Jamie Plusser: Welcome back
to Inside the Board Room,

a podcast from the Carlson
School of Management

at the University of Minnesota.

I'm Jamie Plusser,
the Assistant Dean

for Marketing and
Communications.

In this series, our
goal is to bring you

thoughts, ideas, inspiration,

and points of view from
business leaders and

academic leaders from
Minnesota and beyond.

This episode features a
conversation between SrizaHe,

Dean of the Carlson School,

l and Craig Samet,

President and CEO of

Blue Cross and Blue
Shield of Minnesota.

In their discussion, Sat
talks about the future of

the healthcare industry
and how those changes

could impact consumers.
Let's listen in.

Sri Zaheer: 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
longstanding sponsor

of the First Tuesday
Speaker series. Thank you.

Here's our format for today.

After introducing our
speaker, Craig Samet,

who is 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.

Doctor 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 of Oliver Wyman,

President and CEO of
healthcare 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
healthcare in 2018.

He holds an undergraduate
degree from Tufts University,

a medical degree from
Columbia University.

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.

Craig Samitt: Thank
you very much, Dean.

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.

Okay. So can you see the screen,

Dean, so that I know that
I'm in the right place?

Sri Zaheer: I can see it.

Craig Samitt: Okay,
perfect. Thank you.

So the first thing
that I would say,

let me share a couple
of things about me.

First is, in usual
TedTalk fashion,

I'm not one to bore you

with slides that have a
lot of words on them.

So 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 or 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.

I know that there was nothing

that was taught to me in
any of my education in

the leadership or CEO playbook

that prepares us for a
time of true crisis.

Frankly, a time 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
our organizations.

This has been hard
for our community.

Yet, the other thing
that I've learned is how

incredibly proud I am
to be in Minnesota.

I have joined, it seems
like hundreds of calls,

certainly many of them
Zoom calls since March.

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.

I think what also
has made me proud

is 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.

Then most certainly
understanding

how we address the real need

and the opportunity for us

to bring our community
back to life economically.

One more thing
that I would share

about me that you
should know before

we go forward. I didn't
learn this here.

I learned this before I came to

Minnesota is I think
healthcare needs to be healed.

I am a doctor who believes
that healthcare is broken.

I'm certainly a health plan

CEO that believes that
healthcare is broken.

I've shared publicly
that unfortunately,

I lost a parent in the
midst of the COVID crisis,

and so I am a caregiver
and in many respects,

a patient that believes
that healthcare is broken.

I don't want to dwell
on that at this point,

except to say that COVID
did not break healthcare,

and the George Floyd Murder
did not break healthcare.

It was broken before.

I have always thought

that our industry was
ripe for disruption,

that given it was broken,

something would change us.

I've long been an advocate
that healthcare has

always had the opportunity to

reinvent itself from
the inside out.

In fact, that is

the very essence of our
strategy at 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 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.

First and foremost, I'll
talk about convenience.

How easy has it been
to access healthcare?

Blue Cross, as you know, is

a non-profit organization
whose mission is to ensure

that patients everywhere in

Minnesota have access to
high quality, affordable,

service-oriented, convenient
healthcare for everyone,

not just for some
of Minnesotans,

not just for many
Minnesotans, but everyone.

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 counting

all the folks who
think positively

of your organization minus all

of those that think negatively
of your organization.

I'll share with you
that historically,

and this isn't just in
Minnesota, but historically,

a net promoter score 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 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.

So Costco with an e
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 that

healthcare has historically
not been equitable.

COVID and social injustice

did not break that.
It was broken.

You don't need to
understand the details

necessarily of this graphic,

but only to reflect the
fact that this represents

health outcomes comparisons from

market to market and region
to region in the state.

What is even more
remarkable is while we,

on average, when we

compare the quality of

healthcare to other
states in the nation,

we're in the top 5.

I remember when I
was in Wisconsin and

Wisconsin was number 2 in
the nation in quality.

I looked over jealously at

Minnesota because
Minnesota was number 1,

and it was sort of between
Minnesota and New Hampshire.

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 whether
healthcare is equitable,

we find that we have some of

the greatest disparities
in the country.

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?

Healthcare was broken before
as it relates to cost.

In 2019, the total cost of care

in Minnesota went up
year over year by 9%.

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.

We are on an
unsustainable trajectory.

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,

from a convenience, from
an equity in quality,

and from a cost standpoint,
we have work to do.

Then finally, what I would share

is the crisis has really

exposed the challenges with

our addiction to
volume-based healthcare.

We have worked off of a
chassis of fee-for-service

healthcare certainly
for my entire lifetime.

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.

The model of volume
driven 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

that we have wanted we
profit off of sickness.

We haven't profited
off of wellness.

From my point of view,
that is backwards.

>> I'm going to stop

the rear view mirror
criticism now because I very

much see myself as a glass
half full type of person,

and reflect on the
fact that this talk is

very much about silver linings.

What I worry about is

that we get past

today of these crises and
we go back to yesterday.

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 healthcare
from the inside out.

Most certainly,

I came to Minnesota
because I want us to be

the best healthcare state in
the nation in all respects,

quality, convenience,
affordability, and equity.

We have the opportunity to lead.

Why this photo?

I'm always looking
for good stories to

reference regarding
silver linings.

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
what you see beyond

New Delhi in the background,

I'm told the correct
pronunciation is the Himalayas.

This is the first
time in a century

that people in New Delhi
can see the Himalayas.

For us, what should we see
now that we haven't seen

before that gives us

the opportunity to really
move forward and advance?

We're at the point where we
need to make the choice.

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.

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.

For those who don't know
it, this is Tom Cruz.

He was a famous
actor in his day.

We have a choice.

I very much in business
school focused on

the lessons learned
from other industries

and how to apply
them to healthcare.

When we have choices,

I do wonder whether we
should follow the lead

of other industries and
where they may have failed.

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.

But the Blockbuster
CEO thought it was

a joke and so passed on

the opportunity and focused

instead on business as
usual on 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? 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.

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 were a population
health company.

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.

I remember that that was

the last time the hospital
beds were significantly empty,

not because of a
clinical crisis,

but because people could not
afford to pay co-payments

or deductibles or out

of pocket expenses to
receive health care,

so they stopped
using healthcare.

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 health,

which naturally goes
up and down over time.

What if the day after tomorrow

involved organizations
working in partnership?

You may have seen
that late last year,

Kevin Croston and I announced
the partnership between

North Memorial and
Blue Cross Blue Shield

of Minnesota to create what
we've called Blaze Health.

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.

This wasn't about Blue
Cross getting into

the hospital business or

North getting into the
help 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.

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 healthcare.

In 2019, she and her husband

drove more than 12,000 miles,

to and from medical
appointments.

With some visits requiring
a 400 mile round trip.

With telemedicine, a couple
now can see specialists from

all over the state
right from their home,

their living room or their
bedroom and still have orders,

lab tests, images administered

locally just miles
from their home.

I get asked all the
time, how do we feel

about the future of Telehealth?

I've used this slide
in my presentations

for five years because

the opportunity for
us to pivot to a

more contemporary nimble easier,

perhaps sometimes more
cost effective alternative

is long overdue in our industry.

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?

I wanted to share
with you the degree

of magnitude that Telehealth

has grown just within

the course of the
last three months.

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,

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 shift 991-199.

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

to have a service that

may not need to be
done face to face.

Maybe the future is 40%
face to face, 30% virtual.

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

healthcare looks a little bit
more like to some degree,

the past of healthcare from
a house call perspective.

I'd go further to say,

what if the future of
healthcare looked like this?

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?

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.

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.

What if Livio is

Blue Cross Minnesota's
care delivery partner?

What if Care became mobile?

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?

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.

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?

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 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?

What if the day after tomorrow,

the care team that
we've historically

thought of is complemented
by another care team?

I had some fun coming up with
some new specialist titles.

But what if we had
a preventionalist

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 home calls?

What if there was house calls?

What if there was a
navigast 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 is 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?

>> I think we can do this.

We've done many
things in COVID-19.

We can do this too.

I would argue that we
have the opportunity and

the obligation to see

the silver linings
and what we've been

through and really address them.

If we don't go to

the day after tomorrow and
we go back to yesterday,

I worry that we should we should

beware I have always

believed that we can

reinvent healthcare
from the inside out,

although there are many
that would seek to

reinvent healthcare
from the outside in,

and all we have to do is
look at this slide to

recognize that these
opportunities or

these challenges by
disruptive innovators

have changed numerous other
industries over the course of

the last many years and
I would predict without

any doubt that if
we don't change

ourselves and go to a
day after tomorrow,

we will be forced to stay

where we are or go
back to yesterday.

Then just one more slide,

and it's a story that I
love to tell and hopefully,

several of you have not
heard this 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.

This is the story of
the Choluteca Bridge.

The Choluteca Bridge
is in Honduras.

It was the hundred and 50th
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 Choluteca Bridge.

The Choluteca 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 healthcare
in the nation.

Dean, I believe that's
all I have for you,

so I'm going to stop sharing.

Sri Zaheer: >> Well,
thank you, Craig.

Craig Samitt: >>
Hand it back to you.

Sri Zaheer: >> That
was so inspiring.

I love the story of
the Choluteca Bridge.

I'm going to steal it

from you if you don't
mind. [LAUGHTER]

Craig Samitt: >> Of course.
Anytime, steal any of those slides.

Sri Zaheer: >> That's
such a great story.

But I think 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 said that it's

we want an actual taste
of a more convenient,

more contemporary medicine,

which is more like
other industries.

Clearly, you're so

this acceleration of the use of

telehealth has been
very interesting.

It's been acceleration in

so many industries in
the use of technology.

We see that in education.

Clearly, you're seeing
that in healthcare.

What is the role?

In this kind of a situation

how soon do you expect this
transformation to occur?

Is this something that is

going to happen very
quickly, do you think,

as thanks to COVID,

or will we go back to
the state of affairs?

How is the ecosystem
primed to absorb some of

these innovations that
clearly will be beneficial?

Craig Samitt: >> 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.

I think if we even look
at the use of Uber as

really such a dramatic
and quick evolution

of the transportation business

from what it was to what it is,

we could very well argue,

especially as it
pertains to telehealth,

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.

I think both as physicians,

I wear three hats.

I'm a physician. I'm a
health line executive,

and I'm a patient.

I think collectively
wearing all three hats,

we're 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.

My point here is that
we should change,

and I think we
should change fast.

I worry that the trajectory
that we're on either

we've seen the concerns
and the challenges

with racial injustice
and health and equities.

The Medicare Trustee fund

doesn't have an indefinite
amount of resources.

Healthcare isn't
affordable under

the historical model
for very long.

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 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.

It's very rare that

major disruptive forces
like we've seen,

create an immediate
tipping point.

It's a burning platform,

and I think we should take

that burning platform and do

something with it
and do it fast.

Sri Zaheer: >> This
never waste a crisis.

I think that's very

much the message that
you're giving us.

There have been some
very good questions

already related to

this change and the role

of other parts of the
healthcare system.

What's the role of Pharma
and med device companies?

What about the federal government
and state governments?

What's the role of
government in this?

Would you be making
these changes

without the Medicare
interventions

or whatever it is that,

what's the role of
government in all of this?

Love to hear from you.

Craig Samitt: >> Well, there are
two things that I would say.

One is, I think I

think reinvention of
healthcare is a team sport.

I don't think any
individual component,

any stakeholder or any provider

or any entity for that matter,

can influence the degree of
change that we need to see.

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?

If that's the objective,

then let's change
the dashboards.

Let's change the scorecards.

Let's change the
incentive and let's

get everyone together
and on the same page.

I think that's an order.

I don't think it can
be one organization.

That being said,

I think the other
thing that reinvention

takes is bravery.

I'm not sure I've seen a lot
of bravery in healthcare.

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.

I remember I was also a
dean when the ACA passed,

and I got lots of questions,

and I'm not wading into any
political territory here,

but I got lots of
questions about

how the Supreme
Court's decision about

the ACA would affect

our organization when
I was in Wisconsin.

My answer was, frankly,

it really doesn't matter

because if we
reinvent ourselves,

we become a better organization.

We focus on the patients.

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.

While on the one hand,

and my messages may
be contradictory,

I recognize this
is a team sport.

I also recognize that
someone needs to have

the vision to drive change
and to facilitate the others.

Sri Zaheer: >> I
think there's you

have some very
interesting points,

especially about this
whole thing being

a theme sport and that
everybody has to play

their part in both bringing
healthcare costs down,

making it more convenient,

making it more
accessible, and so on.

Is there a role for big
data and analytics,

especially because we in

our school are very interested
in how analytics can

change the nature of how we

do healthcare and maybe
make it more effective,

efficient, convenient,
all of that.

I was just wondering are you

folks investing in
analytics and big data?

What do you see as
both the promise

and anything we watch out for?

Craig Samitt: >> We can't
get there fast enough.

This is if not,

the number one thing on

the list of contemporary
industries.

It's certainly
within the top five.

I was on a medical alley
call earlier today,

and I shared the fact that

when I went to business school,

I sat there for two
years listening to case

studies about the best
companies in the world.

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 and

incentives and a
lot of the things

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 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.

To connect every
ATM in the country

and to get our information
wherever we are,

whether it's an ATM or
whether it's online.

Why is it that that industry can

do that, and healthcare cannot?

I think that big
data is essential,

it's foundational,
and we've even

seen it in the midst
of the COVID 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.

Sri Zaheer: >> Great
points, Craig.

I think I will just ask
you one last question,

which is [NOISE] strategically,

if you wanted to you
mentioned that Minnesota

was one of the worst in terms of

racial disparities
in health care.

If there was, say,

one or two things that you

would hope to see
implemented quickly,

is there something that

Blue Closs Blue Shield
is thinking of doing

to facilitate this process?

Are there suggestions that we

could take from you on this?

Craig Samitt: >> 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 healthcare state.

Who would not want
that? 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.

I would argue that we need

an effort to look at
wellness strategies,

well-being strategies,
mental health,

prevention, racial injustice,

social determinants of health.

Again, if we use the moniker,

an ounce of prevention is
worth a pound of cure.

I had too much time on my
hands when I did the math,

16 ounces in a pound.

For every $10 million that

we work together to rally

to focus on wellness
and prevention,

we would save $160 million in

sickness or death or expense or

low-value care that would no

longer be needed and necessary

because our community
was truly healthy.

That would be my hope and
my ask of the community,

and that we should set
our differences down and

recognize that there is

a unified approach to transform
healthcare in this state.

Sri Zaheer: Great, Craig.
I know there are tons of

questions in the Q&A
and chat groups,

and I've tried to pull

some of those into the
questions that I've asked.

But if there are
things that you've,

please do raise your
hand and we will try

and you'll be unmuted,

and we can try and see if we

can actually get to
ask the question.

If not, I will continue

to try and summarize
from what we see.

Amy: Cherie.

Sri Zaheer: Yeah.

Amy: We do have one question,

and we have a couple
of questions coming

in on our Raise the Hand.

Marci Lindquist, I'm going
to unmute you and if you'd

like to ask your question.
Marci, go ahead.

Craig Samitt: Marci,
you need to unmu

yourself on your end, as well.

Marci Lindquist: 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?

Craig Samitt: What
an awesome question.

I should share a quick story.

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.

I asked a similar question
because we were focused on

so many great community causes.

I'm a very linear thinker,

and I would say, well, which
one should we start with?

If we could pick the one

that would influence all
else, what would it be?

I think that I would have
to pick economic security.

Because I very
much believe that,

you know, on average,

we're an excellent
healthcare state.

Some of our greatest
healthcare quality state.

Some of our greatest
opportunities to improve

the average quality and
the health of the state is

to address health disparities
and racial injustice.

If I were to think linearly,

I would say that

economic disparities lead
to housing insecurities,

lead to food insecurities.

I think that's the one that I

would likely focused on first,

but it's really hard

because they're all
interrelated and one could

equally argue that
housing and security,

if we solve for that,

we would address
income disparities,

and then we could address
food disparities.

A really difficult question.

I think the more
important thing is that

we have the opportunity
to test that now.

A charge that I would
again make is let's

unify and begin to solve true
problems in the industry.

I'll give you an example.

Every healthcare
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?

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, Marci.

Amy: Craig, we have a
question from Carrie Shear.

Carrie, I'm going to unmute you.

Or you want to unmute yourself?

Carrie Shear: I'll
unmute. Did that work?

Amy: Yeah.

Carrie Shear: Good.
Well, thank you so much

for taking my question.

I really appreciate
it. I'm an alum.

I'll date myself, 1983,

and UOM that's from

the business school
and two more degrees.

Nessa, I will take a moment
to say when I told my aunt,

my God, I'm going to be

40-years-old when
I finish my PhD.

She said, guess what?

You're going to be 40 anyway.

Why don't you just be 40
with a PhD? Here I am.

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.

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
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 applications are
met with the response

of "we have too many
providers in your zip code".

I do live in Minneapolis
and I thought,

well, what if I
had a home office?

My office currently
is in Minnetonka,

although at the moment, it's
in my living room, sadly,

but in Minnetonka is
land of therapist,

then I thought,
well, guess what?

You live in the city, Abbott,
Northwestern forget it.

I decided to open

an outste office where

a good friend of mine
lives in Luverne,

Minnesota, and I actually
just looked it up.

The 2010 census said that
the population is 4,745.

I was told there are too
many therapists there.

My friend is a nurse
and has lived there

for 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 Luverne and who
you're going to

bump into down the street.

People would adore seeing you.

If you came here once a week,

even once a month,
they would love it.

I got the same response,

and I have applied
numerous times.

I'm just wondering if you
can address that phenomenon,

and if you can suggest

anything because I
hear horror stories

about people in the cities
who call place after place,

and they can't get in
and especially now.

Long question, sorry,
but thank you.

Craig Samitt: No, I
appreciate you calling in.

I think the best way for

me to very much
answer the question,

which I'd like to is for

you to send me an email,
and this is for all of you.

Feel free to send me an email if

I can't get to your questions.

It's craig.samitt, S-A-M-I-T-T,

@bluecrossamen.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.

Some of your story
doesn't make sense to me.

Please send me the details,

and I'll look into
it right away.

I would encourage any others

of you who have an
individual circumstance,

please feel free to reach out.

Sri Zaheer: Amy, are there
any urgent questions.

There are lots of questions
on the book in the chat.

Craig has very kindly offered
to respond to all of you.

We will make sure that
any questions that remain

unanswered do get picked
up and sent to Craig.

If your question hasn't
been answered already,

so please, rest assured

that we will try and get
them answered for you.

I just want to say that
and maybe at this point,

is there any, Amy,

others who have their hands up?

Maybe you can take
one more question?

Amy: Yes, I think
we can do one more.

We're getting asked also in

the chat if we can
send your email.

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.

Lori Larson.

Lori, are you still there?

Lori Larson: Did I unmute?

Craig Samitt: Yes, you did.

Lori Larson: 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
healthcare system

being able to do that?

Craig Samitt: I think
it's us. I think we're

our own worst enemy.

We use the expression, sorry
for all my expressions.

Where there's a
will, there's a way.

I think there's a way.

I think that frankly,

if you look around the country,

there are many organizations

that have innovated healthcare,

and for some reason, those
innovations don't spread.

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.

I think that we've been our
own worst enemy that way.

Frankly, 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 healthcare
organization is to

convince it to go in a
different direction,

especially one that
requires reinvention.

It requires a lot of bravery

and inspiration
and enlightenment.

One of the things I'm proud
of is 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 healthcare.

I think that's historically
been the greatest barrier.

We need to be willing to
pursue a better future.

Lori Larson: Well,
my question relates

to the incentive is

to not change financially.

I don't see what a few
people can do when

the incentives are so reverse
of what it needs to be.

Therefore, there's no
economic incentive

to make a change.

Craig Samitt: Well, it goes
back to my comment about,

can we unify around
a common purpose,

and unifying around
a common purpose

also means unifying
around common incentives.

What if we were all rewarded

if people are well
and safe and healthy?

That's where the reward
came for hospitals and

doctors and health plans
and pharma companies.

I agree that incentives
have to change.

I've long been a believer in
population health payments.

That folks are rewarded when

outcomes are better,
service is better,

access is better,

and healthcare is safer
and more affordable.

I do think that we have
to change incentives.

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?

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
alignment of incentives.

I think you're absolutely right.

But before you can get
to aligned incentives,

people need to be willing
unless they're forced.

That's why I picked

will as the first thing
that I would pick.

I think I would pick
incentives as my second.

Sri Zaheer: Thanks,
Craig. Thank you

for a very inspiring talk.

I think it just reminds us of

the need for
collaborative efforts,

for the need to focus
on the ultimately,

who is it that we're
trying to help?

Your focus on the patient,

I think, is extremely important.

Just as we in higher education,

we try, as long as you
focus on the student,

you come to the right answers.

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,

will there be some competitive

disruption in this industry?

That can be an incentive,

as well as we go forward.

But I look forward to
continuing this conversation,

and hopefully we'll
get you back when

the day after tomorrow
happens to tell us if

it's indeed happening the
way we hope it will happen.

Thank you so much, Craig.

This has been an extremely
interesting discussion.

Jamie Plusser: Well, that's
it for this episode.

Thanks to Dean Zahir and

Craig Samet for the
thoughtful conversation.

You can find more information
about this podcast,

including previous
episodes on our website,

z.umn.edu/boarder.

I am Jamie Plusser from the
Carlson School of Management.

Thanks for listening. [MUSIC]