice view. OK? So the first thing that I want to show you that, so the model is smart, but sometimes even it can't determine what an individual's pronouns are. And I know from your record that your pronouns are not day them, they are she her. And I can very quickly change that in the note, correct itself very quickly. It's very easy for me to do that without having to think much about it. But let's just look very quickly. Let's read a couple of lines of the history of present illness make that a little bit bigger as I look over at the screen there. So patient presents with fatigue and ankle swelling. It started at the arrival at the conference. You had no other symptoms, although you did note some increased exertion while chasing the panelists around here, we talk about your preference for fast food specifically at mcdonald's that, that, that picked that up as we talked about that. And I'd love to see, I mean, you know, you could forget about what we talked about. So how do you even know if this is even a, so this is really cool. So this is um you know, I forget what I talk to my patients about, believe it or not, you know, if you see 20 patients in a day and you get four patients behind or five patients behind, many doctors stack their documentation at the end and they say, what did I talk about when they first patient? How do I know that this is correct? So I can actually go in here and talk about in order to have high cholesterol levels. And it's going to take me to the recording and I'm going to, and I'm asking you about that because your blood work, your cholesterol was a little bit high and I was surprised but, you know, so I can go and validate the conversation that I had from the note that it was created. And so it confirms to me. Yes, that was discussed and the patient told you about that. So I can, I can prevent those hallucinations from happening just by, by, by confirming that within my note. And as I scroll down here, just to go through and talk about the assessment and plans. So I talked about stress cardiomyopathy, recurrence and the diagnostic testing that I'm going to order in a nice bulleted fashion. This is in a format that we call a soap note to anybody who's trained in medicine, understands what that format means. It's how we all create our documentation, make it very straightforward to follow. So it looks, I mean, it looks dead on. But what do you do at the next point where you need to figure out how to build this visit. So, um you know, as a provider, you know, we have to create codes because part of what we do gotta make money. So I'm going to show you from our conversation. So these are codes that came out related to the conversation that it's asking me if I want to include with the chart. It's not leading me at all. It's just saying, hey, based upon the conversation that I heard this is what you could possibly use and I can click through here and select those that I see and you can see for cardiomyopathy is a diagnosis that has a lot of codes with it and it gives me some very generic codes and it gives me more specific codes and I could use those as a way to, to document. So it's interesting, I didn't even say Takato syndrome. Actually, a stress induced cardiomyopathy is another term for Takato Syndrome. So it's fascinating that it can do that for me. Yeah, I mean, you know, just seeing this, it, it does give me some degree of confidence that you can basically kind of just sit here and, and communicate with me, which is what you want to be doing as a, as a physician. But what, what would you say is kind of the one downside if you had to say want to a system like this, the downside, it's, it's, it's learning a new workflow. That's the only, that's the biggest step. It does sit an epic. So it's within, it's an epic, it can work independently. It's really, there's different ways to utilize it for a provider who works in an electronic health record to have that within the health record. It definitely is an easier thing to do because I have to use the health record for everything else that I do. I'm just showing you very quickly the patient summary, right? And just the summary for you as a layperson as opposed to me in my clinical documentation. Wow. Well, thank you so much. This has been great. Thank you. And I'm glad I'm not dying. Yeah, you're going to be ok. Just cut off. Thank you.

Julia Cohen Sebastien, Co-founder and CEO, Grayce Ellen DaSilva, Founder and CEO, Summer Health Moderator: Holly Ojalvo, FORTUNE

Brainstorm Health 2024: The Next Generation of Multi-Gen Caregiving

Dr. Rajaie Batniji, Co-founder and CEO, Waymark, Dr. Sachin Jain, Chief Executive Officer, SCAN Group; SCAN Health Plan, Brent Nicholson, Co-founder and Chief Partner Officer, Carrum Health  Moderator: Chrissy Farr, Second Opinion Media

Brainstorm Health 2024: Technology’s Role in Value-based Care

Dr. Rajaie Batniji, Waymark, Dr. Sachin Jain, SCAN Group; SCAN Health Plan, Brent Nicholson, Carrum Health, Chrissy Farr, Second Opinion Media

Value based care. So maybe five years ago at a similar conference in another time, we would have been the hot panel, but now it's the A I panels that are the hot panels. So I think I'm going to start with Satin, who's written a lot about this topic of value based care and how much it's real and whether the implementations are actually doing what they say would love to get your sense with where we're at now just on value based care in general. Has it met the promise? I think it's easy to say, no, it has not met the promise. And I think one of the reasons is that I think everybody still has got a split personality about it. Um And when you actually look at what's happening under the hood in most organizations that are so called committed to value based care. Um The commitment is only an inch deep and, you know, a mile wide. Uh And I think a lot of organizations haven't done the hard work to really ask themselves the existential questions about how they're gonna actually evolve to a new business model because they haven't necessarily had to do that. So I think, um, you know, it's largely been an incomplete experiment so far from, from where I sit. I, I wouldn't say that that's uniformly true. I think the future is here in many places where value based care has been implemented at scale. But I would say nationally it's, you know, we're still in the early innings of the value based care story. J do you, do you agree? Do you have a more optimistic view? I mostly actually agree and, and actually, it's a pleasure to agree with that. And you know, I would say that the biggest issue in, you know, way, Mark, we work in Medicaid. The biggest issue we we see in value based care is that there's so much like fake value based care. I wrote a piece on this, um for health affairs called value veneers where I think what we're actually seeing is there are a lot of programs that sort of like check the box on value based care. They, they technically meet the requirements of it so that a health plan and a provider could say yes, you know, C MS, we're doing value based care, but they actually failed to do what value based care was intended to do. And value based care was intended to actually change the nature of care delivery. And so I think my rubric for looking at a value based program is not, you know, is there incentive payment for Xy or Z but has this program changed the nature of care delivery? Um And for us, like that means like, you know, have we created a new health care workforce that can reach patients where they are? Are we able to move responsibility and accountability for care outside of the traditional brick and mortar health care system and directly into the communities that we're serving where those interventions could be most impactful. And so I think unfortunately, so much value based care is kind of operating almost like a loyalty rewards program rather than truly something that can change what's paid for in health care. And that's actually what we have a true shortage of is real value based care. We have an excess of veneers. So one of the things that I think Sarin has also been writing about is just that value based care can focus on a few things like you look at hospitalizations and making sure that people are getting discharged quickly. That can be one way of thinking about value based care. And there are others that we tend to focus on a lot of that based on how the bill works and how we record outcomes Brent for you as you look at what is value based care and what isn't. And through this context of thinking about fake value based care and veneers, what do you think of the true measures or outcomes that we should be looking at so that we don't just get fixated on a few things that may or may not be right for that individual patient. Yeah, sure. I, I think uh what, what we focus on is actually engaging in arrangements with providers that have both upside and downside risk. That's in our version of true value based care. It's engaging with the provider to ensure that they have a shared accountability and actually are invested in the outcomes of the patient. And so, uh you know, what, what we're looking at is uh you know, condition or episodic uh based care in the specialty care area, uh in engaging with providers to have more ownership outside, say the four walls of an operating room uh to extend their accountability to uh not just did we technically perform this procedure correctly, but did it actually get the patient better? Did it actually address what they went into the facility to get the operation for in the first place? And maybe I'll just kind of jump off of that and throw the question out more broadly. But does that kind of work require actually thinking about which physicians are good at what they do and not good at what they do? And I know this is a very uncomfortable topic for a lot of people when we start thinking about how do we rate and rank physicians. But that is essentially part of what you're saying. Right. Absolutely. I mean, we are not believers in the general hospital model that you can have a building that is good at health care across the spectrum. And so when we're looking at, we're zeroing into specific episodic conditions and looking for expertise and top performance down to a very granular level. And you know, we use the power of, you know, massive data sets to help us gain insights into which providers do meet that very high bar of top 10% 10 top 10% performance. Um, and we're looking to engage them in these upside downside risk arrangements, um, so that they can, uh, really do what they do well, and, uh, don't have to be saddled with the administrative burdens of figuring out how do we then figure out how to submit claims and how do we then figure out how to do the authorizations and how do we figure out then handling with the payers to make sure that we get the money in the door. We want to find the best providers, allow them to do what they do well and then make sure that they are rewarded for that. So, so I wanna just say I love this conversation because, um, I think a lot of value based care conversation is actually not about what you're talking about. It's not about getting patients to the best clinicians. It's actually about labor arbitrage is how do we take the work that specialist M DS we're doing to generalist M Ds and then then take work that generalist M DS were doing and take them to nurse practitioners and then take work that nurse practitioners were doing and take them to our ends and take work that RNS were doing and then take them to community health workers and then take the work that community health workers are doing and then give them to people's family members. And I think we have to talk about labor arbitrage and we have to talk about actually what is an excellent health care system actually look like. And I think most of us intuitively get that. You have to actually go to a great clinician who really understands the condition well and knows how to treat it and knows the, you know, boundary conditions of that condition to be able to effectively get the kind of treatment that we need. But that's not the conversation we're having about value based care. For the most part, I totally agree on the labor arbitrage piece. And then, you know, to flip that question, push it further with J how do you see the role of the patient here? Because if they feel like they're just getting pushed into a lower level of care with less of a specialist, wouldn't, wouldn't they? As a patient say, you know, why, why I want to be in the other system? I want to be in the system where I can see the specialist that I want to see. I, I mean, I think to me, we, we center our approach literally around the patient. And so if you think about what's broken in the health care journey, imagine you're you're covered by Medicaid, um which all of our patients are in all the the states that we're in. People have a hard time accessing a physician. They have a hard time navigating the health care system. They need to use social resources that no one has helped them get to. And so to me, the point of value based care is let's actually get the physicians to see them, let's make availability happen. Um Let's wrap those physicians with the expertise that they need to appropriately navigate this member and literally guide them the whole way through their journey. And so to me, it's about complementing the existing system by creating net new resources. I mean, if you look at the data and this is we always start with data, if you look at the data about like what works in health care delivery for a certain population. And I think you need to do this population by population in, in Medicaid, for example, it's like totally clear, right? Like study after study proves that the same models work. The challenge is that those models have been funded either by, you know, a one off grant. Um They've been funded out of like a special budget from a health plan or health system and to actually do these things and do them for a long time so that communities can know that they can rely on these services to exist in the future. You can do them under a value based arrangement so that you can have that kind of permanent source of funding where actually accountability for care can actually move toward these, these new care delivery groups. So just a reminder to the audience that we are taking questions, so I'll slip to all of you next. Um I'm gonna ask you a question about A I because that has been a big topic of this conference. Um We've talked a lot about actually using A I in diagnosis, not just kind of back office, which is where it tends to be more kind of discussed today. Um Sergeant, do you think in a value based world, a true value based world, there is more room for A I in that context because it becomes less about who's going to pay for this. Yeah, the I think yes, a lot of, you know, kind of value based care is in like full delegation of risk to a downstream entity. I think the real challenge of freeing up enough resources to actually invest in A I. Is that how that downstream entity that's taking full risk, actually allocates those dollars to sub entities, how they pay specialists, how they pay primary care doctors, how they pay ancillary care providers. And that is still happening very much in a fee for service way and So then the question becomes like where does the A I get introduced? Does it get introduced at the risk bearing entity level or does it get introduced at the level of, you know, the primary care doctor or the specialists? And is there enough margin in what is actually being delegated, sub capitated to the primary care doctor of the specialist to actually integrate A I in ways that are gonna reduce cost and improve quality of care. And that's, that's a long way of saying, I think we're still figuring it out. Yeah, I would, I would add to that. I mean, I think so much of like the way we talk about A I and health care is about well in the future, you know, humans will be talking to machines, machines will be doing the diagnosis. I I think that's actually totally wrong and you know, our, our approach to A I development is really let's automate the routine tasks so that we can allow our caregivers to spend even more time with patients. Um and second, let's automate the identification of which patients are gonna benefit from certain services so that we can actually spend our time targeting the appropriate patients. And you know, we've been, we've been publishing actually quite, quite a bit on our, on our development in this this realm because I think that is where you have step change, improvement in improving access to care is you're gonna create and enable a net new workforce through A I and actually give them the pattern matching of somebody with years more fair. Yeah, I would offer a slightly alternate perspective uh from scan, which is, you know, our view is that, you know, A I is going to enable humans to become super humans. And so, you know, when you call your health plan member service representative or you're talking to a nurse from, you know, uh a care coordinator department, they're gonna be able to do more and know more about you and, and be able to leverage everything within our system through, you know, advanced decision support to be able to make those interactions more valuable and more meaningful. That's, that's how we're thinking about it. I guess two other um angles, at least from our point of view of Kam is uh agree with Rae what you said about using the power of A I and specifically machine learning to help identify the right patients, get them to the right programs and services at the right time because there's just a sea of information out there. And it can be very hard to understand and navigate for a common patient who just has too many options available to them, too many mouths trying to get their attention. And so being able to do that and say, identifying only a small percentage of the population uh in our instance that we're able to then say we can identi we can correctly identify, say up to 95% of the surgeries that are likely to occur over the coming years. Uh And then uh being able to serve up the appropriate pro program to meet the needs of that patient. And then from the providers point of view, being able to help these providers perform better in value based care arrangements. Um We've seen some tools out there that uh help to uh create these uh personalized care plans that uh you know, harvest all of the information from millions of different patients rather than just a handful of patients that one doctor has seen to be able to do things like optimize variables around, you know, the length of stay the discharge destination, the post operative care protocols so that, you know, they can zero in on a likelihood of readmission and then be able to uh adjust and tailor their follow up and check in protocols uh accordingly to then result in the best outcomes and then perform better under these value based arrangements. I'm gonna flip for a question from the audience who's got a burning question on Vala I RJ does a stats of one inference for the individual. So I love what I'm hearing about, you know, these patient care journeys and how you're really tailoring them. I'd love to know what um what the biggest challenge is to incorporating A I or anything like that into that workflow when well, I I'd say for us. Um you know, one of the considerations is to try and shield the patient from all of the complexities of what we're talking about here up on stage is really to um you know, make it so that the patient doesn't have to uh understand or navigate well, am I in a value based program? Am I not what you know? Uh And so, one of, one of the things that we work on is um ensuring that we are working very tightly with our uh providers on the patient identification um and the and the patient attribution. And so that's one of the things where um we have a, you know, very specific implementation process. We have a very specific pre registration identification process that ensures that uh when the providers that we're working with are seeing a caring patient, they can understand uh that and uh they can uh follow the, you know, the program protocols accordingly. II I think we have a similar challenge for us. The biggest challenge is like, just imagine, right? We, we serve a new market, we're serving 50,000 patients covered by Medicaid there, you know, where do we start? Right? Like how do you know which patients to, to reach out to? And so, you know, our first A I use case was we built this product that, that, that allowed us to bring in all of the historical medical claims, the local zip level social determinants, data information from food banks and housing registries and actually build this composite picture of a patient. And the result of that, which we published earlier this year in nature, the scientific reports was that we had 90% predictive power, positive predictive value in anticipating who's going to use acute care in the coming days and weeks. That means er visits, that means inpatient admissions compared to the next best model that was performing at like 30% right? So that means that now one out of 10 of our outreach is the patients are to a patient that we can't serve versus seven out of 10 if we're using a prior model. And so I think you have to get really efficient at doing that modeling so that you can actually direct your, your resources as effectively as possible. Sergeant. I'm gonna call on you for a last question. We have a few minutes left. Um So one of my, the, you write a lot of pieces, you've written a lot for Forbes. Um And I loved what you said about just the chan problem and having a patient for a single year because obviously, we, we do enrollment annually. How problematic that is. Can you just end us on a note of talking about your idea with a three year? Absolutely. I, you know, so I think one of our biggest challenges in our industry when we actually think about interventions that will actually move health outcomes is that most people are in their health plan for a year. That's the most that we can actually be certain that someone's gonna be in their health plan for a year. So, so, very little right. And the most you can do in a year is maybe you can do an annual wellness visit, maybe you can get them appropriately coded. Um, but as far as actually better managing their chronic disease and then seeing the return for it, it's just not gonna happen. And so, um I believe at least in the Medicare space, we have to get out of single year enrollments, we have to be thinking about 3 to 5 year enrollments, which would then give us the confidence that our investments in year one would have some payback in year 234 and five. I believe that's the foundation of value based care that has been missing in most of the, the so called value based care models because without the reliability that a member is going to be on your books in three or five years, you're unlikely to want to necessarily make the investment in year one to actually, you know, create some health outcome benefit in year, year, year three or year five or you may want to. But it doesn't necessarily pencil from a financial perspective. And I just think um it's these types of structural changes that are gonna actually lead us to true value based care as opposed to the value veneers that uh Rege has written so eloquently about how, how optimistic are you that's gonna happen. So, I think the, the number one objection people have is like, what if somebody finds their way into a plan that, you know, is really bad for them or they're being treated badly by that plan in year one and they really need to get out. Um, you know, I think we have to get comfortable with the trade offs. So, um I think it'll take a while for us to get comfortable with those kinds of trade offs. But I believe that the centers for Medicare and Medicaid Innovation, in addition to all the science projects that they're running right now, should add 11 more science project, which is to really look at what a three or five year enrollment in a plan would do and have it be voluntary. People should wanna enroll and do it. I think people will wanna enroll and do it because it'll be intuitive that a health plan that's, you know, that owns your life for three or five years is going to view your care very differently than a plan that owns it for a single year, time horizon, for risk and a time horizon for, for change. You need to line up. Exactly. Well, you had it here. We love it. Thanks everybody for joining us. Thanks so much.

Dr. Rami Bailony, Co-founder and CEO, Enara Health Dr. Razia Hashmi, Vice President of Clinical Affairs, Blue Cross Blue Shield Association Moderator: Andrew Nusca, Fortune

Brainstorm Health 2024: The Impact of GLP-1 on Health Care and Beyond

Vasu Nadella, Co-founder and CEO, Vital Biosciences Moderator: Andrew Nusca, FORTUNE

Brainstorm Health 2024: Reimaging Lab Testing 

Hi, I'm Vasu and this is my co-founder Munir. We are incredibly excited to be speaking to all of you today. Everyone in this room is doing something to make health care better, whether that's moving care closer to the patient, making care more proactive or bringing uh clinics and pharmacy clinics into pharmacies and care into the communities. One thing we realized is that as people are trying to move care closer to patients, they are fundamentally constrained by the limits of lab testing and the physical infrastructure necessary to deliver care. In particular, we realize that the fundamental constraints around care model innovation around lab testing are fundamentally limiting the things you can do, whether it's moving care into the home, into pharmacies or even things like telehealth. We decided to do something about that. So over five years ago, over 100 biochemists and engineers brought together the best of the latest advancements in microfluidics, biochemistry, computer vision and optics to build something that people said was impossible. We built the first platform that enables comprehensive routine lab tests in minutes everywhere patients are all from a small sample of blood. We call it the vital one and we're really excited to show it to you today. So, di vital one only uses 600 microliters of blood. That's less than 3% of what's typically used for a comprehensive panel like this. What that means is you can use either vacutainer or micro tainer from a finger stick sample. So man is going to drop the micros today into the vital one and then he's going to slide in our two consumable components, a disc pack and a support pack. And from there, he's going to hit go in less than 15 seconds of hands on time. We're going to return within 15 to 20 minutes. A comprehensive panel of tests including a complete blood count, comprehensive metabolic panel, lipid panel, HB A one C for diabetes and immuno acids like thyroid stimulating hormone or vitamin D covering common and guideline recommended tests. Let's contrast. This is what happens today. We draw tubes and tubes of blood from patients. Then it takes over an hour to let that blood clot centrifuge it and process it to get sent across the country to be run and have lab results returned days later. Instead with the vital one, we're going to enable patients to get their blood drawn while they're getting roomed. And by the time the physician is ready to see them, they're going to have access to a comprehensive panel of tests to enable what we call real time medicine. So you're all probably wondering how does this work and we got a few slides to go through today to show you. So inside that disc pack are three microphonic discs. Each disk does a different modality of tests. And within that support pack are reagents and tips within each disk are these small Lioy beads. Those beads contain all the regions that are necessary to run these tests and they're freeze dried to eliminate the need for refrigeration or coal chain shipping, seamlessly fitting into your workflow. Now, I'm going to show you a video of the inside of the system. So the left hand side is the front of the vinyl one. You're going to see the drawer come in and you see that we actually mix those samples within the system, removing a big source of pre analytical error from poorly mixed samples. Users are never exposed to any blood. So the tubes are dec capped automatically, we automatically also move each disk into each of their respective subsystems, taking a small volume of blood and buffer and dropping it into the center of each of those discs. And what you're going to see is that those disks starts spinning. So unless you can blink 6000 times a minute, it's really hard to see what's going on on those discs. Luckily, I've got a stroboscopic video for you here. So what this is doing is taking a picture every, every rotation of the disk to let you see what's going on. And what we want to tell you is that all we're doing is accelerating and decelerating this disk to run all the footing functions that are necessary to process these results. We're using high precision injection molding to deliver high quality lab results with high precision accuracy and most importantly, repeatability. We have tested this extensively. We've run this on nearly 6000 patient samples with partners like labcorp and academics from leading institutions. We're incredibly confident with the data we're seeing. We're also really transparent. We put it all on our website for anyone to go and see vital bio.com/data. Our team is working really hard to follow the rules and do this right. Work as regulars like the FDA and we're well on our way, I want to leave you with two things. One, the future is coming, right? We're going to expand the design space that all of you have to deliver care more proactively and closer to patients. And the second is we need to work with everyone in this room. We need partners like all of you to actually take great technology like this and bring it to patients and change how care is delivered. We're going to be hosting a handful of demos in the Bay Area in L A in early June. If anyone is here and interested, we'd love to show you. We're also right outside the door. Happy to take questions and you can feel free to play the vital one yourself Thank you all for the amazing work you're doing to advance healthcare and thank you for having us. That sounds pretty cool. Good to see you, by the way. Thanks Andrew. Um I got a couple questions for you. So look, we have been talking a great deal about hype versus reality at this event and I want to know every test has its limitations. So what are the limitations of this device? How do we make sure that we don't, you know, imbue this with every hope and dream that we have totally. Look, central labs aren't going anywhere. We're not to bring every liquid biopsy test to detect every kind of cancer to the point of care. What we think we can do is bring all of your routine tests to enable primary care and urgent care to be a lot more productive. And if we can do that, we can improve outcomes, close gaps in care and take what is today a very disjoint experience and make it a lot more cohesive and better for patients. Got it. All right. So the one company that's on my mind that is probably on the minds of a lot of folks in here when we're talking about rapid blood tests. Rhymes with barrow nose. Yeah. Um I have no idea what you're talking about. Yeah, me neither. Me neither. Me neither. Um No, I wanted to ask you. Look uh that came before. Sure. Yeah. Here you are pitching a rapid blood test. Um, reception might be a little bit cooler than uh if that hadn't happened. Uh So tell me a little bit about that. Uh What are your challenges in this regard? Uh Where, where are people's heads at when you start talking to them about this? Yeah. Look, I think it's a shame. People look at what happened there and completely stopped working or innovating in blood testing. We almost look at it as like this amazing, you know, billion dollar consumer research survey, right? It captured our attention, it captured our imagination because we all saw the impact innovations like that could have. And I think from the very beginning, we were really thoughtful to try to get the most skeptical people aligned with us, right? Working with folks like labcorp, we even have like former directors of the FDA in diagnostics on our board. And we tried to bring in all these folks to tell us how to do this the right way, how to have the highest bar and how to compare ourselves to the gold standard properly. So all we can say here, right is we're just incredibly focused on doing this the right way, doing it with the FDA and, and not, you know, cutting any corners. Um And we're just gonna be relentless in doing that if the mission is too important to give up just because, you know, we get compared to a company once in a while. Sure. Sure again, never heard of them. And then um you know, before you stepped into this role, you were an entrepreneur in residence uh at Innovia Capital. So you worked with a number of different health companies and I'd love to know some lessons, some observations from that time before you were so hyper focused on this. You know, I think like a lot of the round tables here and, and conversations in general are going to, you know, talk about things like you got to really focus on aligning incentives and fitting into workflow and all of those things are incredibly true and you have to do all those things. But I think something I've come to appreciate having spent time with founders and now working on vital for five years is that it all comes down to that founder's relentlessness and ability to push through those barriers. Like that's the thing that you're underwriting to in these situations. And so I think what's amazing about health care is we all see the impact we can have and all these great companies that have come out of the last 10 years in digital health and in therapeutics and diagnostics. They've all come from a place of real mission. And I think that's what's been really important for us too. And when we in bringing in really great talent, my last question for you, my session yesterday talked all about the great reckoning in the market for health tech start ups, I wonder are you feeling like it was good for the category? What, what's your, what's your mindset about it as a, as a founder, you know, for us it's like a rising tide, you know, lifts all both. It's always been great when markets are great for us to go raise capital. But on the other side, I think being a company that's focused on the data and pushing forward kind of doing what we're doing. What we say we're going to do has meant that we get kind of our pick of investor and I think the best companies get to pick their shareholders and we've been really lucky that way. So look, I think it always sucks when you see a bunch of things turn over and companies die. But out of that comes all of these other really great things, people can work together, they can bring teams together that weren't possible before and that's been true for us and it's been awesome. Right on. Well, thank you for joining us at Brainstorm Health. Thank you, Andrew for sure. Appreciate it.

Dr. Rebecca Mitchell, Executive Vice President, Investment Team, Vive Collective  Kevin Spain, General Partner, Emergence Capital Jeff Tangney, Co-founder and CEO, Doximity Moderator: Chrissy Farr, Second Opinion Media

Brainstorm Health 2024: The Health Care AI Reality

Dr. Rebecca Mitchell, Investment Team, Vive Collective, Kevin Spain, Emergence Capital, Jeff Tangney, Doximity, Chrissy Farr, Second Opinion Media

So good to be with you all. Again, I'm gonna dive right in with the question for Jeff. So you and I have known each other. I would say going on almost 15 years. Um And I've seen you through a few different iterations, Hippocrates, which I would say was a standout in the mobile health area and then doximity, which really came along around the time that digital health was taking off. So I'd love to hear from you what you think the next wave might be today? Do you think it's a, I, do you think we're that like, how, how do you think about that as somebody who's been involved with both cycles? Yeah, that's a great question, Chrissy. So doc I think folks know we make medicine mobile for doctors. We have over 80% of all us physicians who use our app, they call their patients, they sign their digital paperwork, they check their calendars and we have over um all of the top 20 Pharma companies and hospitals as clients. Uh 475 million in revenue last year, 230 million in profit. All right. So what's the next wave. Uh We do think it's, it's a I, so we stood up a product, we call doximity GPT. 14 months ago, we've had thousands and thousands of doctors using it and using it very consistently. So we've done millions of prompts now and looking back across the 14 months of millions of prompts, I think what we've seen is it helps with letters with notes and with answers. So letters with the first use case, it was helping with insurance appeal letters, the residency recommendations, I have to write the, you know, the service animal letter for the patient who wants to bring their puppy on a plane. Doctors have to do a lot of letter writing and it really helped out a lot with that notes was the next kind of surprise feature though. That got a lot of use. Doctors have to write a lot of notes to patients and they have to write it in a language that patients can understand and they're taught in medical school how to speak in medical Latin, but they're not taught, taught how to speak to 1/4 grade, you know, patient, right? So it's really been helpful with that and then the last area is answers. So we've seen a lot of doctors just asking clinical complex questions that need to go into the literature. And we recently announced a partnership with perplexity to add the citations and sources and make that part easier. So listen in the grand scheme of things. Physician burnout is a real issue in this country. The doctors who've used their GP T say that they can save 13 hours a week on average using A I, which is a major improvement I think in being a physician in this country. And Kevin, that kind of dovetails very nicely into a question that I had in mind for you, which was really about this kind of in health care. We, we sort of struggle between, do we invest in, in software or do we invest in services and doximity? You, you more think of as a software company? It's now a public company, one of your investments. How do you think about that in light of A I? Because your firm has been doing a lot of writing on this, that A I could change the services side of a lot of different industries. So as you look at where the need is in health care, are you a software or, or services? Sure. And why? Well, I think it's a, it's a really interesting question, you know, for us at emergence, we have been software investors for the last 20 years. I mean, we've been lucky to work with companies like doximity and sales force and Zoom and others. Uh ser uh software businesses are phenomenal businesses. They're very high gross margin, they're very scalable. Uh And ultimately, they can become very profitable like doximity once they reach meaningful scale. So I think for us, we will continue to be primarily software investors. But one of the really interesting things that I think A I enables that I don't think technology has necessarily been able to enable in quite the same way is we can now build soft companies that actually can in many ways replace certain kinds of services businesses. You know, many ways software has been really good at improving productivity, right, making companies that do things maybe produce services more efficient at doing them. But now you can actually see the opportunity to build technology companies, software companies that can supplant services. Now this will not apply to all services. I think there will be lots of areas, for example, with health care, where people are going to still play a very important role in providing services, for example, to patients. But when you think about all of the outsource services in health care, like all the third parties that do work for health care services organizations that themselves are services companies, we see an opportunity to build technology companies that can actually now for the first time, actually supplant those services with software. And so in some ways like what we're, what we're talking about and writing about is the opportunity for A I as a venture investor is more interesting in services than it is in software. But in the way that you know that I just described Rebecca, where do you land on that specific debate? Because you've been involved, you know, both as an advisor to companies like doximity. You've been at, at the VGO, which ultimately sold to Teladoc more on the services side. You're also a physician. What, where do you stand in that, in that conundrum? And what do you think is actually going to make life better for everyday clinicians? Is it going to be more services or more software? Hm. Um, so I'd actually love to answer this question by pulling forward beyond how do you make the day to day life better for clinicians? Because I think if you really talk to clinicians, one of the reasons they are the bigger reason they are so burnt out and demoralized across the board right now. Yes, it is so much note, writing pajama time writing notes um feeling like they can't do the right things for patients because it's not covered. But the bigger moral injury I hear from many of them that they're experiencing is feeling more and more distanced from having a meaningful impact on the health of individuals and communities and it getting better over the years of their career and being part of shaping how to make it better. So a lot of the clinicians that I work with as an investor and I worked with for the last 15 years and product isn't as an operator in digital health companies. What made their life most better was actually sitting alongside ceos like Jeff sitting in product teams being clinical leaders and thinking about how to combine the best of medicine and science and technology to solve clinical problems in completely different ways where you could invent new medicine and bring the best existing medicine to far more people in the world than it does today. I grew up in rural, pretty like blue collar, like no good hospital in sight, Wisconsin. And I mean, my family are some of the most aggressive adopters of digital health tools and it is absolutely changed like their health care experience as like infrastructure that we think of as like typical health care has moved further and further away over that same period of time. So I'm a big fan of what people like Morgan Cheam are saying we have to get beyond the faster horse problem both in digital health and using generative A I and pull people together who can re invent the way we deliver care. And Jeff, I, I think a lot of that speaks to you especially, I mean, we sort of lost over this, but more than 80% of all physicians are using your service. That's an enormous number. I think you said 900,000 or something along these lines, use it all the time. So how do you, you, you must interface with just so many physicians every day? You see the inside of this culture, you see the burnout. What do you think is finally going to move the needle and give the clinician the right to live this entrepreneurial community and lifestyle that they thought they were signing up for. Well, I guess I'd say two things on this. We, we just completed a survey we do every year 7000 physician respondents asking, would they encourage their child to go into medicine? And the answer is as low as it's ever been. Uh, 62% of us physicians would not encourage their Children to become doctors today. And that's down from 40% or so 56 years ago. So it's gotten worse. I do see, hope, I do see an opportunity here where that pajama time everyone gets a scribe, everyone gets a helper and they're able to focus more on the patient experience and less on the keyboard. Right. So I do hope that that turns around specifically as I look back. I think there's this misnomer out there. A lot of people think that doctors are afraid of A I because it's going to start competing with their diagnosis. Well, that's already been happening with Google for a decade, right? And the reality is in the United States, we don't pay doctors to diagnose patients. You can make $50 for a visit trying to get a complex diagnosis or you can make $150 cleaning your ear wax, right. It's amazing how that isn't really supported by a reimbursement system. So I think physicians actually can look forward to better diagnoses higher quality care. Again, using A I using tools that the patient could do maybe pre visit to help them out. So again, I'm I'm hopeful that this will really change what has become really just uh an untenable job for a lot of doctors just reminded the audience that we will, we will be taking a question. So stop thinking about it. Um Kevin, one of my favorite memes on Twitter right now is um this people doing this side by side between the the most amazing technology that you see in other industries and then what you see in healthcare. So like one headline is like this incredible, you know, A I robotics and it's related to another industry. And then at health care we get, you know, oh this new product that's gonna make a fax machine work more seamlessly. So as you look across health care and your firm invests in other industries as well, like how do you even make the case internally for? Like we should just continue to invest in this area when you see it be so far behind so many other areas? Well, I think it's a great question and I mean to be fair, it's not just in health care, there are a lot of industries, a lot of what we would call kind of rusty dusty industries, industrial sort of parts of the market where this is also true. They have the same means they have the same uh you should follow those accounts. They're kind of fun too. But um but I do think that there's still, it's sort of interesting as an investor and I think also for founders too, it's so interesting to me that here we are in 2024 and we still see so many places in the economy, so many industries where there is still so much opportunity to build better technology, to enable businesses to operate more effectively and efficiently. Uh It is a shame that health care is one of these industries, right? Uh We all obviously in uh interface with health care and we all deserve a better experience and I firmly believe as a technology investor, uh that technology is a key part of the equation to make that experience better. Um But why has this happened? Why has this happened in health care? Why are we here today? Um I think, you know, a lot of it has been uh fear, right? I think fear of change, right has been, you know, something that we have seen in the health care industry, you know, for a while. Um and as a result of, you know, some of that fear of change, uh we've seen less adoption of new and innovative things, not everywhere. I mean, certainly, I think in the clinical realm, we've seen a lot of adoption of new and innovative things, but we're now only starting to get to a place I think where health care is starting to realize that the technological innovations um that we've seen adopted in other industries are really necessary to be adopted here. Think A I is one of these things where, you know, we see this, you know, through doximity, you know, physicians are picking this stuff up and they are using it. Right. And that is the signal, right. I think that everyone in healthcare should be paying attention to that. The time is now to start adopting this stuff in ways that they haven't before. Totally agree. And I think Rebecca and I would have both experienced this, but we, we sit in these rooms talking about A I and meanwhile, every physician out there is already using it. Um I'm gonna throw the question on to the audience if anybody has one. Ok. Hi. Uh Muir Kusa, co founder of Vital Bio. Thank you all very much for being on the panel today. Um I'm just wondering if I could hear from each of you what the goal is of A I? And are we trying to get to a place where we get A I? Good enough that A I will never be the cause of harm? Or is it just to get it to a place where on average A I is reducing overall uh harm or pain or um uh inefficiency in health care? Ok. Sure. Um So I wouldn't answer this question the same for any new wave of technology. I, I think the goal is to create a better health care system and bring more of the best medicine to as many people as possible as quickly as possible. And we are utterly lying to ourselves. If we don't pretend the status quo doesn't have many people being left out. It's delivered imperfectly all the time. And one of the things that has drove me the most bananas, whether we're talking about M health, digital health, like ML like now generative A I is holding all of these two technologies, these new technologies to a completely different standard than the status quo of medicine. I mean, I mentioned Wisconsin, the other first five years of my career were spent in global health contexts. Other countries are not waiting around for like the gold standard to be evenly distributed like even 20 years ago, right? They were using community health workers and S MS based health care delivery in really rural environments. And it was extraordinary seeing what was possible when you unleashed a bit of that creativity even though it wasn't perfect. So I am fully in the second category of your question. Yeah, but I think this is an interesting question. I mean, if I can put it well, like with any new technology, they're going to be upsides and they're going to be risks, right? And this is no different. Uh I think there are a lot of people speculating that the risks around this new technology may be greater than technologies that we've seen in the past. I don't think we really know yet. Um And the other thing I would, I would offer is that when a new technology emerges like this, it is kind of unstoppable, right? You can't put the genie back in the bottle. So the, the thing I think that we need to focus on uh more than trying to tamp down the risks uh because I think the risks are just, there is trying to get the most out of it that we possibly can, right? How do we get the most value out of a new technology that is the best way for us to ultimately deal with the fact that there will inevitably be risk. So, you know, you know, I would love to see A I adopted in health care as broadly as possible. And along the way, we'll identify some risks. But I think the benefits if we do this, the right way are going to greatly outweigh them. Yeah, real quick, I'll just say better care. That's the goal. And I would look at radiologists as an example of a, of a specialty that's had A I image reading now for well over a decade. And at first, there were fewer physicians going into radiology residencies because they were worried that we wouldn't need radiologists anymore. And of course, that didn't happen. What happened is people started getting better care, more people get more ct scans and more Mris than ever before and were able to spot things earlier. So I think that's an example of where technology has led to greater efficiency, has led to better patient care. And I think there's a lot more areas that we can go there, Jeff, I'm gonna throw the final question out to you and, and perhaps, you know, just hear what you think and what I really appreciated what you did with the doc. Somebody it is that you invited some of the physicians who had been involved with your business for a long time on the product side to get in on it and be part of it. And some of them made great returns. And so I'd love to hear from you a little bit more about that. How do you think physicians should be getting skin in the game when it comes to digital health and the technologies that they use every day beyond just being customers and evangelists? Yeah. No great question. So, you know, it's our goal to be the most physician owned public tech company. I think we are. It's hard to prove it. But I believe that we are today, we have tens of thousands of physicians as shareholders. And you know, each year Rebecca has come, we do these deep dive physician Summits for a whole weekend. We're really all of our best ideas, including automating the facts early on. That was one of our early hits and we joked, we had posters in the office fax to the future. You know, it's hard to get engineer excited about working on FAX technology. But it is what doctors need because it's what insurance companies require. And that's the nature of our world. So you brought the engineers to those events too, which is exactly how you, and they could hear the excitement of facts to the future and all the time it would save. I agree. So, yeah, it's our goal to continue to be the most physician owned tech company. And I do think that, yeah, there's just a lot of pride we take in serving. What we think is one of the most noble professions, which is caring for caregivers, caring for people who spend their days dealing with honestly, the hardest, the poorest, the sickest people in society and trying to help them with better tools. I hope more companies adopt this. The reality is medicine has become more corporate, not more clinical in the last decade or two. And in some ways, my hope is that technology can, can change that, make it more about that patient relationship. Excellent. Well, thank you so much to the panel. Really appreciate all of you for joining us today. This is wonderful. Thanks for having us.

Aneesh Chopra, President, CareJourney Lloyd Minor, Carl and Elizabeth Naumann Dean, Stanford University School of Medicine; Vice President, Medical Affairs, Stanford University Moderator: Deena Shakir, Lux Capital

Brainstorm Health 2024: Defining AI Standards for the Next Era of Health

Aneesh Chopra, CareJourney, Lloyd Minor, Carl and Elizabeth Naumann Dean, Stanford University School of Medicine; Vice President, Medical Affairs, Stanford University, Deena Shakir, Lux Capital

Hello, everyone. Delighted to have this conversation with two such wonderful panelists, Anesh and I go way back to our days uh in the early days of the Obama administration and doctor Miner needs no introduction. So today we're here to talk about the acronym on everyone's minds at whatever conference you're at these days. But in particular, at the intersection of A I and health, uh I want to start with a framing question. And so let's start with you Anish, what is A I in the context of health care? Well, to me, there's basically a policy construct for A I and health, which is to realize the promise that we made, we made the investments in electronic health records that is we promised a productivity revolution that would make the system better. We invested in the technology, we've not yet gotten the productivity gains. And so A I is essentially the maybe the next chapter to finish the story of what we initially invested in, which is, it's the engine that will drive productivity and health care. That's sort of one aspect of it. The more pragmatic aspect of it is it's a prediction of a next event. And one can look at that by looking at historical data and then sort of drawing a line using math to get to the next event or with these new exciting large language models to basically see what happens when you throw all of the information in the internet into a system to help it figure out what goes next. And it looks like a reasoning engine, which is what has cut the excitement for all of us today. You know, if you ask any doctor and there are many of you here in the audience about their experience with, with health care. It's often not a positive one. I come from a family of doctors. And I distinctly remember the day my father had to switch his E hr and how frustrated he was and yet the promise of technology has the potential to revolutionize productivity of the health care workforce. When I think about A I and health care, I remember the early announcement of doximity and how this very same sentence where doximity was announcing an integration with chat GPT included the word fax machine. And I thought that is the most health care example that I have ever heard in terms of technology and A I dr minor in the context of the work that you are leading at Stanford and in particular the conference that you held last week. How are you thinking about A I in health education specifically? Sure. Thank you. And I think there's an enormous amount of green space here, right, in terms of the impact that A I is going to have throughout the continuum of medical education care delivery, discovery based science. And also importantly access to care. Uh We talked a lot about efficiency of of health care, talked about improving the quality of the health care delivery. But also, you know, A I has the potential to dramatically increase the access to specialists, the access to the type of specialty care that oftentimes is only granted today, only given today in centers in the educational sphere. You know, we're educating physicians and scientists for the next 3040 years of their productive lifetime, medical education, even scientific education, biomedical science used to be heavily based upon memorization and understanding of a core basis of facts that's been diminished. But I think it's going to be diminishing even more as generative A I becomes multimodal, generative A I and incorporates more than language, incorporates images, incorporates data from wearables and other information that can be assimilated in ways that today we depend upon humans to do it. Whether or not those humans are physicians or scientists or a mixture of the two. That's really an exciting space for us. I think education has received overall less attention uh today than some of the other applications we've talked about. But the potential is just as enormous. One area that I wanted to get both of your thoughts on in particular is this question of bias in A I which is uh which is the topic I know that is top of mind, certainly at Stanford and, and for the work that you're doing and niche, we talk about garbage and garbage out. If A I is mirroring human bias, how can we mitigate that impact as A I replicates that scale? So we spend a lot of time on this question because we deal with regulating inputs. That's one question, how do you regulate models? But we also think about managing outputs and so acknowledging biases, but then building processes in place to address them may actually be the key. So if you look at the home page of the White House website on algorithmic discrimination, it's the poster child of the Optim algorithm that allocated care management resources to based on spend which you know, incorporated the bias of where and how people access health care. But if you focus on the outcome, which is who has the highest and best need and how do we allocate limited resources to address it? One can build outcomes programs to deal with this issue. Even if the model itself may not have the right information, by the way, that is a part and parcel of why over 40 systems and health plans committed at the White House in December that they would take on a more of a self regulatory process to focus on the outcomes and the use of A I as their, as their obligation rather than just worrying about what's in the, er, or what's in the software. I think outcomes focus is the key with the focus on outcomes is value based care. A better use case for A I. Well, we're going to get that in a minute. But absolutely, if you said, what's the productivity function of the health care system at the hospital? It might be nurse productivity to get staffing ratios down. If it's a health plan, it might be medical loss ratio more broadly. In the case of like, what do you want your mom and dad to get for the best possible care? You want them to live longer and healthier and you want them to be on track with all their preventive services. A value based care organization's key performance indicators, productivity improvement on those aligns best to societal goals. In my view as a, as a VC, it's my job to be an optimist. But I think we need to have a conversation about what could go wrong in this case. And as we were chatting earlier, you know, I think back to the early 20 tens and the promise of social media and technology as a democratizing force and a force for good years later, we look back and realize there were unintended consequences and it's not always going to go the way that we anticipate. As we think about the rapid deployment of A I and the rapid innovation in this space. How can we mitigate future unintended consequences, Dr Mor? Well, I think one important topic is how do we think about the responsible role of regulation and compliance? Um And I've been very impressed, not surprised but very impressed about how federal agencies, the office of National coordinator of the FDA are really leaning in and wanting to understand more about how systems today are deploying A I. Um how A I models are validated, what, how that validation may need may need to be incorporated into a national regulatory framework. But to the analogy with social media and what went wrong in a sense and what can be prevented? Um I think with health care from the get go, we will have more engagement appropriately from regulatory agencies than we've had in social media because of some of the legal constructs protecting companies from liability. On the way the platforms are used, certainly in health care, there will be decisions made about how liability is apportioned, but there's no question that systems doctors are responsible for the care that's being delivered, whether or not that care is being augmented and hopefully improved A I or not. So that's one I think key difference is we'll have more engagement appropriately from federal regulatory agencies to help drive this dialogue and make sure that we're focusing on consequences that could result from models are only going to be as good in making predictions as the data that they're fed, as you said, A I is in a very real sense, a mirror as to what it's learning and if what it's learning is from a biased data set, then its output is going to be biased. Um So understanding those processes and then having appropriate regulatory oversight, I think it's going to be really important moving forward. Maybe Dean, if I could just build on, on the dean's thoughtful comments, I think the engagement with regulators is a very positive, but it's a takes two to tango situation. We also need early adopters to collaborate in a more of a think of it, more like instead of a two sides to the negotiating table where I'm representing the folks who are using it and you're the regulator, we sort of have to be more at a table like we see in this room where we're, we're all rolling up our sleeves to learn together. So Harvard Business School and uh uh Boston Consulting Group did a study and they found that actually the smartest analysts were dumbed down, not enhanced by A I because they defaulted to the answer and sometimes the answer wasn't as good as what the best performers could do. So that was a head scratcher. What does that mean? Well, the regulators are not going to get to that level of minutia in what the regulation should say, be mindful of dumbing down. So you want stakeholders to set norms So University of California at San Diego said when we do the inbox draft notes and I think Stanford does this too to send messages to patients. There's no button that says submit. So you get the auto generated, there's no like send without it. The words are start from scratch or edit from where the A I left off. That kind of default setting is a norm or a behavior that is designed to mitigate against a learning that sometimes these things may have a negative effect. So as we learn together and we share best practices, there may be more coming out of the normative behavior of what should be the way we do this with the regulator saying thank you. Keep going. Relative to say the idea that we're waiting for a rule that may take a year and a half to get through the process to actually close whatever the perceived gaps are in just a moment, I'll turn to the audience for questions. So raise your hand and somebody will come to you with a mic. But in the meantime, I want to hear more specific examples about what you're excited about because A I can mean so many things and I think to, to, to an individual, sometimes A I and health care means an A I chatbot that's taking care of you. And we know that there's so much more to it than that. So can you share an example Dr Minor of an A I use case that you're excited about. Sure. And let me first follow up on a really important point that Anish made and that is a really important role for convening right now and for sharing ideas. Last week, we hosted at Sanford four days of conferences related to A I is deployment in health care and biomedicine beginning with a conference related to our initiative, raise health responsible A I for safe and equitable health. So if you ask me what I'm excited about, I'm excited about the way people are coming together, bringing their problems, their ideas and collectively reasoning how, you know, we can come together to solve those problems. This isn't going to be, you know, one massive deployment. It's going to be a lot of incremental deployments. It's going to be a lot of incremental advances but sharing ideas, what's working, what's not working, having methods for validating A I models before they're deployed as the coalition for Health A I or C which we convened the first meeting of that group last week at Stanford as well. That's going to be the way in which we determine the best applications and make sure that A I is being deployed responsibly and achieving the benefits that Anish and you and so many others have talked about that we should be attaining from A I absolutely question from the audience. Yes, back there. So we've heard a lot about A I in terms of productivity and improving the patient doctor relationship. Um My name is Rami Baloi. I'm the CEO of an no, but also a doctor who's been using A I. My question is, is what is the chances that A I by making certain administrative and third party services within healthcare so cheap that actually cements bad habits and uh stifles innovation. And to give you an example, um probably one of the largest growth areas in A I and health care that's not been talked about is billing coding, prior authorizations, prior authorization denials. And I would say this is even pre chat GP T and I will tell you the number of prior authorization denials that I've gotten that are A I generated and clearly missed the mark. This year has expanded exponentially. And so when those administrative burdens become so cheap, does it then decrease the risk taking of organizations to adopt a totally different model to go away from a framework that clearly has sort of stifled innovation in the past? If you don't mind, I might just take a stab because I think this gets to the nature of the question of the micro versus the macro policy objective and the goal. So each institution is going to have some use case in their administrative performance where they can use A I to be a little bit better. So that chart review to find that, you know, denial generating reason that's going to happen at scale, right? Now it's pecked because it's an expensive thing for plans to pay for that's gonna happen everywhere. Conversely, you're going to appeal every denial. So we can assume that in a micro economy, this is not the highest and best use of this incredible technology more broadly. What's the number one preventable death in this country? It's still hypertension. It's still uncontrolled hypertension. We launched a Million Hearts campaign in the beginning of Obama. If you remember that and we after all this, it investment, it's still bad. Ok. So what do we do to help people manage their hypertension? It's not, doesn't need, you know, GLPs or anything, you know, this is like simple dollar a day, aspirin sort of thing. So if you look at the productivity function, we want, that's what the Affordable Care Act is helping us to build towards. It was to look at these broader sort of lower quality outcomes that we're seeing in our system and then trying to incentivize organizations to own that as their productivity function. So let me take responsibility for a community to make sure that folks that have uncontrolled hypertension are better managed and they avoid the hospital. So I'm looking for what I refer to as a health information, fiduciary who's assigned with all the information necessary to identify where someone's falling off the tracks and then either directly nudging the individual patient or through a care manager or a physician practice brings them in to manage their care over time. That's the excitement that I see that will have the greatest societal good. We need to have economic model that rewards organizations for putting that service into play. But this is the big moment, institutional micro suboptimal administrative efficiencies A I versus patient centered macro. What do we want the world to be fewer deaths due to uncontrolled hypertension and so forth? And that to me is where I'm going to bet, I'm going to bet we're going to figure this out faster than just tweaking this. It's time for one more question and I see one over here. Hi, Eric J Daza here. So I'm a statistician. I'm bullish on A I, right. Statistics is the engine of the A I Mobile. Um But I'm also a doctor of Public Health and I worry about things like equity in this case, retraining and job training. So you've talked about job training using these A I tools. Can you talk a little bit about um, oh, I have this new A I tool. I don't want it to replace me or like a lot of my skills. How can I get retrained on that so I can still make a living? Thank you. You sure. Well, I think in every advance in technology, we've seen changes in the workforce. Um I, I think it follows on a very important point that Anish made. Um if deployed correctly, I think there will be that type of retraining that goes on in the workforce and will be able to get back in the delivery of patient care both in an individual basis. And at a larger public on a larger public health basis, will be able to get back to the type of interpersonal interactions that historically have been the bedrock strength of our health care delivery system. And that unfortunately, both through the way the system has evolved and also through the implications of current technology, we've been oftentimes separated from our patients. So will there be changes in the workforce? I think undoubtedly, I think there's no way to slow that down really other than to do it responsibly and appropriately. But if done appropriately, I think the workforce can be more effectively, far more effectively deployed in a more humanistic way, in a more rewarding way for workers than exists today where there's so much work that's just devoted to the administrative functions of the system, not directly to improving the lives of patients and populations. With just over a minute left, I'm going to do a fire round. I'm gonna, I'm gonna ask each of you to just say bearish or bullish on this particular use case with A I. So let's let's keep it to one word, bearish or bullish A I chatbot, bullish. Is that one word bullish prior, Bearish imaging, bullish, bullish, definitely voice to script bullish, bullish documentation related bullish also bullish. E hr innovation needed, needed un bullish, needed that bullish mental health, bullish. But man, that's, it's a new model. Likewise, bullish nursing has to be bullish. I hope. I mean, I'm, the protests are scaring me a little bit. So that's why I have a question mark. The uh the, the nurses are protesting the use of A I so anxiety. But I think we overcome this. I hope we'll learn. That's more than one word, pediatrics, I suppose. But bullish, I don't know. The use case specific is hard. Yeah, that's true. But bullish if it, if it helps to, you know, we've assumed all too commonly that kids are just small adults and that's not true. So if it helps us actually tailor health care appropriately for Children, then definitely bullish. Excellent capital b, great, great way to end. Thank you all so much. Fantastic panel.

Stephen Gillett, Chairman and CEO, Verily  Bob Segert, Chairman and CEO, athenahealth  Andrea Downing, Co-founder, The Light Collective (appearing virtually) Moderator: Andrew Nusca, FORTUNE

Brainstorm Health 2024: Data, Security, and a More Resilient Future

Neil Lindsay, Senior Vice President, Amazon Health Services, Amazon Paul Markovich, President and CEO, Blue Shield of California Moderator: Chrissy Farr, Owner and Editorial Lead, Second Opinion Media; Co-chair, Fortune Brainstorm Health  

Brainstorm Health 2024: Reimagining Partnership and Building a Stronger Healthcare System

Neil Lindsay, Amazon Health Services, Amazon, Paul Markovich, Blue Shield of California, Chrissy Farr, Second Opinion Media; Co-chair, Fortune Brainstorm Health  

Good morning, everybody. It's so nice to see you all again. So I'm gonna dive in with just making a comment that I think is, is just classic. Continues to be true today, which is that nobody ever got fired for buying IBM. And here we are today speaking with two people that formed a partnership. But I think, you know, when you read about it in the press, it was, it was big news. This is a big moment, hadn't been done before. So we would love to hear from both of you actually on how this all came together. Give us some of the light insider gossip. Well, well, for us, we, we really just uh we are all driven by our nonprofit mission. We wanna create a health care system that's worthy of our family and friends and sustainably affordable. And the system is just so far away from that particular to the pharmacy system. I call it a forest of opaqueness and profitability. Um When I was describing it that we just said, you know what you need to start over and re invent it and reimagine it. So we spent a lot of time actually just pre COVID designing this thing. And then we had to figure out, well, uh how do you, if you, if you start from scratch and do what we decided to do, which is go directly to the manufacturers do a contract, then you have to figure out how to do the administration that you are currently doing through a pharmacy benefit manager. So you break it down into its pieces and one of the pieces was, well, you have to get the drugs from point A to point B like, well, who does that better than anybody else in the world? Uh And it really triggered a conversation with Neil and his team. Well, and, and our mission is to make some things that should be easier, easy in health care. And uh uh clearly that requires partnerships. You know, we don't have it all and obviously to deliver health solutions, healthcare solutions to people, you need different pieces of the puzzle. And so Paul and I actually met at a conference or something like this uh Not so long ago. And I think we both sort of, I felt that frustration that this is too damn hard, excuse my language, but it is, it's just too, too difficult and that it's going to require some invention and reinvention. And uh we've been inspired by Paul's motivation and uh and excited to help him. One of the books we mentioned uh backstage is of course, the innovators dilemma, which I think is, is very relevant to some of the work you're doing. So, so when you initially announced this, you said Paul, that you could save $500 million annually off of a program like this you've seen now some traction. It's been going for a little bit. Do you think you're gonna meet those numbers? Yes, we're, I mean, we, um, you, it would take us, uh, two or three years to scale up to that number in total. But right now we're tracking to that number and, and that's what we expect. I, I think there might be more, more savings over the long term because we're, we're not just changing the pharmacy benefit management model and the players in the middle, we're also changing the incentive structure for oncologists and hospitals and others. So that really none of the players in the system have an incentive to prescribe or administer more expensive drugs. And I think when we, that happens, like phenomenon, you see today, like how in the world does Humira go off patent and keep a 90% market share? It's because all of the incentives are lined up for these rebates. I mean, everyone's sort of addicted to these, to these rebates. But when you take those incentives out of the system, then all of a sudden you don't have that you're looking for the most cost effective drug and you would get a much bigger swing towards biosimilars faster. So I think that, um, we haven't really factored that in fully to the long term savings. So I'm, I think we're tracking well to the 500 million and I think longer term it could look better. And Neil Pharmacy is a space that I think we've seen just a graveyard of failures in the start up world. It is a very, very tough area to innovate for all the reasons that Paul just said. So if you're Amazon, you've got all the resources in the world, you've got great people on the team and you know that you can do something Greenfield in health care. Why, why, why pharmacy? Well, firstly, uh obviously it's best to build on something you're already good at, right? And at its core, at our core, it's about selection value and convenience. You know, when you think about Amazon more generally, particularly in a retail environment, it's about making available the things you need, doing so at an affordable price and being as convenient as possible. And in many ways, that's what's needed in pharmacy. You need the selection, you need to make it affordable. So things like Rx Pass now, $5 subscription that gives you unlimited access to the generics on the list, including delivery to door. And of course, we're reasonably good at the convenience of delivery to the door. So, uh, well, it's very different and clearly there's some things that make pharmacy uh or healthcare specifically more difficult than perhaps just general merchandise. Uh, those are things that we're willing to invest in and event. So it's not really a stretch to imagine why pharmacy makes sense for Amazon. And as somebody who's kind of moved into health care to take on this work, curious if you, if there are any specific things that have just surprised you about the pharmacy space and kind of moving through this partnership. Uh, well, it makes my head hurt, the economics, make my head hurt seriously. I mean, honestly, the, you know, clearly this is far too complicated, it's far too complicated. We need a simplification. I'm again, inspired by Paul's energy and motivation to uh to find different ways to achieve uh you know, help with medication adherence, help people get the medications they need. Uh and uh you know, we need to work, we, we have a, a very broad customer base clearly. And so obviously, we want to support the system that exists but also be very supportive of the innovation that's possible. Uh But yeah, you know, this is, this is the, perhaps the there's no other part of our business. I think that is as complicated as pharmacy. And uh and that's a shame because it's not in the customer's interest, it's not in the patient's interest and it, it's not helping people get well. In fact, it's probably doing the opposite in some cases. So I, I am uh encouraged by the fact that I think everyone knows that. And so people in the industry do want change and people are looking for ways to simplify this experience for customers and patients. And we've just got to encourage that energy. And Paul to that point, you, when you announced this, you were replacing something which was CVS Caremark and you know, reading between the lines and kind of seeing some of the comments that were made. I think the insinuation was, you know, this is still very early. We'll see how it goes, maybe they'll come back. So would be curious to just hear your thoughts on that. And then how do you, as you kind of meet with other ceos in the blues universe, how have they reacted to what you're doing? Is everybody saying, can I do that too or are they going to watch and wait? Well, first of all, I don't, I don't see us going back and because this model is just so you, you, there's no way you're gonna get to the outcome that I talked about care worthy of our family and friends and sustainably affordable in a model that is built to profit to, to maximize the profit of the players in the middle as opposed to put it really maximize the experience of the patient, the quality and the cost effectiveness. So we're committed to this model. Uh And we're confident we can figure figure out how to make it work and uh I don't see us going back, there's a lot of interest from other blue plans. Um, that I've spoken to. I think they really want us to de risk the implementation by working it through and making it. I don't think any of them wanna be alpha or beta testing this. So I think they wanna see us get it up and running and have it work and in the deep end we'll see how it goes. Yeah, exactly. You, you, you, you figure out how to swim and then we'll know that there aren't, these aren't shark infested waters and we can jump into. So I do think that there's gonna be a substantial movement towards this model once it's successful and it will be, and I, I just think it's gonna be fundamentally almost. I think everyone's gonna have to move to something like this because uh there's just the current system is structurally built for inflation and we can't afford it. So, just a reminder to the audience that if you have questions, I'm gonna be coming to you next. Um But before we do that, I'll, I'll ask one more of my own, which is on the topic of the consumerization of health care. And we've been talking about this ad nauseam for years. You know, are they patients? Are they consumers if we have this system of health insurance? Why do we need to be thinking about things like cash pay and treating this as if it's, it's something that a consumer can just buy on a marketplace which is sometimes true, but oftentimes not true. And so we would love, well, actually both of your thoughts on this, of how much we should be thinking about health care as a consumer problem. And then once we do that, can we start to think in new ways about consumer, the consumer experience, convenience, all of these sorts of things Neil? Yeah. Well, I often use the word customer and patient together. And the reason I do that is intentional because customers have agency and I think patients too often don't feel like they do have agency. And you know, I I often have to clarify that. I'm not suggesting that in healthcare, the customer is always right. And actually if you take that full quote that it's always, it's actually the customer is right in matters of taste. So thinking of patients as customers doesn't necessarily mean that you have to give them exactly what they want, you need to give them what they need. But thinking of this environment as customers encourages us to think about their convenience more to think and we know if things are more convenient, they'll engage in it and if they engage in their healthcare, they're going to get better outcomes. And so I intentionally talk about customers and patients in the same breath often because they want us to think about the high bar of how we treat customers in every other industry and try to strive for that same level of convenience. Well, and I think this is what one of the big things that binds us philosophically. And we found this early on Neil and I did in our two organizations is that we are both just obsessed with trying to figure out how to make the consumer experience or the customers experience better. Um And I, I do think about it. I don't think we should shy away from those terms and talking about people. And one of the reasons is that uh we're interested in the health of everyone, whether they are technically a patient or not, you may not be needing to see a physician or use the medical system. But how are you sleeping? Right. How's your nutrition? Uh Those things all matter to the quality of life and health, they matter to us. But I don't know that they, anyone who's in that situation would consider themselves a patient and see themselves as a patient. So, but I think what really binds us is this notion of this system is not set up for the consumer, for the end customer and the user and we can make it so much better and so much more centered around them. And I think both of our organizations have uh a bit of an obsession with that. It's great to hear. Um I'm gonna throw it out to the audience for any questions, seeing a few hands go up on our way to you. Hello, I'm Naveen Jen from YM, Life Sciences. Um, and the question I have both for you, Paul and Neil, is that in terms of prevention? How does the consumer really focuses on prevention rather than really sick care where the health care incentives are aligned to keep you sick? Because you, everybody makes money when you're sick and no one makes money when you're healthy. So, how do you fundamentally change that? And how do you make this consumer the CEO of their own house? They feel that they are responsible for themselves. Yeah, I, I tell people all the time, it's like I, I'm, I, the biggest lesson that I have learned in my more than two decades in health care is you cannot fight financial self interest. That's why we're going to this new pharmacy model. Like no, I'm not going back to it because I, that I know how the financial self interest is lined up and it's not lined up to get to the outcomes that we're looking for. And so you have to figure out how to pay primary care physicians, specialist hospitals in a way that says you maximize your revenue and your profit when you do the right thing. So we do, I won't walk through all of them, but we have payment models that we think will work. We're putting scaling them up. I think we'll have more than 80% of our primary care physicians on a really good payment model that pays them on a per member basis. And then they get bonuses for quality, for cost effectiveness and for patient satisfaction, all the things that you would want. So you wanna pay the folks in the system that way. And then really we want to be able to have the experience for the consumer, be positive enough that um we're helping them with whatever what's going on in your life. Like, how are you thinking about your health? Because people don't walk around like I, I exercise every day and I, you know, try to eat right and get some sleep, but I don't think about it as prevention. Like I don't walk around thinking I'm gonna try to prevent some illness today. And I think most people don't think about it that way. So being able to then also engage the consumer in that way is important. Yeah, a long form of our mission is how do we make it dramatically easier for customers, patients members to find, choose, afford and engage with everything they need to get and stay well and getting well is an important part of staying well and preventing illness is central to that. And clearly, as Amazon, you know, selection, being able to provide access to whatever you need, whether it's a treatment for an illness or preventative service is part of what we want to do. And we have a long way to go. It's early days. It's day one, we need to simplify that for customers and patients so that they can find those resources more easily, so very motivated to help with the preventative care. So this has been a bit of a month for telehealth. Um We saw definitely some news about um Optum, shutting down the telehealth business. Additionally, news about, about Walmart and telehealth. And now you're seeing a lot of news where people are saying, well, maybe we just overly hyped this during the pandemic and we're going to move into essentially what we had before we're going to slip back into the status quo. As you think about those sorts of opinions that I'm sure you're, you're also seeing that are out there in the ether. How do you think about that? Right? Balance between telehealth in the home, seeing somebody in person. And you mentioned just now the financial incentives, clearly, there are financial incentives to get us back into clinic. Look, I, I think that uh I don't see telehealth disappearing. Um I, I do think it went through quite a craze during COVID, um which was never gonna be a normal model once we got out of COVID, but in terms of the, the mix between virtual and in, in person. But I absolutely think that uh there's gonna be different preferences in terms of how the con the consumer or the patient wants to engage in these situations. And that's gonna be an option that people are gonna take up. I actually think, um, improving access, it's gonna help with improving access. And in particular, I think about behavioral health. I think that is a place where, um, there's a lot of opportunity to use telehealth so, I don't see it disappearing. I do think what you're seeing is that there are companies that are struggling with the business model and, and how to make it profitable. That's what we're seeing, but I don't think telehealth will disappear. Yeah, I think we have to work back from what's convenient for customers and patients. Right. Again, if we're truly going to have a positive impact on human health, you have to make it very accessible. And so if the way to make that accessible is telehealth or in the home or whatever it might be, then we should make that possible and then fight for the economics to work. Uh It's not the other way around. It's not does the economics work? Oh, as a result, we shouldn't do this, it should be, this is what's needed and let's make that work. So that's why we have Amazon Clinic which is a cash pay. Uh You can uh do text based asynchronous care or uh telehealth care at low cost. It's obviously for low acuity conditions or you know, you can have a medical relationship and have that ongoing care for primary care, which also has we have 220 clinics. So and, and I get very excited about what might be possible in the home. Um So while we might have bumps in the road that make things more or less difficult, the trajectory should be the same and telehealth is clearly part of that trajectory. Um, totally agree. And I always say that I think tech and S MS is one of the most underrated ways to receive care. We just don't do it because the business model is so tough. OK, we have two minutes left. So I'm gonna put you both on the spot with a 12th answer. We've got a lot of start ups in the room watching this. Um Tell us, you know, how do they even reach you if they are interested in a partnership, which is the topic for today. Go ahead, Neil. The only way we're going to be successful in health care is by making it easy to access the products and services and professionals that people need. We're not going to create all those that's going to be the services that are in this room that we need to make available. Uh Judging by the number of emails I get, I think everybody already has my email address. So yeah, but uh but what I actually, I think what people miss all the time is they, they, they wanna talk to the CEO and 90 plus percent of the time. I am not the one deciding your face, right? There's somebody else on the team that's assessing it. And so with the people that are real successful are the ones that actually do their research on the company, they understand what the company is doing. They understand who the decision maker is and they actually go to the decision maker because if I took 15 minutes for a cup of coffee for everyone who invited me, that is all I would be doing for the rest of my life and, and clearly I can't. So most of the time those, those emails just get ignored. So I would just encourage you to, you know, dig, do a little homework, find out what's going on with the company, find out what's going on um, with the who the decision maker is in the company and get to them plus one. Well, thank you so much for a candid discussion to both of you. It's a pleasure. Thanks for having me.

Andrew Lacy, Founder and CEO, Prenuvo Dr. Daisy Robinton, Co-founder and CEO, Oviva Therapeutics Alina Su, Co-founder and CEO, Generation Lab Moderator: Alexa Mikhail, Fortune  

Brainstorm Health 2024: The Age of Longevity

Dr. Isaac Kohane, Professor and Chair, Department of Biomedical Informatics, Harvard Medical School; Editor-in-Chief, NEJM AI Dr. Peter Lee, President, Microsoft Research, Microsoft Julie Yoo, General Partner, Andreessen Horowitz Moderator: Chrissy Farr, Owner and Editorial Lead, Second Opinion Media;  Co-chair, Fortune Brainstorm Health  

Brainstorm Health 2024: What’s Next in Generative AI’s Revolution in Medicine

Dr. Isaac Kohane, Department of Biomedical Informatics, Harvard Medical School; NEJM AI, Dr. Peter Lee, Microsoft, Julie Yoo, Andreessen Horowitz, Chrissy Farr, Second Opinion Media

Dr. Isaac Kohane,Department of Biomedical Informatics, Harvard Medical School; NEJM AI, Dr. Peter Lee, Microsoft, Julie Yoo, Andreessen Horowitz, Chrissy Farr, Second Opinion Media

We have so much to talk about and not a lot of time to do it. And I, I feel like we have just gone from Sperm Adon today to climate change. And now we're talking about A I which I think in some ways is incredibly amazing, just thinking about the applications and then others deeply terrifying at the same time. So I wanted to focus what time we have today on not talking about the thing where all the money is going, which is mostly revenue cycle management and payment and anything touching the back office. I want to talk instead about diagnosis. So I'm gonna start um with, with Isaac. I just went to your conference, we talked a lot about the potential for diagnoses using generative A. I tell us a little bit more about why you've come around on this because you used to be skeptical. And I think now you're increasingly saying, I think doctors everywhere should be using this tool in their own practice. So I'm not even sure that doctors everywhere should be using it. I do think they should. But more importantly, patients are using it now. And here's where when I got my phd in computer science back in the 19 eighties, which was also a heyday of A I. And it's we were disappointed afterwards. Why am I not worried about this happening now? Because we released these tools right to the public just as we reached, released them to doctors, doctors do not have privileged access. This has been game changing in the context where we cannot even get primary care for my own faculty in Boston patients on diagnostic Odyssey. We just at the meeting that we were together, we heard about a mom who had a child, has a child who for three years had bad gait, trouble walking, trouble chewing, paralyzing, uh headaches, all the studies for three years, nobody could diagnose. She then types everything into GP T four is told most likely this is a tethered cord syndrome. Your spinal cord is trapped by the bones around it. She goes to a neurosurgeon and there is a neurosurgeon looks at the MRI says, yeah, that's what it is. Go to surgery game changing. This is happening again and again. And so with all the warts that we see in A I today, it's changing and moving so fast. But even as it is today, it's changing the lives of patients. And I think the real question for medicine is, is medicine going to keep up with the rate of change of knowledge that A I is going to bring to patients and do so symmetrically in medicine and medical care. So that brings me to a question I had for you, Peter, which is that it feels like whenever I'm on stage at these conferences, it's a big talking point for the technology companies to say we are not replacing humans, we merely augment them. This is a term I have heard many, many times in my career. Um But what you're talking about is a case of actual replacement. This patient could not get a diagnosis, had to turn, the, the patient's mother had to turn to GP T four. It was essentially AAA physician of sorts in the loop that, that had to be brought in to make this ultimate assessment that proved to be correct. So when you hear about case studies like this, which you must do all the time, where do you land in terms of augment buses replaced? Well, you know, first off, just listening to Zach, it is an amazing journey that we've been on because uh Zach was the first outside person that I looped in brought into the tent, so to speak on what we now know as GP T four. And I think that first phone conversation, you were pretty skeptical. I, I think you were tell us that. What was your exact, what were the words you use? I don't know, I don't know the words I used, but I was just thinking, what is the cell job I'm getting now. He he was very bad at suppressing his eye rolling. Um, but, you know, uh but then I think the first things he tried were some diagnostic uh clinical problem solving puzzles. And it was shocking how well it does allow me to quickly jump in. So there's something called the undiagnosed disease network where you do genetic diagnosis on people who have not been diagnosed for a long time. And I took one of our hardest cases that we had not yet diagnosed um where there were five mutations that could be it. And I just gave it to GP T four as it was much more interesting back then. Um And it got it. And how do I know it got the right answer because we didn't do the, the bench research afterwards and it was the mutation it picked. That was the cause of one. Yeah. And of course, now there have been over 100 gender of A I research articles published in major medical journals, including the new one that you started uh the New England Journal of Medicine. And so it's very well established that there's capability there. And so now the question is, what about this augment uh versus replace um thing. And I first off just as a practical matter uh until we get clear accountabilities or what the bioethicists would call, recourse straightened out in our society under no circumstances, in my opinion, should the machine be replacing a human doctor? It's only with human doctors that we as a society have, uh, clear accountabilities in place. Having said that I do believe very soon sooner than we expect patients might demand that a human doctor double check his or her work with the use of A I in the same way that if you are a pregnant woman and you go to an obstetrician and that doctor says, ah, no, I'm gonna do a manual palpation because I don't believe in ultrasound. I think you'd be pretty uncomfortable today even though it was just the opposite a little while ago. So I think there's going to be some flipping of patients expectations in addition to patients self serving themselves with A I, so I want to disagree but I want to hear instead from your question with, uh Julie. Yeah, Julie, I mean, so many questions for you because you're actually one of the few folks who's really investing right now in A I and um, one of the conversations you and I have had is really about the sheer amount of money that needs to go into some of these companies just because of the cost of compute. And Andre's been posting about this just taking some incredible content going out of just like how much does it cost to spin up some of these models that need to be running? You know, a lot of that money going towards companies like NVIDIA and, and others. So, so how much is VC now just a game of like tons of money going to essentially, you know, propping up at video. I think NVIDIA has been on a, on a great streak. Um, and how do you, how do you think about that as you make these sorts of investments where you're looking to make a return? Yeah, I mean, I just to tag on to this past conversation about diagnosis. I mean, when you look at um number one, like our industry is one of the, one of the only industries, it's not only the only industry that actually has regulatory rails for how to approve diagnostic A I products, right? And so I think it would be a shame if we weren't to take advantage of that and actually lean into that opportunity as the technology evolves um to such that it's appropriate for those use cases. The second thing is that um all the rages, I'm sure everyone or most folks in this room at this point have seen some kind of demo about the ambient describe technologies. I think you had done like a live 11 week ago. OK, great. Um But when you look at what that tool, what those tools are actually doing, it's actually creating a proposal for diagnosis, right? And so that that kind of technology is already out there. It's already in the hands and it's going viral across, you know, physicians. I have never been told by any clinician ever that they were excited about anything, let alone a piece of technology. And how many calls have I received from, you know, clinicians going out of their way to tell me how magical some of these tools have been to uh just transform their careers and their life and actually make it, you know, pleasurable to, to be a doctor. Again. I mean, all these things are, are quite incredible. So I think it's, we're already there. And um you know, again, we have, we, we actually have the regulatory rails within our industry to actually take advantage of this um from an investment standpoint. Um You know, our belief is that number one, we do require specialist models within our domain, right? So yes, um chat G BT and all of the open models are remarkable in many ways. But at the end of the day, our industry, especially when it comes to clinical decision support and, and those kinds of applications require a mix of probabilistic and deterministic intelligence, right? And you're not gonna get the latter with, with just off the shelf um generative A I tools today. And so there does need to be investment in novel architectures to take advantage of both uh you know, more traditional and more next gen um A I capabilities. Uh I think in one on under one roof to be able to do this effectively. And then two, as we also all know, um the data that is necessary to inform these models for the most part lives below sea level, right, uh are in proprietary assets within our health health care system are not yet optimized um necessarily for uh training use cases within the a a landscape. And so we have a tremendous amount of work to do to like really unlock uh all of the investment that we've now put into EHR into other data systems. All this voice data that's out there and all these, you know, call center recordings are just a tremendous treasure trove that we have yet to, to scratch the surface of. And so that's really the work to be done and therefore you need to invest. And so that's really the way we think about a lot of this is that you do need to build proprietary models within our space that require investment that said we believe that there will be a very finite number of companies that do so, right. So there will be a small, just like in the rest of the industry. There's a small number of companies that are actually building these foundational models of the scale that um is being used by consumers. Um We think the same thing is going to play out in our space and there there will be a long tail of companies that then take advantage of those foundational models to, you know, do additional tuning and rag and, and whatnot um to build applications on top of but that, that's sort of how we see the, the industry playing out at this, at this vantage point just to remind us that if anybody has questions, feel free to, to ask at any point. Um So I'm just gonna dig a little bit deeper into this diagnosis question that I think we've all kind of self tackled as being one of the major areas that we will see a I disrupting health care. What do you, what do you think are the main concerns related to, you know, doctors, clinicians getting a little lazy with these tools. Just kind of, you know, we say, oh, it's fine, we'll, you know, we'll audit, we'll double check. Yes, hallucinations happen. But we'll make sure that there is another set of eyes. But we, we know from looking at areas like airlines that, you know, pilots can get lazy and get used to the autopilot mode. So how, how do we avoid that or prevent that from happening in the way that we design some of these tools? And I'll throw that to you first. So I have direct experience with this. I'm a bad driver and I have a Tesla. It's true. Very bad. I am a bad driver. And in fact, my girlfriend who's somewhere in the audience when she gets in the car with me wants me to switch on autopilot. But here's the thing, even with the autopilot, I'm a bad driver. And so I have my hand on the wheel. I know enough to like jiggle the wheel and then um, I do something really bad. I pick up my iphone and I start looking at it and then the Tesla or paraphrase says to me, Zack don't do that. Keep on looking at it says, ok, I'm switching off autopilot so fine. Alright, so I drive home and it's not, not a great experience. I do it again. We're driving. I I look at it and says stop it and I get home and it says Zach do that three more times. I'm switching off autopilot for until the next update. Tesa sounds like your mom a little bit. That's how I talk to my kids. So you know what we're like kids many of times when when people are not looking at us. And here's the point I think that if we're serious about this you have to find out is the doctor awake at the wheel and say something like, oh, just drop into the summary something the doctor didn't say and, and, and when they're checking off and say, oh, he really didn't say that there was an ugly, hairy mole on their nose. There was no ugly, I think we'll it's going to be required checking in. So either we're going to buy into the importance of a set of human eyes in which case we're going to have to check that those human eyes are on the patient and on the decision making or we, we let go of that illusion and drop the doctor out of the loop. But if we think that the doctor has to be in a loop, we have to make sure it stays in. I could tell you long from what we know from informatics the last 20 years, doctors will argue endlessly about certain things. But then when you give them an order entry system, they'll just use the standard defaults without any argument because they're under time pressure and that's it. We have time for a question from the audience. I I hope uh thanks rather than with nana aware, we do uh remote diagnostics at home. We recently got an FDA approval for an enabled hypertensive diagnostic and self administered continuous blood pressure at home. I bring that up not only for the shameless plug for everybody, but in general, that is not a generative A I tool, it's fixed. And part of the reason we got the approval is because we offered to give post uh post market surveillance data every six months or at a certain period of patients that we do with FDA. And this brings me to my question on gen A I, we often, I feel like don't talk about the inputs being static versus dynamic uh blood pressure, for example, bounces all over the place. That's why we have to give PSM data every six months. And then with regards to health care, while we think of gen A I with language models. We also don't talk about closed source versus open source and we were able to create these LL MS because the internet is completely open source and all the dialogue of all the postings that we've done, we don't share data across organizations and across systems in health care in that regard. I'm just really curious on everyone's panel, static versus dynamic inputs and then how do we get to actual gen A I for diagnostics if we're really just going to be a closed source industry? Yeah. Um On the second question, uh part of the question which has to do with data, I think the unfortunate thing that I predict we'll see for a few years and I don't know how long it'll be, I don't know if it'll be one year, three years, 10 years, but some period of time, health data will be more severely protected, not less organizations will be more selfish and proprietary with their data. And the reason for that is that generative A I helps quote unquote unlock the value of data. Forget about the chat interface, chat interface is going to be important. But the real value, generative A I is in its ability to rummage through large amounts of unstructured data and derive structure that creates value. And that is going to make all of those health care organizations that have invested millions of dollars aggregating their data more protective because they want to realize that value and it's going to take some sort of intervention or some sort of tipping point, sort of like what we saw in the early days of networking before people realized that if we all work together, we'll all be better off on the, well, maybe I should give someone else a chance on the first question. Yeah. And I think, I mean, the, the dynamic input piece too. I mean, this gets back to my point earlier about there's entire data sets that need to be created to even be able to train these models to be represented. True, bio biology, true, you know, health care status. And so, um you know, I I think we are today constrained, like I, I think if you're building a model that's entirely reliant on just E hr data which you know, to some feels like a holy grail. I think that's actually completely the point, you know, that the information that's stored in the E hr data is highly biased, highly sporadic, highly, you know, centralized et cetera and is is a very poor represent, represented representation of an actual, you know, no student care journey. And so I think that that's what I meant earlier about, you know, so much work that needs to be done to really lay down additional data rails that don't exist today in 20 seconds. I want to highlight an alternative model which is out there right now. Apple health gives patients access to their own data for over 800 hospitals. That's 40 million Americans. At least if you exercise that you will have in one space, all your health data labs, diagnoses medications procedures and all the uh lifestyle data from Fitbit, et cetera. In one place. I really am waiting for the companies that are gonna take that population based view, take the patients who have greater, far greater uh incentive to share than the institutions. I'll stop. There. Sounds like a starting a start up idea and love it. Thanks everybody.

Sean Duffy, Co-founder and CEO, Omada Health, Noosheen Hashemi, Founder and CEO, January AI Owen Tripp, Co-founder and Chief Executive Officer, Included Health Moderator: Jennifer Fields, FORTUNE

Brainstorm Health 2024: America’s Sick Workforce and Building Better Health Systems

I'm just gonna jump right in. I'm gonna start with you Sean. Um We have more awareness of chronic diseases than ever before and more drugs to treat them than ever before and yet we have more sickness than ever before. So, can you talk about how we got here? Why are Americans so sick? Yeah, it's a great starter question. And it's uh something I've experienced in founding a lot. We're uh 13 years old and every couple of years I feel like I read the exact same jam article, uh which is the epidemiology getting worse, the disease burden is getting worse. Uh The data is getting worse. Uh And that has to change. And uh the thesis that we have is you have to support people on a day to day basis, a proactive day to day basis and the entire health care system of supporting people every now and then with visits just doesn't work for chronic disease. Uh And I think that that's a real opportunity for employers and why that they can get engaged in really helping solve the challenge. So I wanna jump over to you. Um There are so many large employers who are paying for workplace wellness programs. But we also know that workplace wellness programs aren't actually working. Um, can you talk a little bit about why they're falling short and where I'm gonna start with why that's such a crucial problem for employers. This is the largest expense. It's the largest thing that they pay after payroll. It is the largest reason why they can't attract workforce and they can't maintain that workforce doing the jobs that they asked them to do. So, it is actually a problem of American competitiveness. I know we're gonna talk about health care over our time together, but let's just actually start with how desperate this is for, for our economy and our country. Now, why does this happen? Well, we invest that money. We expect people to find these things on their portal to know how to use them to engage in health care in ways that we in rooms like this design and it just doesn't work members, patients, whatever you want to call them, they want to be treated like complete individuals. They don't actually want to think in terms of the labels of their diseases, they want to be treated for their minds, for their bodies and their wallets and it's companies that pull all those things together that are offering the solutions that are winning today. That's great. And New Jan, you do a lot of work with A I and I think we all hear a lot about the promise of A I and health care. Can you talk a little bit about how you think A I can help prevent and manage chronic illness? Absolutely. It's addressing exactly what um what they both mentioned. So, um often we're offering generic services to everyone. They're not hyper personalized to each person. People are infinitely interested in their own circumstances, don't listen to generic advice very much. So, I think A I provides that opportunity for personalization and getting hyper personalized. For example, looking at someone's data and dynamically updating based on, let's say blood test data that comes in um wearable data that comes in being able to essentially help people with everything from s symptoms, tracking to mood, tracking to early detection, for example, looking at someone's irregular heart rate or they even develop symptoms or providing uh just in time care to people. So instead of waiting after someone's already eaten something to tell them, it wasn't a great idea. As a nutritionist might do, you may want to actually say, hey, it's Tuesday. I know Tuesdays you're gonna have a burrito, this is A I is doing this. Um And we have this um and maybe you want to consider this other kind of burrito today. Um Maybe you want to have an alternative, another Mexican tasting thing that has more protein, more uh fiber, less fat and sugar for you today. Um So we can be more responsive that way. So we can provide a lot more uh preventative uh information and we can offer a I health coach, someone who knows you. Um 24 7 is with you and is going to know longitudinally everything about you. And it can, it has the capacity to understand your image data, your blood test data, your MRI data that can read your wearable data, things that are not human, interpretable A I can do for you. So I keep reading these grim statistics about the numbers of people with dementia, uh, the numbers of people with diabetes over the next coming decades. Um, Sean, do you think technology is moving fast enough to keep up with this? Well, we are, we are on a remarkable technology curve. So it's, uh, it's really the tech is moving. I think the adoption needs to move faster and I think the innovators up here are all trying to make that happen. I mean, we're the fastest tech has ever moved. I mean, there's a new model every other day. Um, my bedtime routine with my kids is now to talk to A I at night and I keep reminding the letter my four year old that A I didn't exist in the way that it does now a couple of years ago. So I don't think the tech is the issue. Uh, I think it's how you actually put it in practice in a way that lands with a person that really supports them that hits first principles behaviorally, uh, and actually gets outcomes and that's, uh, that's what needs to happen. Nein, I think a lot of people would argue that the American job is incompatible with health. Um, can you talk a little bit about how we can bring these two closer together? Yes. So, um, a lot of our jobs are sitting jobs. So, a lot of us are essentially, um, uh, spending, you know, having a sedentary lifestyle, which is uh as you've heard, sitting is the new smoking. It's extremely, extremely dangerous to sit for a, for a number of reasons, your comorbidities go up dramatically. So I think employers that take an interest in, for example, treadmill desks or standing desks people because now we are working remotely a lot. So it's not like great offer, a lot of gym subscriptions offer a lot of. So we need to be really flexible because people are not necessarily coming, coming to that central location, to all work together and go to the corporate gym. So I think that innovating companies are providing essentially flexible ways for people to find healthy living wherever they are. And then, and then contributing to the ergonomics of people's um work environments wherever they are. And I think we need to be able to, you know, encourage people to take vacation for example, and all of this needs to happen from the leadership down, right? We need to mean that um and we need to not just say it but actually live it as leaders so that our employees can become a lot more healthy. And it goes without saying that we should care about safety as well, which is really a factor in a lot of jobs. I'm going to open it up to questions in a minute to get your questions ready. But Owen I have a question for you. So employees don't want their companies to become Big Brother. So how do we engage them but also protect their data and privacy? They definitely do not want that. So, but they probably want more than we think they want. They do want a company that looks out for them and cares about them and they're willing to have that company actually make some bold decisions on their behalf. Let me actually tell you a pretty positive story from the last year, Walmart, the largest employer, largest private employer that we have in the United States, one of the largest in the world. Now, they over multiple years evaluated the question of whether they could offer zero cost primary care to their associates nationwide 24 by seven scheduled at times that were convenient for their workplace and their environments and what they saw not only was the loyalty and appreciation of their associates, but they saw 37% reduction in hospital utilization in hospital stay. That is a staggering statistic one that would be hard to repeat in almost any context. Now, this was a deliberate choice by Wal Mart on behalf of their associates, they were repaid with appreciation and loyalty in one of the hardest labor markets. My point in telling you this story is it is doable. We can actually have both of those things together. We can achieve a healthier workforce and demonstrate outstanding corporate results. So I'm excited about that. Um Do we have any questions in the audience? I think we have one over here. We have, we have a microphone coming to you. Thank you. Um As a child psychiatrist, I would really appreciate us addressing the fact that the roots of most physical and mental chronic illnesses begin in childhood, not only from a physical point of view, but the impact of trauma and adversity on Children, but we have a healthcare system that isn't focused on prevention, it's focused on uh once the diseases happen and each of the exciting things you addressed do address current chronic illnesses. But I'd love it if you could talk about prevention and the role of working with Children to truly change the trajectory of us health. My answers could be quite radical. So I don't know, I should, I should offer them. But um well, are you thinking of uh technologies to work with Children to sort of help them as they grow or do you mean um I mean your question butts up right against the human condition. So Children are small. Um And by their size and people just assume that they don't know what they, what they want and they make a lot of decisions for Children. There's a lot of things that happen, that's how they develop trauma, but, but in terms of, you know, big answers to trauma, um not necessarily preventing. But, um, certainly, I think a, I can provide mental health 24 7 therapy. I really believe that it can. Um I've seen some really, really interesting um uh and also psychedelics are a big, big thing coming in and they will get FDA approval this year. Um that I think on maths um should be able to in conjunction with a protocol, help people address some of their trauma. What I would offer is when I hear prevention, I tend to equate it with proactivity, which is something our health care system is very bad at. And when we talk to our members and say, well, what did it for you like? Oh, well, you, you, you asked me my goals. It's weird that healthcare doesn't do that and you were just there checking in on a regular basis, you know, a continual basis. Uh And because if you do that, if you get to know someone that does prevent downstream progression of the disease, uh and complications, did we have another question? Yeah. Thanks for then uh co founder and CEO of Nano Air Sean. Good to see you again. Um And nice to meet uh the rest of you to the last question and maybe the specific for you, Sean, um, food and diet obviously come to mind immediately when we think about childhood progression into chronic disease. How much have you tied over 13 years? Now, you've tied your solution, which was first data driven on a day to day basis. But now I'm sure you've brought in a lot with regards to diet and food and the services around that. Just curious on how you're tying those, those things together and maybe the other panelists opinions on that as well. Yeah, I mean, I think the, the one lesson I offer could probably talk for 45 minutes on this. I think the one lesson I'd offer is if you don't really listen to someone and really try to understand what will work in their world. Does it align with their goals, their circumstances, their family, their preferences, it just will not land durably. So that's something that there's, and there's an art to figuring that out and really listening to people and matching their truth with what can be encouraged and, and kind of work, you know, for them over time. So again, that's a distillation. Uh, but again, it could talk for hours on that. Can I jump in on that first? So we have, um, we've been in research seven years and the single most predict, uh most accurate predictor of people's glycemic response when it comes to metabolic health and managing your blood sugar is what you put in your mouth. So food is incredibly important, more important than activity, more important than everything else that involve that, that affects your glucose, like sleep stress. Um What time of day you eat? Et cetera because measured at all. So food has an outsized role in, for example, um chronic diseases like me metabolic disease like diabetes, which then leads to other comorbidities. So food is really big and we're very excited about food as medicine, picking up steam as a movement in the country right now. I think 11 states are Medicaid. Um organizations are now covering food as medicine and there are medical prescriptions being written all over the United States and this movement is only going to grow any other questions? Sure, there's a microphone coming for you. Sure. My name is Harvey Carp. I'm a pediatrician and the CEO of happiest baby. We make a robotic baby bed called Snoo. Um And I wanted to just make a comment about the um the health of young Children and and chronic disease because A I fantastic but there's some like nutrition, there are some more, get back to the basics in terms of improving health care. And one of the things that we're exploring with snu is um number one, if we can improve sleep and reduce crying, which we've demonstrated to reduce the risk of postpartum depression because we know that postpartum depression then leads to long lasting problems for the mother but also affects the child development. But one interesting fact is that rhythmic holding and rocking is deeply soothing for all beings. Uh And there's evidence that kangaroo care, for example, that is doing that with premature babies leads to improved brain architecture 15 years later. And so the opportunity perhaps is to introduce rhythmic stimuli as a way of improving brain's regulatory ability and reducing the normal stress reaction so that we're not as predisposed to stress, which then predisposes us to chronic disease. So um just saying that there are other ways of kind of thinking about it um to, to try to start at the very beginning and, and improve the care and thousands of people now get this for free from their employers. Uh It's a benefit all across the country. I I want an adult version, please make it. Um I have a question for, for you, Owen. Um So many employees aren't uh they're like gig workers, they're freelance workers, they're not. Um you know, you know, salaried employees, how should we be thinking about them in terms of caring for their chronic conditions and preventing them? Yeah, terrific question because ultimately, you know, sort of one just to frame the question up a little bit more broadly. One of the things if you think about the payment architecture and coverage in the United States, um a lot of the problems that we think of as the most expensive and acute, you mentioned dementia earlier really actually present after you're in the active workforce by and large. But the seeds, the preconditions are happening while you're in the commercial workforce. So actually investment and prevention at childhood at baby is really important, but the people who are on the payment end of it don't actually realize that. And I wanna circle back to that in a half second um for the gig workers specifically, um We and other companies provide uh benefits uh for example, to Instacart drivers to make sure that we are providing that care. Now, there's two good things. One, the member gets an amazing service whenever they need it at low or no cost to them to provide high quality virtual care. But two, you are not passing a time bomb along later to whoever ultimately has that full commercial insurance responsibility that is really, really, really important. Um I just wanna briefly remark on this conversation, by the way, Marty, your product is great. I've seen it. Um is that I have an interest, I think a lot all of us have an interest in the pediatric roots of disease and chronic disease in this country. But I wanna be absolutely crystal clear about something that is not actually where the money is. And so the problem is that if you think about it, all of us, we get reward in our businesses probably like many of you uh around where you get acute, acute flare ups and cost. And so that's actually where the dollars go. That's where the digital health innovation goes. It actually takes a founder mindset, like my colleagues up here to stay in it for the long term and say we wanna actually solve this problem a lot more comprehensively. I hope more of you will stay in that fight for a long time because health care does take a while because then you can take that comprehensive view of prevention, but rarely are you rewarded for starting a business that's focused on prevention? All right, I have a rapid fire question for you. Um If you could answer in 30 seconds each of you, what is the one most important thing that we need to do to begin to reverse the situation? I'll start with you, Sean. It sounds silly, but I think we need to enable payment for asynchronous care because if you think about what I shared the operational models needed for proactivity, require billing for asynchronous care. So all the incentive structures, all the regulatory structures, all the billing models in the entire us that created this problem of a visit by visit like system that doesn't work for chronic disease is because you can't bill for async care. So if you don't actually fix that, you're never going to create a better experience that could lead to better results in chronic disease. I would say uh deploying A I responsibly, I would say on a personal level, all the things that we could do for a person to gain agency over their health, on board them, to their health journey and keep them there, keep them interested and engaged. But also for a company to manage uh programs such as challenges and campaigns, um health challenges, especially in the remote uh work uh that decade that we're in right now. It's really important to get people interested in uh in group activities even if they are remote. And there's many, there are many ways that A I can help, it can dynamically even change incentives. It can decide this group is doing great. They're going to raise the bar. A I can do incredible things for engagement and Gamification. And of course, at an even higher metal level uh corporate um America can really look at trends, look at uh claims data, we can look at um risk stratification. We can see who really needs help and who should we help uh preventatively. And we can scale solutions like diabetes um broadly and we can supercharge telemedicine. We can do so many things with A I. So I would say that's my one. Thank you. I'm so sorry. We're out of time. It was gonna be really good. You'll have to ask me later. It's gonna be the best one. Thank you so much for joining us.

Surella Segu, Chief Heat Officer, Monterrey, Mexico, Dr. Jane van Dis, Associate Professor, Obstetrics & Gynecology, University of Rochester Medical Center (appearing virtually) Moderator: Maria Aspan, Fortune  

Brainstorm Health 2024: The Changing Climate is Coming for Our Health

Surella Segu, Chief Heat Officer, Monterrey, Mexico, Dr. Jane van Dis, Associate Professor, Obstetrics & Gynecology, University of Rochester Medical Center (appearing virtually) Maria Aspan, Fortune  

Soraya. Thank you so much for joining us and Jane, thank you so much for joining us remotely, Jane. I wonder if I could start by asking you just to tell us why. In fact, you are joining us remotely. Oh, sure. And thank you so much for inviting me. Um I uh when I told you that I could only join virtually, I thought for sure that was going to be a deal breaker. Um But in 2021 I signed a uh a No Fly pledge. Um There is a nonprofit called uh No Fly USA. And uh part of my pledge is that uh I'm gonna find other modes of transportation that are not as carbon intensive. Uh We a study come out just last week showing that the, the thinking around sustainable jet travel um is not matching reality. And that, in fact, we would have to have more farmland than the whole planet even has to create the amount of sustainable jet fuel uh to power our current jet travel. So uh slowing down, not flying uh is one of my goals and that's why I'm attending virtually. Well, we thank you for making the time and I have to say it, I say from this stage of this conference that I flew to, it seems like a radical life altering decision but that it also sounds like that is what is needed right now. The urgency of this climate change situation, I feel, I say as a reporter, it feels like it cannot be overstated and Soraya, I wonder if you could tell us a little bit about how you communicate that urgency in public. Well, uh I like to talk about what are the, the heat waves that we are experiencing right now? And this is happening everywhere. Uh particularly well, in, in, since I've been working in Mexico, uh 70% of the, the States or the majority of the States in Mexico City are experiencing heat waves and you've been listening that last year was the, the warmest year, but that is happening and it's been increasing, it is going to be increasing. So I like to say that we are kind of like beyond resilience, we are more into finding ways of uh regenerate, like find how we can regenerate our cities. Uh Because the cities are the places where we experience more heat right now because we are a health care conference, Jane, I wonder if I could start by asking you, you're an OBGYN, could you talk to us a little bit about the links you see and you um and you forge professionally between climate justice and reproductive health. Yeah. So I actually used to live in California. I used to live in Los Angeles and I actually practiced uh for a while, about five years up in Bakersfield. And you can imagine the Central Valley is full of outdoor workers. In fact, um while Black Hispanic or Latino uh persons comprise 32% of the population, they are 40% of us outdoor workers. And so a lot of those outdoor workers would become my patients. And I would actually see some of the complications of, of those who do work outdoors and how it affects their health. For instance, uh that could be increased risk for asthma and obviously increased risk for dehydration. Um A study published last year showed that of 100 and 92 farm workers in the summer on any given day, 33% of those outdoor workers had kidney injury due to elevated heat index. Um and then pregnant women are especially vulnerable to heat. Maternal heat exposure has been associated with increased risk of both preterm, birth, low birth weight and stillbirth for every 1.8 degree rise Fahrenheit in temperature above the mean, there's a 5% rise in stillbirth and preterm birth. So these consequences of our warming world are we, we're seeing that in, in our emergency rooms and in our labor and delivery. So heat is also at the center of what you study from a different perspective. First of all, what exactly is a Chief Heat Officer? And what did you do at Monterey in Monterey? Well, a Chief Heat Officer is an officer in charge of uh leading all efforts in basing what the the impact of extreme heat represents for cities it's uh attached to the major because the the objective is to be uh to have actions to be implemented. So it's not just policy making or raising awareness, but it's also how we can transform cities in a real way. And what are the kind of uh physical transformations in the built environment that we need to do? Give us an example of what, what um what should cities be doing to transform building environments? Well, there are immediate uh actions like of course raising awareness like campaigns for uh extreme heat particularly because uh what Jen was talking about uh illnesses but also deaths are preventable but they are happening but they are preventable. So it's very important that we know what to do in in cases of extreme heat and how we can take care of us and, and uh the citizens of the cities. Uh we can do green roofing, reflecting roofing, uh decreasing the amount of pavement, decreasing the amount of asphalt because this constitutes a lot of um reflecting heat into the city. But also create some strategies at city scale like a green corridors, green like network of parks and green corridors in cities. Uh We can work with in hand by hand with uh the city manager who works with water management because that's another component that is very important. Heat is not an isolated piece, but it's related to uh water management, the quality of air to the amount of vegetation that you have and uh everything is interconnected. So we need to work in an inter uh integral way in cities. You know, it's such an interesting point because we have long known that health care is determined by more than just your genetics and your personal behaviors in this era of climate change. Um Maybe Sara starting with you and then I'll go to Jane, is there enough awareness about how much our environment affects our health care? And and perhaps more importantly, are you seeing appropriate action being taken to improve both? No, I think that we are, we are very short about what we are doing and what we need to do is really think about uh the physical environment, but the natural environment and how we can interconnect both and how, how we can bring in a massive way, particularly in very dense cities uh or very urban cities, like how we can bring more nature and how we can work with the nature that we have in terms of transforming but also uh how close this nature is to the people like uh particularly because I went to another uh meeting, but how the worker goes from home to the workplace and what is that experience for them in the public transportation or even in the car if they walk? How is that experience? And how is the, the working environment too, Jane? And be curious for your answer as well. Well, I'm gonna take um a slightly different approach and discuss the ways in which uh one element which is fossil fuels on which obviously our economy and our lives depend. Um And talk about the way. Uh for instance, um uh the discrepancy of these urban heat islands, I heard on N pr today that um Phoenix has started to open up its um its cooling centers. Um And so we are preparing for obviously another year of above average temperatures across the US. Um I used to live in Los Angeles and in Los Angeles, there could be up to a 20 degree Fahrenheit difference in temperature between uh shady suburbs and uh and urban Heat Island. So very much uh following uh redlining that occurred in Los Angeles back in the fifties and sixties. And so you see market disparities and inequity in terms of how heat is distributed across the population. And what I will say is then the number two way that that fossil fuel is uh affecting the health of, of Americans across the the country this coming summer is going to be in air pollution. So we know obviously that burning of fossil fuels creates a particulate matter. And we actually know that that fossil fuel air pollution. Uh from my perspective, taking care of pregnant women absolutely increases the risk of preterm birth. Um And thanks to uh recent studies, we've also learned that it's responsible for up to 10 million deaths a year worldwide with that number even growing. And unfortunately, when you combine heat with uh fossil fuel, air pollution, particulate matter, um they are, they are additive, they're symbiotic. So, actually, you know, having high density uh air pollution or having a lot of air pollution combined with heat makes both of those those indices worse. Um And we expect, or scientists are expecting that the eastern seaboard might see AAA repeat of what happened last summer with those Canadian wildfires uh throwing that particulate matter down into the, into the United States. And then the last thing I want to mention uh because it, it isn't necessarily always part of the conversation, but it's always part of my conversation because I, I am constantly amazed at how fossil fuel plastics are affecting. Uh my patient's health. I actually, I was sitting waiting in the waiting room for this talk today. A friend messaged me and she said, Jane, I saw your post today about a study showing that uh of, I don't know it was 50 or 60 testes, male testes that were tested for plastics. Um All of the testes were positive for plastics and we saw this in a recent uh study looking at placentas as well. Every single one of the placenta that was tested, it was like 70 plus placentas was positive for plastics. Well, 12% of our global oil goes into plastics. So to me, plastics are a continuum of, of this whole um crisis of the fossil fuel. Um And interestingly enough, uh 75% of the plastics uh that we encounter that make their way into our air and into our water and ultimately into our food and our bodies. I, I am going to stop you there just because I wanna make sure that we get to another. Well, you raise a lot of really important problems and we could, we could spend another 45 we could spend like 45 minutes talking or more. I'm curious about solutions and so I will start with you. We're all aware of this problem. As Jane said, we all lived through last summer. We're preparing for this summer. What solutions do you see and what needs to be done immediately? Well, we need to raise awareness to, to let people know what is happening and also how they can take care of themselves. Uh We are as many cities in the States are doing, preparing cooling centers for people to be able to rest because that's an important thing to do. You can be in outside but then you have to rest and, and allow your body to balance again. And this Jen may know better than me. But uh that. And also um I would say that start working collectively in, in, in doing what we can do each of us, but planting more trees, uh cleaning more uh our environment. And also um I think creating more, more positions even within the industry uh of people who are dealing with these issues in an immediate way. So trying to transform even our, our buildings like how we can create because the, the first idea is that the air conditioning is something that we, we is a solution, but it actually is something that is creating more heat. So how we can find Nature Based Solutions for the process and and also doing research in like bio um biomaterials and other innovations in terms of uh this environment. Wonderful. Well, thank you both so much for joining us and please join me in. Thanking Soa and Jane.

Sarah London, Chief Executive Officer, Centene  Moderator: Erika Fry, Senior Writer, Fortune; Co-chair, Fortune Brainstorm Health

Brainstorm Health 2024: A Conversation With the Nation’s Largest Medicaid Insurer

Zarah. Thank you so much for being here. Thanks for having me. Uh So so much of what affects the health of the population you serve is outside the scope of the traditional health system, access to food housing. Uh Can people afford medications? Scenting takes an expansive approach to providing care? So I wanna ask you what works. Um How much do you know about the circumstances of your 28 million members? And how do you effectively address those needs to improve health outcomes? Yeah. Well, um you know, I think it's interesting this conversation around drivers of health or social determinants of health, I think has been emerging over the last couple of years, although the data has been very clear for a long time, um that you know, the vast majority, 80% ballpark and however, you want of health outcomes are really driven by factors outside of the traditional health care delivery system. Um But I feel like we're only just recently as an industry and from a policy standpoint at a place where this has become an active dialogue and for, from our perspective, that's incredibly exciting. Um But we need to do more than just talk about it. And so as you said, Centene, you know, one of the things that I found when I joined Centene 3.5 years ago was that, that intuitively, this was something that the organization understood because of its origins, right? So we have been in the Medicaid business for 40 years. Um And our focus for the unique platform of Centene is that we focus on government sponsored programs. So we serve 28 million Americans in Medicaid in marketplace and Medicare our customers, our members are among the poorest and the sickest and the most underserved in our communities. And so this question of what works really matters because we are also by virtue of being focused on government programs, essentially stewards of taxpayer dollars. And we are asked by states, we are asked by the federal government, we are asked by C MS through the subsidized population for marketplace to go out and figure out how best to support our members and essentially to deliver health outcomes. And so this question of what do you apply the dollars to that? Actually best deliver and best buy health outcomes is a question that again, it was sort of intuitively native to the organization. And, and it's interesting. So there's a, there's a health affairs article that uh came out in 2021 that I think has been um far too overlooked for, I think how insightful it is. There was a group that went out and did a bunch of polling and they went out and they asked black female democratic voters and white female Republican voters in North Carolina and swing voters. Latino, swing voters in Seattle and male Republican voters in Dallas Texas. The exact same question which was if you had $100 to spend, to buy health in your community, what would you spend it on? And every single one of those groups had the exact same answer, which was that they would put two thirds of that $100.66 dollars to housing food, child care jobs and only $33 to more health care. And so our members, you know, Americans know what makes a difference in terms of health outcomes and we just need to listen to them. And so that's really been how Sanin operates. We work directly in our communities and we of course, make sure that there is access to health care. But we also think about what are those things that are gonna actually drive health outcomes. And so when you're dealing with, for example, postpartum moms, yes, we wanna make sure that they have, you know, access during the pregnancy to good prenatal care, they have access to doulas and to midwives and to great hospitals. But afterwards, we want to make sure that they have access to healthy food and diapers and basics where if they can't, you know, they don't have access to transportation, how do we get them in for a postpartum visit? So those are all the things that Centene has really been focused on in addition to traditional health care access and how do you connect members to those things? Diapers or transportation, whatever it may be. Well, that's part of our local approach. We've always been local in how we approach health care and making sure that we have team members who live and work in the communities that we serve. And so our team in Nevada funded a van that goes out and literally delivers diapers to members, our team in Delaware. So Delaware just passed an 1115 waiver to focus on healthy nutrition and diapers for new moms. And our teams are already organized around that because we actually do that in multiple of our states already. Um healthy food drives, making sure that um we will fund internet access for um members and communities and community partners who allow for health visits. So it's just a lot of thoughtful community investment as part of the total calculus of getting health care outcomes for our members. Great. And I wanna come to the the audience for questions shortly. So think be thinking about them if you have questions for Sarah and you know, one barrier to health for the many in the Medicaid population is sort of the lack of affordable housing. I know this is uh something you're passionate about. We've seen other insurers invest in affordable housing, but you are trying something new and we're lucky enough to hear it here first. So I hope you could tell us about it and you know what, why you're doing it and what's different. Yeah, absolutely. So we're, we're very excited about this. We've talked a lot at Centene about partnership and having really strong local partners who believe investing in our communities with us. And to your 0.1 of the biggest barriers is um access to stable affordable housing. And one of the barriers to the the development of affordable housing units is actually the bottleneck of pre development dollars. And so one of the things we're announcing today, I'm really excited about is that the Centene Foundation is partnering with mccormick Baron Salazar M BS, which is um one of the nation's leaders in the development of affordable housing units and in urban revitalization and together addressing the pre development funds, we are going to unlock $900 million worth of development projects across the country focused particularly on the communities that we serve. And importantly not just create thousands of affordable housing units as a result of this, but it also it's a platform where we can deliver community services that are again critical to those other drivers of health. So think about grocery stores in food deserts, um community health clinics, community activity centers, um early childhood education, and some of those other critical services that really surround the affordable housing and sort of the health journey of our members. So we're really excited about this partnership um over the next couple of years. And I think it's a, it's a slightly different approach, you know, for Centene, it's about doing a lot with a little, which is something that our members are uniquely amazing at. Um And I think, speaks to our mission of transforming, not just health care but transforming the health of the communities that we serve. Great. Um And you know, raise your hand. If you have a question, I'm gonna ask uh Sarah about uh you know, a big, we worry about people falling through the cracks, especially over the past year with what's been dubbed the Great unwinding or the red terminations, 94 million Americans having to go through the process of re enrolling for Medicaid or lose their coverage. Meanwhile, a recent study found millions of Medicare aid beneficiaries weren't even aware they had insurance. Um You know, can you tell us how do you engage with your members? One to make sure they understand uh the benefits they have and then to make sure they understood the re enrollment process, you know, what were the challenges and how has that gone? Yeah, that was, has been a major focus of ours over the last year and actually, for almost 18 months leading up to when the red determinations process started, um We did a huge outreach campaign, we bef you know, within the first month, we had already done 9 million calls out to our members. And that rate and pace just continues through the process. Um whether it was, you know, phone calls, um mailings, we actually got to tech. So I wanna come back to that because that was a pretty important thing. We did 15,000 community events again just in the first couple of months, partnering with those institutions and those community partners that are really good conveyors of information, education, whether that's um churches, uh you know, uh pharmacy partners, clinical partners, really making sure that our members understood what was coming, they understood the process and to the extent that we could partnered with the Medicaid agencies to help our members through that process. And we were certainly not alone in that. I think the industry stepped up broadly um in a big way, but it is a, a consistent challenge in making sure that we can communicate with our members the way frankly they wanna be communicated with. So, one of the challenges coming into redetermining was the um T CPA and the fact that it actually precludes us from directly texting members. And so congress sort of waived that through this process. Um And the chairwoman of the FCC did some awesome work to make that possible. But I think it speaks to the fact that um in many ways Medicaid is due for a modernization, not just from an infrastructure standpoint or a process standpoint, but frankly, from a consumer standpoint, right. Our to think that our Medicaid moms are not attached to their phones. I think they're not juggling 8000 things is completely naive and we need to be in a position to be able to be in a position to serve them and to support them the way that they wanna be supported as consumers. So I think we saw some great strides but, um, it's an opportunity to push that forward. Uh Great. And we have a question over here. Hi, my name is Tim Leen. Excuse me, I work for the Association of Schools and Programs of public health. And you're, you're describing is a very public health approach which is fantastic. Um Can you talk a little bit about how we can scale this model in order to have even a broader impact um across the whole country or the world potentially? Yeah, I think so. So two things, one is um to me scale is kind of the the power of the fabric understanding that health care and public health is local in delivery and in sort of nuance. But then how do you extract and extrapolate best practices? Right. And so um the the first thing is making sure that we have an integrated approach and that we embrace this idea that the drivers of health are not just some buzzy progressive way of talking about health care, they actually work the math works. Um And we should be investing from a public dollar standpoint in health outcomes in this way. And then I think the other bigger answer longer answer um but I'll make it pithy is data because if we have broad access to data and we do the work to make that data liquid and to really look at it, not just around local be best practices, but then where there is there connectivity, where do you get scale and proof about what should be sort of standard of practice that that's how we're gonna start taking some of these great local innovations and pushing them out across the country and across the world. And that is really sort of the core of cent's thesis, which is our platform of 28 million Americans in 50 states. We see where the innovation is and we have that data and being able to pull that up and integrate that into the conversation, whether that's policy operations service, that's really how we innovate. Um And quickly before we're out of time, we got to. Uh Hi, so sorry. OK. Question the back very quickly. You mentioned scaling, I wonder how you are working across states because your 50 states only a few of them have those 1115 waivers. Like you just mentioned, how do you work across so many states that aren't even expand, hadn't expanded Medicaid at all? Um And how do you get the social determinants into those places? Well, so part of, it's a great question. Part of why I, I am so enamored with this polling that was done is that, to me, it is proof that while 1115 waivers certainly are increasing in their um adoption uh that sitting in 32 states for Medicaid, very different politics. But when you get on the ground, there is not actually a difference in terms of what people know, makes a difference and being in a managed care spot, we can actually direct those dollars and, and create the proof points and then move the conversation regardless of the politics. Great. Um Thank you, Sarah, good note to end on. Um And thanks again for being here.

Khaled Kteily, Founder and CEO, Legacy Dr. Brian Levine, Founding Partner and Practice Director, CCRM Fertility of New York Pamela Pure, Co-founder and CEO, Posterity Health Dr. Neel Shah, Chief Medical Officer, Maven Clinic Moderator: Deena Shakir, General Partner, Lux Capital; Co-chair, Fortune Brainstorm Health

Brainstorm Health 2024: Advancing Male Reproductive Health

Khaled Kteily, Legacy, Dr. Brian Levine, CCRM Fertility of New York Pamela Pure, Posterity Health, Dr. Neel Shah, Maven Clinic, Deena Shakir, Lux Capital

Dr. Uché Blackstock, Founder and CEO, Advancing Health Equity Dr. Hala Borno, Associate Professor, Medicine, University of California San Francisco; Co-founder and CEO, Trial Library Dr. Jayasree Iyer, Chief Executive Officer, Access to Medicine Foundation Moderator: Deena Shakir, General Partner, Lux Capital; Co-chair, Fortune Brainstorm Health

Brainstorm Health 2024: Keeping Health Equity a Priority

Dr. Uché Blackstock, Advancing Health Equity, Dr. Hala Borno, University of California San Francisco; Trial Library, Dr. Jayasree Iyer, Access to Medicine Foundation, Deena Shakir, Lux Capital

We have a veritable American flag up here today. I love it. Red, white and blue, but we're, we're here not just to talk about America, we're here to talk about global health and equity. And I'm simply delighted to be among such an incredible group of women, of clinicians of researchers. I want to start by defining health equity. So if you could each briefly just explain to us what does health equity mean to you? Well, I think its health equity as every individual person having the opportunity to reach their highest health potential and as a physician, as an emergency medicine physician, I think that is what I want for every single one of my patients. And that motivates me to do the work that I do. Thank you, hea When I think about health equity, I always think about that tree, the fruit tree that's leaning, maybe some of you have seen this metaphor. Um imagine a fruit tree that's leaning and you have two people reaching for fruit, someone is able to reach the fruit more easily than the other person. Health equity is making sure they have custom tools. So one person has a taller ladder than the other person. So they can reach the same amount of fruit. But hopefully, we also talked today about justice, which is when you actually fix the fruit trees so everyone can access the fruit that they need. And for me, health equities about uh the fact that people, regardless of where they live, their socio-economic uh class, their race, their uh sexual orientation should all have equal access to care. And that includes 80% of the world's population living in low and middle income countries. So I want to turn the conversation to an acronym that has come under a lot of scrutiny lately. And that acronym is de I, there was a period of time where AD E I was all the rage and everybody wanted to have some effort that was advancing DE I and in recent times, it has actually come under some scrutiny and has seen a lot of critics. How do you think the state of de I today is affecting the work that you do? Maybe I'll start with that? Well, yeah, I mean, it's very personal for me. So for some of you who don't know me, I, I left a career in academic medicine because I felt that, you know, as um ad I leader, I could not do the work authentically the way that I, I really wanted to do it. Um And I left and I found that advancing health equity, you know, we working with health care organizations to, to create more diverse, inclusive workforces because we know ultimately, that trickles down onto the care that we provide our patients. And so, um I would say like, what, you know, the, the scotus decision of last year as it relates to um admissions to higher education, um There was a federal piece of legislation called the Educate Act that specifically targeted um de I in medical education that said that if medical schools were going to have D I programs that would lead to them not receiving federal funds. You know, to me, that means like we're in a crisis because we're talking about the most, some of the most horrible statistics now as they relate to health equity and then we're trying to reverse decades of advances within medicine or within health care. So that is very scary to me. It is a terrifying prospect. Hela, how are you seeing that impact the work you're doing in particular in the clinical research side? Absolutely. Well, I can say de I leaders didn't sign up for a performative de I they want material change and they wanna be empowered to do that in my work in oncology, clinical trials. I'm really focused on how do we advance access to research? We recognize that not only does that have immediate benefit for patients but certainly has a long tail benefit. And in order to do that, you really need to think about the social conditions the social determinants of health. We heard a lot about social determinants of health. Earlier with the Centene conversation, you really need to think about the conditions in which patients live in order to make true transformation. And de I leaders are tasked with thinking about that and are able to make transformation if they have the power and the authority to do so, Jay, we, we've talked a lot about sort of the headwinds here in the US, but it's a whole another ball game. And we're talking about global population health, what similarities or differences do you see in the context of the work that you do? So in the context of the work uh that I that I do, I mean, we're, we're in the business of making sure that the pharmaceutical industry is uh inclusive in, in their uh in the business to make sure that their products reaching patients all around the world. Um specifically looking at 100 low and middle income countries. So if you believe in the E I principles, not only must your, your governance model and equal pay be, be, be afforded to headquarter and, and the sea level executives around the world, but that needs to be available for also their businesses in low and middle income countries. So that means we look at specifically at, at sort of governance uh model for um for the companies themselves, how they improve access in low and middle income countries do they actually reach different populations, including uh vulnerable populations all around the world. Um And, and finally, is that, is that done in an equitable and a fair uh way. So I think that has been extremely transformative and as an employer myself, I think, uh and, and as a woman of color myself, I think for us, you know, it is really important that when we are dealing with stakeholders who are engaged in driving and empowering industry to do better, that is a diverse group uh that is brought forward to, to make that change itself. And you especially see that in sectors of the health care industry, like in medical oxygen that we evaluate. Um the medical gas oil companies are very male driven uh industries. Um And now, you know, they're, they're really trying to make a big effort in, in making sure that it's more diverse and more inclusive of the different populations around the world. It seems to me that there's a damning amount of evidence pointing to the importance of of diversity in clinical care providers. In fact, there was just an article a few days ago uh in Jama that was uh looking at the impact on women's health, in particular with women care providers. There is all sorts of data out there showing that impact as well from a from a racial perspective. And yet there are so many forces that are preventing tho those changes from happening. How do you take on, on some of these headwinds. Yeah, I mean, there's even a study, I have to say this even study from last year, from the Journal of American Medical Association that showed that uh one US county, they had one black primary care physician that improved life expectancy for black people living in that county and actually everyone else. That's incredible. I know. So like, you know, people underestimate like the, the impact and the importance of diversity. Um I, I will say that, you know, just like how that many, many of us that are in that, that are doing this work, it means very, very much to us, right? Um We are working against practices and policies that um are centuries old. Like one thing I wrote about was like the Flexner report and that's a report that closed medical schools um at the turn of the 20th century, um it closed five out of seven of the black medical schools leading us to lose between 25 and 35,000 black physicians. So one part is understanding that today in 2024 while we may see some dismal these dismal numbers, part of it is because of the history. So understanding that history, understanding how other policy changes can improve or hinder the statistics that we see now and working with the communities that need to be centered. So I always say a lot of the answers as they relate to health equity and D I really lie within the communities. We serve our patients, our community members, they can tell us what needs to be fixed. Um We just need to listen to them. So I really would call on folks in this room to really interact with the community that you're serving. I love that. I heard so much about social determinants of health on this stage because that's what we've been talking about for a long time time. Um maybe not in this room, but we've been talking about it as it relates to health for a very long time. Um And we know that those are the key drivers of what leads to good health. Absolutely. And, and, and like you left a career in academic medicine to start a company actually taking on this problem. Why do you believe that a a tech company is the solution to advancing precision medicine? Yeah. So um I realized that this was a home in my back of my mind that I just needed to react to. And I felt that in some way, my academic career, I was incrementally making progress, but I wanted to make impact now and the moment was now and the opportunity was now um as an academic oncologist, I was seeing a few patients a day and committing the rest of my time to science. And there was an evidence base for how can we actually move the needle on recruiting diverse patients, making sure we're expanding access. And our model is really focused on going to the provider, 77% of patients that enroll in an oncology trial do so because of a provider recommendation. So the question I started asking are, who are the providers that are offering trials and who are not and why aren't they? And so we started thinking about let's address the pain points that they experience in their clinic and let's ensure that we can give them an opportunity to easily offer trials to patients. And this led me to conversations with oncologists all around the United States. And I frequently ask a community oncologist, how many patients do you see today? And they'll say 40 patients. And so that's just a number. But I want you all who aren't health care providers to think in your chair, imagine a day where you have 40 meetings and for every meeting, you need to make a decision and you also need to document the data you collected to make that decision and also the justification for that decision. And you have to follow up for all the meetings you had the day before. That's the reality of a health care provider in the community, serving diverse patients that we want to have enrolled patients to trial. So of course, they're struggling. And so technology has a role, of course, there's other innovation that needs to be at play and that's what I get the, the pleasure of addressing every day in just a moment, we're gonna turn to you all in the audience for questions. So raise your hand and a mic will come your way. But Jay before we do that, what role does global Pharma play in all of this? Well, at the end, global Pharma is responsible for uh developing and delivering uh the medicines that we all need in order to, to um you know, treat the conditions that we have and prevent the diseases that we have. So, and global Pharma plays a very strong ups upstream role. If some of the biggest companies in the world can make sure that their business is more sustainable, more inclusive uh more serving, you know, 80% of the world's population uh in a fair and equal way, then they can make a huge impact. So one of the things that we really um you know, push for is that investors who invest in the pharmaceutical industry, we also need to invest differently. So we actually host the uh the largest signatory base of investors in health care in the world with about 100 and 40 investment firms that sign on to the principles of our work and and invest differently in the pharmaceutical industry. So their shareholder resolutions are basically trying to convince companies or demand that companies need to expand their, the the broader reach of, of their, of their products in, in, in uh for patients all around the world. Make sure that their clinical studies are inclusive, diverse and um around the whole world and make sure that their products are registered and delivered in in in the world in an affordable way. So that is the kind of transformative work that we need to do in order to convince some of the the biggest companies in the world to to move over to the audience. Now, I think I saw a hand being raised earlier. Any questions from the audience? Yeah. Hi, Joe Harrison, uh founder CEO of Avail Health. Um I just wanted to comment as a white man. I was lucky that I started unlearning and continue to racism, classism, etcetera, very at a very young age. And I'm just thinking about the powerful positions and who's sitting in those positions. And I just wanted to ask for comments on, you know, what are you seeing in terms of, you know, minds changing, um outlooks, changing, understanding, like learning um that I think has such, you know, such an impact if it happens, I have no line of sight on that. And I'm wondering what your experience is in the roles you're in. It's a great question. Yeah, I think that's a great question. And I think in the work that I do with advancing health equity, we're working with a lot of organizations who already have buy in from leadership. Um But we, we always see that that's the key to success like the the leaders who truly believe in the importance of equity and that look at every decision that they make or every part of their strategy through an equity lens. Those are gonna be the ones that really care deeply about what their workplaces look like, like, what, what is the culture of their workplaces? How does that, how does that uh associate with how care is delivered? Um And so we probably have a selection bias um and who decides to work with us. Um And, you know, obviously we would want more leaders to be deeply, you know, about the same issues. But um I think, you know, it's, it's a matter of life and death, you know, we, we see people and we took overall Americans are not living long lives like life expectancy continues to go down for every racial demographic, especially people of color. Um And so really, I think everyone in health needs to be committed to improving these outcomes. Another question over here. Yes. Hi, I mea, I'm a chief medical officer with Simpler. I'm a Hispanic uh internist background. Um Very proud to work for a company that's a very strong in D I. Uh but as an internist, I think one of the things that you mentioned was that the paper that was published that showed difference in outcomes uh based on the concurrence of, of the care that's delivered. Um I, I think that's, that's what the voice, the voice should be about. The science behind it, the evidence that providing care in that concurrence can improve outcomes. My question to you all is how do we raise that voice to our corporate level to make it less corporate and more about the medicine that we're delivering? I can take that. And so I think there's, there's a couple of solutions to it, right? Um There needs to be quite a strong uh strong strategic embedding of, of, of what it means to be a uh an organization or a company that that is delivering in a, in a diverse and equitable way and that comes really from the top, but it cannot just live on at the top. It, it needs to be really embedded in the system. And one of the accountability tools that we use is to measure that over time to see whether there is progress being made on any organization over time. The CEO um uh bonus structure is that associated with performance and access to medicine um globally. Um Is there uh is there and other firms obviously look at uh diversity and inclusion parameters at the leadership level and across across the, the the company. Um a metric. Uh there's also a metric on uh clinical trial uh diversity um uh on top of the ethical uh components to it. So to me, I think it's really important uh as a as a company to have very strong uh a very strong policy in place that is actually implemented globally. It's also really important that today's workforce demands uh uh that the leadership and a company's philosophy is really breathes through its business itself. And, and for us, we find a lot of power in internal change makers within any firms that really drive, drive that change. Um and then external pressure, I mean, you know, right now, at least in the pharmaceutical industry, the pharmaceutical industry is filling a gap in, in education systems and in health care systems, but also supporting, using funding. Um and when the primary work is delivering on the medicines itself, so keeping the focus to make sure that the primary role of a company is in delivery, I think it's, it's, it's, it's a, it's, it's important to, to maintain and then additional additions to that can be added on. So a strong accountability mechanism needs to be paired with, with sort of a overarching strategy. Thank you. Oh, we're almost at that time. So I'm just gonna do a quick fire round. So 10 seconds each. Uh uh and I'll start with this question was COVID an accelerant of DE I and health care or did it slow things down? 10 seconds, I would say accelerant, I think you expose the deep fissures within our health care system. Many of us knew what those fissures were, but I think to a more general audience, it exposed them in a way that had never been exposed before. Yeah, I agree. I think it emboldened organizations to talk about de I when they weren't interested or have the bandwidth to do so before. But I think now is sort of the time of reckoning where they're starting to define what it means and how they can consistently apply it within the organization. Ok. So health equity has been an, an, an issue. That's a, that's a chronic issue for time, a memorial already. So COVID basically accelerated the understanding uh of, of the city and the barriers behind it, but not a lot has changed in terms of are people still receiving care really at scale across the world. So there's still a lot of work to do um but it can be done and there the fantastic models out there on how this can be done in real life tested and um methods out there. So it's about scaling that up. Excellent. Well, you're saved by the bell. I had another fire round of questions, but we're at time right now. So thank you all for a fantastic discussion.

Dr. Uché Blackstock Presented by: Denise Bradley-Tyson, Executive Chairperson, Bernard J. Tyson Impact Fund, American Heart Association Accepting Award: Dr. Uché Blackstock, Founder and CEO, Advancing Health Equity Moderator: Jennifer Fields, Fortune

Brainstorm Health 2024: Bernard J. Tyson Memorial Award

Bernard J. Tyson Impact Fund, American Heart Association Accepting Award: Dr. Uché Blackstock, Founder and CEO, Advancing Health Equity Moderator: Jennifer Fields, Fortune

Now to what might be the most meaningful and inspirational part of this gathering, something the brainstorm health team cares deeply about deeply the presentation of the Bernard J Tyson Memorial Leadership Award, the late Bernard Tyson, former CEO of Kaiser Permanente was undeniably one of the most influential health care leaders of our time. As a steadfast advocate for expanding healthcare access, Bernard worked tirelessly towards ensuring that everyone has equal access to quality care. His beliefs and actions showcased his strong conviction in the crucial role that social determinants play in health. He recognized that improving the lives of others went beyond just medical interventions. He was a strong advocate of looking at the whole picture importantly, in individual social and economic conditions. Bernard passed away in 2019, leaving behind an indelible legacy. He was not only a visionary leader but also a great friend to us at Fortune Brainstorm Health. We're forever grateful for his contributions to our event and to the health care industry as a whole to celebrate his work and memory. Fortune created the Bernard J Tyson Memorial Leadership Award. Bestowing it upon those who reflect Bernard's values and actions. This is our fifth year pre presenting the award. And we're grateful to welcome back, executive chairperson of Bernard J Tyson Impact Fund at the American Heart Association, Denise Bradley Tyson, who will do the honors, Denise? Thank you for being with us. Please join me on stage. Thank you very much Jennifer and I have to take a moment to thank the entire Fortune Organization, Fortune Magazine Organization for having honored my late husband with this prestigious award. So it's a pleasure to join you once again this year to honor the work of my late husband and to continue his legacy studies have shown that the richest Americans have a life expectancy that's nearly or almost or probably more than because, you know, data can be a little fuzzy sometimes, but it's at least 10 years higher than the poorest where a person lives can predict the likelihood of their developing a chronic life-threatening condition. I just heard from Dr Michelle Gordin from CV S on a panel earlier today, say for neighborhoods five miles apart, there can be at least a 20 year discrepancy in their life expectancy. The life expectancy of black men is the shortest, shortest among all demographic groups. And black women are more than 2.5 times likely to die in childbirth than white women. All of this points to what the Center for Disease Control and Prevention has said racism is a serious public health threat. But there are those of us who've known that racism in health care and its connectivity to the social determinants of health has been sort of an open secret. And I'm glad to see that there are more people in the industry who are getting woke to this fact and are now focusing on, on addressing the social determinants of health as part of one's overall health and well being and life expectancy. My late husband was on a mission during his time on earth, which for me was far too short. He was a champion of combating the disparities that exist in the US health care system. Now, many of you knew he was the chairman and CEO of Kaiser Permanente when he died and he had spent almost his entire career working in health care mostly within the Kaiser Permanente Organization in order to continue to serve that mission we must do as Bernard did and focus on measurable sustainable outcomes. This year's recipient of the Bernard J Tyson Memorial Leadership Award is someone of like mind on a similar mission who I am honored to be asked to present the award to Dr Uche Blackstock is a founder and CEO of advancing health equity where she and her team advise healthcare organizations about ways to provide racially equitable care and how to address factors contributing to racial health inequities. Dr Blackstock is also the author of the book Legacy, a black physician reckons with racism and medicine, which takes a critical look at the intersection of racism and health care. Her perspective on the US health care system comes from both her personal and professional experiences while studying at Harvard, Dr Blackstock suffered a near death medical emergency. What she believes was una was avoidable and likely happened because she was a young black woman and her issues were not taken seriously. That experience coupled with her time working inside the health system as a physician help reshape her view on healthcare in the United States. She knew then she needed to take urgent action. We're going to hear more about Dr Blackstock journey and her book in just a moment. But first, it would be my distinct pleasure to recognize Dr Blackstock for her work. Doctor Blackstock. Could you please join me on stage? Yeah. Thank you for being with us here today. Doctor Blacks. We would be honored if you would accept the Bernard J Tyson, the brainstorm health. Bernard J Tyson Memorial Award for your work to highlight and eradicate the deeply rooted inequities that exist in health care and around access to health care. We thank you and we offer our sincerest, congratulations. Thank you so much. Thank you. Uh um I am so incredibly honored by this award and Dr Bernard Tyson was an idol of mine, someone I respected for such a long time. And so this is even much more of an honor truly. Uh I am I am the the second generation of Dr Blackstock. So I stand up here representing my mother who was the original doctor Blackstock, um, who grew up in Brooklyn, New York, uh was, grew up in poverty. Um, born to a single mom, um made her way to Brooklyn College and had a chemistry professor there who encouraged her to apply to medical school and she did and she made it to Harvard Med school. And a but after that, she came back to New York City, she trained at Harlem Hospital and she worked in the very same neighborhood that she grew up in caring for our family, friends and neighbors. And this is what I I wrote about my mom in, in my book Legacy. Um And so the legacy that I continue is a legacy that my mother taught me of always giving back to our communities, right? We go to these prestigious, prestigious institutions, we take advantage of these experiences and we come back and we work in service to our communities. Um But it's also more on a systemic level of, you know, addressing these racial health inequities that have been around way too long in our country. It's actually quite atrocious. Um one of the the richest countries in the world that we have, the statistics that we have. And um the work that I do is out of love, it's out of purpose. Um It's because I think all of our patients deserve so much better. Um And, and they deserve to live long full lives. I think everyone in this room would agree. So I'm so very proud to accept this word um in memory of Doctor Bernard Tyson, and I am motivated even more to continue to do the, the health equity advocacy work that I do. Thank you so much. Congratulations, Doctor Blackstock. Thank you so much. As Denise mentioned, we'd like to take a few minutes to hear more about your work, your book and your path forward. Um I there are so many really powerful and moving moments in your book just to show the cover. I love this cover. I so sorry, I just wanna say to the cover because the cover actually has a lot of different meanings if you read the book at the stethoscope with different pieces to it. Um And uh if you read the book at decipher, what each of the pieces of the stethoscope mean? So Doctor Blackstock, the og, Doctor Blackstock um figures very largely in your book. And you write about this moment when you realize that all of your mother's success was not really a story of exceptionalism, but that she was actually a lucky person. She was the lucky one who made it through a system not designed for her to talk about that. Yeah. And I know that sort of um it's a of the story I think that we love to tell, especially in this country of like an individual success, right? Um But yes, So my mom, I'm so incredibly proud of everything that she achieved. She was class of 76 from, from Harvard Medical School and really just had to overcome so many barriers just to get there. She was in the same class of one of Jackie Onassis relatives, one of her um classmates, father had won the Nobel Prize in immunology and here she was her mom. Her mom's greatest achievement was getting her GED while working full time and raising six Children, right? But what I recognize, thank you. Thank you. But what I recognized is that my like, like my mother, there were so many people from her, her neighborhood or neighborhoods like hers that have also ended up at Harvard med school. You know that they, they could have had if they had had different opportunities, right? They could have also ended up there. So for a very long time, I I did think she was exceptional. I still think she's exceptional. But I also recognize that there were many more brilliant Children that grew up in her neighborhood that could have also been um you know, what we, what we, what we um say successful, successful. I, you also write about how the combination of the pandemic plus the Black Lives Matter protest is when you finally came into your power and truth as a black physician and advocate. Can you talk about how that set you up to take the next step? Yeah. And so just so everyone knows the background. I've been in academic medicine for most of my career for almost 10 years, um in emergency medicine doing. And I loved academic because the wonderful combination of patient care research, uh and, and uh working with trainees, medical students and residents. And I really loved it. And it's the only thing I knew my mother was in academics, you know, only a certain percentage of physicians stay in academics. So I was like, this is what I wanna do. Um And I recognize that being in that environment as a black woman physician actually was really, um I felt really silenced, I felt very muzzled. I felt incredibly underappreciated. Um I felt like what I was bringing to my department wasn't something that was very much respected or valued. Um And at the time, I felt very isolated because in my department, I really was like one of the only black faculty or one of two. And this is in the middle of New York City, one of the most diverse cities in the, in the, in the country. Um And so I made this really difficult decision to leave academics and I said, I'm going to, I'm going to work on my, my company advancing health equity because I will be able to do the work I want to do in an authentic way. Um I was still seeing patients and then the pandemic hit and everything went sideways and, but I stayed the course I started writing about, I started writing op EDS about what I was seeing. I actually wrote an op ed before I left academic medicine in sta news. As Nicholas Sinclair knows um I wrote an op ed that ends up going viral about why black faculty leave academic medicine. Um I got so many emails, so many text messages saying thank you so much for saying what we couldn't say. And so then I started writing about what I was seeing in the pandemic. I literally wrote my first op ed, my first op ed about the pandemic before the end of March. And that ended up being published in Scientific American. Um But I felt it was very important to get uh sort of a distress call out there that communities of color were going to be disproportionately impacted because I already knew I already knew that people with chronic diseases, um people who worked in public facing jobs were going to be the most likely to be infected and hospitalized and die. You also have at the end of the book, um all of these Calls to Action for various people um involved in health care, but also outside of health care. And now you're sitting in a room full of people who are in health care, decision makers, policymakers. Um I would love to hear what is the call to action for all of that. Yeah. Well, so call to actions. But I think the biggest, well, one of the biggest ones is really to understand and I know we supposed to talk about social determinants of health. But I don't think people understand truly how, and, and, and I had to relearn this as a physician that when I'm in the room with my patient, it's not just the two, it is their employers, it's their family members. It's like, you know, whether or not they're able to exercise in their neighborhood. Is it safe or not? Um What kind of housing they live in? Are they exposed to lead? Like literally all of those factors impact how healthy my patients are. So only 20% excuse me, only 20% of what I do actually matters. 80%. I I have, I think I have no impact on. I actually should be aware of it as a clinician, but 80% 80% patients do not get to determine what happens if they are systemic factors. So I think for everyone in this room, think about what role you have within your organizations. What impact can you have on those systemic factors that contribute to how healthy people are to really have a broad understanding and and like um Denise Tyson said this is not new, but it has not been integrated into how we care for patients. Um And I think as for me, as a physician, once I saw that I couldn't unsee it. And so now it's not enough just to write a prescription for a patient, it's not enough to, just to make sure someone has access to telehealth. It is really a holistic way of understanding how we deliver the best care possible and that we make sure that care is not just available, but it's also accessible. You also say really beautifully in your book and also through some very harrowing examples, really demonstrate that racially concordant care for black people is a matter of life and death. Um And that's been, you know, the basis of so much of your work. Um What is the answer to getting more, more racially concordant care? And, and what I wanna say also is that yes, racially concordant care where the clinician and the patient are the same racial background, it matters especially for black people and people of color. But that doesn't mean I feel like that means like I'm saying all other physicians shouldn't know how to care about their patients. No, we want everyone to be educated and trained to be care of, to, to take care of everybody. Um However, I do think that we need special attention to the pipeline. I talked about the Flexner report and how it lets the closure medical schools. Um Xavier University just mentioned that they are opening a new medical school, take about 2 to 3 years for that medical school to open. But what's important to recognize is historically black medical schools still account for graduating the most black physicians and there are only, there are only a handful of them. They're less than five. So, what are the other medical schools doing? It's a great question. I'm sorry, we have to stop there. But thank you so much. Congratulations again. Thank you for writing your book. Thank you, Senator. Thank you.

Cathy Friedman, Executive Venture Partner, GV (Google Ventures)  Alyssa Jaffee, Partner, 7wireVentures  Anarghya Vardhana, General Partner, Maveron  Moderator: Andrew Nusca, Editorial Director, Fortune

Brainstorm Health 2024: Building Resilient Healthcare Companies

Cathy Friedman, Executive Venture Partner, GV (Google Ventures)  Alyssa Jaffee, Partner, 7wireVentures  Anarghya Vardhana, General Partner, Maveron, Andrew Nusca, Editorial Director, Fortune

Hey, everybody. How are we doing? All right, we've got a great, a great session in store here. Um I want to start off by reading something that I was reading in a report uh from last year, so much has changed since last year, but it was a report last year about kind of the market conditions. It was, it's hard not to have a glass half empty view of the health tech market. Uh The reasons were that the public market markets were underwhelming. Uh that venture capital funding uh had been down since about 2021. Um It is however way up from a decade ago, I want to just say that um now we have lots of macroeconomic anxiety, soft landing versus hard interest rate cuts. A few, many, nobody knows what's going on. So I want to ask, are you feeling optimistic or are you feeling cautious? I am feeling optimistic. Uh And the reason I'm feeling optimistic is that there are a ton of great technologies and companies out there that need to be financed because they're meeting unmet needs for patients. Um And at our fund, we have a really long term view and I think if you have a long term view, these needs need to be met. There's money to be made and patience to be served here. So I am optimistic. I'm so sad to hear that people are feeling that the glass is half empty because while the heyday of the pandemic is over, what came out of Pandora's box was the consumer empowerment that we've all been craving in health care. So we're all looking to become better stewards of our health, right? Patients are people that have things done to them and consumers are active stewards of their health. More companies are getting funded today. The bar to start a company is lower. And so we're seeing innovation come in health care that we've never seen before. So while the funding markets may tell one story, the actual um capabilities of these businesses, the commercial traction they're getting from health plans, from health systems, from Pharma orgs Employers is beyond. I think what any of us thought could happen five years ago and please, I'll, I'll start with the hard part which I think if you're an entrepreneur right now, it can feel like fundraising is really, really hard, it can feel like the bar is higher than ever, which it is, it can feel like there's a lot of pressure from your board to hit certain unit. Economics hit certain goals. So the glass can feel kind of hot half empty as an entrepreneur. But I think the positive side of it is that now is the time to build an incredible company, the resilience, the grittiness, the forced constraints are allowing for companies to discover new business models, innovative ways of reaching customers in non expensive previously, Facebook and Google and also creating environments where companies and payers and providers who are purchasing the products are also demanding really, really high quality. So I think the clinical outcomes that will come out of this batch of companies is going to be better than ever before. Let me stay with you for a second. So you can invest in lots of different kinds of companies. Health as a category has different considerations. Share your perspective. What is great about a health uh uh uh company from an investment standpoint. What is a difficulty, a challenge? Yeah. So for context, I'm a consumer investor. So I invest in companies who think of the end patient as the consumer. So a lot of the business models are B to B to C, some are B to C and in health care. Unlike many other companies, there's so many considerations including ethical clinical clinical ones. Are you doing? What's right for the patient at end of the day? Are you driving better results? I think in the heyday of a lot of funding, we saw companies that were trying to deliver growth at all costs. That wasn't always the best thing for the patient. And I think we could all name a number of companies that were driving for that growth without always having the necessary guard rails around the company to protect the patient at the end of the day. Yeah, we um so our thesis is called the informed Connected health consumer. So how to all of us here in this room today? How do we get access to information, connecting into the system? The system connects back to us to improve our own health outcomes. But the thing is health care companies are not consumer companies and there became a very blurred line early on about in the pandemic of what those companies were and how companies were marketed or where the bulk of the dollars lie in health care, the bulk of the dollar dollars still lie with the incumbents and a lot of companies believe that if you build it, they will come and in health care, they will not come. That's and so creating business for they might come and stay for five minutes or they'll do a pilot and and not pay nothing, ask you to actually pay for that pilot. So I think ultimately, um what wasn't working? What doesn't work is people that don't have that understanding, people that don't have founder market fit, right? We talk a lot about product market fit. But why are you your team the right people to build this to do this? There's way easier ways to make money than to do this in health care. You've got to be here for something else. And that's what's most important, you know, you said founder Market Fit, is that right? So, so I was, I was, that was gonna be my next question, which is in this moment. Yes, thank you. I appreciate it. Well, no, in this moment, it's clearly a kind of a moment of reckoning. So what's working and what's not, are founders sufficiently resilient is capital, sufficiently patient, you know, are are the cost structures sustainable. This market environment is really tough to fundraise the bar is higher. What investors are looking for is different than what investors used to look for in the past and it's causing friction and frustration. But I think it also creates resilience in companies. I have not heard so many conversations about profitability in all my years of being a venture capitalist than I have in the last 18 to 24 months that we are actually building the right kind of companies, the appropriate level companies. And I think an argue says as well of clinical outcomes, like we are in this business to actually drive value in health care, to improve outcomes and to reduce costs. And that's not a buzzword on a slide, although we see it often on those slides, that is really the mission and the goal of what we're trying to do and many people miss that. So if you're building a company that actually shows how you can do that often, those companies will become the most successful. Yeah. And you have to have a clinical out comes, but you also have to have financial outcomes. So the best companies create dashboards that they say they set up uh goals that they want to reach and they, if they reach them great, if they exceed them even better. But if they don't reach them, they rejigger themselves and figure out how they can reach them because not setting goals. And just assuming some great story is going to take place because you have some great patient, something to deliver doesn't work in this market at all. I think that we're seeing uh a batch of founder who are incredibly mission and purpose oriented and financially oriented and want to build a business versus perhaps in the previous set of companies, there was a lot of mission, a lot of purpose and there was a hesitancy to even say, hey, we're building a business that can actually sustain itself with revenue and it feels like the two are finally coming together, maybe, maybe also the naivete around. Um I, I built this thing in tech or I built this thing in consumer. But gosh, being a health consumer is so hard and so frustrating and creates so much friction. I gotta go do that thing now. And it's an amazing passion and mission. But welcome to this world that all of us know is extremely complex and convoluted. And so if you aren't able to understand how to unlock it, many companies have found themselves really stuck in that process. Yeah. And I think you need to decide if you're gonna play inside the current system, meaning the payers and the providers, the employers, how it is right now, or if you're gonna do something completely different and play outside and we've done some investing on outside as well, which is also interesting. So folks, I'm gonna come to the audience in a few minutes with questions. So think about it. All right, I, I wanted to ask you. So where are we seeing in? What subcategories are we seeing success versus not that BioPharma comes to mind. Uh uh V BC comes to mind where in your particular portfolios, where are we seeing good and not so good? We tend to be vertical investors. So we really focus on companies that solve problems. Um We're less of a horizontal investor. Technology is great. A I is incredibly transformative, but it is not a one stop shop. And so where we focus on is how can A I be an application or component for care delivery? Um But it's not the thing. And so what is the thing that drives value? All of us are actually on a board of an amazing women's health company called Caraway that focuses on Gen Z women. So how do we help young women gain independence and agency in their health care? Journey. We're seeing a lot of these types of solutions start to really materialize because of their focus on the communities that they serve. I have a slightly different angle um which is a lot of the companies I'm seeing now have a different focus on the actual clinician than I've seen previously. I think that pre pandemic, a lot of clinicians, which I think a lot of you here in the audience are clinical practicing folks. Um We're almost seen as just a part of the business you use them, you move on, you get new ones, whatever. And for the first time, I'm seeing a focus on hiring great clinicians, retaining them, keeping them happy, developing them. And actually thinking of your clinicians as your big best and biggest asset, which is a big shift. I think in the start up world where that can sometimes feel slower and more cumbersome than let's just grow users by any means. Yeah, I think also really focusing on access because there are a lot of um areas within medical care where there just isn't uh a big enough supply. And the examples I can think of in our portfolio in menopause. We have midi, we have ULA, we have a Lara where you just don't have doctors that cover those specialties. So by providing that on in a telehealth way with the ability to go somewhere else for four wall treatment, you can make access so much better. So you don't have as many care deserts around the US. You know, I was actually that, that, that leads into, uh another question I was gonna ask is, you know, COVID and the pandemic just exposed a lot of gaps in the system and then there was a big rush. So, in your opinions, do you feel that those gaps persist? You know, are we starting to solve for any of them? You know, I think the gaps still persist, but the one that's been the most heartening for me is the focus on behavioral health. I think the pandemic showed America and, and the larger world, how lonely people are, how much connection they need and how important mental health is equally, if not more important than our physical health. And that acceleration, you know, we see tons of companies and behavioral health where investors and things like two chairs and bend and really being able to see companies focused on folks with mental well being I think is heartening and just continuing. I would, I would add to her comment, which is the physical and the mental are very connected. And in our prior prior to COVID world, it was sort of you had a mental health problem and you had a physical problem. And I think through COVID, it's become much more of common knowledge that those are very related. So you can't just have a mental health solution, you can't just have a physical health solution. They have to be integrated. The thing is Andrew. We are um I think we, we're at this time today where we're going to spend our entire lifetime and multiple lifetimes over trying to solve these problems in health care. And that's scary, but also um enticing of how big this thing can be. And we talk about access to care and the Medicaid population and companies, the number of who are here today Summer House, who does uh Tebas pediatric care, a company called Ground Game that does uh works with CB OS and a number of kind of scoh opportunities to really close gaps in care. There's so we can name a million more companies that are starting on this journey and even just getting initial penetration, we heard from Sarah London and the CEO of Centene. There's just so much that we have to do. Um And I think that should hopefully be an encouraging message to those in the fans today who are actually working to do this on the front lines because we are making progress. It just, it does take time and a brief follow up before we go to the audience. Um So many lifetimes, you know, investing does require a return. Have you heard this longevity thing? We're gonna live for many lifetimes. Keep investing. I see. OK. OK. Got it. Got it. All right. Let's go to the audience. They will live on forever. All right, let's, let's right over here. We'll wait for the mic for and please uh introduce yourself. Just name and, and organization, please. Hi there. I'm uh Doctor Natalie Davis from prevent Scripts. Alyssa, I can remember on a start up health call. Probably this was pre pandemic. I think you talking about series A metrics. Um Could you give us an update on series A metrics for 2024 and how that goal post may have tweaked on the Yeah, on the record, I don't actually think my answer personally has changed much. My answer is again, um We invest mostly B to B to C 50% of our capital comes from strategic organizations, health plans, health systems, pharma, employers. And so what I look for is if you know, Cigna is an amazing partner to us, for example. And if Cigna says, wow, your business is so amazing. I wanna do this. I wanna roll you out to all my national accounts. Are you gonna thrive or are you gonna be crushed? That is how we look, get a series A it's uh we don't have a definitive metric around revenue. I'm sure that, you know, my, my amazing panelists can give some more guidance, but at the end of the day, the core of what we think about is is your business in a place where we can take you to these large incumbents and you are able to carry whatever comes of that. Hopefully very, very large and long lasting contracts. Yeah, I would just add on to that. We don't have any specific tailored revenue tax, whatever, but we're very focused on the number one thing, which is the team, the number two thing, which is the product market fit and the number three thing, which is the ability to scale and that usually involves having some tech that's very good and deep. Um, so those things have not changed in this market at all. Well said, all right, let's find one more another, another audience question. Forgive me. It's very bright. Yes, way back here. Hello everyone. My name is Elena, the co founder and CEO of generation lab and we actually work in longevity. So that word is becoming bigger and bigger in the space right now. What we are doing is starting out from 19 different organ health and build a personalized plan from lifestyle, nutrition, medicines and also workout. So I want to hear a perspective of health care because it's becoming a new world from sick care that we used to be. How do you guys think about the new healthcare world is changing? Especially longevity is becoming a real trend right now. So, um I believe that the most important thing in health care is early detection right now before I joined Google Ventures, I was the chair of Grail. And to me, we can detect things early and that was cancer. But there are many other things and some people earlier today were talking about Children and detecting things early. So you have to be able to detect them early and that requires diagnostics and other things there. And then once you detect them early, you have to have personal medicine to deal with them. I'm less concerned with living to be 100 and 50 than I am living to be some age where I can be active and healthy and whether that's 80 or 90 or 65 doesn't really matter. Um But I don't want to be into the business of longevity investing just for the sake of living longer. I I think that a lot of the longevity conversations, content products are really tailored to certain like niches of society. And as a consumer investor, I think a lot about how does this get mainstream, how do regular people in the world use this access this and that feels like a lot of the missing gap. Of course, stuff has to launch first and they are early adopters and such. But, you know, my vision is with the power of A I, there is a possibility where people can know what is exactly the personalized tailored thing for them because right now the question is like, what test do I use? What protocols do I follow? Should I listen to this podcast or that one? And the more that can be personalized and accessible, the better also payers have to pay for it. So, you know, I think you you even in V BC and the, the journey to value based care is much more complex and not as straightforward as we thought. And we longevity fits. I'd say there's probably still a, you know, a knock on the fee for service door of how you can think about the entry way to build that relationship with the health plan in order to get to a real bundle or a real risk based contract, given the value of longevity. All right. Well, um, 2025 then is it gonna be the year of Pretenders or the year of contenders contenders? Absolutely. I think a lot of companies that are building right now are gonna be of a strength and girth and revenues w um, that it's gonna be a great market and you, you know, they're 30 companies right now that could break out to be phenomenal companies in 2025. 1 2nd. I'm gonna say contenders because great companies get funded. All right. All right. Ok. And Contenders. Ok. But please, that, that, that's our time. Give them a round of applause. Thank you so much. Yeah, that's correct.

Brainstorm Health 2024

Brainstorm Health 2024: Lessons from the Music Industry

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D.A. Wallach, Recording Artist; Co-founder and General Partner, Time BioVentures

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Brainstorm Health 2024: Lessons from the Music Industry

Brainstorm Health 2024: Meditation Moment

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Brainstorm Health 2024: The Health Care Affordability Crisis

Brainstorm Health 2024: The rise of cancer in young people

Brainstorm Health 2024: AI In Action

Brainstorm Health 2024: The Next Generation of Multi-Gen Caregiving

Brainstorm Health 2024: Technology’s Role in Value-based Care

Brainstorm Health 2024: The Impact of GLP-1 on Health Care and Beyond

Brainstorm Health 2024: Reimaging Lab Testing

Brainstorm Health 2024: The Health Care AI Reality

Brainstorm Health 2024: Defining AI Standards for the Next Era of Health

Brainstorm Health 2024: Data, Security, and a More Resilient Future

Brainstorm Health 2024: Reimagining Partnership and Building a Stronger Healthcare System

Brainstorm Health 2024: The Age of Longevity

Brainstorm Health 2024: What’s Next in Generative AI’s Revolution in Medicine

Brainstorm Health 2024: America’s Sick Workforce and Building Better Health Systems

Brainstorm Health 2024: The Changing Climate is Coming for Our Health

Brainstorm Health 2024: A Conversation With the Nation’s Largest Medicaid Insurer

Brainstorm Health 2024: Advancing Male Reproductive Health

Brainstorm Health 2024: Keeping Health Equity a Priority

Brainstorm Health 2024: Bernard J. Tyson Memorial Award

Brainstorm Health 2024: Building Resilient Healthcare Companies