Dr. Patrick Soon-Shiong, Co-Chair of the Bipartisan Policy Center’s CEO Council

(Music)

Mark Masse ll i: This is Conversations o n Health Care . I am Mark Masselli.

Margaret Flinter: And I am Marg a ret Flin ter .

Mark Masselli: Well Marg a r et , Christmas time is here , a time for family and
coming together and sharing of good tidings and looking back on y ea r well - spent.
Perhaps the biggest change in terms of health care is the roll - out of the new
online insurance marketplaces . For the first time , American s seeking coverage
are able to shop for plans online through online insurance marke tplaces.

Margaret Flinter: And for the first time , Mark , those folks who a re seeking that
coverage cannot be turned away due to pre - existing conditions and they can’t
find their coverage ended because they got sick. This is so huge for the country ,
and as we know , change of this magnitude doesn’t come easily and there’s
certainly been a lot of complexity connected to the rol l - out of the online
marketplaces and Obamacare in general , so no shor tag e of challenges.

Mark Masselli: But t here will be continue d corrections moving forward.

th
Margaret Flinter: Open enrollment does continue through April 25 if you are
going to be able to get coverage in 2014 . So those a re really important dates for
people , and I think a s the message becomes more clear , we will see more and
more interest in getting that coverage in place.

Mark Masselli: But Margaret , a recent AP poll shows that three in four
Americans are blaming the Health Care Law for higher premiums . I think that’s
probably opinion now , not necessarily judg ment . We have seen it go up and
down over a long period of time.

Margaret Flinter: Well Mark , even if you look back just on 2013, I have to keep
coming back to the same conclusion , we have come a long, long ways towards a
true shift in health care in Am erica and making health care a right for people ,
been bumpy but the ti d e is turning and that hope of triple aim , better care, better
quality, containing c ost I think is going to come t o fruition.

Mark Masselli: There is a sea change in technology side in health care , also
slow in coming but coming nevertheless.

Margaret Flinter: Well innovation is something our guest today knows quite a bit
about . We are revisiting our conversation with a remarkable innovator in the
health care arena. Dr. Patrick Soon - Sh iong is a physician inventor , 50 patents to
his name, mostly in the pharmaceutical and biotech space , but also the Head of
the Bipartisan Policy Center’s CEO Council on Health and Innovation.

Mark Masselli: He is leading a team of some of the nation’s most successful
CEOs to build an information superhighway for health care that will take into
account a patient’s genomics and proteomics to accelerate the p a ce of health
information exchanges . He is doing some really exciting work.

Margaret Flinter: A nd the Managing Editor of Fact C heck.org pays us a visit . L o r i
Robertson checks into claims that are being made th at some insurance
premiums will double.

Mark Masselli: But no matter what the topic , you can hear all of our shows by
Googling CHC Radio , an d as always , if you have comments , email us a t
www.chcradio.com or find us on Facebook or Twitter because we love to hear
from you .
Margaret Flinter: We will get to our interview with Dr. Patrick Soon - Shiong after
Headline News with Maria n n e O’ Hare but first , let us all hear a t Conversations on
Health Care wish you a very happy holiday.
Mark Masselli: Happy holidays and peace and health in the New Year.
(Music) Maria n n e O’ Hare : I am Maria n n e O’ Hare with the se Health Care Headlines. It’s
the end of the year and all is clear . The spotty roll - out of the health insurance
exchanges continues to dominate the message of the Affordable Care Act . The
Obama Administration has been aiming for 7 million Americans who ha ve signed up on those health insurance exchanges during open enrollment, and while the
pace is picking up and in some cases dramatically , the numbers are falling short .
While some 2.3 million Americans have opened accounts on
www.healthcare.gov

or some of the state sites, 1.9 million ha d yet to sign up for
th
plans by mid December . Open enrol l ment continues through April 15 but folks
st
seeking coverage by January 1 need to have signed up by now. Some states
are d oing very well by most accounts , those states who have setup their own
exchanges . But other states have been plagued by issues since the start , with
Oregon being the most problematic.
Meanwhile, o ne of the goals of the Health Care Law is to pull back the lid on
price secrecy in health care and that is something that is coming to fruition in fits
and starts. A recent survey of New York area hospital showed a dramatic price swing from hospital to hospital for similar procedures . The organization catalyst
for payment reform points to New Hampshire as a model . Its state website
allows consumers to plug in their insurance plan , hospital and procedure and get
a n accurate projection of real out - of - pocket cost. I am Marianne O’Hare with
these Health Care Headl ines.
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Mark Masselli: We are speaking today with Dr. Patrick Soon - Shiong, physician,
scientist, entrepreneur and co - chair of the Bipartisan Policy Center’s new CEO
Council on Health and Innovation, which is combin ing the efforts of CEOs from
some of the nation’s largest corporations to develop strategies that will improve
employees’ health and wellness and lead to more cost effective health care. Dr.
Soon Shiong is the founder of numerous pharmaceutical entities and is
responsible for over 50 pat ents for groundbreaking drugs and medical
procedures. He is Chairman and CEO of the Institute for Advanced Health and
the Healthcare Transformation Institute. He also founded the National
Lambda R ail and NantWorks, LLC, whose mission is to converge semico nductor
technology, supercomputing advanced networks, improving innovations to
revolutionize the health care delivery. Dr. Soon - Shiong, welcome to
conversations on Health Care.

Dr. Patrick Soon - Shiong: Thank you.

Mark Masselli: You know, the Bipartisa n Policy Center just announced the
formation of a group that you are co - chair of, the CEO Council on Health and
Innovations, which features CEOs from some of the most formidable companies
in the country. And the goal is to highlight innovative strategies that are going to
improve the health and wellness of employees working for those large
corporations. You know, Margaret and I both have a good friend Mike Critelli
who was Chairman and CEO of Pitney Bowes , and we know when Mike was
CEO, he had a real pass ion for this type of transformation in his setting. Tell us a
little bit about the collaboration that you have built and some of the key players
and the passion that really drives the team.

Dr. Patrick Soon - Shiong: So you mentioned Mike Critelli and he and Craig
Barrett had created this organization called Dossia with the concept that really
the private sector and the large employers could significantly impact this country
by transforming health . And I had the good fortune to meet with visionary
leaders such as Muhtar Kent at Coca Cola and Lowell McAdam at Verizon and
Brian Moynihan at Bank of America, who had the very same passion, wanting to
make a real difference not only to the employees but to the nation with regard to
health care. So this council I think I honestly believe will be one of the most
important impactful organizations that will really drive action rather than just a
council for policy or as a think tank. And these are very, obviously not only
visionary leaders but operational leaders w ho run major corporations and see
health care as a crisis for our nation. And I am just honored and proud to be a
part of this organization with Muhtar, myself and the rest of the board.

Margaret Flinter: So Dr. Soon - Shiong, I think I understand that th e CEO Council
on Health and Innovation isn’t planning to issue a report on strategies or best
practices until next year. So what kind of strategies are you planning to focus on,
can you give us a glimpse into that, that look to have the most potential ?

D r. Patrick Soon - Shiong: Let me give you little bit of the history. About four
years ago, I met with Brian Moynihan at Bank of America with a concept that
collectively we needed to create an infrastructure in this nation , a fiber
infrastructure, such that information sharing could occur to address not only
chronic diseases but things important like cancer. And then I met with Lowell
McAdam at the Verizon level and we participated together in the World Congress
on Health and we found the same passion. And then I met with Muhtar Kent .
And so over the course of the last two years, we have actually quietly
implemented tiny little pilots inside our own organizations. And what I am excited
to say is that the implementation is actually moving forward in real t ime as we
speak, and the CEO Council is the first public announcement so to speak.

Mark Masselli: Cam you tell us about the sort of three - pronged approach that’s
being used by the CEO Council to improve health and wellness of employees
and how it aligns with the goals of the Affordable Care Act?

Dr. Patrick Soon - Shiong: We need to figure out a way to manage the patients in
the continuum of the entire life when they are well but on the other hand, when
they are desperately ill . And then there is a third element in between when they
have hypertension, asthma, diabetes, obesity, and what we call willingness . So
you have wellness , willingness and illness. And the private sector is the one
that is actually going to be able to do this much faster than the g overnment can.
So the mission of the Council is to implement innovative strategies to take
advantage of the wireless technology and advanced computing and the Cloud
technology that currently exists today and apply that. So we have implemented
strategies that unfortunately can only be done with areas of speed and
implementation between the private sector, the nonprofit sector and philanthropic
sector, and then finally, the NGOs and the government. So this is very much an
implementation council of actually testing and validating technologies at large
scales so that it could be implemented across this country but also be used on a
global basis. The Council is to look at health care delivery systems, to address
coordinated care, to address wellness programs that are real and measurable , to
address illness programs where we take advantage of the genome and the
proteome that’s going to enter in all areas of care.

Margaret Flinter: Well Dr. Soon - Shiong, I think we know that there has been so
much innovation ov er the last decade I would say around strategies to change
behavior . We would really be interested in hearing about some of the specific
strategies and what the breakthrough is in the thinking or the implementation or
the innovation that moves this ball f orward .

Dr. Patrick Soon - Shiong: I think the issue is let’s talk about cancer for example.
I don’t think what people realize in our country now , we have over 20 million
cancer survivors and there are two million cancer new diagnoses a year. There
are 4 0,000 patients with breast biopsies a year that are read for the wrong

patient, 20,000 prostate biopsies a year that are read for the wrong patient.
Would it be acceptable for example that we now know from 2001 to 2005 in
California that patients with pan creatic cancer received the wrong treatment 65%
of the time?

I think these are the kind of statistics that are not only unacceptable, it’s
unconscionable that we not address. So we ask ourselves how is it possible for
us ever to be able to bend the cost curve or even get the best care when we are
spending more than any other country in the world and ranking lowest on the
tables. And the question is very simple, how could we ever hope for example in
cancer to bend the cost curve and get the right treatmen t when we don’t know
what the right treatment is to be given before treatment begins . If you have
pancreatic cancer, the dogma is that you have a standard of care which is the
current standard of care which is a single drug which is on the market. The
su rvival rate is maybe two months to six months. Yet, if we were to tell you that if
in fact you had the correct treatment and the correct molecular profile, the
opportunity for you to be free of disease, completely free of disease and be alive
five years o ut, and in fact , we say we now have multiple patients with that exact
statistic.

So this is the challenge that there is no such thing as I call a national information
highway and the interoperable system that for the first time connects not only the
knowl edge base of the nation and the collective wisdom of the nation to the
delivery system but also connects the delivery system to the payment system.
On the knowledge system, we are making such amazing breakthroughs and we
will make more scientific technica l biological breakthroughs with in the next five
years than we made in the last 50 years based on the genomic and proteomic
science. But that information will not enter into the delivery system; it may take
10 to 17 years to enter the delivery system. Whe n you go to the delivery system,
there is a total disconnect and absence of any coordination of care.

So there is actually a non - system of care and a quite dangerous system of care
because not only the knowledge is not available, but the coordination does n’t
exist. When you come to the payment system, the only way the providers are
incented is to do as much procedures as possible because it's a fee - for - service
based system. There is no ICD - 9 code for healthy . So then if you look at the
knowledge system, the delivery system and the payment system, the barriers
between these three create such a non - system of care. It's no wonder we spend
$4 trillion and have no way of accountable value - based care, no way of
measuring outcomes and no way of having real - tim e knowledge that can actually
be actionable to change the clinical direction and the clinical cost.

That’s the strategy we have taken in the last five years to seven years to build an
infrastructure across this nation that you would then tie the knowledge system to
the delivery system. And inside the delivery system, you would create a
coordination of care and then tie that to the payment system, so that the payment

system incents health rather than illness and mitigates from illness to wellness
back to w ellness. And I think the CEO Council now finally reaches the payment
bucket to completely change the payment system and to incent the providers or a
healthy human being.

Mark Masselli: We are speaking today with Dr. Patrick Soon - Shoing, a
physician, sci entist, entrepreneur and co - chair of the Bipartisan Policy Center’s
new CEO Council on Health and Innovation which is seeking collaboration
among some of the nation’s largest corporations to develop strategies that will
improve employees’ health and wellne ss and lead to more cost - effective health
care. You have been talking about this knowledge network that works with the
delivery system and the payment system, and I wonder if the delivery system
isn't at the heart of the problem here, this whole quality i mprovement process.
How are you thinking about change management when you are thinking about
the delivery system because it's a radical redesign that’s needed?

Dr. Patrick Soon - Shiong: And nothing motivates more than change management
by incenting payme nt to adopt the change. On the delivery system itself, you are
completely correct. The greatest fear I had when the Health Information
Technology program was launched, and we had the $800 billion of stimulus
funds, was that we would build, what we call, medical bridges to nowhere. But
the embedded current software systems that currently exist in the United States
totally prevent interoperability.

The only way that we would absolutely be able to get true care coordination and
population management is hav e the capability of a patient when the patient is at
home, he is in the clinic, on the community hospital, or the doctor or in the tertiary
center and then back at home with continuous information exchange of real - time
clinical data at the fingertips of bo th the patients and the provider. That
technology and that interoperable system did not exist. And so I presented
myself six or seven years ago to Dossia and said, “We as leaders need to create
this infrastructure for the United States.” That is why I t ook on the National
LambdaRail .

The National LambdaRail is a fibre infrastructure that’s NASA used to land the
shuttle. So if one could then take technology that currently exists today and then
the magic of what we call machine - to - machine learning, wirel ess technology,
whereby vital signs could be monitored directly out of the machines, and then we
integrate that data continuously into the cloud with all the clinical labs and the
imaging and tie that to the activity down to the activity level of whether i t's a nurse
practitioner, whether it's a doctor, physician’s assistant and provide them both
transparency and clarity of treatment, and then be able to monitor the outcomes
in real time and create continuous learning systems across the continuum, we
will t hen truly transform this care.

So I presented this plan around 2008 to the Institute of Medicine at the National
Library of Medicine to initiate this on the country. And unfortunately, I could not
get the government agencies to adopt this. So we then le ft out on our own and
created the Institute of Advanced Health. And let me share with you now with
excitement where we are. In order for the doctors to know what is the right
treatment to give these thousands of different clinical protocols with hundreds of
subtypes, it’s beyond the cognitive (17:37 inaudible) how the doctor to
understand what treatment to give.

We have through a Software - as - a - Service in the Cloud now deployed this
decision tool amongst 8000 oncologists as we speak today. And the insura nce
companies have now been given a tool to approve the payment and know in real
time before treatment begins that the patient and the doctor is getting the right
evidence - based treatment. If we can then capture the vital signs of a human
being in a hospi tal and at home, now there is 4000 different medical devices out
there, we have created APIs that can message and talk to every one of these
medical devices. This year, we will be capturing three billion vital signs across
the United States, so that these vital signs will self - populate the electronic
medical record regardless of what the electronic medical record is.

If you can now tie that information across the continuum from the patient when
the patient goes to the clinic with a software system that ac tually captures the
activity and cost in real time, we have now adopted that, and that’s running
across three million lives in the United States today in cancer patients. If you can
then interconnect that to imagings of CAT scans, if you could take these CAT
scans and PET scans and put the data into supercomputer so that instead of a
64 slice images or 120 slice images, you have a million images because it's
every second of the data, you then have a way of creating image in the Cloud
down to the patient.

We now have this deployed at places like Cleveland Clinic and Mount Sinai and
have 14 FDA approvals to deploy this across the nation. We recognize that all
the information we ultimately need will come out of a blood test, and the blood
test will be the ge nom ics but not just genom ics but leapfrogging to proteomics.
You need then a supercomputer to manage this kind of analysis because this
kind of analysis right now takes 11 weeks to do for one patient. So that’s why we
built a supercomputer that has now t aken 6000 human genomes, 3000 patients
and computed that complete analysis in 69 hours. That translates to the fact that
we can now complete the analysis for one patient in 47 seconds.

The images that can be analyzed are from any CAT scan any MRI and pla ced
into a connected device in the patient’s and doctor’s hands. The vital signs that
could be captured remotely from machine to machine and self - populate your
data, and the decision support tools, that is all evidence - based. All of a sudden,
we have a r eal learning system that is totally scalable, and that’s the strategy that

we have been deploying, and that’s the strategy we can deploy across this nation
through the CEO Council.

Margaret Flinter: We have been speaking today with Dr. Patrick Soon - Shion g,
physician, entrepreneur co - chair of the Bipartisan Policy Center’s new CEO
Council on Health and Innovation . You can learn more about the Bipartisan
Policy Center’s Council on Health and Innovation by going to
Bipartisanpolicy.org, and you can follow h im on Twitter @solvehealthcare. Dr.
Soon - Shiong, thank you so much for joining us on Conversations on Health Care
today.

Dr. Patrick Soon - Shiong: Thank you.

Mark Masselli: At Conversations on Health Care, we want our audience to be
truly in the know w hen it comes to the facts about Healthcare Reform and policy.
Lori Robertson is an award - winning journalist and managing editor of
FactCheck.org , a nonpartisan, nonprofit consumer advocate for voters that aim to
reduce the level of deception in U.S. polit ics. Lori, what have you got for us this
week?

Lori Robertson: Well, House Speaker John Boehner ’s premiums are going up.
He says his premiums will double, and his deductible will triple under the
Affordable Care Act. It turns out that’s true, but his experience is atypical
compared with most Americans and even other members of Congress. It all
shows how some will pay more and some will pay less under the law. Boehner ’s
rates are doubling because of his age. He is 64, and his wife’s age 65 plus their
high income. The speaker is being forced out of his employer - sponsored
insurance through the federal government and into the exchanges, thanks to a
republican amendment to the Health Care Law.

Exchange plans can charge more based on age making this a co stly shift for the
64 - year - old Boehner . Plus, he smokes, making his premiums higher. His wife is
now joining Medicare, and the couple will pay a higher Medicare premium
because of their income. We reached out to representatives Joaquín Castro of
Texas w ho is 25 years younger than Boehner . Castro chose the same plan on
the exchange as Boehner did, but his premiums are going down by about 50%.
In fact, he could have selected a more generous plan in terms of the deductible
and still saved money. That’s m y Fact Check for this week. I am Lori Robertson,
managing editor of FactCheck.org .

Margaret Flinter: FactCheck.org is committed to factual accuracy from the
country’s major political players and is a project of the Annenberg Public Policy
Center at the University of Pennsylvania. If you have a fact that you would like
checked, email us at Chcradio.com, we will have FactCheck.org ’s Lori Robertson
check it out for you here on Conversations on Health Care.

Mark Masselli: Each week , Conversations highligh t s a bright idea about how to
make wellness a part of ou r communities and everyday lives. Asthma and
COPD are growing health concerns in this country. 18 million adults and seven
children suffer from the condition, and those numbers are on the rise. In spite of
how much is known about the disease, many with asthma and COPD have a
hard time controlling it, and it’s difficult to predict when an attack might happen.
GPS to the rescue, the FDA has recently given an approval to a tiny device that
asthma and COPD sufferers can attach to their inhalers.

The GPS device is linked to software on the user’s smartphone that sends
information to their clinician whenever they use the inhaler. The idea being that
you can track where and when an asthma attack is trigg ered and logged details
of the location where it happened to get a better handle on what triggers to avoid
in the future. The data are also collected and coalescent to a larger database
that can chart areas with higher incidences of asthma to inform publi c health
decisions around controlling the disease. The asthma map has been undergoing
clinical trials for several years through the CDC and has already been deployed
successfully in two cities with higher than normal asthma rates, Sacramento and
Louisvill e, now with the FDA approval of the device, Asthmapolis plans to make
the product available to the general population.

Marrying simple GPS in mobile phone technology with medication use, leading to
healthier outcomes for millions of asthma sufferers, now that’s a bright idea.

Margaret Flinter: This is Conversations on Health care. I am Margaret Flinter.

Mark Masselli: And I am Mark Masselli. Peace and health.

Conversations on Health Care, broadcast from the campus of WESU at
Wesleyan University, str eaming live at Wesufm.org and brought to you by the
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