Fortune Brainstorm Health 2023

Chelsea Clinton, PhD, Vice Chair, Clinton Foundation; Vice Chair, Clinton Health Access Initiative
Moderator: Deena Shakir, General Partner, Lux Capital; Co-chair, Fortune Brainstorm Health

Brainstorm Health 2023 - Global Health: The Power Of Public–Private Partnerships 

Conferences

Chelsea Clinton, PhD, Vice Chair, Clinton Foundation; Vice Chair, Clinton Health Access Initiative
Moderator: Deena Shakir, General Partner, Lux Capital

Global Health: The Power Of Public–Private Partnerships

Well, hello everyone. It's so nice to see all of you. We, we've already started the countdown clock. We've only got 14 minutes and I have so much, I want to talk to you about Chelsea. So we're going to go ahead and dive right in and because of the limited time, start thinking about the questions you have. I'm hopeful, we'll get to at least one, maybe two. And there is somebody going around with a microphone who will come to you and will call on you once I get to ask a few of mine. So without further ado Chelsea Clinton, I want to ask you about the Clinton Health Access initiative also known as over the last two decades, Chai has negotiated over 100 and 40 global deals to lower the price of health products by 50 to 90% which is absolutely phenomenal. Can you share a bit more about Chai's origins and its approach to creating these types of partnership models to reduce health care costs? Yeah. Thank you so much, Dina and I wanna thank uh fortune um for inviting me and particularly giving me the chance to talk about uh public, private partnerships. Uh I also want to thank everyone here um at the Ritz Del Rey for keeping me hydrated and caffeinated. Um And I do know that uh these events are always real team effort. So just thank you to everyone I've met and everyone that I haven't met uh for bringing us here together today. Um So the genesis of chai really was in the HIV AIDS equity crisis, you know, more than 20 years ago where people living in places, you know, like Los Angeles at the beginning of the 21st century, were able to access uh largely anti retroviral drugs that were turning aids into certain desinence into a chronic disease. And my father and Nelson Mandela decided to work together kind of in their post presidential lives to try to help ensure that more people in more places could access these life saving medicines in 2001, the average price per person per year of a R V s in the global South was just over $10,000. Fast forward to today. It's about $60.21 million of the 29 million people who access antiretrovirals every day. Um, adults and kids alike access those medicines through agreements that the Clinton Foundation helped negotiate. But, oh, gosh, thank you. This is great. I feel like you all should travel with me all the time. I get like audible woos and applause. Um And I'm really proud of that market shaping work of of shifting um the power of the market to change a high price, low volume dynamic into a high volume, low price one now has characterized so much of our work. And so we've applied that same approach to the pneumococcal vaccine, the rotavirus vaccine injectable, long lasting reversible contraceptives point of care, diagnostics. We're now spending a lot of time in hepatitis in trying to increase access to medical oxygen and and so much else that we so often, I think um maybe don't take for granted but are not cognitive of what we have access to here in the United States to try to ensure that anyone anywhere has access to life saving medicines and commodities. And the last thing I'll say is a new effort that we're a part of is the new initiative launched by the World Health Organization last week to try to catch kids up on their routine immunization in 2021 alone, more than 25 million kids under the age of one missed at least one routine immunization. And so we're working with W H O and the Gates Foundation and others uh to hopefully have the largest kind of childhood immunization effort ever over the next 18 months to catch as many kids up as possible. Um because no one should die of polio or measles or pneumonia, including in this country where we also need people to be vaccinating their kids. Absolutely. Such incredibly important and impactful work. And you know, the topic of our panel today is public private partnerships and it's particularly meaningful for me because 13 years ago, I happened to be working with your mother at the State Department when she created the Office of Public Private Partnerships. Uh, so much has happened in those 13 years, including a pandemic. And I'd love to hear a little bit more about what the role of public and private partnerships is today in the context of global health and health care more broadly. Oh, goodness. Well, I think we have to continue to build on kind of what we know works and certainly, um you know, it is so much of our market shaping work and we also try to support our partners who are doing um work uh in kind of innovative delivery models and thinking about the work that partners in health and others are doing in Liberia and Sierra Leone to try to increase health care, workforce capacity and with innovating training modules to train front line nurses to be able to provide basic psychiatry kind of screening and care that's not in our bally or area of expertise. But hopefully, as those models prove themselves or iterate to prove themselves, we can help and try to bring them to scale. I do think though, you know, when you ask about the role of public private partnerships kind of after the last few years, I think we spend so much time, understandably focused on the M R N A vaccines and technologies. I spend a lot of time thinking about um the really uh unfortunate to try to use a not too judgmental word, um kind of rise in not only kind of vaccine hesitancy and questioning, but outright kind of rejection of vaccines and of kind of science and the scientific kind of process and also too often on our scientists, our epidemiologists, our frontline health care workers. And so I do think we need to have a much more robust conversation and sense of urgency because I think we are less prepared today than we were arguably in January of 2020. Partly because of the kind of um lack of trust and confidence in uh in not only our scientists um but in, in science itself, um and certainly in the public health professionals. And so I think we need kind of the public sector to hopefully stop doing things like stripping away public health emergency powers from state public health agencies. But we also need the private sector to help candidly like do a better job of helping explain kind of the science that you are already commercializing and bringing to market, but also what you're working on and and help us kind of in the broader conversation, not be uncomfortable with the discomfort of uncertainty. And so I do think we need really good ideas for how best to do that because we all deserve to hopefully not be as unprepared as I worry, we are at the moment. Well, speaking of good ideas, one of the many hats that you wear is also as an investor and we're actually co invested in a company called Summer Health uh in the pediatric Space. And you've also invested in women's health, which is an area that I'm also very passionate about. Can you talk about the role of technology and innovation in these topics specifically around maternal health where this country is in a maternal health crisis, particularly among uh underserved populations of black people. Absolutely. So I'm originally from the state of Arkansas which uh has the iom um kind of a place at the moment of having the worst maternal health outcomes in the country. Um Now, some of this is probably what you're all kind of thinking of lack of prenatal care, kind of insufficient access to not only prenatal care but maternal health care and um kind of post natal care. That's absolutely true. It also though is kind of a place where we see so many of our inequities uh coalescing in really tragic ways. So a rise of opioid use disorder deaths in expecting a new moms, a huge spike in death by suicide in expectant and new moms in Arkansas. Not surprisingly, the number one leading cause of those deaths by suicides are with a firearm. And so we do see in Arkansas kind of all of these painful um kind of intersections of the failure to adequately protect kind of public or patient health and particularly our most vulnerable are black and brown expected in new moms. And so, you know, something that I am a huge believer in and I'm so happy to be able to manifest that kind of belief, you know, as an investor and an advocate is in having more midwife centered and O B G Y N supported care. We have not only reams of data over the last years and decades, but arguably, you know, far longer of how important kind of midwife centered and empowered care is. And so I'm so proud to be able to partner with a company that we've invested in Medora to bring that first to New York City. And then hopefully, you know, more broadly across the city and around the country and know there are many people in this room, you know, who are similarly working to kind of provide more women, more kind of continuous kind of high quality kind of access to care while they're pregnant, while they're giving birth and postpartum, you know, up to a year or longer, depending on how long they're breastfeeding or what sort of support those new moms need. That's good for those moms. That's also, of course, good for us as a country, not only kind of on an ethical or moral basis, although I would posit that should be sufficient, but also certainly on an economic basis given we know how much lost productivity there is uh for mothers who are not sufficiently supported, kind of in being their full selves. Absolutely. And not to pull a Rihanna in case anyone was wondering, I'm also expecting a baby soon. So very much appreciate all the innovation you have. You are bedazzled. You can, you are be we're gonna turn it into the audience for one question. So I think we've got a paddle somewhere right there who she's going to call on someone for their, for? My favorite color is blue. Great. Thank you. Um My name is Raj A, I'm a, a past surgeon and I'm just starting a company in the obesity and metabolic health space. And um Chelsea, you, you paying something in me, you said the cost of the antiretrovirals went down from $10,000 to $60. We know the obesity crisis is massive by 2035 4 billion people in this country will be sorry in the world will be suffering from obesity. That's about half the population. It's due to cost $4.3 trillion right? Which is about 3% of the global GDP. We've tried exercise lifestyle, let's move sugar taxes, all this kind of stuff. Medications are really taking a hit now. So how do you think we um manage this global crisis? Yeah, I think um such an important question and I think too, um, this is a question that affects not only those of us in this room. But, but more broadly, I mean, you know, for close to a decade now, uh the Joint Chiefs of staff have said that obesity, uh the obesity crisis in our country is a national security issue. You know, we have many um local fire departments and police departments that are not able to recruit kind of sufficient numbers because of a lack of kind of overall kind of health and fitness levels, you mentioned kind of the coming cost, but we, we see very much those costs here today already, not only kind of health care costs but also in loss of productivity. Um I would though, uh respectfully take a slight um kind of contention though, with you said, we've tried a lot of things. We haven't really tried any of those things at scale and in coordination and fewer than 10% of American kids in public elementary and middle schools have daily pe classes. We actually, we're talking about public private partnerships. If this is something that you all care about, put pressure on your kind of uh local school boards and depending on kind of what school district you live in and where the sources of funds are coming, kind of on your city council, on your state governments that they're title one schools and what the federal government is specifically allocating funds for. Then we tried sugar taxes. We haven't really, I mean, like Philadelphia is the only major city in our country that has a real soda tax. Um I know there is a big movement to try to put pressure on E BT and snap benefits. I don't support that because I'm deeply uncomfortable with telling people already living on the margins that um they should not have access to kind of the full choices of people not living on the margins. But I do think there needs to be a more concerted effort to try all of this in concert for kids, adolescents, you know, young adults and adults and you would know better than I, we also know different interventions are more likely to work um with greater effectiveness in those areas. And also absolutely. Um we need to be looking globally in the same way we did and continue to do with our market shaping work on kind of what will the generic sorry to the pharma companies in the room? But like what are the generic versions? What are the input costs? How quickly can this be manufactured? Can those be manufactured in a globally um purposely globally diverse way in the way that we've seen with antiretrovirals? Um antibiotics and increasingly vaccines can be manufactured in Latin America, in Asia, in South Africa, and East Africa, in West Africa, in Eastern Europe, you know, and elsewhere. Um And then how do we build on the pre-existing supply chains um to help ensure that the people who could benefit from, from medicines as part of a larger set of interventions have access to them. And of course, then having enough health care professionals who actually are there to deliver those and then assess the ongoing impact. And now Dana is cutting me off. I'm getting all right. Well, thank you so much Chelsea. There's so much more we could talk about, but really thanks to everyone. Thank you. Thank you.

Dr. Robert Wachter, Chair, Department of Medicine, School of Medicine, University of California, San Francisco
Moderator: Michal Lev-Ram, FORTUNE 


Brainstorm Health 2023 - Assessing Covid For The Long Haul

Dr. Robert Wachter, Chair, Department of Medicine, School of Medicine, University of California, San Francisco
Moderator: Michal Lev-Ram, FORTUNE

Assessing Covid For The Long Haul 

Dr. Robert Wachter, Chair, Department of Medicine, School of Medicine, University of California, San Francisco
Moderator: Michal Lev-Ram, FORTUNE 

All right. Well, I'm delighted to introduce our next guest. He is a bit of a celebrity to me as we were in the midst of the pandemic, he would be the person I turned to every time I needed to figure out what was actually safe to do or not. It is the one and only Dr Robert Walkter, chair of the Department of Medicine at the University of California, San Francisco Bob, as he is known, was quoted earlier this year saying COVID now is probably what COVID is going to be a year from now and two years from now. In other words, the new normal, he's an expert on clinical public health and policy issues related to the pandemic. He's also an author and as I said, a pretty popular guy on Twitter amass amassing a following of 275,000 people including yours truly, with his data driven detailed threads where he explained his own thinking, his own experiences, his family's experiences on COVID becoming a trusted resource and a real counterbalance to the plethora of misinformation that was out there. Dr Walker still believes the virus is a threat with long COVID, particularly troubling for so many. He joins Mihal Lev Ram for a conversation on what lies ahead and how we can all prepare ourselves for the future living with COVID. Please join me in welcoming them to the stage. So I'm guessing a lot of the audience here follows you on Twitter. But you were just saying how many Twitter followers you had pre COVID and today give us the number. I think I had 15,000 pre COVID and about 300,000 posts. So I think it's COVID and not me, I don't think I got that much more interesting in the last three years, the pandemic did something for you to do that. OK. So I'm going to start out with a question. Something that was just in the news earlier today, which is that the COVID crisis Commission came out with a report saying our government pandemic response exposed collective national incompetence. And I'm just wondering from what you've experienced lived through, from what you saw from the report. Are you surprised? No, that sounds right. I think we screwed it up pretty badly. Um Interestingly, one of the things the report said was operation warp speed was a real triumph. I mean, that was extraordinary, really involved, a public, private partnership with a lot of, you know, a lot of government resources but giving the private sector an opportunity to do its thing and the fact that they came out with vaccines that have been amazingly effective uh as quickly as it, it is remarkable. But testing uh non vaccine treatments, data, data gathering, data aggregation, you know, we just expose massive numbers of holes. And I guess I'm worried because next time I think will be harder. Uh you know, that this one part of the challenge of course, is the politics and the politics this time for the first six months after COVID hit, I think the Libertarian part of the country kind of gave it a pass. They said, all right, we'll go with mandates. We'll go with shutdowns next time. I think that's not going to happen next time. I think there'll be a push back on any, anything that the government tries to do starting on day one. So I'm quite worried about the next one and the next one could be worse than this. This was a very bad pandemic. Obviously, more than a million people died in the United States. But there's nothing in the, in the Book of Life that says you couldn't have a virus that's as infectious as this one, but far, far more lethal. So it's, uh that's kind of a bummer, but it's kind of, yeah, thanks for starting with the bank here. Um We'll get cheerier from there. I don't, I don't know about that. Um So sticking with the current pandemic that we've been living through or have lived through. Um, we've over and over. We've, we've kind of recalibrated our um our risk tolerance, right? And just how we speaking of ma mandates, you know, what, not just the mandates, but there were a lot of individual choices. We saw people make very different choices at this point in the game. What? There's been a lot of interest in what you do, you know, this is like the friend who you look to like, are you wearing your mask? Are you not? What should we be doing? Um How do you approach different scenarios in your life today? And what can you share with us? Well, I can't say I always wear a mask because here I am. But um first of all, I got my second by Val and booster uh two days ago, feel fine. Uh My judgment is that the rules that the FDA put out, which is if you're over 65 or you have comorbidities and or I suppressed, it's a reasonable thing to do. Uh I don't worry anymore that I'm going to die of COVID and that's very different than March 2020 when I was hiding it in my kitchen table. Um The main reason is that I got this booster is it's pretty clear that after six months, the effectiveness of your booster wanes pretty considerably in terms of preventing a severe case, you can bump that back up again to me at essentially no cost. I mean, the vaccine is incredibly safe. Uh You know, it's been over because for the anti vacc community has pushed very hard about its bad side effects. They're really nonexistent. It's one of the safer things that we prescribe in medicine. So I took the val and I think it's a reasonable thing to do. I wear a mask in crowded indoor spaces. And so I flew here this morning, I wore a mask on the airplane and maybe 20% of the people did. I think it's reasonable to wear a mask in a crowded indoor space that's not well ventilated and, and reasonable at this stage, if you're well vaccinated, not to wear a mask in less crowded spots. I now have indoor dining, do indoor dining, which I didn't do until about six months ago. So, talk to us a little bit about long COVID two and what we know today, not just about some of the very real symptoms people are experiencing and living with, but also some of the longer term risks that, that we're finding out about and, and is that not a deterrent or, you know, something that incentivizing people to still not want to get COVID? Yeah. No, I think that's exactly right. My feeling is the main reason to avoid getting COVID is to avoid getting long COVID today. Certainly there are still 150 people a day dying of it. So it's not nothing but the main reason I am still moderately careful, more careful than many. Um, and, and in part, the main reason I got the vaccine, uh probably the main reason I would take pack of it if I got COVID is the vaccine has been demonstrated lower the probability of long COVID. So has PAX of and the best way to decrease the probability of getting long COVID is not to get COVID. Um There are two things that what, what are the chances of getting long COVID if you get COVID? probably if you weigh all of the studies about 5%. So if you're thinking through the risks of everything and I, I, I use a risk of about one in 20 chance. If I get COVID, I'll get long COVID. It feels a little realer to me because my wife has Long COVID. Uh she's a very high functioning journalist. Uh She got COVID about a year ago. She will say to you, I don't have long COVID. If you were speaking to her now, she's a hell a lot smarter than I am, would not know, but she hits a wall most days at about one or two in the afternoon needs to take a nap. She'll forget appointments, which she never did before. So that and when you look at the spectrum of long COVA, there are people who are disabled by it, but I think more people look like her. It just has diminished her quality of life. I think it's worth thinking about that as you weigh risks and benefits the other thing that I think is very hard for people to factor in is it's not just symptomatic long COVID study after study. And these are really, these are bummers. I mean, there's no way for me to talk them away study after study shows that people who have had COVID compared to those who have not have a higher risk a year later of having heart attacks, strokes, diet study just came out yesterday on autoimmune diseases. There's a whole bunch of bad stuff that seems to be associated with getting COVID. You might say, well, I already had COVID so I don't have to worry about it. The problem is your risk of the second case is worse than if you only had one case. So I think we've sort of all decided collectively as a society not to even think about that. But I think as individuals weigh their decision making and whether to be a little bit careful to me, I think it's reasonable to be careful largely because of long COVID. I've still not gotten COVID as far as I know most of that at this point is luck. Uh, you know, I, I, because I, I'm certainly not being as careful as I was until about six months ago. But having seen my wife and, and really understanding the literature, I think if I can keep it that way, it's worth wearing a mask on an airplane to, to do that. Ok. Um, What about variants? Are there new scary ones on the horizon? Do we, do we just not care anymore? I feel like we don't care about it. Yeah, we, we should care a little but I don't think it's worth the average person obsessing about it. You know, we're basically still on the same Greek letter we were on 18 months ago, which is amazing because we, we all have to learn a new Greek letter every six months for the first two years. And uh so where we're seeing our variations on the theme and each one, if it takes over, it usually takes over because it's a little bit better at its job of infecting people or evading immunity than the prior one. But at least for the past really since January 2020 when Omicron first bait became a thing, there's been no variant that has been a game changer. There's been the yes, they have your immunity a little bit better than the old ones, but the vaccine still work fine. Pavid still works fine. Your home test still works fine. Monoclonal antibodies don't. So that's been thrown out as a, as an option. But the fundamental parts of controlling the epidemic, you know, does a mask work, does my home test work? Will packs of it work? Will the vaccines work? Does my prior infection protect me against getting infected? There's really no new variant that has changed that equation and none of the new variants which pop up every month or two have really seemed to be on the horizon. That will change that equation. That's no guarantee about tomorrow. A new variant could come out tomorrow. It could be a new Greek letter. It could make the vaccine not work at all. It could make, it could laugh at your prior immunity. But I think most of us feel like the chances of that is less than 20%. I think we probably throw out these things that scare the, let's talk about something happier. But yeah, I think that I think it's a reasonable way to approach the life now and say the state of COVID now is probably about the state of COVID three years from now. That's the best guess. And so whatever you're doing to live, your life is probably a reasonable way of thinking about what you're going to be doing going forward. Ok? I will take that. That's a little like it's like neutral of a bummer. Ok? Any questions for Bob, please raise your hand, we will bring a microphone over to you. You're welcome to raise your hand a little later. We've got one over here if we could get a mic over and if you wouldn't mind standing up and introducing yourself, you know, she wouldn't have to do that. I know. Hi, I'm Janice Whaley. I'm from Donor Network West. I'm in your neck. Neck of the woods. My question to you is Um, and I, I know you can't predict the future, but do you think that we're vulnerable again to a different type of pandemic that may come about? Um, and do you think that COVID ultimately is just gonna, like disappear? I don't, I can't see ac it's a good question. I can't see a circumstance where it just disappears. Uh You know, what has changed now is there's no one in this room of 100 and 50 people that has no immunity. You either have had a vaccine or you had infection or for most of you've had both. And so it's going to be around, but it's not going to kill people the way it killed people in the beginning when they had absolutely no immunity to it. I think that's the likeliest scenario for it probably forever. And at some point we'll just forget about it. It will just be something in the environment the way flu is and the way colds are, there's no way of predicting whether there will be something like it or worse than it. Uh, in the future. It's all maths. I mean, it's all viruses mutating and eventually coming up with some formula that turns out to be good at infecting people and good at hurting them and killing them. I think the chance is that, that will never happen again is zero. Uh, the last time it happened and it was as bad as this was 100 years ago. Will it be 100 years for the next one? That's possible. It could be 10 years. It could be 20 years. It seems unlikely it'll be a year or two from now. But it could be, I don't think there's any way of predicting. So I think we have to learn from this experience. So we're better at dealing with it the next time and report really made it clear that there's a lot of things we have to learn from. I mean, the CDC was just not built to do the things that we asked it to do. The fact that it basically had to beg for data from all of the states. You know, please give me your data so we can analyze it and tell people what's going on is ridiculous. That's a crazy way to run a railroad, but at least today it hasn't changed very much. And I I know you look at things very holistically, you look at systems, right? Um And you've talked about how during COVID, the health care sector as a whole, the entire ecosystem just became, despite all the issues became a lot more nimble and agile and innovative and collaborative is that all out the door? Just where, where is it now? Well, probably the, the two biggest things, the health care system. First of all, we built a tremendous amount of capacity. I mean, my hospital, every hospital, we had patients in the parking lot, patients in the cafeteria, you know, stuff we, you know, I've been a fan of telemedicine for 10 years and I had really been pushing it very hard at U CS F and managed to get our percentage of outpatient visits from 1% to 2% in about a decade. And it went from 2% to 70% in about two weeks. So just to show you the influence I have. Uh again, it's all the pandemic, it's all the pandemic. So I think we demonstrated how nimble we can be when provoked to, to it and when the payment and regulatory system lets us be. But I have to say it's somewhat disappointing. We're seeing new rule, we're seeing some of the old rules about telemedicine. For example, that for, you know, for example, I now would need to get a license in the state of Nevada to have a tele visit with a patient in Nevada that was all suspended for the pandemic. And all of those rules that make no sense whatsoever are being re erected. So we, yes, we became more nimble, but I'm a little worried that the system is sort of snapping back to the status quo. Are we better off or worse off than we were pre COVID as human beings in terms of uh no, it as as in terms of the industry, in terms of patient care. Well, I I think that COVID moved the I to me the most important issue is the digital transformation of medicine. I think me and that's a lot of the subject of the next day or so. A lot of medicine is going to be transformed by digitization by A I all that kind of good stuff. I think it moved us forward quite a bit. It probably leapfrogged us by five years uh where we can of our of data presenting data to people in forms that allows them to make better decisions. So I think we're better off in the big picture of how do we create a health care system that's better and safer and more equitable and less expensive in part because it accelerated the digital transformation of medicine. Ok. Well, I have to say, despite all of your bleak prognostications, you are such a comforting and calming and informative presence pretty fast trick today, those two things, right. So, thank you. Thank you.

Alyssa Jaffee, Partner, 7wireVentures
Alexis McGill Johnson, President and CEO, Planned Parenthood Federation of America 
Dr. Sandra Milligan, Head, Research & Development, Organon 

Brainstorm Health 2023 - Disparities In Healthcare: How Gender Plays A Role 

Alyssa Jaffee, 7wireVentures
Alexis McGill Johnson, Planned Parenthood Federation of America 
Dr. Sandra Milligan, Organon 

Disparities In Healthcare: How Gender Plays A Role 

Karen Lynch, Chief Executive Officer, CVS Health
Javier J. Rodriguez, Chief Executive Officer, DaVita
Moderator: Clifton Leaf, Former Editor-in-Chief, FORTUNE, and Founder, Brainstorm Health 

Brainstorm Health 2023 - The Future Of Integrated Care 

Karen Lynch, Chief Executive Officer, CVS Health
Javier J. Rodriguez, Chief Executive Officer, DaVita
Clifton Leaf, Founder, Brainstorm Health

Karen Lynch, Chief Executive Officer, CVS Health
Javier J. Rodriguez, Chief Executive Officer, DaVita
Moderator: Clifton Leaf, Former Editor-in-Chief, FORTUNE, and Founder, Brainstorm Health 


I don't often talk about silver linings from the pandemic, but there is little doubt that people are more focused on their health, more more now than they've ever been. We're more knowledgeable about it too. Um But with all this focus, we do want convenient, affordable, accessible care that is connected at all levels, integrated services, holistic approaches and a continuum of care are not new concepts, but they are being implemented more broadly across the health landscape to the benefit of patients and providers. So that's exactly what our next our next guests are here to talk about. Karen Lynch is the CEO of CV S health, one of the five largest companies in the United States and one of the 10 largest companies in the world. Uh I would also like to note that Karen has topped Fortune's most powerful women's list for two years running and CBS is the highest ranking Fortune 500 company ever led by a woman. We also have Javier J Rodriguez Ceo of devita, one of the largest providers of kidney care in the US with operations in 10 countries worldwide. They join, they join Fortune's former editor in chief Clifton leaf for this very timely conversation. Please join us in welcoming them to the stage. Well, it is great to have you both here and those are some accolades for both of you. Um I've gotten a chance to hear you present your company strategy for many years and you're a great, very clear and compelling communicator. Two action verbs have always stood out, one is extend and the other is engaged and the extent I think is clear from your strategy, you've got the minute clinics, you've got 9000 stores, you've got, you've just spent all of this money $20 billion almost to buy two big primary care providers going into the home care industry. What is the engage? How do you envision the engage in this? Well, first of all, hi, everyone. Thanks for having us here. We're really thrilled to be here to talk about integrated care. You know, I think the most important thing if you think about someone's health, right is it is all about engagement. And if you want to be healthier, what we saw with the pandemic, people are more concerned about their health and engagement is the power of being healthy or getting to health. And the way we've really thought about it. And you said, you know, we're kind of accumulating kind of extending our assets. The way we've really thought about it is how are we going to use technology in different ways so that people can engage in a simple and connected. One of the things that if you all kind of like think about your experiences in health care. What's the first thing that comes to your mind? Fragmentation? Not simple, hard to navigate? You think about every other experience that you have in your everyday life, you think about simplicity, you think about engagement, you think about easy access. So we're thinking about how do we engage people in their health, using technology in various ways so that people have a connected and seamless experience with the ultimate goal of making Americans healthy. That's really what we're trying to accomplish. And the rest of your life is simple, easy. What were the so Javier, I mean, engagement, this is, this is something where your relationship with your the patients you serve is very intense. I mean 100 and 44 times a year people come in for hemodialysis to your centers. That is more engagement with a health care provider than, than most of us who don't have end stage kidney disease can imagine, talk a little bit about how you are improving that relationship because you know, for many, it's sort of a very dire and, and, and, and and brutal experience. Uh First of all, good, good to see you and be on this steam panel with the most powerful woman. And I don't know how many uh spheres. I'm just another guy here. Uh from uh from our perspective, the most important thing that you have is when, when a patient is as sick as our patient population is, you want to comfort them and make them sure that they have that relationship. The first week when I was the CEO of DaVita, I went to a center in Iowa and I wanted to meet a patient. His name, his name is Jack and he has been on dialysis for 46 years, 46 the, the average person is on dialysis for five years. And I said, this guy has got to have something special. So I said, Jack, tell me what makes you special. He goes well, my name is Jack. So I have a shot of Jack Daniels every day. And I said, please tell me there's more. I came all the way to Iowa. Uh and then what came across was the relationship that they have with the caregivers. And so for me, one of the mandates that I want to do now for DeVita is create a culture where every one of our 40,000 caregivers has that relationship with the patient. And that is very, very hard to do in today's world. Uh with all the technology, all the things they have to do and all the fragmentation of care that you talked about. And we have important point though is that relationship, um you know, with providers and patients or providers because that makes a difference. We talk about technology very often and we need technology for us. But you know, we're, we're partners with um manages uh many of our patients as well and you can't replace that personal relationship in health care because health is one of the most valuable assets that you have. And I think that as, as um as technology and everything evolves, we can't forget that human engagement and that human connection that you do so well. Is CV S Caremark going to preapprove Jack Daniels? Now? Can we, can we get some news, man? I would love to see that. Um So Javier like like CV S uh uh your predecessor bought a primary care physician practice. You had it for about five years. Uh Your, your predecessor sold it. It, it didn't really integrate into your uh into your journey to create a uh to move dialysis from a dialysis company into a kidney care specialty company. But what did you learn from that experience? How did you learn about how to integrate? Well, a couple of things, uh what we want to do is revolutionize the way care is delivered. And we, we want to make sure like you that we take on a broader part of health care. So our patients come to us incredibly sick and, and people say put wrap around services on them and it's a little like building a house without a roof and then it rains and pours and whatever and someone says go fix it and you're like well, you know, you should have put a roof on the house, right. So from our perspective, what we wanted to do in that acquisition was move upstream and have broader access so that we can avoid the progression of kidney failure. What what we ended up doing is we started to get a lot of learnings. Of course, when you make an acquisition of that size, and we realized that uh that model wasn't scalable around the country. So that was our first finding. And then secondly, that there was a better owner of that asset. And so it wasn't that we didn't like the model. It's just that when you uh when you start to see that someone is willing to pay more for something uh than what we were willing to have, it was, it was good to divest it. You know, you both have invested a lot in analytics and data. And one of the challenges is to find people before they get into kidney failure before they need more serious help. Talk a little bit about how you're sort of moving into this preemption model with the data you have. Well, I think, you know, it first starts, you know, as, as you said earlier, one of the things that we've been extending our services into primary care. Well, you know, we have found uh you know, people are interacting with their primary care and if, if they do that gives them, you know, we've seen better health outcomes as a result, which is why we did the acquisition of Oak Street Health. And I think it's an important part because, you know, primary care wield significant influence over the entire health care ecosystem. And they've been using a lot of data and analysis to really understand, you know, kind of patients and how to interconnect with them. At the same time, you know, we, we have people in our home health asset through, you know, signify health where we're using data to really understand their needs. And then one of the things that's really powerful is that we'll be able to return those individuals to care, using technology, using those interactions, using our pharmacy information to do adherent. So you can see tech is gonna weave and and analytics will weave through that entire sort of continuum as we advance value based care, which is critical to, I just want to let people know that the Oak Oak Street and the sign both they have a lot of Medicare advantage, but a lot of Medicaid patients as well. And so there, there is a lot of people who are, who are often sick and uh have a lot of comorbidities that you're you're dealing with trying to implement a value based care approach to this, right. So the data would be help you to prevent some of these diseases or complications of the disease. Yeah, absolutely. And it's mostly Medicare. And if you think about just step back and you look at what's going on in the market. There are more people between the ages of 50 and 64 than there are over 65. So, you know, you can imagine there's like this tsunami of people coming in to Medicare. And really what you want to do is make sure you're engaging because that's going to put pressure on the entire health care system, right? So you want to make sure that you're engaging with them using the the technology and analytics. So we can kind of help with some of that preventative to keep sort of that, you know, keep them healthy and manage their chronic diseases more in real time. That's tsunami. Just to put a little finer point on it. Uh In 2000, we had 30 million Americans above 65. And in the next 10 years, we'll have 65 million Americans. It will be the first time that we will have more seniors than Children. And so that's got massive consequences of what we want to do right now. And the most powerful woman in end stage kidney disease, the only way out is a transplant, it's a kidney transplant. Uh Correct. And so there and so there aren't that many kidneys available for transplantation. So the only other option is to really try to prevent people from getting to that point. How are you using your data and some of your acquisitions to identify those patients. And what can you do to actually stop that progression? We're, we're really excited about this part of our strategy, which is there's 35 million Americans that have kidney disease and only around a million will have their kidneys fail. And so this is a little like finding a needle in the haystack. So you can actually make an intervention because you can't make an intervention on the 35 million. And so what we're devoting all our algorithms and our intelligence and working with people like Karen is to make sure that we put the equation together and move upstream. So those care teams actually intervene before you actually have all of this uh downstream illness on this stage. Uh many years ago, not that many years ago, I should say. But uh one of our heroes uh Bernard Tyson um talked about reconnecting the body and the head, the head and the body and, and really his devotion to the idea that we need to reintegrate mental health care with, with the rest of our physical health care because they really aren't separated. I know mental health is an area you're moving into and it's very personal for you. Talk a little bit if you would about how you plan, how CBS plans to start bridging that integration. Yeah. So, um you're right, it is very personal. Um And it is right now in, in the US. Um It is uh you know, a huge issue um with mental health, particularly in Children. And what we're seeing is we're seeing an enormous increase in suicide of um young adults. And so we're in um you know, an area that I think the country has never uh been in. Uh So we're doing a lot on, on this front. You know, one is we, we, we've expanded our E A P resources. We've actually put counselors in some of our CV S locations and we've also expanded our T A um mental health capability. So people have access and just to put a finer point on that before the pandemic, we had 9000 tele tele mental health visits. Now we're up to almost 20 million. So the 9000 to 20 million, right? And so the demand is, is amazing. Uh but it just, you know, shows that there is a uh a need in this country. Uh But we have a lot to do. Uh the provider system isn't working. People aren't going into the profession. We need to figure out ways to get people, people to go into the profession. And um you know, because your head is connected to your body. And, you know, I always use this example if you've heard me talk before women when they're uh you know, when they have a baby, it's the most joyful time. A lot of women suffer from postpartum depression and we never talk about it and we aren't ready and equipped um in their, you know, kind of post discharge plan to say this could be something you may experience and what do you, what what are the tools and capabilities that are available? So we're kind of we're thinking through all of those experiences so we can have those care plans. So we think about it holistically because until we think about it holistically, we're not gonna address those issues. And just to put some numbers on this, I think among Americans, 50 age 15 to 30 or 34 suicide is the number two cause of death. It's kind of amazing when you think about that and, and you know, the other thing that's, you know, that kind of uh talking numbers, you know, one in college, one in 12 college students have an actual suicide plan. So it's just been an amazing um you know, kind of issue that we all, we all have to deal with Javier. I mean, when people think about kidney disease, we think about this life and death situation. But what you also discovered in your very enormous practice um is how powerful the psychosocial effects are, how depressing it is. People literally go into a sort of a almost a death spasm emotionally. Um when they're thinking, when they realize that they've got to go through this, it's, it's a tough thing, right? And, and if you hear that you have cancer, you have age renal disease or you have any of these it's, it's obviously uh too much for people to take. So what we try and do is educate you through the process very slowly because we know at the beginning you're not even listening, you're just trying to go through that process. And so our education is months, not days or weeks, but we wanna make sure that you act to the new lifestyle, the new diet. So we surround yourself with a care team, dietician, social worker, uh et cetera so that you can address all of your life elements. But, but it's, it's really hard and, and one of the things that, that I want to do and, and Karen is doing as well is uh there's a lot of you that are taken on point to point solutions, right? And, and chasing a bit of the dollar if you will and, and it's, you know, called attribution and it's got all these different technical names that only people in this room know if not, you wouldn't be very popular in a cocktail party. Uh But at the end of the day, what we're trying to do with DaVita is to, to think like a patient, they don't think of attribution, they don't think of an app, they don't think of a, a point to point solution. So we're reverse engineering everything as if we were a patient and then surrounding ourselves with the best partners or the best acquisition in order to bridge that whole continuum. And the other thing that we're, we're working on together too, I think is just the reimbursement thing. Because if you think about health care in the future, there's two things that really are gonna change health care in the future, value based care, which we have models um together and tech. And those are the two things that if you think about what's going to make health care evolve and, and be more patient centered. It's those two things, you know, the other item is cost and, and part of the evolution, we have to figure out a way to make things uh less expensive or we're gonna drown in these costs. You're both in areas where, where you understand that the pressures of cost, um obviously how the air kidney, kidney cancer is extremely expensive or kidney disease is extremely expensive. 1% of the patient population, 6% of the US health care costs. Part of that is this engagement, we talked about the 140 or so. Um you know, visits that, that everybody has to go through. Um But how do you rethink the cost structure? Well, we're trying and, and one of the things that we're really proud of is when you put those type of stats, you're like, whoa, well, the reality is if you do it by the hour of care, so our patients are with us for four hours every session. We charge roughly like $90 an hour and I haven't had any health care, uh, in my life, even if I go get my teeth cleaned, be at that level. So we are very happy at the way we standardized care and we've delivered the efficiency of care, but that doesn't make it any cheaper because of the frequency of the exchange. Right. And so what we're trying to do is of course, do more things for patients to go home and to have more of the care that they want, wherever they want it. We have just a minute left um, here and I know you both actually have venture groups where you invest in innovation. Where are you looking? Uh what's the most exciting new technology that you, you're looking at now? Well, we're, we're taking a look at, um, you know, kind of all health tech services mostly, you know, looking at things in the home where, where are some of the advancements in the home? Because, um you know, we saw over the last couple of years, people are much more willing to do things in the home. And so we're looking at kind of that health, you know, health services tech in the home. Um Mostly, well, I have to say this is the first time we've had such uh esteemed Boston college graduates, both of them on our stage. Not, not since Doug Flutie drove the passing yard. Uh uh for I was actually there when he was there. Oh, you were so have we had this kind of a just PC crowd here. So thank you both for being here. Thank you. Thank you.

Aike Ho, General Partner, ACME Capital
Annie Lamont, Co-founder and Managing Partner, Oak HC/FT 
Kareem Zaki, General Partner,Thrive Capital
Moderator: Michal Lev-Ram, FORTUNE


Brainstorm Health 2023 - The Vc's View: Investing In Health Care

Aike Ho, ACME Capital
Annie Lamont, Oak HC/FT 
Kareem Zaki, Thrive Capital
Michal Lev-Ram, FORTUNE

The Vc's View: Investing In Health Care

Aike Ho, General Partner, ACME Capital
Annie Lamont, Co-founder and Managing Partner, Oak HC/FT 
Kareem Zaki, General Partner,Thrive Capital
Moderator: Michal Lev-Ram, FORTUNE

Connor Landgraf, Co-founder and CEO, Eko 
Moderator: Michal Lev-Ram, FORTUNE 


Brainstorm Health 2023 - An A.I. Enabled Stethoscope 

Brainstorm Health 2023 - An A.I.-Enabled Stethoscope 

The National Institutes of Health say that valvular heart disease VD is a leading cause of cardiovascular morbidity and mortality worldwide. And the stats are all just going in the wrong direction. Negative outcomes from V H D are only expected to increase in the decades ahead. Millions of Americans have this disease. Millions of Americans don't know they have it. So detection is key. And so now what we're going to do is show you a really innovative platform that's been described as Shazam for heartbeats. Shazam is that app that you can get on your phone and play any music you want. It will hear it and tell you what the song is. Well, that may get your heart pumping with music. But the cardiovascular disease detection platform echo E K O Echo is tapping into a different set of beats. Uh The system utilizes machine learning A I powered stethoscopes and a library of nearly 80,000 heart sounds to identify murmurs which are a key sign of V H C. So let's see it at work. Please welcome back. Fortunes Mikal Lev, along with Connor Landgraf co-founder and CEO of Echo, they're gonna give us a little show and tell here they are. Ok. So we're going to play a heartbeat for you guys and you have to guess who it is. Just kidding. Tell us about echo. Yeah, absolutely. So the stethoscope is the world's most ubiquitous medical device. Probably the world's most iconic as well used hundreds of millions of times each year by clinicians to do critical decision making around patients, risk of cardiovascular pulmonary disease. And yet it's, you know, incredibly subjective, highly open to physician interpretation. They have to hear those differences between health and disease and that's, that's really challenging for them to do. And I think if you ask most physicians, they'd say they're not super comfortable using the stethoscope as a diagnostic tool even though it is so iconic and ubiquitous. And so what we'll demonstrate here is we'll give an example of the way that A I is being used to inform this critical clinical decision making on the front lines of care. We'll take this stethoscope, place it on the simulator here. This is my friend, Manny Manny is a mannequin. He is missing, missing some appendages today, but he does simulate a heart sound of a patient who has valvular heart disease. And we'll demonstrate how that A I can inform that clinical decision making so quickly. OK. And let's take a closer look on the screens at what we're looking at here. Then go hold still, Manny. All right. So what's happening there? We did a quick recording of Manny's heart sounds here. We sent it up to the A I algorithm in the cloud. Did the analysis sent the results back down and they're displayed here. We see a structural systolic murmur likely highly associated with a vaguer heart disease called aortic stenosis. Uh This is definitely a situation where Manny should be referred to cardiology probably urgently. Um But that there is highly likely uh pathology here uh that we could quickly screen in just 25 seconds in a patient exam room, right at the front lines of care. Um So amazing. OK, I wanna ask you a few more questions. Let's make our way over there and leave Manny to his space over there. By the way, is your heartbeat in the database, Connor? It is uh I've done a lot of the recordings early on. So my heart is probably over represented in the database, but it is one of several million heart sound recordings that does encompass this machine learning algorithm. What is pretty exciting to us is that, you know, it's it surpasses almost kind of any clinician experience that they would be able to be able to see. I mean, the clinician will see maybe 30,000 patients in their career and this data set has been informed off of millions now. Um And you know, it's not that dissimilar to Siri or Alexa, these kind of voice assistant technologies just applied to a new clinical application. How how does one actually go about generating this data set though of millions of heartbeats, we've done a lot of work over the last several years doing prospective clinical studies, working with academic institutions to sit in their cardiology labs when patients come in and get an echocardiogram or a CT scan or you know, an EKG will capture their heart sounds alongside that. So we have a really strong gold standard reference point and everybody has a unique heartbeat. They do and and unique ECG as well. We do find that there are really signature fingerprints within these signals that help us, you know, hear those subtleties, we're hearing the flow of blood inside the heart itself and when that flow becomes turbulent, when there are kind of abnormalities, they have very kind of consistent signatures to them. And so is that process of just kind of learning what the signatures are so that the algorithm can provide that accurate result? Have you learned anything specific to your own heartbeat? I it's funny you ask, I've definitely struggled with palpitations in the past. And it's been pretty neat to use the technology to understand my own condition, understand that, you know, it's not necessarily something that I need to be worried about, but having that knowledge is pretty, pretty comforting, I would say and talk a little bit more about the stethoscope. Why is it, does it need to be a stethoscope? It doesn't have to necessarily be that clinician form factor, you know, that that familiar form factor. But one of the things we recognize based upon kind of our learnings with clinicians was that to have the impact we wanted to on primary care and to get the utilization, it needed to be comfortable, it needed to be familiar to the clinician. It needed to look like the tool that they expected it to, it needed to fit within their existing workflows. It couldn't be something that would take inordinate amounts of time in the patient exam room, it wouldn't be utilized otherwise. Um and it needed to be fast and non invasive. You know, I think one of the things that we've recognized is that primary care is going to take so much more responsibility in the coming years to support a holistic integrated care. Primary care will be more and more of a gatekeeper and having technologies that can fit seamlessly into primary care workflows is critical for their success in adoption. So it's a little bit like how the camera on the iphone makes that clicking sound, which is completely irrelevant, doesn't need to be there, but we're just familiar with that. Yeah, that, yeah, that comfort. OK. Um And talk a little bit about, you know, what else can you do with this? What else can you really decipher glean from heartbeats? Where, where do you hope to take it next? Yeah, I mean, we're, we're building what we think of as a digital biomarker, an acoustic digital biomarker for disease. And you know, the stethoscope has survived for 200 years of medicine simply because of the fact that there is a tremendous amount of data in sound in our breath, sounds in our lung sound, the crackles, the wheezes associated with asthma or COPD or pneumonia. These are all signature clues to helping us understand decipher the physiologic status of these patients and we can continue to evolve the A I to to work well, even in these applications outside cardiology, our recent clinical data is showing that we can double the sensitivity of primary care physicians using the A I that, you know, there is so much opportunity to improve the timeliness and accuracy of cardiovascular disease detection at the, you know, at the front lines of care at that first opportunity with these patients. So they don't have to wait to get a cardiology referral. They don't have to, you know, go down a long chain that's likely to be broken before they get, before they get confidence and clarity. Um Can you give a sense? I mean, you, you shed some light on this but, but give us a better sense of just how much more effective the A I is and at what scale than human beings. Yeah. So our devices, we now have more than 300,000 providers using our devices to serve in their physical exam tools in that primary care setting. And we're seeing tremendous results. As I said, you know, we are more than two xing the sensitivity for identification of substantial murmurs associated with Faul or heart disease and other common conditions. And what, what's exciting to us and what motivates us is thinking about the patients who might not likely be, be, you know, be risk factors for cardiovascular disease or have suspicion, think of, you know, pregnant mothers, for example, or pregnant women who have substantial risk of cardiovascular disease. But not every physician is going to be thinking about that. And so having these non-invasive tools that can help us uh quickly ascertain whether there are signs of disease and then get those patients to the appropriate testing. Um The clearance pro FDA clearance process for you, I hear was pretty quick. It is, you know, the actual submission process itself is, is relatively quick. But the work that goes into those applications is strenuous and it took us, you know, more than three or four years to gather enough clinical data to demonstrate safety and accuracy validation before we submitted to the FDA. So it's a lot of lead up to a lot of materials. Think our submission packet was close to 6, 700 pages of material to really show that, that, that the algorithm could perform the way that we, the way that we wanted it to. And last question for you, obviously, a lot of we'll be talking about this later on as well. But a lot of interest in generative AI open A I all the, you know, competing products does, does, does that excite you? What else could you do with that involved? We do think. Yeah, there's a lot of interesting corollary with large language models and chat GPT. I think what we, we have stayed really focused on is just being that, you know, the acoustic analysis tool. The thing that machine learning is particularly effective at when there's a large data set powering it and where we can kind of map, you know, a single input to a single output for disease detection. And we're excited about the impact we can have and even global health too. OK. I'm gonna ask you actually one other thing. Could you recognize your heartbeat? That's a good question. I don't know if I can actually recognize my own heartbeat. Uh I, I don't think my ears are that so. No, no. You know, I mean, that's why we have a, I, I guess so. Thank you so much Connor. This is um exciting. We'll be excited to, to watch what you do in the, in the coming years. And um hopefully Manny is doing ok. I hope so too. Thank you so much.

Bakul Patel, Senior Director, Global Digital Health Strategy and Regulatory, Google
Dr. Monique Smith, Director, Design and Innovation, RockHealth.org
Moderator: Chrissy Farr, Principal Investor, Health Tech Lead, OMERS Ventures; Co-chair, Fortune Brainstorm Health

Brainstorm Health 2023 - The Role of Regulators On Responsible Health A.I. 

Bakul Patel, Google
Dr. Monique Smith, RockHealth.org
Chrissy Farr, Fortune Brainstorm Health

The Role of Regulators On Responsible Health A.I. 

Bakul Patel, Senior Director, Global Digital Health Strategy and Regulatory, Google
Dr. Monique Smith, Director, Design and Innovation, RockHealth.org
Chrissy Farr, Principal Investor, Health Tech Lead, OMERS Ventures; Co-chair, Fortune Brainstorm Health

I am so excited to get to moderate this particular panel because I have been on maternity leave the past few months and reading nonstop about generative A I um because I am a total weirdo. Um But now I get to talk about it with these two um who know, honestly, everything there is to know about this, this space um even as it rapidly evolves. So I'm gonna start by picking on you. Um And I would love for you just to give us like a quick 32nd intro to where we are at right now with uh regulating A I, what is FDA doing? What's AJ S doing just like a snapshot? Yeah. So before I left FDA, which is about a year ago, um we had put out an AI regulatory framework that sort of proposed a couple, couple of unique ideas about how do you allow algorithms to evolve and change over time without actually going back or back to FDA for approval. So those, those things are now, well, one of those things which is called a predetermined change control plan is now in law that FDA has in the toolkit now. So that's a good advancement that allows people to sort of iterate their models and, and, and not go to FDA like more frequently. So that's one thing, Nis put out a framework and then the White House put out a principle to document, I think when you start looking at where things are and I believe there's an R out from NTI A to ask like, how should we think about regulating? So those are, those are sort of where things are in the government today. HHS is obviously thinking about health and what should be done. And I think one of the key principles in, in health, like people are like gravitating towards is transparency, like explaining in layman's term to the users, what the algorithm does, how it got to what it got to and what its recommendation really means. I think that's one of the fundamental principals how to get there, what to do. I think still work in progress. Um Yeah, that's definitely helpful and a lot of confusion I think still around which agencies specifically should even be regulating this space that um we will definitely be be watching because it's, it's unfolding as we speak. OK. So um I recently put out a poll on my account which I, I do sometimes um question was in the US, we will regulate A I not nearly enough thoughtfully or with over caution. Can anybody here guess what the answer was? 40 to nice people. I'm gonna go with a caution. You know what, when I see patients in the emergency department, there's this tendency to think that anything that we're doing and decisions that we make don't have enough, um, rigor around them. But I think actually our government tries to do well with that and it's actually gonna go over the bar that as providers, we probably will have less latitude, um, to kind of play with clinical decision, support tools and everything else that we do. We do right now. Um Yeah, I would, I would agree, but I would also hope there's with enough caution, people regulate because there is the, the thinking around how do you sort of push technology to be useful to the benefits part and then the risk part. But if you can, if you were to like, transpose exactly what we do today, it's a lot of the risk sort of angle, right. So I think so, I think there's going to be a balance and it's gonna be a struggle for regulators to think about that. Um So most people disagreed with the both of you. Um, 78% of people thought that the exact opposite actually, of what you thought, um, not nearly enough was the, was the response of touch. So, um, any thoughts on, on why, um, the public or at least, um, however many, uh, folks answered my poll, uh, think this way, I, I think, um, I started to enter I guess, I think if I talk to my friends and family, I think people are really, really cautious about, like, using technology for the sake of using technology. And also you're reading news articles that sort of talks about how, you know, we can ask a question to general and gives you something that you should not be getting or you would be afraid that somebody else, like your, your child should not be getting. So I think that I think there's a lot of that fear built into it. Um As, as, as I imagine it is an emergency doctor, I always think first do no harm, right? And I think a lot of folks are worried about harm and that's the idea of under regulation. The elephant in the room is that there's this idea that what we're doing in medicine might be codified to the extent that there's less choice, there's less autonomy. You know, a lot of our health care system and the beauty of it is built on the fact that we can do what's best for the patient in front of us. And when you layer algorithms on top of that, that might not be on the best data. Um You certainly have challenges. Um Quick reminder, everyone that if you have a question, um look for one of the, the lovely ladies with a mic and ask at any time. Um So, you know, along these lines, you're both doctors, um how do you? Well, are you? You're not, I'm not a doctor. Oh my God. OK. So you are a doctor. Um So I'll direct this question to you, Monique. But um there is definitely some evidence now that these A I algorithms can sometimes outperform physicians, especially, you know, not, not all doctors are the top 1% of the profession. So how do you think the physician community copes with that knowledge? Especially as these algorithms get more and more small over time. So the question is outperform for whom? Right. So each of these algorithms are built on a specific training data set and that data set is a set of people like people in this room and the people who came here today in this room are different than the people who came to another location today in this room. And so the ability to outperform, you have to ask that again on an individual basis, you also have to ask that over time, right? So as our world changes, algorithms don't mix in, that's why as we mentioned, the FDA is thinking about how do we actually allow algorithms to evolve. So I don't worry about my job stability one because I resuscitate patients and no algorithm is going to do chest compressions for you. But also because there's this element of human interaction that matters, right? I don't think anyone's talking about replacing physicians and the role of that knowledge, they're actually just talking about how can we have let you work top of license. How do we make this more efficient, less, painful, less burnt out? And there's a lot to be figured out in that mix, particularly because medicine in and of itself is already a little bit flawed. The data that we have to work on on the baseline already has biases that are embedded within it. You mentioned bias, which I think is, is a key point here. Um Humans are obviously biased. So are the algorithms that we create and we're seeing more and more evidence of this now. Um So as we kind of move these technologies into health care and it may be slower than other sectors, quite frankly, but it will happen. How do we ensure that we don't have all of that kind of bias baked in? So I'll give you an example during early pandemic, our emergency department partnered with our Bioinformatics Corp and we were really trying to solve the problem of, we don't have enough personal protective equipment, we don't have enough doctors, but we need to screen patients. We need to know who's sick and who's not sick. We want to use very well known facial recognition technology to do some very simple vital signs. Do you have a fever? Are you turning blue because you can't breathe and you're short of breath and use that to differentiate where people should go and that's, you know, something that looks at your face and decides, I mean, we had a great group that really put together technology and they said, hey, we're an academic center. This is as far as we can take it based on our training data set. And this is a training data set based on the population in Atlanta, which is reasonably diverse but still didn't have a wide variety of melanin in the facial recognition software which causes problems. When you're thinking about thinking about blueness around the mouth, even for the element of sensing temperatures for facial recognition, you know, much to my chagrin about, you know, four months later, I had a well known and established technology vendor come with me to a company that they had acquired and this company, they were doing facial recognition for vital signs. And I was like, this is great, you know, we're doing really great things in telemedicine. Maybe this can be incorporated. I'm so glad you've solved this problem. Tell me about your training data set. Absolute crickets. I never heard back from them. I had to ask a few months later when they were telling me about another technology and said, you know what that training data set has zero diversity in it. That's the problem, right? So it's a level of accountability that spends all the way from local decision makers, all the way to the FDA. It's an ecosystem, right? I as a purchaser have to make the decision that is this appropriate for my population and not just appropriate at the point of purchase, but also it, six weeks from now, from year, six years from now it's six decades from now. We can't just have a one and done policy and then it stands up to the way you think about, you know, how you actually build for it and whether or not the FDA said it's ok. I think it's a very broad problem that has many, many actors that have to take part to make sure they're all safe. Yeah, I absolutely agree. So, bias, we know huge risk. Another one which we already mentioned is that we might actually not do enough to regulate A I, how do you think all of this plays out as we see other countries globally? Like China and Russia move ahead and start to do quite amazing things. But, you know, potentially things that require more caution, more thoughtfulness, more regulation even. Um Do you think that the States will look at examples like that and think we need to keep up um without kind of doing the work to keep people safe? I, I just have some, some positive hopes that, you know, countries like ours would probably be more responsible and not just followed suit with all the other countries that do. I think there's a lot of, a lot of harm that can be done and for long periods of time. And I think that's the, that's the key risk here. And if you're not responsible in terms of how do you develop technology, how do you sort of make sure that you have the bias thought process in the, in the, in by design and, and not, and not only that, but also like thinking about how do you make sure there are the right filters in place as you can see, like Geneva, like the chap and bars of the world are, are now not giving you answers that they used to give before. Right? And, and that's sort of the evolution that needs to happen. And I I know there is going to be this is kind of in other scenarios that we have seen in the past, in the future that people will race down this path. But I think people who do it properly will probably be succeed in succeeding in the long term. So I feel like the industry, the technologies, the users and states would have to be responsible in terms of how do you sort of get to the next level of using and realizing this potential for A I to be actually be useful for us in health, especially when it's more important. Um You know, along these lines, I was reading about kind of all these technologies like I mentioned on my maternity leave and then my mom actually fell and broke her wrist and we ended up in several different urgent cares that same evening. And of course, given imaging on a disk drive that we then had to take between the two urgent cares and then get a PC P referral and then take the disc drive imaging over to the surgeon. And the whole thing just reminded me of what it is actually like to be a patient in health care today. And that we still live in this era of fax machines, which is a very long winded way of asking, you know, we've got A I, on the one hand, on the other hand, we still use fax machines. Um How do we square both of those things? And um can, can I believe sincerely that um in the next kind of, you know, 1 to 3 years, we true health care will truly be disrupted by this technology when there is clearly so much invested in the status quo. So there's a company that I'm super interested in um that we've, you know, deeply partnered with at Emory in this space to enable us to have, enable your mom to have a much better experience, right? There's this element of meeting patients exactly where they need to be met, that there's a I that can help with that triage. There's an element of being able to use the technology that allows us to communicate in a way that makes sense based on where you are to be able to have a result on the other side that you don't have to carry a CD 1000 places that information travels where it needs to be. And maybe your mom has someone come, if it's her foot that's broken and she can't walk, she have to do that X ray as opposed to having to get up and go to an urgent care. Right. You've got to think about all those different things. There's an emergency doctor. You know, we often are like catching the rest of the health care system. Something we firmly believe in is how do we work upstream of that? And technology enables that right? The ability to catch people before they have like last result, I'm going to wait in the emergency department forever. And I think there's a beauty of A I in terms of the way we triage folks, there's the beauty of like the way technology platforms now engage and appropriately diagnose and care for patients that are appropriate for the platform. And I think there's a lot that's going on in that space and I'm excited to see more happen there. I could you guys remember and probably in the audience when he used to fax things you would just call and and said, did you get my fax? And this is exactly the scenario, right. I'm sure that the image went over the electronic system. But in order to make sure that the patient does carry it with them, the CD was given. So I'm hopeful there's a positive lining into all this that down the road. We'll probably not think about this. Like carrying a CD is a burden, but carrying a CD is like more of that phone call. Like, did you get my facts kind of thing? Although I did, I did call Urgent Kara and he said, well, you just bring back the disk drive and then you take a photo on your phone of us use it like it was just like insane. Like what or you could just use Box or Dropbox. Like haven't those existed for like a decade? The best part is when you fill up in the emergency department by ambulance with the disc and you've got the entire care team saying where's the disc for like 20 minutes and like, oh forget it. Let's just send her an X ray. Yeah, I mean, yeah, anyway, um but I think you're hitting up on something which is near and dear to my heart is in, right? I think a I can only help when the data is there in front of you. It can operate, it can sort of operate on that data on the disk, right? But it does not do the transfer of the disk to point A to point B I think when we, when we start talking about interoperable solutions, I think they're getting there. I think this journey has been there for a very long time. You and I chatted what at least 10 years ago about this? And we are we are still working on this, right? I think c is actually pushing this agenda on inter ability further and we need to continue to push that and it needs, it will probably take all of us the health care systems, the technology vendors, etcetera, who's in, who's in for the challenge? And are these people in the room that might be? So A I, we talk often about the clinical applications, we've already talked about that on stage. Um What about all the back office on sexy stuff? Um It seems like it's probably gonna revolutionize claims in some fashion. Look at all the waste that we see in the health care system. Could A I do anything about that? Um How exciting, how near term do you think these applications are? I I, one of the key, one of the most exciting things that I'm really thrilled about is education. You know, if you think about generative A I and you know, Google's Met product that is, that is basically A I literally like scored 80% in their A S M L E exam sort of test. And that to me is phenomenal. I mean, can you get a machine to like pass the exam that's hard and, and to me that just opens up doors for many other things down the road, right? I mean, you can, can you just imagine a place where you're not supplementing medical training with generative A I I think to me, those are even fundamental changes that you can, you can see and I'm excited about this. I think there's a really interesting space here of what the A I does, right? When you talk about adjudicating administrative items, whether it's a pre authorization or figuring out, you know, should this person be able to, you know, get physical therapy, you have to have this element again of the interaction, right? Because there are personalized pieces might not fit across the algorithm and you're only going to discover that if you're looking for it. So when I think about a I think of it as the assist, right? As like the assistant that no one in medicine has, like you pull together the pieces of information really quickly for you to be able to make a game time decision as opposed to having the backlog, it reduces that down so that people are still making decisions that are relevant to other people and that technology is the assist. Um So I love to kind of leave it on the note of giving people ideas and something optimistic to think through. So if there are any potential founders in this room, what would be an idea that you'd love to have them work on in say 20 seconds or less in this space, to further kind of health care in a in a more positive direction, hopefully get rid of the fax machine too. Uh You know, one of the things that I find most painful. Um, is that when I'm seeing a patient real time really locked into them, there's something that I need for their plan. Right. Like I need them to be able to get this medicine and also have this diet plan and for that to be neatly packaged and appropriate for where they live and their zip code and all those things to be figured out and the ability to offload that thought to make sure that my well thought out plan that gets lost in execution is actually delivered. Yeah, that sounds great. I'd buy that. I would actually go back to your original question. I was like, what all the back end applications that create inefficiencies in health care? Like getting to a doctor getting that care. I think once the, once the patient is in front of the doctor, you get phenomenal care, but getting there and sort of following through, I think that's where all the work is necessary and needed. And I think if we can use technology to sort of remove some of that friction will be great. Amazing. Well, we, we managed to end on time um without the A I so really appreciate you both being here and sharing your thoughts, your perspectives. Um Thank you. Thank you.

Guy Friedman, Co-founder and CEO, SteadyMD
Rich Roth, Chief Strategic Innovation Officer, CommonSpirit Health 

Brainstorm Health 2023 - Addressing the Healthcare Staffing Shortage 

Addressing the Healthcare Staffing Shortage

Guy Friedman, Co-founder and CEO, SteadyMD
Rich Roth, Chief Strategic Innovation Officer, CommonSpirit Health

Right. How was everybody's afternoon? Hopefully good. Um I've been like incredibly impressed so far with all the content. Um I think this is the first conference I've been to where I just wanted to sit through absolutely everything. So um really means a lot that you're all here. Um So next up, we are having a panel on the crisis in care, the health care staffing shortage, which I think is just such an important topic, not nearly talked about enough. Um It's been called a public health crisis and it absolutely is one, this problem began before the outbreak of COVID. But the pressures and the demands of the pandemic led to so many nurses, doctors, other providers just leaving the industry in record numbers. And even now we're, we're continuing to see this trend. According to the Association of American Medical Colleges, the US will face a shortfall of 124,000 doctors by 2034. Um And this statistic doesn't even take into account the lack of nurses, dentists, mental health professionals, and just so many other providers across other professionals as well. And in addition to this burnout, there's also this rising aging population that we've talked about. Karen Lynch mentioned this, we have more seniors now than kids and the rising demand for care and problems in the education pipeline as well. Um So how do we even get people to want to be doctors these days? Um Big question that we're facing. None of this bodes well for any of us. Um So joining us today to talk about this is our fortune. Well reporter Alexa Mchale, who will be diving deeper into these challenges and potential solutions. Um With a panel that includes we Deng, the CE C O and founder of quit board health Guy Friedman, um co-founder and CEO of Study MD Rich Ross, um who is the Chief Strategic Strategic Innovation Officer at Common Spirit Health. Please welcome all of them to the stage. Well, first, thank you all for joining us and I want to jump right in as we heard in the introduction, the causes of the staffing shortage range from the education pipeline to burn out to this growing demand for care, which I wanted to start with you. Common Spirit Health operates over 2200 care sites across 23 states. I mean, do you agree with these causes? And what for you has been most top of mind in addressing right now? Yeah. Well, I mean, first of all, I remember, you know, during the pandemic when my dad unfortunately has cancer and you know, it was a time where you couldn't visit. And he lives in rural Pennsylvania. And, you know, I, I was calling nurse, you know, all the time checking in on him and, you know, one time I checked in on her and I said, hey, how are you doing? And, you know, literally we talked for 10 minutes and she cried for most of it. And you think about, you know, how caregivers went from heroes at the beginning of the pandemic to kind of villains with mass mandates and vaccines. And then all of the things that they, they do each day, you know, gun violence that we see in the news, you know, fentaNYL abuse and all these other types of things, they can never turn that off. And so ultimately, I think burnout and mental health is the largest challenge that we have and all innovations that we need to focus on really have to center there because I don't think we're going to have a stable workforce unless we're able to do that, right? And, and you bring up burnout. And we, I wanted to turn to you, your platform. Clipboard Health gives primarily nurses, nursing assistant and medical assistance the ability to uh grab shifts at health care facilities at an a need basis. And so I'm curious, you know, from your work and your perspective, you know, how has that increase in flexibility, addressed the burnout epidemic that, that rich brought up and um and, and really kind of address the ability for people and, and clinics just to stay and, and stay in the workforce. Yeah, thank you. So, the way that we've approached the problem is to offer the health care workers more flexibility in both their schedule in terms of when they want to work or if it's an AM shift or shift PM shift. You know, there are quite a few parents on the platform, a lot of single moms who have to deal with constant changing child care. And then the other uh way that we're addressing is by providing for the health care facilities, they have their own full time staff, staff, some of whom are burnt out because they have so many patients come in that they have to treat. So giving them more staff to help just more hands around the table so that the patients get better care, but the actual workforce in the facility themselves get more relief as well. Definitely. And guy I wanted to bring you into the conversation. Uh you now manage a national Digital Health Network that allows other digital health care companies is to use those clinicians across all 50 states. I mean, we've been talking a lot already about tech and virtual medicine and you know, I'm curious from your perspective, what are some of the hurdles and obstacles you know about seamlessly integrating telehealth into this care continuum and thinking about retaining clinicians as we move forward. Yeah, I mean, since we're national and we're taking appointments from all different types of lot um users from the systems to payers to self insured employers and the types of appointments can be different as well. So it could be synchronous or asynchronous. Um I think if you think about supply and demand, you wanna create a more efficient appointment uh to create more hours and more capacity for the whole industry. So in digital health, we have an advantage where we can take in all that appointment data kind of um uh like itemize it and then allow the supply to be really scaled across all the different uh all the different appointments coming in from all over the country. Um I think that's, that's like the kind of the biggest lever that can unlock it um in terms of barriers, um I think the biggest one is state licensing. So um most people know this now, but it was really not really well known, but uh the clinician, if they're prescribing needs to be licensed in the state where the patient lives. So we have a big licensing operation where we're licensing clinicians all over the country. But that's probably the biggest like regulatory hurdle that gets in the way of really, really scaling definitely and, and rich from your perspective, you know, thinking about on the ground and, and in the hospitals and clinics, I mean, how are you thinking about digital innovation? I mean, do you have examples of how that, how that looks on a daily basis, you know, say I'm going into, you know, an appointment. Yeah, I mean, I'll give a perfect example. So when you think about patients going to physicians and they're worried about their physical health and then they also may disclose, oh, my gosh, I actually have a mental challenge. I'm depressed. I am, am anxious. I'm something along those lines and the typical world is, you know, provide that you say, ok, well, that's mental, it's different. So here's a binder. Good luck, you know, you know, finding an insurance, finding a practitioner. So we've actually transformed that a bit where, you know, telephonically through an outsourced group, similar to what they're talking about, we can provide behavioral health assistance over 90 days immediately with any insurance to, to those patients. So if they're asking for help, we get them help in 24 hours versus the current system, a historic system where they may or may not ever ask for help again. And so our real goal is how do you, you know, expand that access through innovation and technology? Definitely, definitely. And after this next question, I, I wanna go to the audience. So if you have anything top of mind, um keep, keep a look out for that. Um But yeah, we I'll turn back to you. Um You know, I want to think about also addressing this crisis in the long term, right? We've, we've talked a lot today already about, you know, the aging population and um the number of Americans aged 65 older will reach 80 million by 20 40 more than doubling over the next 40 years. And so I'm I'm curious how are you also thinking about what your either platform or, you know, just having adequate staffing for seniors, especially um thinking about the next 20 to 30 years. Yeah, for sure. So I think there are a few ways worth thinking about it. Um The first is, you know, the missions of companies very much to lift people up the socioeconomic ladder. And with that in mind, we over time want to partner with other educational institutions so that we can really move up a CNA to become an and to become a nurse and really actually address some of the shortage problems from the root. So on the educational front and then the other one is a lot of careers only moving to home. So working with home health agencies and partnering with them to give the nurses who sometimes they want access to patients one on one. They like having that long term relationship, giving them more opportunities because right now we mostly serve long term facilities, some community hospitals, but not as much in the home. And so bringing some of that care in the home to, to address those seniors who want to stay home and have care delivered at home. Yeah. And guy How are you thinking about that the next 20 to 30 years? Um Yeah, I, I think um I think uh a few different levers you can pull. Um 11 big example is just moving from synchronous care to asynchronous. I think um that's a big lever that almost, you know, people ask me like sometimes for advice and how to scale. I think that's probably one of the biggest things you can do is try and move as much of the experience to an asynchronous uh model and then really save the synchronous part for like the true care and skip kind of the um intake and then on the back end trying to minimize the paperwork. Um to that, that's a real piece of the burnout is the amount of time clinicians spend documenting. So actually in a digital situation or a digital ecosystem, you can really, really fine tune that so that the the um the care is maximized and the documentation is minimized. So if you're controlling things end to end, you can really open up a lot more capacity for like true care versus um the stuff that really burns doctors out uh which is like, isn't really the time they're spending with the patients, the other stuff, right? And, and that's nearly 25% of, of their time in, in certain that's a, that's a low, I think it's even higher. Yeah, great. Um I wanted to turn to the audience does anyone have a question? Oh, I see over here. Great tim, with the association of schools and programs of public health. It, it occurs to me that we're not going to have enough people to do this work you're talking about and we need to think more about prevention. How are we going to add prevention to this? So we avoid too many people going to the hospital or having to get care. Yeah, go ahead. You know, um uh you know, I think most systems are working towards more value based care. I think it's a very, a very large question, but I would also take prevention in terms of the workforce burning out. So as an example, we um it costs us $40,000 to replace a nurse. So training bonus uh and we have to replace 10,000 nurses every single year. So that's $400 million right? Uh These are huge opportunities um to create more sustainable um professions for individuals where education is provided along the way where peer mentoring is, you know, part of the standard process, we've created something called a nurse residency where we're adopting 5000 nurses a year and providing them with this education, peer mentoring and support. We've actually spun that out and formed a company and we're doing it for Kaiser and a few others. But our hope is that prevention of the workforce is through their ability to have a healthy and well respected profession. Right. And, and you mentioned burnout again, I mean, symptoms of burnout is that really like emotional exhaustion and, and not feeling good about, about the work that you do? I mean, is that what you're integrating into these mentoring and coaching opportunities? How do you actually address that emotional mental health piece? Absolutely. All of our caregivers now have mental health. We have programs dealing with conflict resolution dealing, you know, again, all the social strains that we see, you know, in society and maybe we can turn off our Twitter feed and maybe we can turn off the news. They can't, you know, and so they're bombarded with these things. And how do you deal with that conflict resolution and how do you deal with? I would say the other piece we're working on is really trying to get new individuals from different sources and have historically come into the health care. So we've partnered with more health school of medicine where their residency site here locally, we partnered with Charles Drew, bringing in new doctors, new nurses of the community that may have a better ability to understand some of these issues and resonate. And so it's a multi pronged approach, but that is exactly the burnout. People are feeling definitely. And guy thinking about prevention and partnerships, I mean, do you have anything to add on to it? Which I would just say I'm not an expert. I think rich is more of an expert in the topic. But I would say in, in digital health, you have a lot more data more quickly. So if you're tracking the frequency of interactions and um maybe uh there is this like place where you can go, where you can theoretically see, burn out earlier and then intervene earlier. Um So I think uh in digital health, it's a, it's a, I see MD as we're a leader in this space. So I see it the responsibility of our company to really make sure we don't replicate a lot of the things that have happened in the past where clinicians like really don't like their job or their um you know, very high rates of burnout. Um So we work really hard on creating a good culture as well as preventing that with data. I'm not an expert in the topic, but I know like we can track things much more quickly. Definitely, definitely. And yeah, and I wanted to ask another question of, of each of you. We, I can start with you. Um you know, thinking about this on more of a broad scale as well. I'm, I'm curious, you know, if you can talk a little about what you have learned in the last few years, you know, during the pandemic that has changed the way you think about health care and your vision for the future of your business and the future of addressing addressing this crisis, which has had multi faceted layers as we've talked about so far today. Yeah, I think the thing that I don't know if it's a new learning but um actually many of the health care workers, they went into the job because they really do want to interact with patients, they want to provide care. And I think the condition, we've made the conditions harder for them to do that. And during the pandemic, it was highlighted that these health care workers, you know, were watching colleagues suffer or watching many patients die from COVID. And, and so I think actually the um you know, back to what you're saying about the administrative work, like many doctors went into the field because they want to care for patients, not be saddled with, you know, administrative uh just all this paperwork and similarly, with the nursing assistants of that, we work with many of them still at the end of the day, wanna have interactions with patients. So if you enable them to do that on a um work with better nurse patient ratios so they can give each patient the care they they deserve. Um I I actually think that that does help them um prevent from burn out. I mean, we hear from the providers on our platform that, you know, when they have other, other people from our platform go to the facility or they have people that they know who are there, they actually feel energized by the mission of, you know, by sort of the purpose of their work. Great. Yeah, I'll go down the line guys. You want to answer the question? Yeah. Thinking about, you know, the last few years during the pandemic and, and, and what you've learned that's maybe changed the way that you think about, about health care and the future of your business and addressing this crisis. Um Yeah, I mean, I think um how, how do you increase capacity? You can increase the number of hours available or you can increase uh decrease the amount of time it takes to see a patient like efficiency or um and I think um if you're trying to do the second one, you can't ignore like the clinician culture and uh burn out and feeling around that. You have to really build a product that takes that into account from the get go. Um So I think uh that's something like you can't just uh build the most optimal optimal system because that, that, that might not be the, the best for the doctors long term and clinicians long term. I think uh we've learned to really try and build our product with that in mind. I think the role of workforce and what people want to do is changing so dramatically. You know, I'll give two examples. One is millennial caregivers, you know, like they don't want the same job. They want to be a nurse, wants to be an ICU nurse. Next week. I want to be a cardiac nurse. Next week, I want to be, you know, on the rehab floor and like the system is not built to like transform that model of practice so quickly. And then on the other side, you know, there are more 10 staff, the traveling is so before the pandemic, about 3% of our nurses were travelers right now. It's about 25% maybe even higher. And it's fascinating when you talk to these individuals, I was talking to one nurse and she was from Iowa and she loves to hike and her partners are tired and they're basically just hiking across the country by doing three week stints here and there. Meanwhile, she's renting place in Iowa to other nurses that want to transfer that want to work there for, you know, their personal reasons. And so there's this entire network that's been created. I think it's going to be really hard to dismantle in terms of, you know, nurses preferring different types of workforce than they ever had in the past. And obviously, it's social workers and physicians, it's others. But the dynamic of what his work is changing interestingly and what is, oh, sorry, I don't wanna, I was just gonna say, and we actually see the same data where the uh over 80% of the workers on our platform work at two or more facilities and like 60% work at three or more facilities. So that choice of today, I wanna go to this rehab center tomorrow. I wanna do home health tomorrow. I wanna go to community hospital is, is real too. That's interesting and just, and just changing the way we think about work to kind of even potentially to, to help with that education pipeline and, and explaining that this industry might look different, it might look different, different to work there. Um Great. Well, that is all, all the time we have. so going to wrap up, but thank you all so much for joining on this important conversation and looking forward to continuing it. Thank you.

Dr. Rajaie Batniji, Co-founder and CEO, Waymark
Dr. Farzad Mostashari, Co-founder and CEO, Aledade
Dr. Ria Paul, Clinical Associate Professor and Executive Medical Director, Value-Based Care Program, Stanford Medicine
Moderator: Chrissy Farr, OMERS Ventures 

Brainstorm Health 2023 - Navigating the Shift to Value-Based Care 

Dr. Rajaie Batniji, Waymark
Dr. Farzad Mostashari, Aledade
Dr. Ria Paul, Stanford Medicine
Moderator: Chrissy Farr, OMERS Ventures 

Navigating the Shift to Value-Based Care 

Dr. Rajaie Batniji, Waymark
Dr. Farzad Mostashari, Aledade
Dr. Ria Paul, Stanford Medicine
Moderator: Chrissy Farr, OMERS Ventures

So we've talked a lot about transformations in health care so far today. But there's another vitally important and impactful shift underway that we want to delve into this move from volume to value a system of value based care rather rather than fee for service. It comes down to reward good outcomes instead of paying based on the amount of services provided. These models are meant to drive both patients and providers towards maintaining better health rather than dealing with problems downstream. The hope is to also reduce cost, streamline the process and improve accessibility. Medicare wants every beneficiary to be receiving value based care by 2030. And investors have taken notes according to mckinsey and company private capital inflows to value based care companies quadrupled during the pandemic. So let's talk more about how to make the most of value based care with Dr Raja A N G, co founder and CEO of Way Mark and Dr Farzad Matahari, co founder and Ceo of Alidade and Dr Ria Paul, clinical Associate professor and executive medical director of the Value based Care Program at Stanford Medicine, speaking with Chrissy Fary back on the stage again to lead this conversation. Welcome. Um, so this time I actually do have three doctors. I triple checked. Um, um, so I'm gonna pick on Z over here to kick things off. Um, we are talking today about value based care, which is the topic of discussion that comes up at every single health care conference and rightly it should. Um, but, you know, usually along the lines of it's great. It's, um, where the heck is it? Um So that I wanted you to just catch us up on just, you know, what's the latest, where are we at? What, what are the stats showing? Um And just uh you know, any kind of recent updates from the C MS side that you think we should be aware of. Yeah, so this administration continues the line of previous administrations that say kind of we have to move in this direction of value based care, paying for outcomes, not for volume. I think the difference from the past 10 years is we now have a lot of evidence in terms of what works. And unfortunately, there's a bunch of stuff that didn't work. So what works, what works is giving primary care docs accountability for the total cost of care that works. Um What hasn't worked uh has or has, has had mixed results and, and again, we're still hopeful, we're still looking for models, we're still looking for ways to do it. But what we don't have the evidence for yet is um uh other than for seniors, so commercial is really hard. Uh We heard an talk about that. Uh Medicaid is really hard and I, you know, I have huge respect for the increasing number of groups who are, who are taking that on hospitals is really hard. So, uh you, I, I guess I feel privileged to be doing the easy work here and uh my colleagues on the panel here tackling some of the harder, harder issues. Um Medicaid really hard. You are building a company that's trying to do Medicaid. Um So share with us kind of why you decided to go in that direction, especially having been a collective. You were on the employer side and really made, I would say a bit of a 1 80 shift um into, into this, this Medicaid area with, with way. So um why, why is this need um being so unmet and and why do you think look at first it wasn't really a 1 80? I mean, my clinical work has always been focused on Medicaid, that's where my clinical practice has always been. And my research work had always been on how do we pay for health care and low income settings around the world? And so for me, it was actually a need to say that we had all the creativity and the capital going towards Medicare and employer. And if we were going to do something about health equity, if I wasn't part of the solution then I was part of the problem. And so for me, it was just this mission alignment of, you know, we need to bring some of that same creativity, we need to bring some of that same investment into Medicaid to actually do something about improving outcomes. Um And I think the question is, is it hard? Absolutely. It's hard. It's hard for, for all sorts of reasons. Um You know, there's churn the reimbursement flow. Um probably one of the main reasons that value based care hasn't taken off in Medicaid is that, you know, you actually don't have this arbitrage of, you know, risk adjustment. And so the only way to make a value based model work in Medicaid is to actually improve outcomes and to actually reduce costs. And you know, that's not the same, can't be said for all value based programs. And so that focus is everything for us. And so we have to actually look at far as I talk about evidence, you have to look at the evidence of like, well, what's actually worked and we've seen over and over and study after study in the US and internationally. You know, when you bring care to the community and you've got community health workers, you've got accompaniment for high risk and rising risk patients, you're reducing readmissions by half, you're cutting overall medical costs by a quarter, you're dramatically improving health equity outcomes. And to me, the challenge is everybody says Yeah, but those programs are really hard to pull off, they're hard to implement, like, of course they are and there is no better challenge worth taking on. Yes, go ahead. Um We're not in health care health systems now. Um Well, I was going to direct your question your way. Um So you take care of seniors and um I would say, you know, if we walked down to the streets of, of L A right now, Marina Del Rey and said, you know what's value based care? I don't know that that many people unless you were in this conference would be able to tell you and would know to advocate for it. So how do we actually reach the patients? Do you think that they should know that they're being treated in a value based way or do you think it should just change almost invisibly and suddenly their health care experience is different? Well, I think, you know, first from the health system standpoint, like we are a hospital system and also an Academy Medical Center, which makes it very hard to do value based care. But I think at Stanford, we have taken the bull by the hands. We are, I'm very optimistic about value based care. And though our tripartite mission is to provide innovative care together with education and research, we are focusing on hybrid model where we are providing innovative care but aligning with the value based care principles and as Chrissy alluded to that. What are we doing for the patients? How do the patients know that we are providing value based care? So it's something that happens on the back end, what we are doing with our providers, our providers, we are trying to support them every step of the way in their practice and in their day to day practice because as you know, all primary providers are under the onslaught of various things, right, messages and so forth. So we are supporting them with a care team model where the care managers embedded in the team are reaching out to the high risk patients, the seniors. So then the seniors get a call from the case managers, they feel like they are part of the health system and they are being cared for and that really prevents a lot of er visits and hospitalizations because they don't feel that drop of a hat that they have to go to a hospital or the er and so that is what we are doing and also through COVID, what we saw is like a like a emergence of mental health issues, right? And so we have integrated mental health physicians in our day to day practice to support our primary care provider. Stanford being a very specialist, heavy organization. Many come to Stanford to get specialist care care, has access is impacted and we want to do the value based care model. So what we institute is E consoles where where providers can reach out to specialists just for feedback and particular issues and then get that feedback back. And that is so timely and so convenient. So it kind of encompasses the various strategies of value based care as we practice. And I think the patients slowly begin to feel the benefits. Like one of my patients said, you know, virtual care. I love it now though, he's an elder initially, he didn't like it, but now he says, oh, I love it now. It's so convenient and I think it's cost effective too to the health system. I said you're right, it's cost effective. So I think, I think we are getting there with Valli based care in bits and pieces, small steps. But, but it is a process. I love this patient who wants to save you guys money. That's great. Um OK. So questions from the audience. If anyone has one, you think that's my over there? Hello Ris Bakari. Uh I'm an MD. So uh how sophisticated are we getting in getting providers to accept downside risk as part of BBC contracts versus the kind of current participation awards we kind of handing out today who wants to take this one? So the majority of our lives are now in downside risk contracts and we have downside risk in both um Medicare advantage, but also traditional Medicare and also commercial contracts. Um I personally don't think that it is wise or necessary to put a small practice with like the threat of bankruptcy with a gun to their head to say like, ok, now make good decisions, right? Um I think from an organizational system perspective though, I do think that it's important for organizations taking risk to be facing downside as a uh as a, as a curative to FIFA service incentives. So, Aida, we have 1000 practices last year, 1500 practices this year who work with us, we bear cost risk on the downside, but we don't pass that down to the practices. And we, we take a similar approach at way mark where we take downside risk. My, my view on this is a provider should really take risk on what they control and not things that are necessarily beyond that. And I think in Medicaid care delivery, if you look at the evidence of, you know, what works at actually improving outcomes and recent costs, you know, not very much of that actually takes place within the four walls of a hospital system or a primary care practice. And so, you know, it's actually appropriate for us to take that downside risk for engaging members in the community and doing the things that can actually move the needle but not necessarily, it's not necessarily right for every provider to enter into that risk agreement. I can, I can I jump in on, on the, the the point I raised about uh risk adjustment, go for it. So uh you can't have taking risk without risk adjustment. You need risk adjustment to be able to make sure that we don't get, uh, lemon dropping, you know, whatever skimming the cream, whatever type of things. Um, but it is absolutely true that I think it is done at the, the, the game around discretionary coding really hurt. I think the perceptions around Medicare advantage, risk taking providers because it was just too easy to make money focusing on adding diagnoses. And I'm really glad we started on the traditional Medicare Medicare savings program where that was not an opportunity. And I think it's actually a really important proof point that if the only way to that is proven is not on just risk code, I think that's a, it's really important to like get that point out there. There are a lot of risk taking providers who became specialists in risk adjustment, but that is not the, that is not the, the, the evidence is not entirely rely on for sure on, on, on that group. And there are plenty of groups now who have done it the right way and actually reduced total cost of care. So, on that point, I'm gonna jump in and, um, we are all clearly fans of value based care that's, you know, you're all dedicating your lives to it. Um, and we know, I think we all know the ball case and we're probably all kind of advocates for the most part in this room. Um I'm gonna put you all on the stand and, and give me, give me the opposite, give me the bad case. Um And, uh, you know, we only have a few minutes left but uh, so do it, do it in a way that, that has a little brevity. But um I'm gonna ask you first. Well, the thing is that, uh the, the, the problem with value based care, especially in an A MC like Stanford, where we stand for providing innovative care. That's where it it is at the crossroads, that how we provide innovative care and how we provide value based care. So that's why I mentioned that it always has to be a hybrid model in a, in a, in a academic medical center because will have patients who will come to us for the care that they need and that won't be provided anywhere else. And another thing is that the crossroad is always there. But we see from the specialty perspective, from the specialty side, it is at the crossroads of revenue and utilization. And I hear from every specialty clinical leader at Stanford, why are we doing this? But I think, but at the end of the day, it is the right thing to do and provide physicians are very smart, right, doing the right thing at the right time, right place. And that's that is what we are trying to do with the other part of our tripartite mission is education educating all of our young physicians, medical students, fellow, those residents on the concept of valid this care. We have created a curriculum so that they can incorporate it as they start practicing medicine because without it, there will never be a fire starter. So there's your, there's your bear case for specialist. Why are we doing? Why are we doing this? We're doing fine. Yeah, we're doing fine. Uh My bear case is um, is that if you're uh big, you don't need to actually embrace value care. So the competition and is lacking in health care consolidation has gotten worse. COVID made it worse. And the FIFA service game is the bigger you get, the more power you have in the negotiations. And if you're big enough in the negotiations, then you don't need to take risk any real risk. So you can get some fig leaf value based contract. It can be called an AC, but really it's just another way to pay you more and no one's gonna like, like no one's going to hold you. You're not actually going to be held to account. You're never actually going to be accountable. And I think short of some serious regulatory action in this country, we're going to see entire parts of the US basically handed over to monopolists and, and no, no value based care can succeed where monopoly reigns. I couldn't agree more. I got it. Not just you. Well, well, I, I, I couldn't agree more. Here's, here's the challenge. My bare case for value based care is we've sort of made value based care, the destination when actually it's not a destination, it's, it's the Vietnamese. And so, you know, C MS has a goal of putting 100% in value based care. By 2030 every state Medicaid agency has goals around moving to value in Medicaid. And basically, what that's done is in my mind, created one of the biggest barriers to true care delivery transformation. And that, you know, for, as I called the fig leaf, I often call them value veneers, which is, it technically checks the box of a value based arrangement. You know, there's, there's some shared savings, there's some bonus program, it does nothing to change care delivery and it actually doesn't matter financially for the provider. And so you don't change provider behavior, you don't change care delivery, but you sort of now attributed a member to a value based arrangement. That member can't be part of another one. And so I think making value based care a goal in and of itself is detrimental to the underlying cause of let's improve outcomes and do what's worked. What works, value based care is important because it allows you to do things that aren't paid for under fee for service. And if you're not doing that, it probably doesn't make sense to be in a value based arrangement. Do you think we're going to meet that 2030 goal. No, that's ok. We're gonna make, we're gonna make progress towards it. We're about a third of the, of the primary care doctors in this country are now in, in what I would consider they've actually changed their practice patterns. A third. It's a lot. It'll, it'll, it'll grow, but maybe two thirds. That's ok. And 50% of Medicare beneficiaries are in Medicare advantage. So, um, cool. Yeah, I love the fire we're bringing today. This is like not what I expected to evaluate care panel, but it's great. Keep it going. Um What is the, what do you think is the specialty that will be the first of all in terms of just widespread acceptance and adoption and primary care? Yes, I mean, primary care is the obvious one. But what's next? I'm seeing a fair amount of interest uh in, in among the specialist sub cap or shared risk on oncology. Cardiology are the two that I'm seeing and nephrology are the three that I'm seeing the most where they kind of take accountability for the patient in the same way. No, I I would agree or is coming behind two in a way because so much, so many Medicare beneficiaries need or visits and interventions and so forth. So I would agree with that, the cardiology, nephrology, oncology and or maybe counterintuitively where we're seeing. Actually quite a lot of interest is surprised me. It was not our thesis, but you know, big health systems because for them, especially in Medicaid, where they tend to lose money on each interaction, whatever they can do to keep people out of the hospital, make hospital stays shorter is, you know, hugely creative to their bottom lines. And so we've seen, you know, big health systems be really interested and moving to and again, the value part of it doesn't matter, moving their poor people to. No, no, it's not that it's actually like, what can we do to improve care outside of our four walls? What can we do to actually bring care closer to the community where you can create a new workforce, you can do things that are cost effective that like we can't do in a big hospital system. And they recognize that the wrong point of care for, for a lot of a lot of patients, look, I'd be really happy if the health systems embrace having fewer hospitalizations for their, you know, good case mix patients. I haven't, I don't see the financial incentive for them to do that. And I think people act according to their financial institutions act according to their financial incentives, not people in that, that financial incentive should be universal. Um With that we're out of time and I felt like we had a, an element of debate club on the stage today which I appreciated. Um Thanks for doing the bull case, the back case, everything in between. Um what an incredible group and, um.

Gail Boudreaux, President and CEO, Elevance Health
Stephen Gillett, Chief Executive Officer, Verily 
Moderator: Maria Aspan, Senior Writer, FORTUNE

Brainstorm Health 2023 - How A.I. and Digital Can Drive Whole Health, Safely 

How A.I. and Digital Can Drive Whole Health, Safely 

Lynn Martin, President, NYSE
Maeve O’Meara, Former Chief Executive Officer, Castlight Health 


Brainstorm Health 2023 - Healthtech And Public Markets 

Apolo Ohno, Olympic Medalist, U.S. Olympic Hall of Fame; Author, Hard Pivot Interviewer: Alan Murray, Chief Executive Officer, FORTUNE 

Brainstorm Health 2023 - A Winning Formula For High-Level Performance 

A Winning Formula For High-Level Performance 

It has been an awesome first day of the conference. A lot of real talk up on stage including some more pessimistic view points. But, you know, I think we all appreciate it. Um and definitely some inspiration as well. Um In just a short while, we're going to present the Bernard J Tyson Memorial Leadership Award. Speaking of inspiration, and this year, we're honoring a woman who is unwavering in her work as a reproductive justice and human rights activist. And in fact, is one of the architects of the movement. But first, he is a man on a mission to inspire, to motivate and guide individuals to unlock their full potential. He wants to help people deal with change and transformation and establish behaviors that lead to greater resiliency. And I think we all know the importance of greater resiliency after these last few years. He's a best selling author, the champion of the show, dancing with the stars. Yes, lots of fans here, I'm sure and he just happens to be one of not one of the most decorated us Winter Olympian of all time. Please welcome retired Olympic speed skater Apollo Ono for a conversation with Fortune, Ceo Alan Murray Apollo. Welcome. Oh, thank you. This is a, this is a great honor for me. I usually interview Ceo Si, don't get to interview Olympic athletes. So thank you for uh subjecting yourself to this. Thank you. Yeah, I'm ready. I'm ready to the hot seat and I'm glad Mahal mentioned that not only has the man won eight Olympic medals but also dancing with the stars that we may ask you to do a few moves. There, there was a period in my life when I would walk through security at airports and I was no longer referred to as there's that speed skating guy. I was that dancing guy. Yeah. So uh so I have a confession which is, I've always been a little bit skeptical about athletes telling business people how to do their jobs. I thought they seem so completely different, but I read your book hard pivot and I really appreciated the fact that you right up front said, hey, there are some traits that worked here that do not work here at all and there are other traits that carried over nicely. Can you talk about that? What, what worked? What didn't work? How did you have to change? Sure. I think look the transition point from one identity which you subscribe to. You are given external validation by your fans, by the coaches, by getting the medals by media that you are good. And this is your purpose in life and doing that for 10 or 15 years and then the snap of finger changing direction and kind of wondering adrift of what's next in my life. What else am I good at what passions do I have? So there is a formula there that says what attributes can I take from the sport that I did prior, which is you can imagine pretty foundational, hard work, discipline, structure, consistency, grit, all those kind of elements that I think make any person successful with any career, those are transferable. I think that some of the selfishness associated with being great in individual sports is not transferable, right? And I think that that is a that was a huge wake up wake up call for me when I decided to make the change aside from just trying to identify with, if I want to show up as this type of a person in the corporate setting in the business setting, I have to realize that there are so many people that do not have the same background. So you talk about the selfishness, talk a little bit more about what it, what it was that worked as a skater that you had to learn differently to succeed in business. So I think that the kind of underlying obsessiveness around if it does not help me as a person get better, faster, stronger, it's a secondary priority. And if that means that I win, but someone else loses even on my team that was ok because it was an individual sport. So in business, you can't have that right. You need to be able to kind of garner that different type of conversation in a different way. You you in the book, you talk about empathy and you talk about vulnerability, both of which were not your strong suits as a skater, but you have focused on as in your new career, am I right? I, and, and it's an ongoing journey and, and experience. So you're right, like empathy and vulnerability were things that we had shielded and hid from most of like the world. I never wanted to show my competitors that I had weaknesses. I was unwilling to show empathy to competitors if they had shown their weaknesses to me. And as I transform, as I continue to want to transform into what I call Apollo 2.0, I want to be the type of leader that can have kindness, but also have strength, can have vulnerability, have empathy, be open with my communication, but also with authenticity and those things were, I wasn't taught how to be those things in sport. And so it was a harsh learning lesson about, well, what is a leader in terms of how the external social environment has given me when I was growing up and how do I change that internal perception of what that person is because it's a much different world than it was 20? Yeah. So you gave your book the title Hard Pivot, which is a skating move, right? What's a hard pivot in skating? Hard pivot? I mean, if you haven't seen short track speed skating, a hard pivot is, you're in an inside of an ice hockey rink, you're hurdling down a straightaway going 35 to 40 miles an hour, you cross over onto your right leg and while pulling about 3.5 G forces, you do a complete U turn going in the opposite direction, so executed successfully, you could carry your speed and momentum onto the next corner unsuccessfully. You crash into the pads. Kind of wondering what has happened, which is a great, which is a great metaphor because we all know a lot of a lot of people making the transition that you made do end up crashing. I mean, it is hard. Was it hard for you? It was very hard for me no matter how many people had told me, what are you going to do when you retire? What's next for you, make sure that you prepare yourself. There's a real reason why 86 to 88% of let's just use one sport, particularly of NFL athletes. Three years after retirement are in a really challenging situation. Whether that's bankruptcy, divorce, depression, there's real data and points around this and a lot of it's got to do with the loss of identity loss of purpose that exists and it's actually got nothing to do with money. I mean, obviously the poor decision making has a lot to do with it. But behind that layer is something else. And so when I retired, I just knew that I wanted to win and I wanted to win aggressively and fast. And like, if you had asked me 13 years ago, Paula, what do you want to do? I want to be the best at business. Like, what the hell does that even mean? Right. What are you talking about, kid? You had some missteps earlier? Absolutely. And I think, do you want to share any of those? Yeah. So I think like first and foremost, it was the inability to recognize whether it was partnerships, whether its ideas and sometimes and all of you in business know this, sometimes it's really good to fail fast pivot and then try again, right? As an athlete, you don't ever want to give up on anything. So you're just kind of like picking up this dead horse, carrying it around with you even though there's no more life in this thing. And so that you can imagine that has happened in a few instances in my life early on. So you, you make this hard pivot and when you come out on the other side, what is it, what is it that you think you've learned from your life as a skater from the pivot that is, is worth sharing with other business leaders who are struggling I mean, look, everybody in this room has to go through pivots at one time or another. What, what, what is your, what, what have you learned that you can share with this group? So I think the hard pivot mentality is not just business. I think all of us as human beings will face some sort of loss through loved one, through experience. And there will be a mismatch between what our expectation was and us not hitting that expectation, which results in some level of disappointment. And that can be very dark disappointment, that kind of keeps you paralyzed in the space of not moving. So my entire thesis is how do we create the dynamic psychology around approaching these types of challenges that we all will face in business, in personal relationships in life itself as what they are and knowing that sometimes those pains that we do experience psychologically can be huge levers to lean into and propel us in a different direction. So what does that mean? How is the pain lever that you lean into? So, for example, like most athletes, I would say top tier, top 1% in the world if you had said to them, how many of you love to win and how many of you love to lose or hate to lose? I would say like half of them probably hated to lose more than they loved to win, which is sort of like a strange concept in like deep fear and failure. Well, that comes from some sort of like traumatic experience, probably from the age of like 12 to 16 years old that forms some basis or outsized psychological approach towards a sport, whether it's Michael Phelps Apolo Ono Sean John White, you know, Michael Jordan, these people all have the same type of, of you can call it chip on the show and ceos too, right? Someone who's so obsessive. So micromanaging cares about every detail and every minute of every meeting as if it's like the last thing on earth, there's something associated to that tied to some experience that makes them care outside to the rest of the population. So if we know those things, how do we be able to control them in a way where it does not control us? Right? So this is the best of it without the worst of it. Look this, this is, this is the most powerful asset in the world, right? Assuming GP T doesn't completely just right. Maybe we've got a couple of years left. Um But still this is like this is still the most powerful asset in the world, but this is also the six inch space between our ears is still the most, the world's strongest prison if you allow it to be so many of us are held back. Me included by the insecurity, the self doubt, the fears of failure. The I'm never good enough. I'm not smart enough. I'm not taught, whatever those things are that you're not enough. If those things aren't either motivating you and pushing you in the right direction, they're holding you back. So my idea is if you want a hard pivot, you need to be vulnerable, open human and you can still be strong in all those elements. And so I think first and foremost, having that self acceptance or communicating to your organization, to your team, to yourself, to your family about where you are at today, identifying what, what that is and saying, well, we're going there. So, you know, without kind of faking the funk is what I call it like. This is, this is where we are, this is the, this is the cold, hard truth. This is the challenge. These are things that have happened that maybe didn't uh go our way that we needed to. And here's how we're gonna make a change. And, and was that part of your pivot? I mean, is the skater, were you motivated by the fear of failure? I think for over half my career, it was deep fear, psychologically of fear of failure. Where did that come from? So, I mean, without, we've got five minutes left here. Um We wanna go deep into your life here, Apollo. I uh I, I look, I love like behavioral science, like I love it just, it fascinates me. It's what I studied with other athletes. I grew OK, I'll make it real short, I grew up in a single parent household, Japanese father immigrated from Japan, gave his son everything right and believed in me so much. But also like we talk about like tiger mom, tiger father mentality. If you don't know what that is basically, it's just like this immigrant mentality that hard work is like literally just the standard of getting to that place. So one example, OK, imagine you're 12 years old or your daughter or your son is 12 years old and you wake them up every single day at 3 30 or four o'clock in the morning and you drive them to an empty, empty school or church parking lot, you strap a minor's light to their helmet and you just have them skate around on roller blades while you're taking like, I don't know, random artificial lap times. This doesn't sound like an imaginary scenario. Yeah. So that was me. So that's where my, you know, and you're 12 years old like dad, I hate this, I don't want to do this anymore. And then your father and by the way, I love my dad, incredible like mentor. Um But this is where I'm just being off there. I'm keeping like the real trauma open live, right? I'm still working through the hard pivot. Ok. Um So that's, that's where it started. And then, so my, the feeling that I got of, of showing up as my best self and not being not good enough it psychologically embedded in the hurt. I never wanted to taste that again. So then I was so afraid of having that failure that it kept me so obsessed. I was willing to do what no one else was willing to do for the long distance and long time, the equation is that, which paid off, which ultimately pays off. But so, so it was your, I mean, when you talk about leaning into it, it was your great strength, but ultimately also your great weakness. Yeah, I was talking, I was doing a podcast earlier today and one of the conversations was if I didn't have that pain or if we didn't have, if athletes don't have that pain, is it possible to get the same type of outcome? I think the reality is we think it might be possible, but the percentage is low. I think that there is a reason why these experiences happen that create outsized results, but they have to change some kind of chemistry in the brain. You uh use an interesting Japanese word in the book. I am I pronouncing that, right. I what, what does it mean? It, it's really just about finding your purpose and what is your, what is your, what was your purpose? And what is your purpose? If you had asked me, you know, many years ago, my, my purpose would say like I am only here to, to skate. That's why I'm here. Um Very shortsighted. Did not understand it. Also allowed and gave me the power to jump out of the plane, so to speak with no parachute because I I was all in. There was no plan B I burned the ships. Now, my purpose I feel is to reinvigorate, remind and help guide people all humans regardless of Olympic athlete or not about their own inner potential. Number one and number two, about the fleetingness of life. And so the second being the most important, if you were 90 or 80 years old, and you can go back to your age today, what would you tell yourself or remind yourself of the remainder of those years that you have the way that you talk to your family, your loved ones, your co workers, all these things. And how much of that stuff would you say? Hey, remember all that small stuff that you get mad about? Why don't we just like allow that stuff to not be involved with your day to day? Like it's not an important aspect. And so I think when we think in terms of those metrics of, we have a limited amount of time on this planet. 86,400 seconds per day. Yes, most of us waste lots of those times, right? It's OK. It's being human. But how do we gain more of them back to create real experiential me, memorable um Just times in our life and that's, that's what I feel like I'm here for today and I don't teach, I just want to guide people for their own inner answers again. You in a way you're talking about giving back. Yeah. Yeah. I guess it's giving back. I think it's more like, you know, I first started tasting what this felt like when I would go on stage and spend time with organizations and companies and I would see like the slight pupil dilation, I would see the eyes sparkle slightly and I would see the reinvigoration of people to say like, oh yeah, like I almost forgot that I, I have control over this perceptive reality that I'm that's occurring to me. OK, very, very quickly. How do you, what, how long do you want to live? And how do you take care of your, how do you take care of yourself to extend your life? And are you thinking about those questions uh as a as a quick answer? OK. Uh I would like to live as long and as healthy as possible. OK. Um To where I could like reach down, grab my grandkids and hold them up like that to me is a good, healthy, strong line. What steps are you taking to ensure that you can do that? OK. Four foundational principles. Here we go. All right. We got to get these four. I'm sorry. We, we're about to learn how to live long healthy lives. I'm not going to cut the conversation off. These are these are things that, that I think about that are very simple and they're like just they're repeatable. Ok. So my Apollo is like personal big grain of salt. Ok? You like it? Don't like it, throw out the window, it's OK. Four foundational principles. How am I sleeping? How am I eating? How am I moving? And how am I thinking? Not just about like the world and my social environment, but how am I healthy here within myself when I look in the mirror, am I OK with who I see? Am I accepting that person? So those seem to be like I'm not searching for perfection here. I just want like to get a handle on those. Am I sleeping enough? Am I eating? Well? Am I moving my body daily? And and how is my social environment? And this type of stuff really helps too and we can communicate, we may want to get more detail on that but not right now because Sasha is going to have my head. Ok. Thank you very much. Thank you.

Dr. Vivek Murthy, U.S. Surgeon General (attending virtually) Moderator: Alan Murray, FORTUNE


Brainstorm Health 2023 - Dr. Vivek Murthy: The Nation’s Doctor Will See You Now 

Dr. Vivek Murthy: The Nation’s Doctor Will See You Now 

Dr. Hala Borno, Founder and CEO, Trial Library
Vanessa Broadhurst, Executive Vice President, Global Corporate Affairs, Johnson & Johnson Dr. Aditi Mallick, Chief Medical Officer, Medicaid and CHIP, Centers for Medicare & Medicaid Services
Moderator: Rachel Lobdell, FORTUNE

Brainstorm Health 2023 - Dollars and Sense of Health Equity 

Dr. Hala Borno, Trial Library
Vanessa Broadhurst, Johnson & Johnson 
Dr. Aditi Mallick, Centers for Medicare & Medicaid Services
Rachel Lobdell, FORTUNE

Dr. Hala Borno, Trial Library
Vanessa Broadhurst, Johnson & Johnson 
Dr. Aditi Mallick, Centers for Medicare & Medicaid Services
Moderator: Rachel Lobdell, FORTUNE

I've been so personally impressed with the speakers we've had here over the last 24 hours and the leadership that they're bringing to health care, but really to the world, we obviously need more of that leaders who act with a sense of purpose. What Apollo Ono called Iki Guy and have a positive impact on all their stakeholders. Fortune is doing its part to help develop those leaders. It's, it's led to the creation of our membership driven community for next generation leaders called Fortune Connect. The goal is to create truly purpose driven leaders to help them understand what stakeholder capitalism is really about to help them understand what it means to lead truly equitable and inclusive workforces. The program is designed for mid career professionals who are rising fast on the executive track. I'm sure all of you have folks like that in your organizations. I would encourage you to check it out. Fortune Connect dot com or come to me directly if you'd like to get more information on it. So now let's continue our conversation here today where you're born, where you live, your age, your economic status, and of course your race all of those are just a few of the factors that figure into health equity. They're the so called social determinants of health. They can make the difference between a long relatively disease free life or conversely lead to excess morbidity and premature mortality. Inequities in health care have long been a chronic issue. We've talked about it on this stage before. It's a massive problem that will take a dynamic and multipronged approach to resolve. Uh Today. What we want to focus on is the economic impact of health inequity. There's data from Deloitte. New data that shows that the US US health system cost approximately $320 billion in equity costs. Approximately $320 billion could eclipse a trillion dollars in annual spending by 2040 if nothing is done to fix the problem and that's clearly not sustainable. Joining us now to talk about that, how equitable health can lead to better outcomes across the board are Hela Bono, Hela Bono, a former CEO of Trial Library, Vanessa Broadhurst, Executive Vice President of Global Corporate Affairs at Johnson and Johnson. Uh a male doctor, a male chief, medical Officer of Medicaid at the Centers for Medicare and Medicaid Services. All of them in conversation with Fortune's Jeff Colvin. Please welcome them to the stage. Ok, let's have a seat so much to talk about here. I want to start by asking you all for your views on the same question. Uh The pandemic changed everything is the United States as after the pandemic is the United States ahead of where it was on health care equity behind where it was pre pandemic or no change. I think all of us can recognize that the pandemic put a spotlight on health inequities in the United States. In the early days of the pandemic, we saw that racial, ethnic minorities were disproportionately impacted by the condition. It places an imperative on us to make sure that as we're developing vaccines, something that opened up society allows us to be in this room today, that we actually include the populations that are disproportionately impacted by the condition that imperative has led to a lot of innovation. I'm really excited about the innovation that we're seeing in improving and advancing access to clinical trials. It's also led to a lot of accountability. There's increasing regulatory pressure to make sure that study sponsors those supporting the implementation of clinical trials are actually fulfilling measures, mechanisms that are evidence guided to include diverse populations into studies or that will impact their ability to bring their drug to market. So that really shows this clear linkage that we've always recognized that doing the right thing, including everyone in clinical research is also good for business and that is a good outcome that has come out of the context of our pandemic. The innovation has also impacted the conduct of clinical research where we've seen a lot more decentralized models you know, using technology to access patients where they are engaging them, where they are to reduce the burdens that we're placing on them because we know that including everyone in clinical trials is actually good for all of us. Yeah, Vanessa, did we make progress on this during the pandemic? Listen, I think we did. I think what he said was true that it really exposes, you know, the underbelly of what was going on and COVID just amplified the problem and brought it front and center to everybody's attention which you know has good. Um I think that the the also the good thing that happened from a clinical trial approach, we had to do things very differently. We had to use A I to find out where the disease was going. We had to use predictive models. We had to think of different ways of recruiting patients that maybe were not as face to face intensive. So I do think that the industry is starting to change for good and just the critical nature of that need was exposed through the pandemic. What do you say? Totally agree. I think the bright spots I would highlight are to just foot stomp and echo what's been said, igniting a national conversation that centers health equity. Literally, I mean, you would be hard pressed now to find a health system and ensure any any entity that touches health care that doesn't have a diversity equity inclusion type of office if not entire sets of initiatives. The other thing that I highlight from a policy perspective is massive coverage gains. We are now in this country at historic levels of uninsurance. So a 30% increase in Medicaid enrollment or 21 million people that now have coverage through Medicaid and chip that didn't as of February 2020 right? And we know I will just add that that is disproportionately communities of color, right? So when you look at Medicaid expansion, both in the context of the AC and Medicaid expansion in the context of the Coronavirus Relief Act funding disproportionately that impacts people of color to have the peace of mind really that comes from having health insurance coverage. One of the other great things is just the massive amounts of partnership that it took to get through the pandemic. When you look at, you know, the governments, private corporations, health care providers, there was such a stress on the system that it really created a very unique environment where everybody was really forced to think about how we work together to solve big problems. Audie, I just can't help thinking. You, you mentioned all the people who got on to Medicaid among other things during the pandemic right now. Of course, that's coming to an end and a lot of them are going to be pushed out of Medicaid. What's going to be the result overall, I will say, I wish I had a crystal ball to know, I will say tremendous effort underway to ensure that every eligible person retains health care coverage. Whether that is in Medicaid through the exchanges for folks that are able to access employer sponsored insurance. The estimates are somewhere between 15 to 18 million people with of confidence intervals on either side are subject to coverage loss and about 50% of those people might be for administrative reasons, didn't have the right address, couldn't get a hold of them return mail, things like that, which suggests that they may, they may in fact be eligible and they may not know it. That's right. That's right. And so, you know, to everyone in this room, I think there are things that anyone everyone can do from your vantage point to make sure that people know where they can access coverage. It's check out this website, call, this phone number, go to this address. Um but we are um staring down the pike of what promises to be the single biggest coverage transition event since the launch of healthcare dot gov. Well, I can tell you what to say so. Well, I mean, I I'm concerned of course, that loss of coverage means that we're going to see unnecessary deaths. It's pretty well published that when patients cannot access preventative care, they present with more advanced disease. If they present with more advanced disease, they're less curable. And so that's a reality that we really need to think about and to and to put pressure to ensure that we don't have those unnecessary deaths in the United States. Yeah, there have been mentions of the clinical trials that were done in the uh development of the vaccines for the pandemic trials. Are your specialty? Uh What did we learn with regard to health equity about the clinical trials of these vaccine candidates during the pandemic? Well, the pandemic certainly showed us that clinical trials are a social good with vast benefits to society and an inclusive approach is worth it. But it takes effort. It takes community engagement and ear on the ground provider activation, activating the providers who are seldom offering these opportunities to their patients. So we've learned a lot about the ways that we can innovate to actually do the hard work to achieve inclusivity in clinical trials. And when you look at the demographics of patients that participate in the COVID-19 vaccine clinical trials, they were remarkably diverse and much better than what we have been doing for decades. We have known about a lack of representation in clinical trials for many decades. And there's been legislation around this since 1993. But now we're seeing this shift this real shift towards accountability and intention and actual investment in the innovation that's required to make the difference and continue this inclusivity. And I think importantly, getting out to the community centers, right. So when you look at, for example, cancer, uh if you take multiple myeloma it affects 20% of multiple myeloma patients in the US are African American. Now, they usually have a less severe form of disease, but they actually die earlier and that's because the diagnosis comes later and they aren't always afforded the opportunity because of, you know, inequities in the system to get the most infectious or recent medication. So when you look at how you change the clinical trial process and get um underrepresented minorities into the clinical trial process. You can't just go to the same institutions, talk to the same K O L s. You really need to expand the audience of who you're talking to in a culturally um with a health care, culturally appropriate dialogue uh to, to get them to seek care in that way. Uh We can't talk about any topic. Uh It seems these days without asking what's the effect of A I uh which has become so much more prominent in the past few months, Audie, I'll start with you. But uh what do you see happening? Uh One would suppose that a tremendous advance in technology must be good. Is it going to be two thoughts? One is, it's only as good as what goes in, right. So L's large language models are only as good as the data that they are trained on, right? We are all keenly aware of existing systemic biases. Certainly on the medical side, things like how we calculate kidney function, how we calculate heart function. Right. There are a variety of things that we think of as bread and butter. Certainly, I did as part of medical training that actually have race based adjustments to them. Um, garbage in, garbage out. Right. And so if that's what you are feeding an L L M to do, um, we, you know, it stands to reason that if we have trained it to be biased, the output will be biased. Um, And that's a, that's a solvable problem. So I don't mean to paint that as doomsday, I mean to paint that as let's all be keenly aware of what it means to make them equitable engines of innovation as opposed to perpetuators of inequities. I think the other thing I'll say is I think less so from uh well, I think this also has health activity implications around who exactly do, do A I tools sort of replace in the future of work, right? And I think generally speaking, um it tends to be the, I will say lower tendered or lower less skilled parts of the workforce. And so I think there is not just intentionality that needs to be put into how those LMS are trained, but also how they are deployed in such a way that is conscious of what that means for the future of work re skilling, upskilling. How do these models actually enhance productivity and not lead to uh employment and labor market implications that would disproportionately impact marginalized populations. I I think this is, this is critical because part of health equity and the bias there has to do with trust and has to do with historical trust within the health care system. So if we, we have to be really be careful um as we input data, garbage and garbage out to make sure that that trust is foundational because we could take a, you know, unit system and potentially um make it, you know, we need to use caution. Well, I totally agree that A I can perpetuate bias. If you're using biased data to train your models, you're gonna get biased recommendations. I think all of us understand that theoretically. But what does that mean in clinical application? I continue to see patients. I'm a medical oncologist at the University of California in San Francisco and I use risk risk scoring systems all the time, especially for patients with early stage disease. I'm trying to determine, are you at high risk for recurrence or are you at low risk? Should I give you more treatment now or should I put you on surveillance? So let's imagine, I have an African American woman with early stage disease where the model which was trained on non Hispanic white women with breast cancer tells me she's on, she has low risk and she recurs with metastatic disease. The next year I have failed her, I have failed her because I used biased data that gave me biased results that is a real harm. Let's think about the other scenario where we have a patient where we say she's high risk and I give her a lot of chemotherapy. She now has debilitating neuropathy and is on disability. She didn't need that chemotherapy again. I have failed her because I overt treated her based on biased data. So I am really concerned that if we are not, if we are more casual rather than cautious in our integration of A I in clinical practice, we can do harm. And that keeps me up at night. Uh I'm going to invite questions here in just a second, but just following up on this, uh if if we can get the bias out of the A I, I would think that it still could be a tremendous plus for equity in health care. Fair enough. I I think yes, of course, um technology can make a vast difference and we should be rapid adopters of technology. But we also need to look at the implementation of this technology which health systems in the United States are actually using these amazing technologies to deliver individualized treatment recommendations. Is it the same have and then we have the have nots. So really thinking also with an implementation lens to make sure that we have equitably distributed benefits of these technologies. But that's the same thought if we can get past the bias thing, which is gonna be a lot of work. But if we can do it then what's the issue? Well, I think that just like any other technology, there is also um non equitable, you know, resourcing of technology. So even if you think about, you know, a a medical center, a teaching center versus a community hospital, you can still get inequities of care if the same technology is not available everywhere. Um there are systemic issues that you know, the health care system in the United States is still trying to fix. For example, just having your records, you know, transfer and be visible throughout the medical system. So I think there is enormous hope here, but I think there's a lot of work to do before we get the great end state that we will be at someone who pays for it. Yeah. So like you can solve all the bias but like somebody's got to foot the bill comments, questions. They're so brilliant that there's really nothing we Yeah, I think so. Um Yes, uh a microphone will get its way to you very shortly. Yeah, there we go. Uh Please, if you could stand up, say who you are and hold the mic close to your mouth. I think, I think many folks who know me by now. I'm hi everyone. Um A general partner at X Capital. I'd love to hear a little bit more. We talked about A I but in the context of clinical trials, how you know, it's a crowded space there are a lot of companies doing, you know, trying to innovate and accelerate here. How can technology now actually change the game in a way that generations of companies have not been able to achieve earlier? Yeah, absolutely. Thanks for that question. So I am primarily focused on the oncology, therapeutic area that is the largest therapeutic area in research and development. And we know that in the United States, we see inefficiencies in recruitment, the vast majority of studies close early due to inadequate recruitment. We also see inequities, right? Um But what we also know is that only 13% of oncologists in the United States participate in research and there are a variety of pain points that are driving this and technology has a role to really activate providers to engage with them to make their lives easier so that they can see that research is an opportunity that they can implement into their actual care delivery. Yes. Yeah, I think that a lot has been tried, but the industry is really starting to see some successes and we saw that we see that in terms of a few things, one is the technology that we use, whether it be, you know, through partners or through our own organization to make sure that we are inclusive and and predictive of sites where they are, they're going to have diverse and qualified patients for clinical trials. So I think the application of using data sciences and A I to clinical trials is critically important in drug development and it's use that I have seen be most effective is expanding and to find the patient populations that we need to get into the trials. Personalization. Personalization. Yeah. Right. The ability when you've got billions and billions of records, you can be much more precise about this person. This treatment in a way that I don't think was possible before. Yeah, it's a great point. Uh, aggregating all of the data that's available has been this holy grail for a long time. We're actually apparently getting closer to it. Sound right. Yeah. Ok. That's great. Uh, our time has flown past but we're out of it now. So, uh, all I can say is to each of you. Thank you so much. Thank you. Thank you.

Dr. Patrick Conway, Chief Executive Officeer, Care Solutions, Optum, UnitedHealth Group Elizabeth Mitchell, President and CEO, Purchaser Business Group on Health
Moderator: Erika Fry, Senior Writer, FORTUNE; Co-chair, Fortune Brainstorm Health

Brainstorm Health 2023 - Employers Stepping Up: Making Health Care More Affordable 

Dr. Patrick Conway, Optum, UnitedHealth Group 
Elizabeth Mitchell, Purchaser Business Group on Health
Erika Fry, FORTUNE

Employers Stepping Up: Making Health Care More Affordable

Dr. Neal ElAttrache, Head Team Physician, Los Angeles Rams
Dr. David S. Gazzaniga, Head Team Physician, Los Angeles Chargers Moderator: Michal Lev-Ram, FORTUNE

Brainstorm Health 2023 - Special Teams: The Role Of NFL Doctors On And Off The Field 

Dr. Neal ElAttrache, Head Team Physician, Los Angeles Rams
Dr. David S. Gazzaniga, Head Team Physician, Los Angeles Chargers Michal Lev-Ram, FORTUNE

Special Teams: The Role Of NFL Doctors On And Off The Field 

Dr. Neal ElAttrache, Head Team Physician, Los Angeles Rams
Dr. David S. Gazzaniga, Head Team Physician, Los Angeles Chargers 
Michal Lev-Ram, FORTUNE

It was a frightening moment on the gridiron back in January Buffalo, Bills player Damar Hamlin suffered cardiac arrest on the field mid game after a tackle. And I'm sure we all remember those startling images of his collapse playing out almost as dramatically was the quick response of the medical staff who administered CPR and restored dear's heartbeat on scene before he was taken to the hospital DEMAR survived. And as you all probably know, announced last week that he's cleared to return to play the actions of the medical professionals that that day resonated with so many people, even those who don't follow football regularly. So what does it take to be a medical specialist on the sidelines ready to ensure the safety of players at any moment? What's it like on the inside? I'm going to be joined by two doctors who are definitely in the know on this, Dr Neil Ella Trash is head team physician with the Los Angeles Rams. Doctor David S Gaza is head team physician with the Los Angeles Chargers and we are thrilled to have them with us today. Hey, we're very l A heavy today. Um I wanna just start with, you know, giving us a sense of who's actually there, who's on the sidelines. What's the team made up of what happens on game day? So, the medical staff, uh, there's, there's a meeting at 60 minutes before the game starts. And so it's probably easiest to, to describe who's there based on that meeting. So, uh, let's say our teams are playing each other Neil and I would be there two internal medicine doctors, there would be a um physician is in charge of airway management in case somebody needs to be intubated on the field. There's a visiting team, medical liaison who's there, uh who helps the other team in case they need to prescribe medicine or go to the emergency room. Um There's uh each sideline has a neurotrauma specialist that's there, they're unaffiliated. So if someone has a concussion, they get evaluated um by an unaffiliated neurotrauma specialist, there's also one up in the box that's watching the game from there. There are two spotters that watch for concussions constantly throughout the game. Um And so that sort of makes up and then there's E M T s with an ambulance that sits right at the doorway on the edge of the field. Uh So there's AAA fairly large group of people for the efforts. Uh A dentist, I don't think there's, I don't think it's hyperbole to say that um probably the safest place you can be in public if you have uh a life threatening emergency, uh is on the NFL football field. Uh, you know, if you consider the number of people that David, um sort of enumerated there that, uh the people that are trained and ready to, to save somebody's life, everybody from the, from the people that are on the staffs of the medical staffs of the teams and also the, the paramedics and um that are, they are ready to go, uh, all trained in, in CPR AC L S. Um So, and you saw the, the people jump into action when it came to what happened to, you know, the, the, the, the trainer that was doing CPR for over nine minutes, basically saved his life. And the head team physician, uh Les Bisson who did a fantastic job directing that, that emergency when it was there until the paramedics could come and take care of it. It was remarkable, really, really something. So you're just, you're ready to spring into action at any moment and Neil brings up a good point. Uh just one, give special attention to the head athletic trainer. It's, it's a position that's underappreciated uh in the, in the world. You know, when you see someone go down on the field and someone runs out, um, they were instrumental all during COVID, they had to, you know, make sure all their players were safe and um head athletic trainers pretty much run the show as far as that goes. I want to get back to the dentist though. What, the teeth getting knocked out. What's the, it's, it's just, you know, they're ready for any occurrence essentially. So, um, you know, those, those things are just available and, uh, I used to be the team doctor for the New York Islanders hockey team and a dentist was highly regarded. They all have great smiles, all the hockey players, they're not real teeth. That's why, what, um, this is probably a silly question. But, you know, I think obviously we have a lot of doctors in the room also and we're all very familiar with the oath that a doctor takes with what the, the, the mission and the mandate of the medical profession is. Is it any different when you're a team physician? What's your, what's your purpose? What's your mission? Do you see it any differently? Yeah. You know, uh when I, we have a medical meeting before the start of every season and we're supposed to talk about specific things. But when I introduce myself to the new players, is that one thing I try to make sure that they know is that I don't covet my position as a team position, meaning that I cannot root for a team and try to look for team success and care for the individual at the same time. So I have to be able to separate that. It's not easy sometimes because obviously the competitive juices get flowing. But for me, I tell the individuals that I'm most concerned about their health, their family, their ability to provide for them and that sort of allows for trust to be built up in that way that they, they know that I'm not, you know, flying on the corporate jet and I'm not, you know, going to dinners and hobnobbing and things like that. Um, you know, you're wearing a Charger hat but I have mostly because I'm bald but Neil anything dad. Well, you know, I um here in L A, we, we are, we're one of the prime destinations for professional player care in the country. Um when people tend to get injured and, and if they are gonna leave their hometown, they, they, this is the number one place they come, we take care of so many people from so many different teams. Um and that they've mentioned the word briefly uh mentioned trust that, that, that builds over time. And so, you know, I think that I can safely say that I don't know of a physician in the NFL that's taking care of these players that is considering his team obligation or his team affiliation over and above taking care of the player. I mean, we can get into some specifics that have happened recently with regard to medical legal issues that, that show that the, the physician is really that, that physician player relationship is uniquely stands on its own. It's, it's unprotected. Um and it, uh it only works because there is that, that, um, relationship between the physician and the player. Um, and so the, the team is sort of, you know, protected and on the side. But, uh, the physician and the, and the player that, that patient doctor relationship really is what it is. Uh, so it takes precedent and, uh, I think that, um, you know, like I said, we can get into that but it's, uh, it's really come into focus recently with, yeah, so give an example of that and, and that tension really, um, the C B A for, in, in the leagues prevents a player for bringing litigation against trainers who are employees of the, of the team and against the team. Um, the physicians are not protected in that situation. Um So the, if, if there is something that goes awry in the training room, if, um, if they can say that the physician wasn't paying attention to their rehab or certainly, you know, with their surgical medical care, um, then the physician is, is that relationship is direct, there's no going through the team. The physician is not indemnified by the team as the entire staff of the team is. And so if you don't have the physician's best interest at heart, I mean, I'm sorry, the player's best interest at heart as a physician, you're, you're really on 10 ice. And so I don't think you see that, uh, the NFL especially, um, but the major leagues, um, in this country, I think have amassed the, the best orthopedic and sports medicine talent that there is, um, in, in this country. And, and so I, I think that, uh, I think that everybody's intentions and priorities are in the right place. And Neil, uh, just an example. We Neil and I were just at the NFL combine and there was a new doctor that joined the team and they were discussing all the risks involved with being a team physician. And, uh, this new doctor stood up and said, um, I just want to say, what the heck did I just get myself into? You know, and, uh, it seems like this, it is an amazing opportunity and, uh, but the balance of risk and reward is, is, um, is always uh something to consider, um, and a little bit of a tangent. But I think, you know, obviously one of the areas where there's been a ton of, of scrutiny is on concussions and concussion protocol. And, um, I was wondering if, if either of you could just kind of walk us through what the protocol is now because it's pretty complex, right? And I think it also, you know, one of my questions here is like, it seems like another point where there could be a bit of um, tension between the player and the doctor because I'm assuming a lot of players want to get back out there. But correct me if I'm wrong. No, I think you're correct. There are times where, um, and like I said, there's a spotter who's up in the, up in the box and he's, if he sees a player that has any psychomotor dysfunction or any difficulty after a play, he will, uh, announce to the referee, the referee will take the player to the sideline and that player has no choice but then to go through the protocol and be assessed. So they go to that little tent that you see that, um, he sits in there and then, um, the unaffiliated neurotrauma specialist will be involved as well as the, um, the team primary care physician. Uh, and they will begin to ask the questions that, um, are typical for, um, an initial concussion uh evaluation based on that, they also have to watch a video to see what the impact looked like. If it looked like something that would be worthy of continuing on or if it was, you know, there was no trauma to the head. Uh, and then from there, they have to go into the locker room and then there's, um, a test that they have to take, um, on an ipad or a similar device, a tablet. And, uh, and then based on that, the neuro trauma specialists will decide if they're ready to go back into the game where they're cleared or they need to then get onto this protocol, which then takes place after they, uh, after the game is over, they meet up then with a, uh another neuropsych specialist. And so you have to go through a series of hoops to jump through and, and is it correct that some players are not so eager to do this or are they submitting themselves to, you know, I think that, uh, the, the education around brain injury has, has, has been and now at all levels, um going back all the way into when these kids are playing in school. And, uh, so I think the there's more and more understanding that, you know, these are, can be cumulative problems that can end a career and can ruin a life. Um There's been some tragic things that were high in the media of some very, you know, well known, you know, top notch players that, uh what's happened to them and it's been related to brain injury. So I think that that player education has been good, uh that so I think the, the willingness to sort of hide these things. Uh I think it, yeah, you may want, you may want to stay in the game, you may not want to want to show that you're dinged so to speak. But, um, I think that the, the understanding is that you, somebody's going to notice it and, and it's going to, and it's going to be a problem and if you continue to play with, with that, with that injury during that game, it's going to mean a lot more time out. So it may happen but much, much less frequently than previously. Uh One thing that's not spoken of as, uh Neil is mentioning is that it depends on the player and his position with the team. Uh, and you know, where he is in terms of contracts. So there are a lot of things they get involved with it. Um, football is fairly unique. It's such a violent sport, but the contracts are not uh necessarily guaranteed. Uh So if you don't go forward and play, then you don't get paid and, and so a player that's very much on the bubble might behave differently, you know, but that's where the education really becomes important where, you know, you can't have short term goals that don't have long term success. So, yeah, it makes sense. Um I think we have a question for you over there and we'll come over. Hi, I'm Alicia Bazzano. I just finished my tenure as the Chief medical Officer of the Special Olympics and uh different population, but a lot of the same kinds of challenges, especially around stress, around game day stress and uh and trauma related mental health conditions. And I was curious to know what's the relationship between you as the head team physicians and the mental health, uh team members on your team? And what are the processes and protocols generally for that as well as just more broadly? What do you think that we can learn as health care teams from what you do. You know, you, you, you bring up a really excellent topic and that's the, not just the familiarity but the relationship of, uh, of the physician with the people that they're taken care of. I mean, it doesn't matter if it's in, if it's in your office, in your private practice or if it's taken care of a team, you know, to, to know, to know these people, to be around them, to understand what their personality is like and how that may change when they're under the stress, pre competition or during a competition. And to understand, you know, that player, some of them become non verbal, you, some of you, you can't even speak to. But if you, if you know them, if you develop that sort of that relationship, then then you can communicate with them where pretty much no one else can. And that's, that's really important because if something does happen to them in a game, they're a completely different person sometimes on that field or before a game than they are. And it doesn't matter if it's, if it's a special Olympics population or, or, you know, anxiety does that to people. And, and so I think that that stresses that intimate relationship, that, I mean, David and I, we can be, we're completely ineffective if we're not in that training room frequently enough where the players know us and, and we know them. And so I think that this speaks to your, your bigger question is, I mean, the lesson learned is just a reinforcement of what, what you all know that that nothing happens without that relationship, that intimate relationship that you have with them and nothing can replace it. Um We're a little short on time, but I, I want to just very, very quickly ask both of you. Um You know, I think it, it, it just kind of hit me as we were talking backstage. You have an incredibly insane travel schedule. I mean, you're on the road, you're working in the off season, of course. But how many football games have you both watched? Um, more for Neil than for me. But, uh, even though he has more hair and do you actually, are you watching because you're observing for something very specific? Are you able to enjoy the game? Yeah, it's, it's, um, as we were talking backstage, you know, um, I moved to California. I had no intention of being in the NFL as a team doctor. And then I got called by the Chargers as they were moving up to Los Angeles and my name got into the mix and, uh, I talked to my wife and she said, oh, the kids will love it. You should do it. I'm like, all right. So that's truly what happens. And then after about the second season, she's like, what the heck you're never around. That's uh, this job sucks. So, we have to travel with the team. Yeah. Yeah. Yeah. So, so the reality is, it's, it's, it's very harsh, it was harsh on me. Um, because I had very small Children at the time and, and so literally every weekend you're spoken for, for five months, um, more so if you're with the Rams. But, um, the, uh, the, uh, the reality is, it's just, it's a very, I love the, those soft digs here. We're more so for the Rams because they play in the postseason more than we do. But, and we do need to wrap. I'm so sorry. But we, we got, you know, we got a sense of just how many games you've been to. So, um, Neil David, thank you so much for being with us. Thank you. It's fascinating what you do.

Dr. Megan Ranney, Incoming Dean, Yale School of Public Health, Yale University 
Moderator: Michal Lev-Ram, FORTUNE 


Brainstorm Health 2023 - Learning From Dr. Tiktok

Research shows that more than 60% of adults look online for health information and like so many things in recent years, the pandemic boosted this trend with more people jumping online to devour information and sometimes even to self diagnose. There is no doubt that digital channels can be a powerful positive resource. For example, offering a vehicle that allows health professionals to connect directly with the public to share accurate and useful information. But oftentimes it's not credible research that people are turning to. It's random postings on social media. The problem here, social platforms are fraught with medical misinformation from amateurs, pushing unproven theories and advice. So let's talk about the effects of digital misinformation, how it can be countered and how social media can be used in a positive way for better health outcomes. Joining us now are Dr Sasha Hamdani, psychiatrist and CEO of focus Genie Jessica Mala Rivera Research program assistant at the Johns Hopkins Bloomberg School of Public Health Center for Health Security and Doctor Megan Ranney, incoming Dean of Yale School of Public Health at Yale University. Please welcome them to stage. I thanks so much for um joining us here. So I'm curious to, just to start with, um, to hearing a little bit about your own personal relationships with how you use social media and I'm gonna start with you because you're, you're an avid user and because I'm uncomfortably close to you. Yeah, I can move a little if you want. Um, yeah, so I, um, I'm a psychiatrist. I'm based out of Kansas City and I got onto social media around the same time that everybody got onto social media, which was around the pandemic. The reason that kind of got me onto social media in the first place was really that my patients were holding up their phone to the telehealth visit and they were saying I have a DH D because of this and like nine times out of 10, it was not a valid video, it's kind of dumb. And so I, I initially started creating content to put out information that was accurate and valid to create kind of a safe space on the internet for that and it snowballed from there. Ok. And I, I did see you've got like, you know, your public apology to the barista because you spoke in a British fake British accent. That was very interesting. And then, and then you've got, you know, stats on a DH D I mean, it kind of runs the gamut. Is it, was that something that came naturally to you having the entertainment factor and the, the information or did you have to sort of, I mean, maybe, I don't know, it's, it's constantly evolving. It's, it's mostly um to provide educational content, but it's kind of like hiding the broccoli in a meal, you know, you're providing, you know, you're giving educational content within a entertaining scope just to make it more digestible. Ok. Can you share, you know, similarly where it kind of happened accidentally, I had a very private, you know, per existence on social media prior to the pandemic. But a lot of people who knew my training, which is in infectious diseases and specifically in emerging infectious diseases and pandemics. Uh My, my D MS and my texts were just inundated with questions from people who knew my training and said, can you just help me understand all the headlines I took to Instagram, which was just the first app that I picked and decided to do basic informational highlights 101 contact tracing 101 virology, 101 just to kind of explain what was happening because in studying infectious diseases, so much of my work was in the science communication behind them. And so explaining both the epidemic, the emergence of the disease and the info mic that was kind of in tandem. Um it just took off from there and I realized there was an a an insatiable appetite for that kind of content on social media and had quite the captive audience really quickly. Yeah, I I would imagine that, uh, being an epidemiologist and a communicator came in very handy these last few years. So, pretty amazing, uh, skill set there. Um, so you've got a little bit of a, of a different, uh, you know, relationship probably with, with social media. I mean, I think you all are and I will ask you about both the good and the bad, right? But, but give us a sense of just what your relationship is. So I've actually been on social media, very active on Twitter since about 2010. I'm also a practicing emergency physician and so originally used it as a way to network with colleagues across the country. I created studies through partnerships on social media. I found identified patients who became partners in my research using social media. And then I'd say my use of social media started to change in the mid 2010 s actually helped create a movement called This is Our Lane in 2018 where we physicians, public health professionals, nurses took to Twitter, which was at that point, the dominant form of social media sharing ways in which firearm injury is a health problem and is very much the lane of health care professionals. We did that in the wake of an NRA tweet telling us as doctors to stay in our lane and not talk about gun violence as a public health problem. Use social media at that time really to help drive the lifting of what had been at that point in over 20 year uh absence of federal funding for firearm injury research, we got uh the CDC and N I H refunded to start doing that research in 2020 for the first time since 1996. And then it grew from there. My use of social media changed during the pandemic as it did for all of you as a, as a, you know, front line provider. I talked a lot about the need to get Us PPE actually use social media to organize a nonprofit called Get Us PPE that then delivered, donated personal protective equipment to those who needed it most across the country. And then of course, also do research on it because I am an academic and currently Deputy Dean soon to be incoming dean. This question of how can we use social media to organize, to share good information but also to combat myth and disinformation to fill these information voids that Sasha and Jessica have acknowledged. I'm sure there were all sorts of domain names like get Us P pe available before the pandemic but not, not anymore. We bought them very quickly. Yeah. Um So it's interesting, I mean, you just said, you know, putting out good information to combat misinformation. Um is that, is that enough? And there's so much we're all constantly reading and talking about this and you know, it's the social media companies and their responsibility. There's the government there's, you know, what's going maybe will happen on the federal level, starting to happen on the state level for better or worse. Right. Um But is what's the role of putting good information out there and how much can it really do to combat the misinformation that is very clearly going to be a part of social media networks for the foreseeable future. So I think it is absolutely essential. I see no way for social media companies to fully un route misinformation and information. There are some safeguards that they can put in place and that they need to put in place. For example, we've seen a huge rise in anti vaccine messaging on Twitter since Elon Musk took over and allowed many of the dirty dozen back on Twitter. So there are things that we can do to root out those worst purveyors of disinformation. But the better thing is to elevate the voices of credible social media purveyors. I actually worked with the World Health Organization, the National Academy of Medicine and youtube to help define what a credible messenger looks like on social media. So health care providers, nonprofits for profits, health care organizations can now get a check on social, on youtube to say that they are a trusted information source and then have that message elevated. I think that's the most important thing that we can do is to flood the airwaves with real trusted information is Elon Musk paying for them to get the check. So Sasha, can you talk a little bit about? I mean that you kind of fell into this, you know, because of, of your patients, right? Um There is a lot of good information out there, not just you other professionals are, are are posting, there's also a lot of value obviously, especially in the mental health space to having that community, right? And that support system online, but self diagnosis just to name one, you know what's the risk there and how do you try to mitigate it? So, I mean, I think it boils down to responsible consumption, right? And we we know that this algorithm is very interest based. So if you're interested in something and if you have questions about it and if you are engaging more with certain content, it's going to feed you more of that content. So if you get pigeon holed and if you continue to go down that pathway, you can get very entrenched in diagnosis. Um and that becomes problematic at times when people are trying to use that to self treat. Now, in terms of self diagnosis, I think that the initial steps to self diagnosis of people learning more about their internal condition, finding the words to explain what's happening, finding relatable content. That's all there's a lot of positive in that they are using that information theoretically and hopefully right, to go to a credible source, to go to their physician, to go to their therapist to go to someone who can help them and guide them through this journey. Um So I think there's positives with that. I think it can get dicey when they're trying to self manage it though. Ok. Um Jessica, what are your thought? You actually? And speaking of positive outcomes, I know you've managed to convince some people to get vaccinated, including some famous people. So what works there? What was, what was effective? So my 9 to 5 is data all day, every day. It's a very evidence based. And I use that even in my science communication because there is a science to it and there's evidence behind certain methods in that process. One in particular is information inoculation or pre bunking. So essentially anticipating the logical fallacies, the conspiracies before they happen, as you kind of see the news cycles, you know, spin things and equipping folks to be prepared for those opportunities to make bad choices or good choices, health. And I think that a lot of times science is a missing component in the scientific process and the scientific method. And when we're not training providers or even educators in these institutions to take science beyond the laboratory, beyond the peer reviewed journals that are only being read by nerds like us, you know, it's not really helping society. And I mean, I can I look at it as fluent in another language and instead of dumbing it down, it's really trying to elevate people's literacy in that so that they can feel empowered to make those choices. And it went a really long way. It was not shame based, it was not fear based. It was using a lot of inclusive language leaning into my identity as a woman of color, as a mom, making choices for my Children and all of those things kind of kind of added to the currency of trust in my messaging. Um I'd love to get your questions in. Please raise your hand. We'll bring a microphone to you if you'd like to question or come and we've got one over here. Hi, thanks for speaking to. I run a small newsletter called Stats of one. I'm a bio statistician by day. Um So some public um so because I run this newsletter, I also use social media. I put out uh you know, tweets and all that stuff. We have a podcast now. Um Is there like a gotcha in each of your respective experiences that comes to mind like, oh, this is something you should watch out for, you know, this is going out to the world. What is there something like that that it's like, oh, ok. You know, look out for that, like things to look out for. Exactly. I would say there's a lot of themes that kind of are common in the traps that people fall into when it comes to consuming medical misinformation. And a lot of times it's the very obvious things like the appeal to nature fallacy, you know, that kind of consistently becomes an issue of what are these ingredients or I can't pronounce them. Therefore, it must be bad or this sounds scary because it sounds like this and reminding folks, you know, kind of, of the role of science and the fact that it's not done in order to control or to all those scary words, those verbs that people kind of assume when they don't understand something has really kind of dissolved. A lot of the fear. I mean, I would argue nothing is as destabilizing or as fear inducing as a pandemic. Anybody who is alive is at risk. It's very different from a localized conflict. So, um you know, when you kind of normalize that and say, you know, we're all equal, we're all human, we're all at risk, but here are ways to not fall into these traps. Um You can kind of see it from a distance like, oh, that's gonna turn into this type of messaging or that's gonna turn into this type of opportunity to sell a supplement or sell some sort of snake oil, maybe, maybe in a, some kind of A I system in the future can try to, yeah, there's keywords for sure that can be identified early on and, and you know, used to target that and combat misinformation and also going off of what Jessica said earlier, I think that we have a responsibility as science communicators to be proactive. So an example was we all knew that the vaccine was, the COVID vaccine was gonna be approved for Children under 12. And yet so many people were sitting on their hands and waited until the approval started to start messaging. Meanwhile, you'd better believe the anti vaccine had been developing their anti child vaccine messaging for not just months but literally for decades, right? This dates way back to the Mmr vaccine. We lost our period of time to prep the public and to pre bunk those ideas that we knew were going to come forward the other. Gotcha or kind of caution. A much more personal one is to always take a breath before you post something that is potentially inflammatory and particularly around those kind of back and forth arguments. The trolls are real sometimes people that criticize you are not trolls, but I have taught myself over the years. I'm not always perfect, but to always take a breath before I respond or engage because nothing can truly be deleted from social media. So it goes like it's out there and it's just not worth it. When you start going down that rabbit hole of engaging with the trolls, it it doesn't end up well for anybody. It just makes you look bad. So, so, so that kind of taking a breath caution I think is a really important one for all of us and one of the things that could potentially be helpful in what Megan was saying with, with people coming at you for information that they understand or don't understand those crediting your source. I think that's really important in terms of, um, you know, because as soon as you don't do that or as soon as you forget to do that, then all of a sudden this is not even a credible source of information. Where is this coming from? Usually it's, you know, if you have this, OK, this was cited in this journal, this is where you can find it that that already takes a lot of steam and the bad actors are getting more sophisticated. So it's also showing people how to become better consumers of even things like data visualization, which has a stickiness to it. You assume somebody's smart and really gifted at Tableau or Excel created it, but the bad information looks really science. Y so it's kind of training eyes to interpret the X and Y and the meaning behind the data, all you need is a pie chart and exactly you're good misinformation. We have another question back there. Thank you. Uh Harvey Carp from Happiest Baby. Um um One of the things and, and Megan to your point about the anti-vaxxers, you know, they're out there 10, 10 months ahead of you with their, with their um with the materials already and beautiful graphics as well and it really seems like this is an opportunity for organized uh medicine to be organized and to um and to be able to have centers of excellence that prepare these materials. So they can be disseminated. The academy of pediatrics, for example, has what they call T pediatricians. Uh where once a month we get a list of, you know, topics, uh suggestions and so we can all sing to the same uh the same hymnal. Um And uh and on, on Happy as baby, we've got about two million visitors a month who are coming for long form, not just for tweets, but they want information. I think that there are other platforms as well where we not only can give the message of the day but really kind of expand upon it so good to be organized. Yeah, so that I think that is actually the key, none of us can do this individually. I don't know how much time the of you spend on social media, but I spend a lot, it's a lot of work to gather the data to present it and doing less these days as I transition into my new role. But those sorts of collaborations with trusted messengers who are already out there is so critical, preparing the data in ways that is consumable. Stay tuned for what I'll be doing at Yale would love to collaborate on that. But, but I will also say that there is um you know, that that element of training and policing our own is critical. The public good project just released a report saying that about a third of the worst purveyors of disinformation on social media are physicians and nurses. We need to kind of watch out for our own. You know, one of them is the surgeon general of the state who actively manipulated some data that got published and created concerns about COVID vaccine in young men. Um And it's now been shown the degree to which the the study was kind of manipulated. How do we police that? It's a question that every Board of Medicine, nursing boards and schools of public health need to really take on anything to add. Have you been a part of any kind of growing more coordinated effort to get those tableau out there or, or just to collaborate in some ways on the communication piece? I mean, Megan and I worked together on that W H O partnership and that was really impactful to kind of see the the value of how do you differentiate a, you know, one source from the other? I will say it's become deeply concerning to see platforms like Instagram and Twitter now kind of throw it all away and, and have a way of identifying who is notable. And I would say some of those thresholds may needed to be, you know, audited because they could have been just, just based on popularity or celebrity. But the fact that we're not seeing that across the board to help people be better at discerning who is reliable and who is not does make this, you know, this info that we're in um even more difficult to navigate Sasha anything bad. I I I'd also like to add that. I think that this is an area of growing interest. Um just kind of across the board recently, I was part of a health care leaders on social media round table at the White House. And uh they would send out information about things that were coming down the pipeline and using us to kind of like review the information and find ways to make it digestible for the public. So I think that this is something that as, as social media continues to grow and expand and evolve, it's important to start incorporating those changes and how we behave on social media and how we look towards social media to getting information respectively. Ok. Well, if you don't follow these three on social media, please do. Um Thank you so much for coming and sharing with us again. Thank you.

Gary Foster, PhD, Chief Scientific Officer, WeightWatchers
Saeju Jeong, Co-founder and CEO, Noom
Dr. Nisha Patel, Hospitalist and Director, NAFLD Weight Management Clinic, Sutter West Bay Medical Group
Zachariah “Z” Reitano, Co-founder and CEO, Ro
Moderator: Jennifer Fields, Editor, Fortune Well, FORTUNE; Co-chair, Fortune Brainstorm Health

Brainstorm Health 2023 - Weighing In On How To Overcome Obesity 

Gary Foster, WeightWatchers
Saeju Jeong, Noom
Dr. Nisha Patel, Sutter West Bay Medical Group
Zachariah “Z” Reitano, Ro
Jennifer Fields, Fortune Well

Weighing In On How To Overcome Obesity 

Gary Foster, WeightWatchers
Saeju Jeong, Noom
Dr. Nisha Patel, Sutter West Bay Medical Group
Zachariah “Z” Reitano, Ro
Jennifer Fields, Fortune Well, Fortune Brainstorm Health

Gwendolyn Floyd, Co-founder and CEO, Wile Judy Greer, Founding Partner, Wile Moderator: Chrissy Farr, OMERS Ventures

Brainstorm Health 2023 - Hear Them Roar: Menopause’s Market Opportunities

Hear Them Roar: Menopause’s Market Opportunities

So here is something that might not surprise you, menopause is not new. Did you all know that? Um But what is new is society's changing attitude about menopause. It is no longer a taboo topic. One rarely spoken about. It's no longer considered a time in women's life where they become invisible, irrelevant or past their prime. Quite the contrary, some of the most powerful and influential women in the world are over the ages of 40 and 50. Right now, more than 50 million women in the United States are over the age of 51. The average age that menopause hits and for some menopause symptoms start even earlier around age 40. There are those who have taken notice. It's even been called the menopause gold rush. I've never said that sentence before. Um the global menopause market hit $15.4 billion in 2021 it's projected to reach nearly 24 a half billion dollars by 2030. But beyond the business opportunities, this is an important and beneficial shift affecting so many women's lives as we all know, and we want to talk about both joining brainstorm health, co-chair Chrissy Farr to do so are two of the leaders behind the women's wellness brand. Wow. I hope I pronounce that. Right. Maybe it's Wiley, like Wiley Coyote. Gwendolyn Floyd is CEO and Judy Greer is founding partner. We're thrilled to have them here today. So please welcome them to the stage. Hey, so we have a packed afternoon, um, with a lot of panels on women's health. Um, and we will start this one off with, um, a topic, the topic of menopause with ya. No, no, it's really great near and dear to all of us for, for many a reason. But, um, we have this, this incredible panel here today and I wanted to kick things off by talking about the cultural depictions of menopause. Um, last night, a very good friend of mine who was in the audience reminded me of the sex and the city reboot. Um, does anyone remember the moment where Kristen Davis is experiencing what it seems to be perry menopause and she's wearing a white, white pants and gets a period. And, um, it's this like incredible moment. But, um, Leslie and I, last night at dinner, we looked up, how old would she have been in that while shooting that scene? She was actually in her late, mid to late fifties, um, which is just, you know, it's an amazing moment for so many reasons, but also kind of an inaccurate one because a lot of women experience this way sooner so maybe we should stop there. Just like, yes, we're making progress but when are we gonna start getting actually real about menopause? Um, Judy, I'm gonna throw this one to you. Well, now that Gwyneth Paltrow is talking about it, I think we can all agree that it's a real hot topic. Um, yeah, one has got it. You got it. Um, well, I think, you know, because we always sort of look to Hollywood and celebrities, whether they're actors or just celebrities. Now we just have people being celebrities for, I'm not sure what reason. But, um, you know, now that, that something that's being addressed on film and we're watching it in our favorite TV shows. I mean, it'd be nice to see it start a little younger. Like you're talking about Kristen davis' character being 57 when she shot that scene. And, like, it'd be great if she was in her forties, maybe shooting that scene. But it doesn't really matter because I was thrilled to see that as we discussed earlier that now, like a huge television show, like sex and the city is really talking about this and I think that's unfortunately a great start and I thought it's good. Yeah, I mean, from my perspective, I think it's, um, as we were talking about earlier it's very uncommon for women to be going through menopause in the late fifties. Um, yes, if you're incredibly privileged because unfortunately there's a relationship between stress and para menopausal like symptoms and expression. And that's also why, you know, co color and minorities actually experience para menopause earlier and they have much more exaggerated symptoms. And so I think it is kind of classic on that show, which represents women living at the height of privilege and white women to boot. Ok. Yes, they're having symptoms in the late fifties. So not only is it inaccurate, but it also, I think magnifies some inequity in the care system and, and honest conversation about when it begins to affect women, which is oftentimes early forties and even like for myself, even for myself, late thirties. Um So I'm just gonna put it out that we are way too comfortable with women's pain as a society. Um Yeah, I mean, I just had my second child and it was, I was reminded of this all over again. And um you know, we all remember the indignity of putting the towel down at night because the sweat that you get after you have a baby and nobody tells you about this. You're like, what is happening to me? Like am I dying? Um And fortunately, you know, it goes away but then you get per then it comes back, it comes back and this is just one of so many symptoms that, you know, I think we, we tend to kind of underrepresent um trivialize. Why, why do you think that is and, and how do we fix this Well, I think, you know, there's so little education out there about peri menopause and it really is peri menopause. I mean, menopause is, is one day of your life, like the day 365 days after you've had your last period. So we're talking about one day versus potentially 12 years leading up to this one day. So, like, we're not educating our health practitioners, they're not learning about this or they're choosing not to. So they're not telling their patients about this. And really like when you're a woman and you either are done having kids or you decide you don't wanna have kids, it's like good luck, don't get osteoporosis. Like that's what happens. And you're just kind of like, you know, you go in for your once a year scraping and you're boob smashing and, and like if everything's normal, like, you know, enjoy these years, but, but there's not, you know, if we're not doing our own research, like, how are we supposed to know? Like I thought I was depressed, I thought I was sick. I thought there was something really wrong with me. The fatigue was unbearable. I couldn't remember my lines. I was sad and I've never been a sad person and I was told to go on PROzac, I was told to go back on the birth control pill, like, and this is for my doctors. So it was frustrating. So I think, you know, like we have to do our own research and we have to start holding the medical community accountable. I mean, we're, you know, there's 10 times as many articles about pregnancy as there are about menopause. When you search pub med, that's what you'll find. But all of these women who are having babies are going to go through menopause like you are. So, I don't know why this is why this isn't being discussed and why we're not being treated like uh we're relevant. Yeah, I mean, over 80% of medical schools do not include menopause in the curriculum. And if it is, it's an elective and there's a neuroscientist who studies the brain and menopause in women um at U C Santa Barbara and she has this line I love, which is women's bodies are not an elective, you know, that needs to be driven home and be true within practice because it is, it's a, it's an institutional issue from an education perspective. Um And it is also a cultural issue because it's not only it's unfortunate, perfect storm of lack of awareness and education for the for the end customer and for the patient um women thinking that it's them or you know, it's psychological and the fact is that it actually can be true because hormonal changes express themselves as behavioral and mental health issues. And so so many women think that yes, this demographic has the highest suicidality rate of any female demographic. We are the highest antidepressant users in the world, right? But that has a hormonal correlation. And so, unless we're approaching it both from a woman's psychological and emotional experience and the hormonal regulation that's happening, we're actually doing her a disservice and there's this massive weight space out there that is, goes far beyond the anti aging rhetoric of like wrinkles and weight gain. You know, that really is ripe for innovation, technology. Like we don't even have a clear picture of who she is. And that's the irony. Like we have talked to over 45,000 women in depth. We're starting for the first time ever to have a really granular illustration of who she is. And only then as an industry, as a medical community, as a culture, can we appropriately address and support her? So it's just, yeah, it's manifold the issues and challenges, but it's such a huge opportunity and it's vital that we address it. Yeah. And I love, I love that we keep talking about, you know, who is she part of the problem is the invisibility that this population faces. So, one of the most kind of widely cited studies out there from the UK shows that something like 900,000 women have left the workforce due to uh perimenopause or menopause. Um That is insane. Um And I'm jealous. Just kidding. I love my job. I, I, I get it. Um So, but yeah, I mean, we're like, we go through our twenties and thirties. We, we're told we're too young to have a, have an opinion and we hit our forties and we're suddenly like, now, ok, we can, we're power women. We know we're like, do you have cancer? No, you're fine. Ok. And then it's like this hits and women are out of the workforce again because of how severe it can be. Um, so how do we, how do we go about kind of addressing this, how do we reach these women and actually give them the help that they need so that they feel that they have options if they wanna continue to work. I think we have to approach it from all fields and we need to approach it collaboratively. We always say that we're sort of this perfect gateway, you can find our products, you know, on shelf at Whole Foods at CV S and it work stores across North America and of course, online as well. And um the landscape has been strangely balkanized between like H RT and kind of pharmaceutical solutions and kind of plant based or natural over the counter solutions. And to us, that's ridiculous because these two domains can both work fantastically independently, but they also work great synergistically and there's such a limited care out there that we shouldn't be kind of fighting with each other. All of us believe in our developing products that are science back based on clinical data and really data driven. And so it's an opportunity to collaborate and try to create solutions across the board that can really support all women because unless she's able to find it on shelf where she shops and then have that experience be normalized. Understand that like be educated through that journey of what per menopause is that she's not crazy. It's yeah, honestly, depression, then that's going to also open up the gateway for her to then talk to her doctor about it who granted only has, you know, 15 minutes to see her, which is not a lot when it comes to the manifold symptoms that you might be experiencing through this life phase. So again, we always say like all, you know, all ships rise together, it is such an underserved category and there's so much opportunity in all kind of in all spaces. But also only if we work together and only if you really kind of combine forces and look at all the different solutions. Are we going to be able to have an impact across the board on women's lives? What I love about this product and um is that I feel like uh so much of the promotion about aging and aging gracefully um is about what you put on yourself and not what you put inside of yourself. And I think like when you're feeling great, you will look better and you will want to take better care of yourself. But when you're just like putting, you know, and there's great creams for women who are aging and all of those things that I'm not um against those products at all. But I do think that like, healing ourselves from the inside out is the best attack on this because we will take better care of ourselves if like our symptoms are being alleviated. So like putting on a face cream is not necessarily going to make me feel younger and feel better about myself, but like getting great supplements will. And I also think it's an issue of so it's consumer awareness and education, but it's also creating a narrative. It's a cultural, it's a cultural issue I would say over the past 100 years, a woman's lifespan has increased by over 30 years. So that's an entire life phase that we don't have cultural dialogue around. We don't have, yeah, we can't identify with that's really not spoken of. And so we speak to all these women and they feel invisible at a loss at a life phase that really hasn't been defined or story told about. And that is unbelievably important. We can't, yeah, we can't kind of undervalue the again, the synergy between like really effective solutions and also providing kind of a cultural landscape for women actually feel seen, feel heard. We actually like women thank us for asking them questions about their health and about their well being in this phase of life, which is egregious, you know, that should not that should not be the case. So it's, we always say this is, it's a, it's a life phase issue. Yes, we're creating a portfolio of products, you know, that can be mixed and matched and really address the specific kind of emotional and hormonal symptoms that she's experiencing as her kind of experience change, changes over an up to 10 year journey. But we're also providing kind of a cultural platform and dialogue that really helps empower her to step into this opportunity, to thrive, to feel great and to have the impact that really this life phase should be designed for. This should be an aspirational phase in life where you, you know, we, we should be, I mean, it should be the best time in our lives. So we have the most impact at work at home, you know, in your personal and social lives. Questions from the room. Any questions? All right. Well, I'll come back to you. Uh you thinking here we have a question. Hang on a second. We've got the mate coming. Oh oh, ok. Um First off, please keep doing your job. We all love you for uh uh What about funding in this space? Right? That's been something that's been such a at a crisis for 15, 20 years like what you guys experience with that and what's your point of view on it? That's a great question. I love it. Love, we love the money, it want it is it, it's really complex. We've thankfully had a lot of luck with fundraising but it's been harder than it should have been. Like, we've experienced everything from, like, the weirdest internalized misogyny and, like, women investors to, you know, or how about the male investors that tell you about their wife and, like, their wife represents all women? Yeah. Oh, yeah. Yeah. You know what, I'll take it. Yeah. He's got money and his wife is having really bad symptoms. Yeah, I think a great bring, bring, bring the money. So I think it's, this is a weird correlated between like what's happening culturally, just like translated to the funding landscape. But like we're either two dimensional, you know, or overlooked. There are thankfully some incredibly innovative investors that are out there that are really have partnered with us and I want to continue to partner with us and we love them. But it's also a strange time in the investment landscape at large. Like they're like, yeah, you should, you know, you need to be profitable and have rapid growth within the first year of operations. You're like, well, that's, that's quite difficult to achieve. Um And that I think it's important that the investment like especially within women's health health, like there are different models that can be incredibly profitable, but they're not gonna have hockey but growth. So like right size growth that require education of a customer that has been largely in the dark is going to have a different growth growth trajectory than like another, I don't know, photo sharing app or something. And so, um it's about, I think it's about vision and, and that's unfortunately across, across culture, across investment across medicine really lacking when it comes to, to women's health. Still at large. So, um Judy, you've definitely been played the role of the, the best friend we had in honor of you. We had a dinner table question last night about whether you did the protagonist or the best friend in a movie, um which is a great friend. Um But you know, from that context, like, how was it for you to, to speak about menopause? Did you experience pushback? Because, because you wanted to take this on and how, how did you navigate it? Well, at first I said uh to, to my partners in while I was like, well, I don't want to say the word menopause when I talk about it. So I'll just talk about hormonal changes and they were like, OK, that's gonna be kind of hard but sure Judy. And um and then as I started to talk about it publicly, it's just been so heartbreaking but awesome. The people that come and want to talk to me, people coming to me crying like fans, but also like people who are using the product and loving it and it's been so great and I don't want to deny that anymore. And it's scary as an actress it scary as any woman to publicly talk about like this phase in life and perry menopause, which is where I am now. It's so great. Uh So awesome. But um so like talk about that, but one of the nice things I'll say about not being a movie star is that like, I can play all kinds of roles and I don't have to worry as much about uh I feel like that kind of stigma but I think that stinks and I think that movie stars should talk about this and, and they're starting to um but it's, it's really encouraging to have started this dialogue. And one of the reasons I wanted to be involved with wild is because I wanted to start this conversation because when I started having symptoms like a few years ago, no one would talk to me about it. And when I was talking to my friends about it, my friends from college, my lifelong friends are like, I don't want to talk about that. I'm like, but it's just the two of us walking with coffee. Like, why can't we talk about this? Like, I know I don't have that. I'm like, well, I think you do but me and on that note it's a wrap. So thank you so much for just elevating this issue to both of you. Um And you know, love the topic of Just hear them roar I think was the title of like hell, yeah. Like, you know, we are, let's just keep, keep it going, keep talking about it. Thank you so much. Yeah, thanks for.

Dr. Irogue Igbinosa, Women’s Reproductive Health Scholar and Instructor, Maternal Fetal Medicine, Stanford School of Medicine, Stanford University
Charles Johnson, Founder, 4Kira4Moms
Loretta Ross, Associate Professor, Smith College Dr. Neel Shah, Chief Medical Officer, Maven Clinic Moderator: Deena Shakir, Lux Capital

Brainstorm Health 2023 - Black Maternal Health: Reversing The Mortality Crisis 

Dr. Irogue Igbinosa, Stanford University
Charles Johnson, 4Kira4Moms
Loretta Ross, Maven Clinic 
Moderator: Deena Shakir, Lux Capital

Black Maternal Health: Reversing The Mortality Crisis 

L'Oreal Thompson Payton, Certified Yoga Teacher; Reporter, Fortune Well, FORTUNE

Brainstorm Health 2023 - Mindfulness Moment 

What we're going to do for the next couple of moments is just take some time for yourselves. There's a lot that's demanding your attention right now. I bet your emails are going off. You're getting slack notifications. Maybe your families are like, hey, when are you getting back? But right now this moment is about you. It's about taking some time to get in touch with your mind and your body and just practice what we're talking about, right? Because if we don't actually put it into action, then none of it matters. So I'm going to invite you to close your eyes if that feels comfortable to you. If that feels safe, if not feel free to look straight ahead, look down at your nose, find a focal point on the ground and just take a moment to exhale, we're gonna lead you through some breathing exercises and then we're gonna do a little seated yoga and then we're gonna go about our days feeling much lighter and just more well rounded. So to start, put your feet on the ground, relax your shoulders. We're gonna try some box breathing here. And what you're gonna do is inhale for four counts. Hold it at the top for four accounts and then exhale for four accounts and I'll lead you through it. So start by inhaling 1234. Hold 1234 and exhale for 1234. I'm gonna do that a few more times. Inhale 1234, hold 1234 and exhale 1234. I invite you to go at your own pace. Remembering to inhale and hold and exhale. Continue to inhale, hold and exhale. I can return to your normal breathing pattern, whatever feels comfortable to you. And now we'll do a bit of seated yoga and like I said, we're not going to get wild with it, so it's ok. You can continue to have your eyes closed and listen to my voice to instruct you or feel free to look up here on the stage. So I have my feet planted on the ground. I have my hands on my knees close by and I was going to round your back making ac shape. This is your cat think of a alley cat, Halloween black cat against the moon picture that you've seen. I'm sure a million times and inhale as you bring your chest forward into that cow position, go ahead and inhale or I'm sorry, exhale into cow. The cat exhale in the half. Just do this a few more times at your own pace, bringing your chest forward. Exhaling around in the back. And if you're feeling spicy, you can add some circular movement, doesn't matter which direction you go and we're going to switch in a bit, but just inviting some more movement into your bodies continuing to inhale. And you bring your chest forward and exhale. As you come around to the back, we're gonna switch going in the opposite direction that you started in. Inhale, bring your chest forward and exhale, bring your chest back and do that a few more times and come back to center. So I need to roll your shoulders out, roll it back. You may hear some noises. That's ok. We've been sitting for a long time and then bring your shoulders forward. Yeah. And then invite you to settle down again and to close your eyes and to get comfortable. That is yoga. I know there's a lot of emphasis in our society on the or the postures, the movements, the positions and there's a lot of interesting positions you can get into. But at the end of the day, it's about breath. It's about being present. It's about being here with yourself in your mind and your body because you deserve this moment and this rest. Yes, the work is important. Yes, people need you. Yes. The to do list is a mile long and I guarantee you it will still be there after we finish this. But it's important that you take time to pour into yourselves because we all know that you cannot pour from an empty cup. And this exercise, these breathing exercises, this grounding movement is available to you. If you're in a suit, if you're in heels, if you happen to be in the middle of a health conference, it doesn't matter where you are, you can always come back to your breath and to this moment. So it takes some time to settle in and to pause, can picture your happy place. Sack at the beach with calm waves crashing in the background or at a park with your family at brunch with your friends, whatever that place is, try to picture it. What are you wearing? What are you doing? What does it smell like? I want you to evoke all of those senses to create a moment of serenity for you and your well-being. Who's with you in this space? What does it sound like there a little kid laughter? Are there birds tripping? What does it feel like? Is it a hug from your mom or your favorite person? Is it the cool side of the pillow? Because that's always nice. Whenever you're feeling stressed, I invite you to come back to this moment, to mentally visit that happy place and you need a moment to pause, to ground yourself, to just escape for a little while. You can create these mental vacations as I like to call them and invite that ease into your life. You deserve rest. You do not have to earn it. You don't have to work for it. It is your birthright and it is available to you whenever you like. So if you still have your eyes closed, take a few moments, take a snapshot of that mental vacation and when you're ready for you to open your eyes, take a look around and thank yourself for showing up for yourself. My name is l'oreal and I appreciate you all taking this mindfulness moment with me. Enjoy the rest of your day.

Helmy Eltoukhy, Co-founder and Co-CEO, Guardant
Anand Parikh, Co-founder and CEO, Faeth Therapeutics
Robert Stone, Chief Executive Officer, City of Hope
Carla Tardif, Chief Executive Officer, Family Reach
Folasade P. May, MD, PhD, MPhil, co-leader of the Stand Up To Cancer Colorectal Cancer Health Equity Dream Team; UCLA
Moderator: Clifton Leaf, Brainstorm Health 


Brainstorm Health 2023 - Breaking Down Barriers To Cancer Care In Underserved Populations 

Helmy Eltoukhy, Guardant
Anand Parikh, Faeth Therapeutics
Robert Stone, City of Hope
Carla Tardif, Family Reach
Clifton Leaf, Brainstorm Health 

Breaking Down Barriers To Cancer Care In Communities

Helmy Eltoukhy, Co-founder and Co-CEO, Guardant
Anand Parikh, Co-founder and CEO, Faeth Therapeutics
Robert Stone, Chief Executive Officer, City of Hope
Carla Tardif, Chief Executive Officer, Family Reach
Moderator: Clifton Leaf, Brainstorm Health 


Dr. Justin Barad, Co-founder and CEO, Osso VR
Dr. J. Jeffrey Carr, Professor of Radiology, Biomedical Informatics and Cardiovascular Medicine, Vanderbilt University Medical Center
Dr. Taha Kass-Hout, Chief Technology Officer, GE HealthCare
Jean Olive, Chief Technology Officer, Best Buy Health
Moderator: Rachel Lobdell, Editorial Director, FORTUNE 

Brainstorm Health 2023 - Data And Technology’s Role In Improving Health Outcomes And Boosting Efficiency 

Dr. Justin Barad, Osso VR
Dr. J. Jeffrey Carr, Vanderbilt University Medical Center
Dr. Taha Kass-Hout, GE HealthCare
Jean Olive, Best Buy Health
Rachel Lobdell

Data And Technology’s Role In Improving Health Outcomes 

Dr. Justin Barad, Osso VR
Dr. J. Jeffrey Carr, Vanderbilt University Medical Center
Dr. Taha Kass-Hout, GE HealthCare
Jean Olive, Best Buy Health
Rachel Lobdell, FORTUNE 

Data And Technology’s Role In Improving Health Outcomes And Boosting Efficiency 

Dr. Vin Gupta, Chief Medical Officer, Amazon Pharmacy, Amazon
Neil Lindsay, Senior Vice President, Amazon Health Services, Amazon Moderator: Chrissy Farr, OMERS Ventures


Brainstorm Health 2023 - Delivering Health Care To Consumers 

Dr. Vin Gupta, Chief Medical Officer, Amazon Pharmacy, Amazon
Neil Lindsay, Senior Vice President, Amazon Health Services, Amazon 
Chrissy Farr, OMERS Ventures

Delivering Health Care To Consumers 

Cathi Ahearn, Senior Vice President, Worldwide Commercial Portfolio Strategy, Bristol Myers Squibb 
Kristina Saffran, Co-founder and CEO, Equip
Janice Whaley, President and CEO, Donor Network West
Moderator: L’Oreal Thompson Payton, Reporter, Fortune Well, FORTUNE

Brainstorm Health 2023 - Getting Better Results For Patients By Making Health Care More Diverse 

Cathi Ahearn, Bristol Myers Squibb 
Kristina Saffran, Equip
Janice Whaley, Donor Network West
L’Oreal Thompson Payton, Reporter, Fortune Well, FORTUNE

Getting Better Results For Patients with Diversity

Cathi Ahearn, Bristol Myers Squibb 
Kristina Saffran, Equip
Janice Whaley, Donor Network West
Moderator: L’Oreal Thompson Payton, Reporter, Fortune Well, FORTUNE

Chris Benecchi, Chief Business Officer, Sage Therapeutics
Joy Burkhard, Founder and Executive Director, Policy Center for Maternal Mental Health
Ariela Safira, Founder and CEO, Real
Dr. Nina Vasan, Founder and Executive Director, The Stanford Lab for Mental Health Innovation Moderator: Jennifer Fields, Fortune

Brainstorm Health 2023 - Comprehensive Approach To Better Treatment Of Depressive Disorders 

Chris Benecchi
Joy Burkhard
Ariela Safira
Dr. Nina Vasan

Comprehensive Approach To Better Treatment Of Depression

Chris Benecchi, Sage Therapeutics
Joy Burkhard, Policy Center for Maternal Mental Health
Ariela Safira, Real
Dr. Nina Vasan, The Stanford Lab for Mental Health Innovation 
Moderator: Jennifer Fields, Fortune

Chris Benecchi, Sage Therapeutics
Joy Burkhard, Policy Center for Maternal Mental Health
Ariela Safira, Real
Dr. Nina Vasan, The Stanford Lab for Mental Health Innovation 
Jennifer Fields, Fortune

Cathi Ahearn, Senior Vice President, Worldwide Commercial Portfolio Strategy, Bristol Myers Squibb Frédérique Dame, Partner, Google Ventures David Koretz, Co-founder and CEO, CopilotIQ Wendy Mendenhall, Chief Operating Officer, Avanlee Care Moderator: Erika Fry, FORTUNE

Brainstorm Health 2023 - Driving Health Care Innovation In A Tumultuous Economy 

Cathi Ahearn, Bristol Myers Squibb 
Frédérique Dame, Google Ventures 
David Koretz, Avanlee Care 
Erika Fry, FORTUNE

Driving Health Care Innovation In A Tumultuous Economy 

Dr. Sree Chaguturu, Executive Vice President and Chief Medical Officer, CVS Health
Dr. Celine Gounder, Senior Fellow and Editor-at-Large, Kaiser Family Foundation; Medical Contributor, CBS News
Dr. Jack Resneck, President, American Medical Association
Moderator: Maria Aspan, FORTUNE

Brainstorm Health 2023 - Building Trust In A New Era For Health Care 

Dr. Sree Chaguturu, CVS Health
Dr. Celine Gounder, CBS News
Dr. Jack Resneck, American Medical Association
Maria Aspan, FORTUNE

Building Trust In A New Era For Health Care 

Dr. Deborah Birx, Former White House Coronavirus Response Coordinator Moderator: Deena Shakir, Lux Capital

Brainstorm Health 2023 - Fighting Pandemics: Why The Private Sector And Government Must Work Hand In Glove 

Why The Private Sector And Government Must Work Together

Fighting Pandemics: Why The Private Sector And Government Must Work Hand In Glove 

I am very excited to introduce our next guest. One of the best known voices to emerge during the early days of the pandemic. If you don't recognize her, you surely will. As soon as soon as she comes on stage, Dr Deborah Burkes, globally known for her work as the White House Coronavirus response coordinator was truly a central figure to so many us in those early days, a very familiar presence at White House press briefings. But her work started well before COVID-19, I was lucky enough to sit next to her during dinner last night and heard about her experiences dealing with epidemics with infectious disease, with HIV AIDS, immunology, vaccine research and global health. She has worked in many locations all over the world and I'll let her share a bit more about how those experiences translated into the work that she did here at home in the US. Dr Burkes knows firsthand the value of public, private partnerships in science and in health. There are critical aspects of battling the pandemic, certainly in R and D in the development of vaccines, but in everything that came afterwards and that continues to come. So please join me in welcoming Dr Deborah Burt today for a conversation on how public private partnerships can help us prepare for the next pandemic. So good to next to you again. I know we're kind of matching but not exactly just keeping everybody awake out there. We got the brightness memo, keeping you awake. So, Doctor Burke, we there was so much we talked about last night and I'd love to share that wisdom with um with the audience today. But let's start with this. How can we prepare for the next global pandemic? We know it's coming. So we're not ready. I mean, we have to start with that. I would like to start with, where are we today? And we're not ready. Um In fact, I worry that we've drifted even further back than we were in 2019. Um And when people say to me, well, why didn't you follow the pandemic preparedness plan? Well, because it failed in the first week and there were no private sector in that pandemic preparedness plan. There was no private sector in planning for the next plan pandemic. So what I've been pushing for is getting the private sector at the table during these we have training sessions yearly where we pretend there's a pandemic and the all the federal agencies get together. But I want to make it very clear that the group that saved Americans was the private sector. And so to not have the private sector at the table makes it sure that we're not going to be prepared because when I came into the White House on too March, there were no tests. The only tests were being done through the public health laboratories. Now, I know you probably know where your public health laboratory is in your States but patients don't and they don't go to the public health laboratory to get diagnosed. The problem was the tests were unique to the equipment in the public health laboratory. That equipment doesn't exist in hospitals, urgent care or any of the large lab core quest or any of that. So on the third day I called, I had a list of the private sector groups I needed to meet with the great thing about the White House when you call people come. But I was expecting to see the lab developers. I walked into a room of the Ceo of Roche Abbot and Logic and and said to them, we need tests within days and they all delivered. So we went from less than 2000 tests a day to 20,000 to 200,000 to two million tests a day. In less than eight months, we talk a lot about the vaccine but I wanted you to know that behind the scenes, the private sector was getting us tests, the private sector was getting us um supplies. The private sector completely rearranged their supply chain based on data that we were giving them. Not asking questions. But I was just, I was stunned at how much help I got. No one ever told me. No, that's amazing. Not the whole time. We talked a bit last night as well about some of your work around the world and the lessons that you learned from that and how they apply to what, what you did in the White House. Tell us a little bit more about some of the work you did in Africa, for example, around infectious disease. And what surprised you when you went into the White House. So we had spent the last 20 years battling HIV TB and malaria. And when I first started working in Africa in 1998 there was syndromic management for everything. And so if you had a fever, you got treated for malaria. If it was a malarious region, if you didn't respond, you got treated for bacterial pneumonia. If you didn't respond, people assumed you had AIDS and there was no treatment. So the whole care paradigm stopped there. So what we first had to do is bring testing so that every fever was definitively diagnosed. So in Africa, if someone comes to the clinic, we can do definitive diagnosis of the infectious diseases that are circulating in that community at the point of care, no matter where you live, then I came back to the United States and we have data on every 65,000 sites go to pet dot gov, you'll see all of our data and every single client, we serve 19 million clients on treatment. That's your taxpayer dollars. Um So we ran it very much like a private sector business where we were tracking outcomes and impact and holding all of us accountable. And so we had data systems where I could see every clinic and how, whether the patients that were being seen there were virally suppressed as an indicator of quality. So I come back to the United States. I say, where's the data? And I get an Excel spreadsheet that says the state has 600 cases. I was like, well, what were they yesterday? How is it increasing? Where is the? I said, certainly there must be, is there a secret database? I have data on everything in Africa and they were like, no, there isn't. This is it. And then they gave me the line which I really believe is a line that the States and local governments have to give you permission. The state and local governments wanted data too. And so when we couldn't get the data, I asked the equipment, the Abbots, the Roche to send me their equipment data every night. And here they are working their fingers to the bone, getting me more tests. And I'm asking them for nightly data and they sent it to me. So I could see every single hospital equipment because they are always can see their equipment. So we're not taking advantage of what is there today? We could be getting, we could be telling communities how much flu, how much R S B, how much of this, how much of that for all community acquired infectious diseases is, I'm not talking about looking at the hospital acquired infectious diseases. I know there's sensitivity there, but we have the equipment that's molecularly measuring all of these diseases and it could be provided. Now, you don't get all the demographics with that. But isn't that great because then no one will be complaining that you're stealing, you know, private information. So that group that sent us that data every night. And Abbott, we were able to see immediately the trend lines. And that's when I knew even though there were only 2000 people who had succumbed by the middle of March, that we were going to easily lose 100,000 Americans in that first eight weeks because you could see that 50% of the 50% of the patients coming to Columbia Hospital and getting tested had COVID. So, you know, because of the work that the private sector did, we were able to get complete visualization. And what I have always believed is data is the place where everybody can start from and everybody can agree on and it's not controversial. So I always start with data no matter what level of person I'm presenting to. But if you don't have any data and you can't see change over time and every hour matters, you have to really bring that together. And the private sector helped us. And because of my experience in Africa, I had worked with J and J and they had helped me, I had worked with talent and they had helped me with the data system. So I worry every day, if, what if I hadn't come back and known you all because these were the individuals who came to help me and dropped everything to help me. And I think when you've looked at the great thing, I think that I was able to bring is a sense of talking to the community, but also working in resource limited settings. And I, I just Mason Henry shine cardinal hell. All of you said to us, tell us where you need supplies, we'll do it. And so they were sending supplies to safety net hospitals and losing the money by not sending it to their high payers. And I think what I've always tried to convey to the American public over the last three years is people have really helped and they dropped all of the pretense of competition. And they just said, how can we help? And I find that all the time. And so when people say, oh, they won't do it, I always say to him, did you ask them rather than you know, because I found so in May, I'll stop then and you can ask your next question in May. Um we were trying to get hospital data because it was crucial to know who was being admitted. How many people were being admitted? What were their ages? I was getting that data from Europe every night, but I couldn't get it out of the United States and everybody told me the hospitals wouldn't do it. Um but I called the hospitals and by that Friday, I had 93% of our 6000 hospitals reporting. So this is what I think people in the federal government believe that the private sector is not there to help. But the private sector helped me from test to data with teer to organizing supplies with all of our large health care suppliers to of course, making vaccines monoclonal antibodies and that saved millions of American lives. But I think to me, the private sector and across the board is really an unsung hero. I want to talk about misinformation, which is uh another important topic in the context of public health, global health and certainly in the context of this pandemic. Um and it's, it's an area in which, you know, on the one hand, data is empirical and should be clear and we can look at the data and yet mistruth run rampant. What was your experience dealing with the plethora of misinformation out there on the COVID pandemic? So every pandemic has misinformation and and for those of you who are closer to my age than many of you that I see in the audience, you're closer to my age. You remember in the eighties, the misinformation about HIV about transmission about cures, about how you could get it, about how it was spread. All misinformation that also was very prevalent in sub-saharan Africa. Lots of its information about cures how it's transmitted. And I always found that the way you combat it again is making data transparent. And though I really worked hard to get that and probably many of you didn't go there. But the tracker project was super helpful, Hopkins was helpful New York Times and getting information out there. But HHS we were able to get a full profile of the country put up and change daily so that people could see not only what was happening but what we were predicting to happen. And I think if you transparent with the data to the community, the community is incredibly smart and we underestimate the community's ability to understand nuance. And I think they can, I think no matter where I work, they have and you need them as a partner. So data making data, data, understandable and available and showing your work, no guidelines should go out without the data justification. That shows why you're making that recommendation. We wrote a weekly report to every single governor with all of their data showing why we were making these recommendations. I think that is absolutely critical that the public can see your work and understand why you are saying what you're saying and not make it into a black box. Uh We have just a few minutes left so I want to turn it over to the audience. If we have any questions, there should be a microphone passed around and I see one right here. If you could please introduce yourself and, and ask your question, Dixon sister love in Atlanta and in Johannesburg. Hey there. Hi. So started sister love empowering women. Thank you. So thank you for acknowledging the need to partner with communities. Um We spend a lot of time talking about uh public, private partnerships and even in the response to a pandemic, the role of getting the information, the education, uh even dealing with some of that uh misinformation and disinformation fell to communities, especially those of us in sexual reproductive health and HIV for so long. Can you talk a little bit more about the success of the work that you've done in Africa in achieving some amazing milestones in countries that we thought had intractable diseases that are doing far better than we are here at home. And I would say larger because you built a system that engaged community partners. Can you talk a little more about? So just as you know, medicine means nothing without the client um community, I think we forget in pandemic preparedness. It says prepare, detect, we failed to detect and then it says, respond and you cannot respond without engagement in the community. And I think that's why I left the White House and was on the road for almost eight months. Community matters the most. And you can't ignore their voices. And I think there's a lot of people who ignore community voices and they are pointing and saying, if you're in a red state, you're dying from COVID because you didn't get vaccinated and you didn't get this and you didn't get that. Well, let me tell you why they died. They died because there was no health care. There, there is no health care in our rural America. None, zero, there's dollar stores. There's no health care. 15% of America has nothing. Tribal nations, the majority have nothing. And we as Americans need to recognize this, speak to it, give voice to it and help our community members be seen by our federal and local government. Thank you so much, Doctor S we're getting the signal. Although I wish I could talk to you for another hour. But thank you. And this was lovely. It was great meeting all of you. Thank you so much. Thank you.

Dr. Shereef Elnahal, Under Secretary for Health, U.S. Department of Veterans Affairs
Moderator: Maria Aspan, FORTUNE

Brainstorm Health 2023 - The VA: Modernizing Care For Those Who Served 

The VA: Modernizing Care For Those Who Served 

I hope you enjoyed and learned from your lunch round table. We're going to start our afternoon of main stage conversations with a topic that is so vitally important and maybe doesn't get talked about enough. And that is the health well being and care of Americans veterans and how that critical mission gets undertaken. Nine million veterans are registered with the Veterans Health Administration to receive care that is the largest integrated health care system in America and overseeing it is not a small task. Doctor Sharif Nahal is the undersecretary for health at the US Department of Veterans Affairs. Doctor Elna is gonna join Fortune, senior writer Maria Aspen to talk about the big issues the va is dealing with right now which include suicide prevention, toxic exposure, the modernization of electronic health records, delivery of care. Much more. Please welcome to the stage, Dr Elena Hall. Thank you so much for being here and thanks so much for having me. You were confirmed to this role in July after it had officially sat open for five years, um during which there was really nothing going on in the public health world. Um What's it been like? Filling this role taking on this massive responsibility. And how are you prioritizing? Well, I first want to thank you Maria and Fortune for having this conference and getting leaders of all stripes together to talk about the future of health care and what we can do on behalf of our patients. And I really believe that we have the best patients in the world. We have people who wore the cloth of our country who, you know, experienced injuries, exposures to toxins and a lot of problems as a result of defending our freedom. And now, uh I have the honor of uh taking on a role where we can make progress on uh many of their issues. Uh For me, it's really been focused on doing the simple but important stuff better for veterans, getting veterans sooner, appointments be more responsive to veterans when they call us. And a lot of that has to do with doing the basic things, right. So getting enough people on board, we're on a hiring spree. We've hired over 27,000 people since the beginning of this fiscal year, we're likely to break 400,000 employees, hopefully by the end of the fiscal year and all of that's important because the president, as of last August signed a groundbreaking piece of legislation called the Pact Act, which finally afforded health care coverage and the ability for us to be there for veterans who were exposed to burn pits during their service in Iraq, uh more coverage for folks deployed in the Vietnam era conflict. Um and so many other exposures, Camp Lee, we're finally able to presume that their problems are related to their service and therefore uh cover the full cost of their care uh and be there for them with their health care. So it requires staff, it requires focusing on access to care, as I mentioned and it requires implementing all other aspects of that legislation, including researching uh many more conditions that may be associated with these harmful exposures. You know, uh Veterans Affairs. Put out an announcement today. I believe that there have been 500,000 claims uh filed since the pact Act was signed in August. How practically how have you dealt with expanding benefits uh in such a short period of time? Yeah. So uh our secretary was very clear since I came on and my colleague, uh Josh Jacobs, the undersecretary for benefits was just confirmed earlier today. Uh But he's been in the role now for just about as long as I have. Um And what I can tell you is we have been planning for a surge in benefits for quite some time. The backlog and the total inventory of claims is expected to go up and already has been going up as a result. Both he and I are on a hiring spree as I mentioned, getting enough people processing these claims in place to make sure those benefits are adjudicated as fast as possible. And then on my end making sure we're building our health care capacity as much as possible so that we don't see a backlog in appointments and increasing wait times, but rather at the very least level, if not improving access, all while we bring more care and more benefits to more veterans. I want to ask another about another big project and the basic thing that is not going very well. Electronic health records. Last week, the veterans, uh veterans affairs paused um its rollout of the $16 billion oracle C contract after, after there were at least four veteran deaths linked to um problems with this project. What went wrong and what's next? Well, I think the major issue uh with the implementation of the new health record was that the end user was not necessarily prioritized in terms of their experience from the beginning. And that means the product wasn't configured to their needs. And as a result, it takes, you know, 1.5 times as long to do most things as it did in our legacy system. At the end of the day, your success or failure as a health care leader depends upon that frontline employee having an easier workflow and doing their work more efficiently and effectively and frankly being satisfied with their work all the while. And when we first ruled this out, uh in the five sites that it exists now that simply was not happening for our end users. Um So instead of plowing through the initiative for reasons other than what's most important, which is enhancing care for veterans. Uh The secretary uh and I and the leader of that program decided to do a full reset where we're going to focus all of our resources and time prioritizing the end users at the sites where the Cerner system exists and iterative, changing the configuration of that product, changing our processes, training, commensurately uh to make it better. Are you stuck with that product? That electronic health record system? Well, I think there's one reality that is just not going to change, which is that we need a new electronic health record. Uh The sustainability of our existing system, which is a homegrown system. It was in fact one of the first E HR s in the United States and in the world uh developed actually under the radar by some of our clinicians many, many years ago. And so there's a big affinity for the system because it was designed for clinicians. E hr s in the private sector are of course designed for clinical care, but they're also designed for revenue cycle and billing. We don't have to worry about that thankfully in B A. Um And so as a result, we've had this system that is tailored to clinicians needs on the front end. But the sustainability of that system is just getting harder and harder, old programming language, legacy engineers who know this system that will eventually not be here and we have to change it. And so we've already on been on a pathway with Cerner and the Cerner Millennium System. Uh We have a lot of private sector partners who use the system and it works. So I know we can get there. And again, it involves people process technology changes that have to happen over the course of at least the next year, if not longer. And what happens in the interim? Um How will you be dealing with electronic health records at all the sites that where the new system is not rolled out? We are confident that the current system can be sustained for some time uh with investments uh with, you know, the personnel that we have who are experts in it, that's not going to last forever. The effort for changing the electronic health record actually started 20 years ago. Uh with many different uh starts and stops and different ideas about how to achieve that. I think we can move to a commercial off the shelf system. But again, the way the system works right now is just not acceptable to our end users. Changing topics a little bit. I want to ask about veteran suicide, which you have called a public health scourge. What are you doing to address and prevent that? So veteran suicide is really one of the most important public health problems. We have to focus on as a country. The reality is more post 9 11 veterans have died by suicide than those who died in the conflicts to which they were deployed. And that's a really tragic fact. We have to band together as a country and solve this. And I use that sentence very deliberately because it's not just the V and that has everything to do with our approach. Of course, we have to make sure our crisis response is robust. The veterans crisis line has to respond to calls within seconds, coordinate care that needs to follow up. We're focused on that. We have excellent performance with our veterans crisis line even though we've seen increases record breaking increases in the last several months. Uh But we also have to work upstream and focus on the social determinants of health as well. And a lot of that involves fortifying the social network around veterans. So we funded uh to the tune of over $50 million community based organizations that are fortifying that social support network around veterans, making sure that uh folks have assistance from the point of transition uh in the military uh to, you know, much later in life. Um And a lot of that has to do with community veteran engagement boards, uh getting uh stakeholders to really support veterans in all aspects of their life. I'll also say that there's a lot of evidence based public health measures around what we call lethal mean safety that really matter. Introducing a gun lock and a lot of our veterans own guns can be a life saving measure. Adding seconds minutes to the period of time it takes for a veteran to activate their gun can be a moment where you can intervene. It can be a chance for that veteran to think twice about doing that. So there are many ways of doing this gun locks are one of them having, you know, two point gun locks is particularly helpful where the caregiver or a spouse of a veteran has to be present to be able to unlock the gun. And of course, there's different levels of adoption there. But lethal means safety is a huge measure that can acutely prevent suicide while we address the root causes veteran by veteran. I'm also fascinated by the Housing First program. The V has been doing because it does address homelessness as a way of treating the whole patient. I wondered if you could talk a little bit about how that works into veteran suicide and mental health. Yeah, I'm just so proud of our homelessness team. You know, veteran homelessness has been another scorch, you know, no veteran should be homeless. These are folks again who sacrificed themselves and served our country. And so just over the last several years, we've seen a substantial reduction in veteran homelessness because we now have the formula end to end on what we can do to assist folks in getting into permanent housing. So last year, we shattered our, our goal of housing, 38,000 veterans, we housed over 40,000 into permanent housing, not just transitional. And on top of that, we are using the housing first method which really focuses and prioritizes housing before all of the wraparound services because that stable social environment is so important if you have any hope of preventing recidivism and getting folks out of the difficult situation they're in. And so we have the benefit of course, of coordinating directly with housing and urban development. The hud bash vouchers specifically tailored to veterans help with rent assistance. And at the same time, we provide health care, we provide food and security work and so many other services to wrap around veterans in the system. So we have the same goal this year, 38,000 veterans, we also have a goal of making sure that 95% of veterans we do place in permanent housing do not return back to homelessness because right now, we're seeing the number of absolute homeless veterans fall every year, which is a good thing. We can't let that cycle go backward regardless of the global macroeconomic trends. I wonder if you could close by telling us a little bit about your approach to innovation, which I believe was your focus during your first stint at the va how do you bring that to solving the addressing the massive challenges that you're now overseeing? Yeah, I spent time in my first stint at the building, the Innovation Infrastructure, uh and the structure that we use to identify best practices and scale them across a system of 170 medical centers, hundreds of clinics. Um And I think that infrastructure has led to a lot of amazing developments that are directly relevant to veteran care. I really think the players focused on making the daily life of front line employees and health care systems easier will succeed in the long run. Because right now, we have just a legacy of patchwork systems that every large system has acquired over time. They don't talk to each other. They require significant manpower to make sure those interfaces are sustained and that the workflows are achievable for the front line. But we haven't yet seen innovators as nearly as much as we should look at that front line employees experience and extend outward with human centered design to figure out how they can actually be assisted with new technologies like A I Another lane where we're really focused is making sure that the really tangible emotional aspects of care that veterans enjoy can be reproduced in a virtual environment. So we have a big push on augmented reality, virtual reality. We have 60 V medical centers using these technologies to assist veterans with PTSD, reproducing, triggering mechanisms and training veterans to be able to sustain and do well with them. But also things like phantom limb pain if somebody is an amputee, they can often sense that their limb is still there. And in fact, feel pain in that limb. If you wear augmented reality goggles that reproduces a mirror image of your other leg for a lot of veterans, their pain goes away. So think about the potential of bringing in virtual group visits with other veterans across the country, peer to peer support, just working again backward from what veterans need and using the new technology, whether it's A I or X R to achieve that is really our focus. Thank you so much. I'm afraid we're out of time, but thank you so much for making the time to be here today. My pleasure.

Fortune Brainstorm Health 2023

Brainstorm Health 2023 - Global Health: The Power Of Public–Private Partnerships

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