Tom Lloyd: … has been on the phone with us for weeks now and we've been talking through well we know how to get to here, to here, to here. And then this is where it starts to get a little gray but that's because we really need to make sure we're staying true to what gets said during the session. So we know what the objectives are for this end. The plan that we want to have when we walk out of here.

What we've been doing is trying to understand where are the real opportunities for you to figure out some strategies to move forward. So what has come out of this in my walking around during the last... working around with some of the report outs, it seems to me there's five potential, and this is just a draft you all know that these boards work at the speed of your mind, right? Just erase them it's gone.

So there's five content areas and then there's another thing we've been talking about getting this timeline out there. And it's always good to get iteration up on that and just what we already know. You know at Vanderbilt University we know when budgets are due. We know when calendars are in and out of session and all that. So we just populate the timeline with what we know today. And then if we start to plan for strategies in the future and then customized the timeline.

So we've got five topics around content one around the project management program is and if you will. The top of the ones are really…how does AHCA enable the consumer -provider relationship? I mean I think it was raised here. We're not trying to take anything away. I mean if anything people need much more information and faith in their healthcare system.

So how do we help that? How does it enable personal health? So the end goal here is for everybody not to never need to go to the doctor, right? Comparison of providers by success with the specific disease. So this is really quality around a disease level and it's across the spectrum. I mean I try not to say 'physician' right? This is provider, broadly defined.

Personal customization of recorded information. So AHCA has this amazing databases of information. They know how much drugs cost. I did look up Odessa, Florida. I think they only have two drugs in their list though my parents did take you to one.

[Laughter]

Tom Lloyd: I'm going to try and see if I can save him his money you know to pay for education.

[Laughter]

Tom Lloyd: But if you could go to that site and put in some personal information and we've talked about the profile, the plan whatever. And that site would then generate for you. Okay and this is what you should expect to pay and it's good within, close your mind, it's $5. I don't know. Some level of understanding of this system more like it should be that. And then how could you price and quality trade-up comparisons.

What's the information that you really need to make that happen. So up until this point we've been providing you with people that you could impersonate. We've been providing you with imaginary futures and you're looking back and you've done all the great things. And now is the chance for you to be really frustrated because we need you to go off and actually design one of these five components, okay?

And then we need a few people, probably not six people on the team but we need three or four people who understand the kind of state legislative calendar, the business calendars, the association calendars, that kind of stuff to help us make sure this timeline is brought to life. And this is the other place where kind of the inmates take over the asylum. We're not going to tell you which team to go on.

We want you to do two things. One is to pick the team that you'd like to go on and we can flex the space as necessary. We'd like you to go there and we'd like you to trust the people on the other teams to do their work while you do yours. So there may be two or three topics up here where you going, "Oh everything needed to be unseen. I don't know." You just have to trust at this point. At some point we have to start believing in the words that you've been putting up on the boards all day.

So first of all, do these sound right? I mean these topics on the right, is there one big one missing that I just didn't understand because I haven't heard your words.

Audience 1: I think the first one like the enhancing the consumer provider relationship

Tom Lloyd: Right.

Audience 1: I don't recall that one. What was that?

Tom Lloyd: So the whole idea of this medical home, you go to the web site and then it tells you stuff and you go to your doctor and he tells you the same stuff. How do you get synchronized with the provider network to make sure that you're building that relationships.

Audience 1: Okay I see, I see.

Audience 2: Tom, this is an additive thing on group C, that it could be broaden to just a specific disease or procedure since there are so many things like hip replacements, joints…

[Pause]

Tom Lloyd: Did anybody mention about two o'clock in the afternoon, three o'clock, feeling a little bit down. I think there's fresh coffee out there when we get up and exercise, it's going to be great.

[Laughter]

Audience 3: So we just go to an A or B?

Tom Lloyd: Do we have the right topic up here first?

[Inaudible]

Audience 4: Just a thought about what other strengths, price and quality tends to equate to the value in healthcare. And it seems to me that we could easily separate price and quality for purposes of reporting as we heard and been seen by some. So my question is this want people want to work on or should be broken into two supplement items price and quality?

Tom Lloyd: So the reason I put them together is I think it would be very easy to stay at this level. And I know we have found in our work that this is great for meeting up to now. But if we are going to make a plan coming out of here that's actionable, we need to pick the one or two things.

It wouldn't be bad if this team came back and said, "Here are the three diseases or the three procedures that we should actually go start working on right now." And figuring out how we could collect that data and do it on a proof concept basis.

I mean we'd really like you to get into some level of detail here. It’s because if you don't. you're just going to sit here and wrestle the hypothetical and that's never valuable. Sir?

Audience 5: I’d like to tell you each price and quality together because it has a national base on and their inter-relationships between quality and price at a certain time versus that. We'd like to key that together and evaluate the purpose.

Tom Lloyd: Is that the language that you would prefer, value-based purchasing?

[Inaudible]

Tom Lloyd: So this isn’t p-for-p and I just want to clear the air on that. It might be a step in that direction but this is, how do I as a consumer make a price and quality trade-off? Design how you make it possible. How you enable me to make that decision?

Audience 6: Do you think the consumer bears a lot? I think that’s important to the coroner and the support group. And perhaps the insurance companies would visit consumer-related care on relationship and efficiency.

Tom Lloyd: I think if you we're to sit here and talk to me today about the people who care about these things I would say no. But I don't know about your health plans and the things that you're changing in your life. But at the rate my plans are changing in HSAs, at the rate which more and more of this is coming out of my pocket. Your five-year strategy better have a very clear understanding of how you're going to enable that.

And how you're going to get started on it now but I think there would be other states that are working on this and they would pass you by if you draw to the side and say, “That wasn’t that important in 2007.” This is a personal statement right now.

Audience 7: What is the patient education about their conditions, is that under the consumer-provider relationship or the personal health?

[Inaudible]

Audience 7: Is that personal?

Tom Lloyd: That could be, yes. So if that's not said, who was going to go with team A? Just a show of hands. That's the consumer-provider relationship.

[Laughter]

Tom Lloyd: Okay so how how about we start at the other end? Who's going to go to E - pricing, quality trade-off comparisons. Who's going to go? So this is the group participation. I ask questions. Okay, we have two people, can all of you trust that they are going to decide what's fair.

Audience 8: Absolutely.

Tom Lloyd: Go people, okay. B - personal customization of reported information. Two, three, okay. Working our way up. Comparison of providers by success of specific disease. Popular, okay. That's good, that's good! Personal health? Very nice, very nice! Consumer provider relationship? Two…

[Inaudible]

Audience 9: I think when I added that up that's not everybody in the room

[Laughter]

Tom Lloyd: Okay, who's going come and help with the timeline? Were going to have a lot of fun.

Audience 3: Great!

[Laughter]

Tom Lloyd: Two, three. Okay great! So freshen up, get that last hit of caffeine. Big end, the big drive. We're going to just plow through this. Alright!

Speaker 1: ...if you need a first team to report out. And then no one else will be last again. Alright. Is anybody having fun yet? Is anybody sweating? Anybody working?

Audience 1: Having fun.

Speaker: Good, good. I'm sweating. I'm working. Thank you very much for being very engaged. That's what we need to drive through the next two days.

[Pause]

Speaker: Alright. We've gone from the individual perspectives, to sharing, to synthesizing. And now we're going to try to work toward some sort of set of guiding principles and definition of transparency and role for AHCA. Who would like to go first? Alright.

Audience 2: I'm all into it.

Speaker: Will you come up? Since we haven't had any formal introductions, you can just briefly introduce yourself, where you're from.