STEVE CASE PRESENTATION
JP Morgan Health Care Conference
JANUARY 10, 2022
Thank you for that kind introduction, David. You probably are feeling a little like I am today - that it's hard to be here without Dan, who initiated this investor conference focused on health more than a decade ago. Dan was very special not only to his family, but also to his colleagues and friends, many of whom are with us.
In fact, the story of my brother's battle with brain cancer is, in kind of a roundabout way, is why I am here. It was Dan's courage and tenacity that launched an innovative approach to end brain cancer, and his experience as a patient that inspired my commitment to try to lead a consumer-based revolution in health care. I will address both issues today.
It was about five years ago that Dan called me late one night with devastating news - he had a brain tumor. Dan told us not to worry and that everything would be fine. I didn't know much about brain tumors, but I knew they were bad. We soon learned just how bad from the medical professionals.
Almost immediately, we met with doctors and researchers and started asking questions.
What caused brain tumors? Nobody knew.
How could they be treated? Nobody knew.
Was there any prospect of a cure? No.
How long might Dan have? It could be measured in months.
It's amazing when you think about it. The "therapy" they were providing patients was the same that had been used unsuccessfully for decades. There had been little progress in understanding the disease. And in the new, rapid-growing world of biotech there were only a handful of brain cancer drugs even being tested.
Because it often strikes individuals at a relatively young age, brain cancer now ranks seventh for adults and first for children in terms of years of life lost. One half of the primary brain tumor patients affected die within 12 months and few survive five years.
What was even more incredible was the "patient" experience. Often when Dan entered a doctor's office, he had to recite his medical history. He filled out multiple forms, many seeking the very same information. Sick as he was at times, he was made to wait and wait and wait to do basic things like have his blood drawn. A low point was when we simply couldn't find a way to get an MRI transferred from one institution to another for consultation. The technology existed but the bureaucracy ruled the day. And worst of all there was little appreciation of the energy drain all this demanded of patients and their families.
Naturally, Dan decided we couldn't accept the status quo. It was his idea to bring together the best and brightest minds in the field, to address the central issue: how to catalyze a rapid increase in treatments for brain cancer patients. The result of those initial meetings was Accelerate Brain Cancer Cure, better known as ABC squared.
ABC squared was conceived as a nonprofit organization with an entrepreneurial mindset. People like Larry Probst, John Doerr, and David Golden joined the Board. We all agreed on a simple vision: increase investments to address gaps in the fight against brain cancer.
There were plenty of barriers to success.
First, a relatively small number of the best and brightest researchers were focused on brain cancer.
Second, that small group of researchers operated in their own silos and rarely collaborated on the search for new therapies.
Third, investment dollars to support pre-clinical testing were in short supply.
Fourth, the risks associated with drug development discouraged public-private partnerships to help get the pipeline flowing.
And fifth, there were no incentives in place to encourage a new approach to the problem.
But rather than be resigned to those realities, we attacked the problem. We sought to build bridges and encourage collaboration among researchers, educators, medical professionals, industry, government, patients, and family members. This approach has had a remarkable impact in just a few short years.
By sponsoring convenings, creating investigator awards to attract new research talent, funding pre-clinical testing, and creating a clinical network, we have demonstrated our model works. One of our most significant achievements is our partnership with Genentech, which has already resulted in promising drugs such as Tarceva and Avastin being tested for brain cancer.
To build on all this success, the board of ABC squared has decided to ramp up the innovative, collaborative, results-driven approach we have modeled for the last five years. At the same time, we know there is a glaring hole still to be addressed: increasing the capital needed for start-up companies that focus on developing new therapies for brain cancer. Other leading brain disease foundations -- including groups focused on Alzheimer's, ALS and Parkinson's -- tell us they have a similar problem.
The result is a dual approach to accelerating new medical solutions. ABC squared's outstanding founding CEO, John Reher, will soon be launching a venture capital firm that will focus on investing in innovative companies developing treatments for a range of brain diseases.
Kate Carr, former president and CEO of the Elizabeth Glaser Pediatric Aids Foundation, will succeed John at ABC squared. Her passion for our mission and her experience building partnerships as an advocate in the nonprofit and government sectors will be invaluable as we intensify our efforts to hasten a cure for brain cancer.
Kate's track record makes her the perfect leader to increase the impact of ABC squared, with one goal in mind: transitioning brain cancer from being a death sentence to being a treatable, manageable disease. A cure for brain cancer may take more than a decade. But if we can limit the severity and growth of brain tumors, we can make brain cancer as manageable as AIDs or diabetes.
But even if we succeed, we all know that more work needs to be done, not just in dealng with diseases, but improving the health care system itself.
No patient receiving medical treatment of any kind should go through the process that Dan went through. And if families receiving health care begin to think and act like consumers, they won't have to.
How much longer do you think people will tolerate paying more and more for care that does not meet today's standards of consumer choice, convenience and control?
How much longer will people put up with a system where they have to struggle for access to their own medical records?
How much longer will people accept a system that fails to recognize the value of life-enhancing and cost-cutting programs that promote wellness and healthy living?
I think we all know the answer. People are increasingly frustrated by the current health care system. They have a sense that there must be a better way. And they're right!
Indeed, that's why I have joined with Colin Powell, Frank Raines, Steve Wiggins, Jim Barksdale, Carly Fiorina, Miles Gilburne, and others to launch Revolution Health Group. We're a new company with a big ambition: to be the leading comprehensive consumer-centric health care company.
I am in this because, like many of you, I don't just want to complain about the health care system -- I want do something to help fix it.
I am involved because I have seen what a fresh new approach can achieve after seeing what ABC Squared has accomplished.
And I am optimistic, because I strongly believe that there is someone who can change our system, and change it for the better: the health care consumer.
I believe in a revolutionary idea - that a health care system driven by consumers, shaped by market forces, and powered by technology, can improve efficiency, lower costs, increase choice, and improve quality. I'm here today as an advocate for those consumers, and as a believer in the power of the change they can bring to the health care system. After all, I have just a few months experience as a health care executive - but I have 47 years of experience as a health care consumer.
I believe the next twenty years will bring consumer-driven health care into the mainstream. Why? Because changes in the health care system are bound to follow in the well-worn path of every major consumer trend in our society: they put more power in the hands of the consumer - leading to greater choice, greater control, and greater convenience.
In the last decade, the Internet has decisively shifted power in favor of consumers. Before the Internet, getting the best deal when buying a car… choosing a vacation… investing in the stock market… applying for a mortgage - it was all luck and guesswork. How low could the used car dealer really go? What was the best price for a hotel room? What was the true cost of a trade? What was the best mortgage rate out there? The buyer didn't know - only the seller did. Not anymore: the consumer has information, competition has increased, costs have decreased, and there are more choices than ever before.
Today, there is one major industry that remains - if you'll pardon the pun - immune to change. That industry happens to be the largest industry in America, one into which Americans pour a whopping $1.7 trillion dollars a year: health care
But the age of consumerism in health care is coming, and indeed, it may already be knocking at the door. A recent study by the Commonwealth Fund found that about 80 million Americans last year paid $1,000 or more out of their own pockets for health care. That's 80 million Americans who spent a substantial sum of their own dollars for health care last year - making consumer-paid health care a very, very large market already.
So, since launching Revolution Health, I've been spreading a simple message. A consumer revolution in health care is coming. The critics can't stop it, the naysayers can't deny it. The question isn't an "if" - it's a question of "when" and "how" and "exactly what will it look like." Those questions are what I'd like to turn to now.
Today, I see many of the same forces in health care that I saw 20 years ago in interactive services. Specifically, I see four trends driving the consumer revolution in health care. I call them the four C's: cost, convenience, control and consciousness.
Let me run through each of those trends in turn, and share how we at Revolution are seeking to both enable and accelerate them.
Let's start with the first trend - cost - that underpins the rest. Like it or not, the cost of health care is shifting from employers to employees. American workers are paying for more and more of their family's health care. These expenses squeeze already tight family budgets. Even consumers in employer-provided, traditional plans are seeing higher and higher co-pays and deductibles.
If Americans are going to pay these extra costs, they are going to demand something in return. Right now, they are just getting higher costs and lower quality.
They will want a bigger role in the decisions about their health care. They will want the right to choose their own providers, and the right to pay the same prices that insurance companies pay. They will want more information and tools to select a provider. They will want more convenience in how they get care.
And they will get these things. Because money means power in the marketplace, consumers will have more power because they will be controlling more and more of the money.
"Consumer pays" is the way of the future - and it's a future we are investing seriously in at Revolution Health.
The consumer-pays trend is giving rise to a second trend: a demand for greater convenience.
Consider the experiences we've all had with filling out the same health-related forms over and over and over. My memory is pretty good. But I can't remember when I had my last tetanus shot. I don't know remember if, as a child, I once had an allergic reaction to a medicine.
For a healthy person, filling out the same forms, time and time again, is inefficient, frustrating, and can lead to inaccurate information. Worse still, for a sick person - like my brother, when he was fighting for his life -- these activities become an inhumane burden at an incredibly difficult time.
There is no reason why we cannot have an online, complete medical history that can either be stored at a central location or carried with a patient -- in a way that protects privacy -- that will make medical histories more accurate and accessible and thus medical care more efficient and more precise. And there's no reason why that can't just be one of a thousand major changes in the health care system that better technology and information management will produce.
What's more, the consumer revolution means that consumers will insist that their medical information belongs to them, not to the medical establishment. I firmly believe, as one health researcher has said, the rule should be "Nothing about me, without me." Later this year, Revolution Health will bring to market a personal health record that will be digitized, customized, privacy protected -- but above all -- it will belong to the consumer.
And the idea of more efficiency, convenience, and control goes beyond technological questions. As a parent, I've been frustrated when a child has developed a fever or a cough on a weekend -- and the only choices were waiting until Monday to see a doctor or going to an emergency room.
Banks no longer work "bankers' hours" -- how can the health care system? As working parents take more control of health care spending, they will demand the kind of customer service from the health care sector that they demand from banking and everything else -- it should be closer to home and available when they need it.
Revolution Health is working to make this happen. We are supporting the roll-out of RediClinics - one of a number of retail-based convenient health care centers that provide fast, affordable treatment for routine medical conditions, as well as immunizations and other preventive services. These facilities are staffed with certified nurse practitioners, and are open seven days a week, with extended hours before and after work. They are springing up all over the country in retail stores like Wal-Mart and drug stores like Duane Reade: at the start of 2005, there were fewer than a dozen nationally -- now there are nearly 100. By the end of 2006, there could be 500. It is a revolution of convenience happening all around us.
A third trend we see today is a greater demand for control over the information and tools that can help people navigate the new, consumer-driven world - and manage their health care lives.
This starts with better access to information about providers. Some of you are doubtlessly fans of the baseball pitcher Tommy John. And right now, if you wanted to buy a baseball that bears his signature, you could go online and find out what's for sale, how reputable the seller is, his track record for the quality of his merchandise and the speed with which he delivers it, and what price others charge for a similar product.
But now, let's say you hurt your elbow, and instead of buying a baseball bearing Tommy John's name, you need the surgery that bears his name. By contrast, in this case, it would be almost impossible to find information on the surgeons that perform the surgery, how many procedures they have performed, what the outcomes were, what they charged, and how satisfied their customers have been.
Think about it: How do most people find a doctor today? They ask someone they know if they have a good doctor or have had a relevant procedure. And then, the consumer hopes that their friend's experience is typical and representative. It's a positively archaic way to make an important life decision.
Consider this: in ordinary hernia operations, the chances of recurrence are one in ten for surgeons at the poorer-performing end of the spectrum, one in twenty for the majority in the middle of the bell curve, and under one in five hundred for the most proficient performers. So, your chance of recurrence can vary fifty-fold - fifty-fold - depending on your choice of a doctor.
As consumers control more of their health spending, they are demanding the information they need to ensure better care. Here, too, Revolution Health is investing in solutions.
Later this year, we will be launching a consumer-friendly health portal that will allow consumers to manage their health needs and the needs of their families. We've already acquired four companies that will provide key elements for that portal, and we're just getting started.
From scheduling appointments, to managing health care finances, to researching health care needs and issues, our goal is to build the leading online resource for health care. And with content will come commerce -- the ability to buy services and products, to help diagnose ailments, identify weak points in someone's health history, and obtain direct online advice and care.
Giving consumers the responsibility to choose isn't the same as giving them the right to real choice - unless those choices can be made with the right tools, with more transparency about price and quality, and fair pricing. And those tools and that support is what we are going to be working on at Revolution Health.
Finally, the new consciousness about health and wellness, which has been growing exponentially in recent years, is now a major lifestyle trend among the Baby Boom generation. The quest for longer, healthier, more active lives, with a greater awareness of the importance of wellness and preventative health care, used to be viewed as fringy and eclectic, but now it's becoming a mainstream phenomenon.
But consumers are ahead of the health care system, indeed, our system has been slow to realize that in many cases it is easier to prevent an illness than to treat one. The cost of people with chronic diseases accounts for more than 75 percent of America's medical care costs. And yet, despite the fact that many of these chronic conditions are preventable, only two percent of our health care dollars are currently spent on prevention.
Our current health system does a mediocre job of reimbursing consumers for sick care - and an even worse job of incentivizing them to stay healthy. The leading health coverage company in South Africa, for example, provides members with "bonus points" for healthy behaviors - points that can be redeemed for "awards" ranging from discounts on health club memberships and healthy foods, to free movie and airline tickets. In turn, members stay healthier, and help reduce the company's costs. Thus, a virtuous cycle is born. That cycle is long overdue here in the United States, and that's why at Revolution we're making investments to make this dream of a wellness-led health revolution a reality.
These trends, taken together, create the movement that some of you have been a part of for years: Consumer Driven Health Care.
Consumer Driven Health Care has become a loaded term these days. Opponents argue that consumer-driven care is nothing more than a fancy label on a simple idea - dump the costs on consumers. Some proponents have argued that individual choice and control are a solution unto themselves - that making consumers spend their own money will fix the system.
I think both extremes are a bit misguided. Empowering consumers need not mean shifting the lion's share of the cost to consumers - it means aligning economic incentives, and shifting purchasing control to them. And at the same time, sharing costs with consumers without also giving them the information, the tools, the support they need to make the right choices isn't fair, and it won't work. And, as we make these changes, we also need to do more to cover the uninsured, and to make sure that all Americans have access to care.
The current debate on consumer-directed care often focuses on ideological points at the expense of practical realities. One practical reality is that consumer driven health care is happening already, whether we like it or not. Even consumers in employer-provided, traditional plans are seeing higher and higher co-pays and deductibles, meaning that they are increasingly in the "consumer-driven" market for the first $500, $1000 or $2000 of health care spending. We need to help make this change work for consumers, not try to resist the inevitable.
One of the reasons I've assembled a team at Revolution Health that draws leaders from across the political spectrum is because we need the debate to move from polarization to a genuine consensus on how to make this change the most effective, successful, and empowering it can be for consumers.
Revolution Health is committed to getting more Americans health coverage - coverage that is affordable and easy to understand. We believe that people should be allowed to pay for only the coverage they need, and that coverage should aim to bring down costs by promoting wellness and prevention, not by slashing care that patients need.
We recognize that when individuals pay for health care out of pocket, they are buying at a higher price. This is one of the most bizarre elements of our current system: that those who can least afford it -- the uninsured and the underinsured -- pay the highest prices for health care. If we are going to transition to a more individualized system of health care, we need to find ways to give individual consumers purchasing power they don't currently have, and at least come close to the pricing that insurance companies obtain.
We have to recognize that a defined-contribution world doesn't mean that everyone will -- or should -- wind up with a Health Savings Account for coverage. I'm a fan of Health Savings Accounts, and Revolution Health has invested in companies that help administer and disseminate H.S.A.'s. But, at Revolution Health, we also own a company that is helping individuals take defined contributions from their employers, and use those funds to purchase traditional HMO or PPO style health coverage plans.
Health Savings Accounts may be right or some people, but not others. HMO or PPO plans may be right for some people, but not others. Various hybrids may be right for some people, but not others. The choice is hard, and I know that many observers are skeptical that individual employees can make these choices for themselves. But I believe - with the right tools, the right support, and access to the right information - these decisions can be moved from the conference table in HR departments … to the kitchen table in consumers' homes.
The way I see it, the technology-driven, consumer-driven revolution in our society has given us more information, more power, more choice in virtually every area of the marketplace … except in what we value most - our health.
When the trends I have talked about today have finally had their impact on the health care industry, and millions of ordinary people have a chance to exercise their market power - our families will have more choices, lower costs, higher quality - and most importantly, better health.
The health care revolution is coming - for better or for worse, for good or for ill, for all or for a few. With your leadership and support - and with the right investments in for profit, not-for-profit, and public sector solutions - we can shape the character of that revolution to mean better care, more affordable care, longer lives, and more healthy lives for all Americans. Let's settle for nothing less.
Thank you very much. And I hope you enjoy the rest of the conference.