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thank you for joining us today for a virtual first tuesday event it's our third such virtual event already but before introducing our speaker for the day i do want to say thank you to those alumni and friends who have been regular attendees over these 28 years and also welcome those joining us for the first time today i also want to acknowledge wells fargo who's been our long-standing sponsor of the first tuesday speaker series thank you here's our format for today after introducing our speaker craig samett who's the president and ceo of blue cross and blue shield of minnesota he will present for about 30 minutes and then i will ask him a few questions of my own before turning to you for your questions but first let me tell you more about craig dr samet oversees the state's first and largest health plan in its mission to promote a wider more economical and timely available of health services for the people of minnesota an internal medicine physician by training he has worked across multiple healthcare sectors his senior leadership experience includes serving as an executive vice president at anthem partner and global provider practice leader oliver wyman president and ceo of health care partners and president and ceo of dean health system inc in madison wisconsin he currently serves on a number of boards in minnesota and across the united states so for nearly 25 years craig has been a nationally recognized expert and true thought leader on healthcare delivery and policy his record of collaborating across the healthcare system to deliver high quality care at a lower cost led to him being named as one of the 50 most influential physician executives and leaders by modern health care in 2018 he holds an undergraduate degree from tufts university a medical degree from columbia university and if all that wasn't enough he also has an mba from the wharton school of business with that craig thanks for joining us and the floor is yours thank you very much dean uh good afternoon to the entire carlson school and your alumni and all the participants it's truly an honor to participate today so let's see if i can meet the first task which is to share my screen um okay so can you see the screen dean so that i know that i'm in the right place i can see it okay perfect thank you um so the first thing that i would say let me share a couple of things about me first is uh in usual ted talk fashion i'm not one to bore you with slides that have a lot of words on them so um i will keep my remarks to the 20 minutes as requested but what you will see this is essentially the only slide with words on it are just a series of images and it probably is more of a prompt for me than it is for all of you but hopefully these images can evoke some of the messages and the lessons that i've learned and some of the things that i would want to convey so let me jump right in and talk about lessons as i'm sure is the case for all of you this has been a heart-wrenching painful and unprecedented time for us um i know that there was nothing that was taught to me in any of my education uh in the leadership or ceo playbook that prepares us for a time of true crisis and frankly a time of not just one but three intertwining crises clinical and economic and social so i will be the first to say this has been very hard this has been hard for us personally this has been hard for organizations this has been hard for our community and yet the other thing that i've learned is how incredibly proud i am to be in minnesota um i have joined uh it seems like hundreds of calls uh certainly many of them zoom calls since march and every time i leave those calls i understand what is meant by a minnesota that rallies i'm proud i'm proud of the unification that i've seen the alignment from provider to provider and provider to payer and business to business from public to private and i think what also has made me proud is we've yes we've spoken up but more importantly we've stood up and we've acted often in lockstep to first address the covid crisis and now to address the social injustice of following the tragic murder of george floyd and then most certainly understanding how we address the real need and the opportunity for us to bring our community back to life economically um one more thing that i would share about me that you should know before we go forward um and i didn't learn this here i learned this before i came to minnesota is i think health care needs to be healed i am a doctor who believes that health care is broken i'm a certainly a health plan ceo that believes that health care is broken and um i've shared publicly that unfortunately i lost a parent in the midst of the covet crisis and so i am a caregiver um and in many respects a patient that believes that health care is broken um and i i don't want to dwell on that at this point except to say that kovid did not break health care and the george floyd murder did not break health care it was broken before i i have always thought that our industry was ripe for disruption um that given it was broken something would change us i've long been an advocate that that healthcare has always had the opportunity to reinvent itself from the inside out and in fact that is the very essence of our strategy of blue cross how can we instigate toward and lead toward a better healthcare system however i thought that disruption would come from amazon or walmart or google or or some other external force that if we could not change ourselves then someone would change us but i honestly didn't think that it would be a pandemic that would actually give us the opportunity to change and to really address what's been broken in our industry so let me point out some of my observations that have come from the pandemic i think that the crises have exposed our weaknesses i think the weaknesses existed before but i think we now recognize a lot of the inadequacies that our industry has had um first and foremost i'll talk about convenience how easy has it been to access health care blue cross as you know is a non-profit organization whose mission is to assure that patients everywhere in minnesota have access to high quality affordable service oriented convenient health care for everyone not just for some of minnesotans not just for many minnesotans but everyone and so when we think about our industry historically how convenient have we been we measure something called the net promoter score which i would imagine that many of you have heard of and know what that is in essence it's it's it's counting all the folks who think positively of your organization minus all of those that think negatively of your organization and i'll share with you that historically and this isn't just in minnesota but historically a net promoter scores and the reality is a net promoter score can be as high as 100 or as low as minus 100. but healthcare has been where you see it here that we hover close to zero it uh it hasn't been a leader and i think we don't recognize how distinct we are until we compare ourselves to other industries so let me put up a well-known organization that many of us know and love um costco so costco with a net promoter score of 79 really highlights the fact that our industry has historically been not very convenient and we've seen that in the midst of this crisis the second thing that i would point out here is is that health care has historically not been equitable kovid and social injustice um did not break that it was broken um and you don't need to understand the details necessarily of this graphic but only to reflect the fact that this represents uh health outcomes comparisons from market to market in region to region in the state and what is even more remarkable is while we on average um when we compare the quality of health care to other states in the nation we're we're in the top five i remember when i was in wisconsin and wisconsin was number two in the nation in quality i looked over jealously at minnesota because minnesota was number one and it was sort of between minnesota and and new hampshire um we've fallen a bit since then so we're fourth or fifth in the nation from a quality standpoint but when we look under the covers or we double click at the whether healthcare is equitable we find that we have some of the greatest disparities in the country and just imagine if we could address those inequities and those disparities what ranking we would be on average from a quality standpoint in the nation and healthcare was broken before as it relates to cost in 2019 the total cost of care in minnesota went up year over year by nine percent um and on on average that may not sound like a lot however i would point out that was triple the national average in cost inflation in 2019 so we are on an unsustainable trajectory and to further underscore the concerns about this this slide represents 20 years of price changes in the united states ending in 2018 and you can see where the costs of healthcare services fare versus the inflationary trends for just about everything else so we have been in a position where our trajectory is unsustainable um from a convenience from an equity in quality and from a cost standpoint we have work to do and then finally what i would share is the crisis has really exposed the challenges with our addiction to volume-based health care we have worked off of a chassis of fee-for-service healthcare for certainly for my entire lifetime and i think in times when it is not safe for us to use the traditional model of healthcare to use a facility model of healthcare or frankly another way that i would put it is what if our society were truly well and that we focused on prevention and people did not get sick that is obviously a challenge for the health systems that we trust and rely upon when we do get sick and so the model of volume driven health healthcare and the reality that this ad which was published by mount sinai in the new york times is the exact opposite of the world we've lived in the broken nature of our industry is is that we have wanted we profit off of sickness we haven't profited off of wellness and from my point of view that is backwards so i'm going to stop the rear view mirror criticism now because i very much see myself as a class half-full type of person and reflect on the fact that this talk is very much about silver linings um what i worry about is that um we get past the today of these crises and we go back to yesterday and we don't recognize the fact that there are things to learn about what we've been through and recognition of our challenges that we now have an opportunity to reinvent health care from the inside out and most certainly i came to minnesota because i want us to be the health best health care state in the nation in all respects quality convenience affordability and equity and we have the opportunity to lead so why this photo i'm always looking for good stories to reference regarding silver linings this is new delhi and this is new delhi today and i tried to find the same exact shot from six months ago but i couldn't but the reality is is what you see beyond new delhi uh in the background are the uh i've i'm told the correct correct pronunciation is the himalayas himalayas this is the first time in the century that people in new delhi can see the himalayas so for us what should we see now that we haven't seen before that gives us the opportunity to really move forward and advance so we're at the point where we need to make a choice um we can stay where we are we can go back to yesterday or we can go to what i would describe as the day after tomorrow so i'm dating myself by showing this slide for those who know it it's the minority report the minority report was essentially all about well if you knew what the future would hold what would you change today that would position you better for success i feel like that's where we're at in our transition now and for those who don't know it this is tom cruise he was a famous actor in his day so we have a choice and i very much in business school focused on the lessons learned from other industries and how to apply them to health care um and when we have choices i do wonder whether we should follow the lead of other industries and where they may have failed um and so this organization on your slide you may have known that in the year 2000 i believe it was this organization had the opportunity to buy another organization for 50 million dollars but the blockbuster ceo thought it was a joke and so passed on the opportunity and focused instead on business as usual in the status quo what was that organization that blockbuster had the opportunity to buy in the year 2000 netflix that is where i believe that we're at and the rest of my remarks now are very much about those silver linings and it's very much about what i would call what if statements what if the day after tomorrow was x so let me start here i'm hunkering back to my past when i was at dean health system what if all the various parts of our health system didn't work in opposition or in silos and we got outside of our lane and we truly worked in lockstep hospitals doctors health plans patients regulators legislators community agencies what if we were aligned around a common purpose what if we were incented to keep people well keep people healthy protect them prevent illness create a sustainable system and the reason i show that slide is when i was in wisconsin that was the model that we had we were an integrated delivery system we were rewarded for population health we're a population health company and the reason why this is so remarkable to me is that i was in wisconsin i was at dean in 2008 during the financial crisis and i remember that that was the last time that hospital beds were significantly empty not because of a clinical crisis but because people could not afford to pay copayments or deductibles or out-of-pocket expenses to receive health care so they stopped using health care and i remember somewhat similarly it's not nearly as bad as it is during covid now but at that time systems were really struggling but our system was not because our system was rewarded for health and wellness and was a system that really allowed us to weather the peaks and valleys of of health which naturally goes up and down over time so what if the day after tomorrow involved organizations working in partnership you may have seen that late last year kevin crosston and i announced the partnership between north memorial and blue cross blue shield of minnesota to create what we've called blaise health um and this this wasn't so foreign except for the fact it may be relatively foreign in this marketplace or it was an example of two organizations that had historically worked at counter purposes or in opposition to one another saying that we're going to come together and we're going to reinvent the future and so this wasn't about blue cross getting into the hospital business or north getting into the health plan business this was about us co-creating what we thought would be a better way for patients and a better way for our community so let me pivot here i want to be cognizant of the time what if the day after tomorrow allowed patients to get an actual taste of a care delivery model that was more convenient more contemporary more like the way frankly we access other industries i should share a story one of our medicare members from northern minnesota wrote us a letter about how increased access to telemedicine helped her family overcome the challenges of a geographically dispersed health care in 2019 she and her husband drove more than 12 000 miles 12 000 miles to and from medical appointments with some visits requiring a 400 mile round trip so with telemedicine the couple now can see specialists from all over the state right from their home their living room or their their bedroom and still have orders lab tests images administered locally just miles from their home i get asked all the time how do i feel about the future of health telehealth i've used this slide in my presentations for five years because the opportunity to for us to pivot to a more contemporary nimble uh easier perhaps sometimes more cost effective alternative is long overdue in our industry u can we imagine if we were unable to do telebanking and we were asked to just go to the teller in the bank whenever we needed to do banking what other industry that we live in doesn't rely upon technological advancements like this and i wanted to share with you the sort of the degree of magnitude that telehealth has grown just within the course of the last three months so i'll i'll start with the fact that before so in 2019 99 of all of the visits that blue cross minnesota paid for with providers were face to face uh underscoring the fact that one percent were virtual but note that now just in the last four months we have generated a million telehealth visits compared to 65 000 telehealth visits that were claimed over the course of the entire year in 2019 that is in essence a 100 fold increase now i don't know whether we're going to you know shift from 99 1 to 199 i don't necessarily believe that that's what the day after tomorrow will hold but what if the day after tomorrow looks like this what if we essentially say we shouldn't go back to the way things were telehealth isn't for everything but there are many things that we've gotten in a car um to have a service that may not need to be done face to face so maybe the future is 40 face-to-face 30 virtual and i would also point out the fact that maybe we want to see the return of a new care delivery model that is back in our homes because we are fearful there is risk there is convenience there are transportation barriers and maybe the future of health care looks a little bit more like to some degree the past of health care from a house call perspective and i'd go further to say what if the future of healthcare looked like this um what if in the home we actually could conduct telehealth visits right within our tv screen securely and safely and many services were conducted there what if i you know the irony i've also used this slide for several years now that we had home delivery of groceries and our care delivery partners would very much want to remind us what the healthy alternatives were and what if in the lower right we had alexa alternatives to serve as a triage mechanism so that if we had simple questions we didn't have to wait for a phone call for minutes or hours to get our answers and what if livio is blue cross minnesota's care delivery partner what if care became mobile so what if someone brought care to you in the home what if it was always available what if it was the whole person not just clinical but social and emotional what if it was cheaper what if it were easier to use what if we saw the return of a modern house call so i'm almost finished here what if we truly looked at healthcare through the lens of prevention we use this expression an ounce of prevention is worth a pound of cure in every other industry we put in place steps so that mail doesn't get lost there are no airline adverse events money doesn't get deposited in the wrong account we're not injured because we have airbags seat belts bike helmets life preservers smoke detectors so what if we similarly did things that caught cancer early prevented heart disease or pulmonary disease truly address the ways that mental health affects our physical health what if we were in the wellness business not in the sickness business what if there was as much health in health care as there was care and what if that also included the reality that racial inequities and social inequities and social determinants of health like food insecurity or like housing affordability what if our definition of wellness and prevention was inclusive of all the things that we could do that we know when we really address and and fix them and solve for them that we actually create a healthy environment for all minnesotans what if we pay for social care as we would pay for health care because we believe that an ounce of prevention truly is worth a pound of cure what if all of this were in the ounce and so what if the day after tomorrow the care team that we've historically thought of is complemented by another care team and i i had some fun coming up with some new specialist titles but what if we had a provincialist whose role was truly to help us stay out of trouble and to make sure that we got all of our wellness efforts completed what if there was a residentialist who was actually the one who delivered modern phone calls what if there was house calls what if there was a navigate who essentially helped us navigate a complex health system because otherwise we have to manage it ourselves either for ourselves or for our loved ones who are sick because it's fragmented what if alexa's involved what if there's a handy person to make sure that our homes are safe what if geek squad came to make sure that we had access to telehealth what if what if what if um i think we can do this we've done many things in covet time we can do this too um and i would i would argue that we have the opportunity and the obligation to see the silver linings in what we've been through and really address them and if we don't go to the day after tomorrow and we go back to yesterday i worry that we should be we should beware um i have always believed that we can reinvent health care from the inside out although there are many that would seek to reinvent health care from the outside in and all we have to do is look at the slide to recognize that these opportunities or these challenges by disruptive innovators have changed numerous other industries over the course of the mass last many years and i would predict without any doubt that if we don't change ourselves and go to a day after tomorrow that we will be forced to stay where we are or go back to yesterday and then um just one more slide and it's a story that i love to tell and uh hopefully several of you have not heard the story yet because i do give this talk about the future and often there are disbelievers about the world changing as an argument to stay where we are to go back so this is the story of the chiletecha bridge the chowtecha bridge is in honduras it was the 150th bridge built in honduras and it was the most stable and the most modern of all the bridges but in 1998 hurricane mitch blew through honduras destroying 149 of their bridges but not the cholateca bridge the cholateca bridge stands today as it was built however this bridge suffered the greatest indignity of all of the bridges which is that the river moved making the bridge obsolete so when we think that our world should stay the same we should go back to yesterday we should stay in today this is a story that change happens around us and change happens to us and we should embrace the opportunity to bring minnesota to a place of the best health care in the nation dean i believe that's all i have for you so i'm going to stop sharing well thank you craig that's send it back to you that was so inspiring i love the story of the chiloteka bridge i'm going to you know steal it from you if you don't mind of course any time steal any of the slides that's such a great such a great story but you know i think there's um there's a bunch of great questions in the q a as well and i will try and get to them too but i think you know you said that it's you know we want an actual taste of a more convenient more contemporary uh you know medicine which is more like other industries and you know clearly what you know you're so uh you know this acceleration of the use of telehealth has been you know very interesting it's been acceleration in so many industries in the use of technology and it's you know we see that in education clearly you're seeing that in healthcare you know what is the role i mean in in in this kind of a situation you know how how soon do you expect this transformation to occur is this something that is you know going to happen very quickly do you think as we you know thanks to kovitt or will we go back to the state of affairs how how is how is the ecosystem primed to absorb some of these uh innovations that uh that uh you know that that clearly will be beneficial i mean i i would say that i think some of the things will happen a whole lot quicker than others but i'm a big believer and i'm sure that many of your audiences read the tipping point and i'm a big believer that industries and our reliance on traditions can change on a dime and i think if we if we even look at sort of the use of uber as really as such a dramatic and quick evolution of the transportation business from what it was to what it is um we could very well argue especially as it pertains to telehealth that we'll see a bigger pivot that said i think that our industry has been very resistant to change we haven't been very inventive and i think both as as physicians i i wear three hats i'm a physician i'm a helpline executive and i'm a patient um and i think collectively wearing all three hats were sort of resistant to change or we believe that healthcare isn't like every other industry and that we shouldn't change and that we won't change and my point here is that we should change and i think we should change fast i um i worry that the trajectory that we're on either you know we've seen the concerns and the challenges with racial injustice and health inequities um you know the the medicare trust defund is sort of it doesn't have an indefinite amount of resources so healthcare isn't affordable under the historical model for very long so i while i recognize that we're resistant to change i would hope that we will move faster in making some of these changes i also think that we have a window of opportunity i i worry that if we even get cold feet and that we buckle when we've got this golden opportunity and we even just begin to make a move toward yesterday that we will hold ourselves up for another decade um it's very rare that major disruptive forces like we've seen create an immediate tipping point uh it's it's a it's a burning platform and i think we should take that burning platform and do something with it and do it fast you know this never waste a crisis i think that's uh very much that you're giving us uh there have been some very good questions already related to this you know change and the role of other parts of the health care system you know what's the role of pharma and med device companies and what can the you know you know what about the federal government and state governments and what's the role of government in this i mean is would you be making these changes without sort of uh uh you know the medicare interventions or you know whatever it is that the you know the you know what's the role of government and all of this i'd love to hear from you well there are two things that i would say one is i think tran i think reinvention of healthcare is a team sport i don't i don't think any individual component any stakeholder or any provider or any any entity for that matter can influence the degree of change that we need to see and i think the world that i came from highlights the fact that when you do get hospitals doctors pharma patients health plans social service agencies and we're all aligned around a common purpose in fact when we have discussions with organizations that we want to partner with we start with do we have a common purpose do we all agree that the future destination is convenient high quality affordable health care and if if that's the objective then let's change the dashboards let's change the score cards let's change the incentives and let's get everyone together and on the same page um and i i think i think that's an order so i i don't i don't think it it can be one organization that being said um i think the other thing that reinvention takes is bravery and i'm not sure i've seen a lot of bravery in health care i think even a bold leader a bold organization a bold community that says we're going to prove that reinvention is possible and we're going to do whatever it takes to be first sometimes those brave organizations can change the world and and i i remember i was also a dean when the aca passed and i got lots of questions and i'm not i'm not wading into any political territory here but i got lots of um questions about uh how the supreme court's decision about the aca would affect our organization when i was in wisconsin and my answer was frankly it really doesn't matter because if we reinvent ourselves we become a better organization we focus on the patience we come up with a far better model then there really isn't anything that would necessarily stop us from being brave and creating something new and so while on the one hand and my messages may be contradictory i recognize this as a team sport i also recognize that that someone needs to have the vision to drive change and to facilitate the others right so it's you know i think there's some um uh you have some very very interesting points especially about this whole thing being a team sport and that everybody has to play their part in both bringing you know healthcare costs down making it more convenient making it more access accessible and so on is there a role for big data and analytics especially because you know we in in our school are very interested in how analytics can change the nature of health you know how we do healthcare and maybe make it more uh effective efficient convenient all of that so i was just wondering but are you folks investing in analytics and big data what do you see as both the promise and any uh anything we could watch out for uh we can't get there fast enough uh this is you know if not the number one thing on the list of contemporary industries it's certainly within the top five and i um i was on a medical alley call earlier today and i shared the fact that you know when i went to business school i sat there for two years listening to case studies about the best companies in the world and not once did i hear a case study about a healthcare company but you hear a lot of stories about other industries that very much focused on consumer centricity and data analytics and process re-engineering um and you know incentives and a lot of the things that you know that have made many renowned companies what they are today data is very much on the list what other industry would say we're not going to unify data we're going to hoard data we're not going to create the vehicles to look at a whole person how do we transform from sick care to whole person health without having all of the data elements to understand in a protected and safe way with that data because we want to keep it secure but how better we we need all that information to make good decisions about wellness and prevention and i would point to the fact that why is it that the banking industry could somehow find a way to keep information safe uh and to connect every atm in the country and to get us our information wherever we are whether it's at an atm or whether it's online why is it that that industry can do that and healthcare cannot so i i think that big data is essential it's foundational and we've even seen it in the midst of the covet crisis if we had perfect information that again was protected and safe we probably would be a whole lot more effective at contact tracing and a true preventive strategy to resolve the crisis more quickly great points uh craig i think i just i will just ask you one last question which is strategically if you wanted to do you know we you mentioned that minnesota was one of the worst in terms of racial disparities in healthcare and if there was say one or two things that you would hope to see implemented quickly is there a is there something that bc a blue cross blue shield is thinking of doing to facilitate this process is other suggestions that we could uh take from you on this you know i i think as we always have we have an opportunity to rally i would hope that everyone in the state wants us to be the number one health care state who would not want that and my question and my challenge and my charge to everyone is let's rally together not to only address challenges when we become sick but let's rally together to truly keep our community well so i would argue that we need we need an effort to look at uh wellness strategies well-being strategies mental health prevention racial injustice social determinants of health a ain if we use the the moniker an ounce of prevention is worth a pound of cure i had too much time on my hands and i did the math 16 ounces in a pound for every 10 million dollars that we work together to rally to focus on wellness and prevention we would save 160 million dollars in sickness or death or expense or low value care that would no longer be needed and necessary because our community was truly healthy so that would be my hope and my ask of the community and that we should sort of set our differences down and recognize that there is a unified approach to transform health care in the state great craig i know there are tons of questions on in the quick q a and chat groups and i've tried to sort of uh pull some of those into the questions that i've asked but if there are things that you're you know please do raise your hand and we will try and see if we can uh get you to actually uh you know you'll be unmuted and we can try and see if you can actually get to ask the question if not i will continue to you know to uh try and summarize from what we see sheree we do have one question and we have a couple questions coming in on our raise the hand so marcy lundqvist i'm gonna unmute you and if you'd like to ask your question marcy go ahead and marcy you need to unmute yourself on your end as well thank you if you were able to have the opportunity to make any particular innovation either in helping people with nutrition or lifestyle situations what do you feel would be the most important thing to help people stay healthy uh what an awesome question um i should share a quick story before i'm on the habitat for humanity board here but i was on the united way of dane county board in madison when i was there and i sort of asked a similar question because we were focused on so many great community causes and i'm a very linear thinker and i would say well which one should we start with so if we could pick the one um that would influence all else what would it be um and i i think that i would have to pick economic security i mean because i i very much believe that you know on average we're an excellent healthcare state so some of our greatest healthcare quality state so some of our greatest opportunities are to improve the average quality and the health of the state is to address health disparities and racial injustice and so and i if i were to think linearly i would say that economic disparities lead to housing insecurities lead to food insecurities so i think that's the one that i would likely focus on first but it's really hard because they're all interrelated and one could equally argue that um housing and security if we solve for that we would address income disparities and then we could address food disparities so a really difficult question um i think the more important thing is that we have the opportunity to test that now and a charge that i would again make is you know let's unify and begin to solve true problems in the industry i'll give you an example um every health care system and health plan in this state touches every minnesotan what if we were to say we're no longer going to create any environment where any patient needs to go to an emergency room because they're hungry that we would address childhood and adult food insecurities to avoid unnecessary healthcare utilization because people don't have access to food could we solve that problem together could a bunch of different organizations look even at a singular community and say if we rally together to address all the social determinants and wellness and prevention can we demonstrate that an ounce of prevention is really worth a pound of cure so i i don't know if it matters where we start but what i would say is we have to start and we have to pick up these problems and do something with them this time thanks for your question marcy um craig we have a question from carrie sheer carrie i'm gonna unmute you or you wanna unmute yourself mute okay did that work yeah good okay well thank you so much for taking my question i really appreciate it i'm uh i'm an alum i'll date myself 1983 and u of m and that's from the business school and two more degrees uh nasa i will take a moment to say when i told my aunt oh my god i'm going to be 40 years old when i finish my phd and she said guess what you're going to be 40 anyway why don't you just be 40 with a phd so here i am um my i am a psychologist and work with both organizations and individuals i have tried valiantly for many many years to become one of your networked providers and to say this is a challenging process is quite an understatement you blue cross are not alone because all virtually of the other large health networks in the state seem to follow the same practice of responding to virtually all and i'm talking about thousands of therapists who i have collectively discussed this and the leadership of all of the major mental health organizations that's minnesota psychological association association of marriage and family therapists and the social workers group have found the same phenomenon that our res our our applications are met with the response of quote we have too many providers in your zip code and i do live in minneapolis and i thought well what if i had a home office i my office currently is in minnetonka although at the moment it's in my living room sadly but um it you know in minnetonka's land of therapists uh then i thought well guess what you live in the city abbott northwestern forget it you know so i decided to open an out state office where a good friend of mine lives in laverne minnesota and i actually just looked it up the 2010 census said that the population is 4745 and i was told there are too many therapists there my friend is a nurse and has lived there for [Music] almost 30 years and she said you can't find a therapist here not to mention who wants to see a therapist who lives in in la verne and who you're going to bump into down the street people would adore seeing you if you came here once a week once every even once a month they would love it and i got the same response and i have applied numerous times i'm just wondering if you can address that phenomenon and and you know if you can suggest anything and and because i hear horror stories about people in the cities who call place after that and they can't get in and especially now so long question sorry but thank you no i appreciate you calling in i i think the best way for me to very much answer the question which i very i'd like to is for you to send me an email and this is for all of you so feel free to send me an email if i can't get to your questions uh it's craig dot sammit s-a-m-i-t-t at bluecrossmn.com and send me an email and i'll look into it yet today as i mentioned our mission is to assure high-quality accessible affordable health care for all minnesotans so some of your story doesn't make sense to me so please send me the details and i'll look into it right away and i would encourage any of the other others of you who have an individual circumstance please feel free to reach out hey me are there any uh urgent questions i had lots of questions on the book in and craig is very kindly offered to sort of respond to all of you so we will make sure that any questions that remain unanswered do get picked up and sent to craig and we will make sure that and so that so if your question is hasn't been answered already so please um you know rest assured that we will try and get them answered for you so i just want to say that and maybe at this point i you know is is there any uh any other others who uh have their hands up is that maybe you can take one more question yes i think we can do one more we're getting asked also in the chat um if we can send your email so yes we will send craig's email in our chat there will be a follow-up email with our survey so please fill that out but we can also include that information as well so laurie larson lori are you still there i think did i unmute yes yes you did okay my only question is on the ability to redesign from the inside out what do you think the greatest barriers are that are interfering with the health care system being able to do that i think it's us um i think it's i think we're our own worst enemy i um we use the expression sorry for all my expressions where there's a will there's a way i think there's a way and i think that frankly if you look around the country there are many organizations that have innovative health care and for some reason those innovations don't spread so we haven't been inventive we haven't been brave we haven't been risk takers we haven't been bold we haven't been as customer or patient-centric as we should be and i i think that we've been our own worst enemy that way and and frankly it's um it's one of the things that i'm most proud of of being at blue cross because one of the real challenges with any health care organization is to convince it to go in a different direction is especially uh one that requires reinvention um it it requires a lot of of of bravery and inspiration and enlightenment and one of the things i'm proud of is i i think that you will find several hundred or several thousand people in our organization that are believers that we can do this and that we can change health care and i think that's historically been the greatest barrier we we need to be willing to pursue a better future well my question relates to the incentive is to not change financially so i don't see how what a few people can do when the incentives are so um reverse of what it needs to be and therefore there's no economic incentive to make a change well and and it goes back to my comment about can we unify around a common purpose and unifying around a common person purpose also means unifying around common incentives what if we were all rewarded if people are well and safe and healthy and that's where the reward came for hospitals and doctors and health plans and pharma companies so i agree that incentives have to change i've long been a believer in population health payments um that folks are rewarded when outcomes are better service is better access is better and health care is safer and more affordable and so i do think that we have to change incentives and yes some of that change can come from the federal government some can come from the state but some can come from organizations like ours that reach out to systems and say would you be amenable to a win-win relationship that is most importantly a win for the patient and the partnership that we forged with north and that we have with minnesota oncology and in part with mayo and others coming are very much aligned around an alignment of incentives and so i think you're absolutely right um but before you can get to aligned incentives people need to be willing unless they're forced and that's why i picked um will as the first thing that i would pick i think i would put and pick incentives as my second thanks craig that's uh you know thank you for a very inspiring talk i think it just reminds us of the need for collaborative efforts for the need for to focus on the ultimately who is it that we're trying to help and you know your focus on the patient i think is extremely important this is we in higher education we try and you know as long as you focus on the student you come to the right answers and i hope that the same thing happens with the healthcare system as well of course we've had some questions about how does the amazon and google efforts you know will there be some kind of competitive disruption in this industry and that can be an incentive as well as we go forward but i'd look forward to continuing this conversation and hopefully we'll get you back when you know when when the day after tomorrow happens to tell us if it's indeed happening the way we kind of hope it will happen so thank you so much correct this has been an extremely interesting discussion