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Taking Health Care to the Streets | Dr. Cheryl Whitaker | TEDxNashvilleSalon


hello Nashville thank you so much for

hello Nashville thank you so much for having me

having me

having me jamming a little Dolly Parton here one

jamming a little Dolly Parton here one

jamming a little Dolly Parton here one of my favorite singers so if they let me

of my favorite singers so if they let me

of my favorite singers so if they let me sing I might sing nine to five if I had

sing I might sing nine to five if I had

sing I might sing nine to five if I had a song but oh I need a clicker thank you

a song but oh I need a clicker thank you

a song but oh I need a clicker thank you thank you guys so much so I grew up

thank you guys so much so I grew up

thank you guys so much so I grew up actually my first time here in Nashville

actually my first time here in Nashville

actually my first time here in Nashville I grew up about six hours away in a

I grew up about six hours away in a

I grew up about six hours away in a small town called Washington Georgia and

small town called Washington Georgia and

small town called Washington Georgia and where I grew up no one that I knew ever

where I grew up no one that I knew ever

where I grew up no one that I knew ever went to the doctor for anything unless

went to the doctor for anything unless

went to the doctor for anything unless they were seriously ill or if they went

they were seriously ill or if they went

they were seriously ill or if they went it was definitely to the emergency room

it was definitely to the emergency room

it was definitely to the emergency room as a matter of fact I remember growing

as a matter of fact I remember growing

as a matter of fact I remember growing up my mom and family would say old that

up my mom and family would say old that

up my mom and family would say old that hospital they kill people over there and

hospital they kill people over there and

hospital they kill people over there and I thought okay has it become a doctor I

I thought okay has it become a doctor I

I thought okay has it become a doctor I look back people’s people’s diseases

look back people’s people’s diseases

look back people’s people’s diseases have progressed so far there was not

have progressed so far there was not

have progressed so far there was not much that the hospital or doctors were

much that the hospital or doctors were

much that the hospital or doctors were able to do but I also knew we had

able to do but I also knew we had

able to do but I also knew we had insurance I was able to go through my

insurance I was able to go through my

insurance I was able to go through my entire college career with but without

entire college career with but without

entire college career with but without ever having a pap smear or learning

ever having a pap smear or learning

ever having a pap smear or learning about self breast exams so we never

about self breast exams so we never

about self breast exams so we never access preventive care when I was

access preventive care when I was

access preventive care when I was growing up and I really didn’t know much

growing up and I really didn’t know much

growing up and I really didn’t know much about it at age 20 I had my first visit

about it at age 20 I had my first visit

about it at age 20 I had my first visit to the dentist

to the dentist

to the dentist I had a cavity I was in a lot of pain

I had a cavity I was in a lot of pain

I had a cavity I was in a lot of pain and the dentist gave me a choice he said

and the dentist gave me a choice he said

and the dentist gave me a choice he said look you can have an extraction we’re

look you can have an extraction we’re

look you can have an extraction we’re gonna have a root canal

gonna have a root canal

gonna have a root canal and I was twenty years old he’s playing

and I was twenty years old he’s playing

and I was twenty years old he’s playing the root canal I’m like I don’t think I

the root canal I’m like I don’t think I

the root canal I’m like I don’t think I want that that sounds painful I’ll take

want that that sounds painful I’ll take

want that that sounds painful I’ll take the extraction I thought I was making a

the extraction I thought I was making a

the extraction I thought I was making a rational decision but because growing up

rational decision but because growing up

rational decision but because growing up I didn’t know a lot about it I made a

I didn’t know a lot about it I made a

I didn’t know a lot about it I made a choice that actually impacted me many

choice that actually impacted me many

choice that actually impacted me many years down the line and in my 30s I was

years down the line and in my 30s I was

years down the line and in my 30s I was able to take advantage of new technology

able to take advantage of new technology

able to take advantage of new technology and correct it as I look back I would

and correct it as I look back I would

and correct it as I look back I would hear my mom say so-and-so died this

hear my mom say so-and-so died this

hear my mom say so-and-so died this person died and at the time these people

person died and at the time these people

person died and at the time these people were in their 40s and 50s and I couldn’t

were in their 40s and 50s and I couldn’t

were in their 40s and 50s and I couldn’t put all together at the time but I knew

put all together at the time but I knew

put all together at the time but I knew that many of them did have health

that many of them did have health

that many of them did have health insurance coverage

insurance coverage

insurance coverage but they were still dying early and they

but they were still dying early and they

but they were still dying early and they were dying from preventable conditions

were dying from preventable conditions

were dying from preventable conditions like diabetes high blood pressure high

like diabetes high blood pressure high

like diabetes high blood pressure high cholesterol and sort of wandering there

cholesterol and sort of wandering there

cholesterol and sort of wandering there we know what’s going on it but

we know what’s going on it but

we know what’s going on it but definitely inspired me to continue in my

definitely inspired me to continue in my

definitely inspired me to continue in my career heading towards medicine and the

career heading towards medicine and the

career heading towards medicine and the practice of as a young medical resident

practice of as a young medical resident

practice of as a young medical resident out in California as learning internal

out in California as learning internal

out in California as learning internal medicine I began to see patient after

medicine I began to see patient after

medicine I began to see patient after patient again who would present with

patient again who would present with

patient again who would present with advanced cases of conditions that were

advanced cases of conditions that were

advanced cases of conditions that were related to very treatable and manageable

related to very treatable and manageable

related to very treatable and manageable conditions like diabetes high blood

conditions like diabetes high blood

conditions like diabetes high blood pressure cholesterol hepatitis etc and

pressure cholesterol hepatitis etc and

pressure cholesterol hepatitis etc and began to wonder well why is that why is

began to wonder well why is that why is

began to wonder well why is that why is it that people have access to care but

it that people have access to care but

it that people have access to care but we’re still seeing progression of

we’re still seeing progression of

we’re still seeing progression of disease that’s extraordinary remarkable

disease that’s extraordinary remarkable

disease that’s extraordinary remarkable and it will impact their ongoing sort of

and it will impact their ongoing sort of

and it will impact their ongoing sort of morbidity disease burden and their

morbidity disease burden and their

morbidity disease burden and their ability to live a healthy and happy and

ability to live a healthy and happy and

ability to live a healthy and happy and highly functioning life it was it was

highly functioning life it was it was

highly functioning life it was it was clear that at that time primary care and

clear that at that time primary care and

clear that at that time primary care and prevention which is what I was studying

prevention which is what I was studying

prevention which is what I was studying and learning to be was failing many of

and learning to be was failing many of

and learning to be was failing many of our patients many of my patients so

our patients many of my patients so

our patients many of my patients so insurance was important but it wasn’t

insurance was important but it wasn’t

insurance was important but it wasn’t the only issue when I landed in Chicago

the only issue when I landed in Chicago

the only issue when I landed in Chicago and began the practice of medicine on

and began the practice of medicine on

and began the practice of medicine on the south side I realized that wow I’m

the south side I realized that wow I’m

the south side I realized that wow I’m seeing over half the people I’m seeing

seeing over half the people I’m seeing

seeing over half the people I’m seeing are actually covered what’s what’s going

are actually covered what’s what’s going

are actually covered what’s what’s going on here what is it that we’re missing as

on here what is it that we’re missing as

on here what is it that we’re missing as we think about the treatment of

we think about the treatment of

we think about the treatment of conditions that I was seeing over and

conditions that I was seeing over and

conditions that I was seeing over and over what people weren’t managing them

over what people weren’t managing them

over what people weren’t managing them well and it really disturbed me so much

well and it really disturbed me so much

well and it really disturbed me so much that I said gosh I’ve got to do

that I said gosh I’ve got to do

that I said gosh I’ve got to do something about this I realized as I

something about this I realized as I

something about this I realized as I looked at the communities that many of

looked at the communities that many of

looked at the communities that many of my patients were from that they faced a

my patients were from that they faced a

my patients were from that they faced a lot of obstacles and challenges getting

lot of obstacles and challenges getting

lot of obstacles and challenges getting to the care that they needed it wasn’t

to the care that they needed it wasn’t

to the care that they needed it wasn’t as simple as having insurance in fact

as simple as having insurance in fact

as simple as having insurance in fact seem to be a lot more complicating

seem to be a lot more complicating

seem to be a lot more complicating factors as a scientist I realized as I

factors as a scientist I realized as I

factors as a scientist I realized as I looked at the data that well this

looked at the data that well this

looked at the data that well this transcends race or ethnicity

transcends race or ethnicity

transcends race or ethnicity what’s the factor there is there

what’s the factor there is there

what’s the factor there is there something predisposing my patients to

something predisposing my patients to

something predisposing my patients to not following up and not

not following up and not

not following up and not in the care that they need what was

in the care that they need what was

in the care that they need what was getting the way of access even when they

getting the way of access even when they

getting the way of access even when they had health care insurance what we

had health care insurance what we

had health care insurance what we figured out is that actually if you look

figured out is that actually if you look

figured out is that actually if you look at all the data it’s really low income

at all the data it’s really low income

at all the data it’s really low income that has the biggest impact on health

that has the biggest impact on health

that has the biggest impact on health outcomes in our country where you live

outcomes in our country where you live

outcomes in our country where you live matters too and as we look at the data

matters too and as we look at the data

matters too and as we look at the data there’s a lot of data that shows you

there’s a lot of data that shows you

there’s a lot of data that shows you that where people live influences and

that where people live influences and

that where people live influences and has a great impact on their health care

has a great impact on their health care

has a great impact on their health care outcomes low income and low resource

outcomes low income and low resource

outcomes low income and low resource communities often have low resource

communities often have low resource

communities often have low resource areas around them meaning there’s not

areas around them meaning there’s not

areas around them meaning there’s not much that they can access that’s

much that they can access that’s

much that they can access that’s beneficial for them sometimes health

beneficial for them sometimes health

beneficial for them sometimes health plans or providers may have to intervene

plans or providers may have to intervene

plans or providers may have to intervene to overcome barriers that people are

to overcome barriers that people are

to overcome barriers that people are facing and obstacles that they’re facing

facing and obstacles that they’re facing

facing and obstacles that they’re facing transportation is one that we know is

transportation is one that we know is

transportation is one that we know is important you got to get there sometimes

important you got to get there sometimes

important you got to get there sometimes for families with child bear a child

for families with child bear a child

for families with child bear a child bearing age child care is important

bearing age child care is important

bearing age child care is important while mental health we really need to

while mental health we really need to

while mental health we really need to think about it we know that it’s there

think about it we know that it’s there

think about it we know that it’s there and many times we don’t pick it up

and many times we don’t pick it up

and many times we don’t pick it up because we’re not looking for it it may

because we’re not looking for it it may

because we’re not looking for it it may get in the way of how people access

get in the way of how people access

get in the way of how people access health care even recognize that they

health care even recognize that they

health care even recognize that they have a mental health condition or and

have a mental health condition or and

have a mental health condition or and they have a chronic condition that would

they have a chronic condition that would

they have a chronic condition that would do well if it’s better treated sometimes

do well if it’s better treated sometimes

do well if it’s better treated sometimes people just don’t want to go to the

people just don’t want to go to the

people just don’t want to go to the doctor by themselves they may need

doctor by themselves they may need

doctor by themselves they may need support some people are afraid of

support some people are afraid of

support some people are afraid of doctors that’s not unusual I know I took

doctors that’s not unusual I know I took

doctors that’s not unusual I know I took my husband home I he’s also a physician

my husband home I he’s also a physician

my husband home I he’s also a physician we were in our late 20s and my mother

we were in our late 20s and my mother

we were in our late 20s and my mother said to me she goes she was just staring

said to me she goes she was just staring

said to me she goes she was just staring us she goes you all don’t act like

us she goes you all don’t act like

us she goes you all don’t act like doctors I said mom I’m your daughter she

doctors I said mom I’m your daughter she

doctors I said mom I’m your daughter she so is as if a doctor might be an alien

so is as if a doctor might be an alien

so is as if a doctor might be an alien right so we have to realize that there

right so we have to realize that there

right so we have to realize that there are things like white coat syndrome or

are things like white coat syndrome or

are things like white coat syndrome or just myths and fears related to seeing a

just myths and fears related to seeing a

just myths and fears related to seeing a doctor and then follow-up sometimes you

doctor and then follow-up sometimes you

doctor and then follow-up sometimes you get there but then the doctor asks you

get there but then the doctor asks you

get there but then the doctor asks you to come back multiple times that might

to come back multiple times that might

to come back multiple times that might get in the way if you’re dealing with a

get in the way if you’re dealing with a

get in the way if you’re dealing with a low income and low resource situation

low income and low resource situation

low income and low resource situation now the social and economic factors if

now the social and economic factors if

now the social and economic factors if you’re in a low resourced environment

you’re in a low resourced environment

you’re in a low resourced environment can be paralyzing what we know is from

can be paralyzing what we know is from

can be paralyzing what we know is from us from a study get done at Princeton

us from a study get done at Princeton

us from a study get done at Princeton and Harvard is that the the cumulative

and Harvard is that the the cumulative

and Harvard is that the the cumulative cognate

cognate

cognate load of excessive stress can take you

load of excessive stress can take you

load of excessive stress can take you down 13 IQ points the ability to deal

down 13 IQ points the ability to deal

down 13 IQ points the ability to deal with strapped with a with a doctor’s

with strapped with a with a doctor’s

with strapped with a with a doctor’s appointment or anything but an emergency

appointment or anything but an emergency

appointment or anything but an emergency our patients just won’t have that other

our patients just won’t have that other

our patients just won’t have that other things are important well when I began

things are important well when I began

things are important well when I began to really listen to my patients and

to really listen to my patients and

to really listen to my patients and understand what I want to understand

understand what I want to understand

understand what I want to understand well tell me more you you you don’t want

well tell me more you you you don’t want

well tell me more you you you don’t want to take the medicine I’m prescribing for

to take the medicine I’m prescribing for

to take the medicine I’m prescribing for your high blood pressure

your high blood pressure

your high blood pressure will you take anything and they say doc

will you take anything and they say doc

will you take anything and they say doc I take oil

I take oil

I take oil I take vinegar and garlic every day okay

vinegar and garlic how about I add a

vinegar and garlic how about I add a little bit of this little water pill

little bit of this little water pill

little bit of this little water pill here hydrochlorothiazide low side

here hydrochlorothiazide low side

here hydrochlorothiazide low side effects you continue to take that and

effects you continue to take that and

effects you continue to take that and let’s see if together they might work

let’s see if together they might work

let’s see if together they might work and you know what I actually want a lot

and you know what I actually want a lot

and you know what I actually want a lot of battles just meeting people where

of battles just meeting people where

of battles just meeting people where they are but that’s real people have

they are but that’s real people have

they are but that’s real people have their own remedies and in many

their own remedies and in many

their own remedies and in many communities they may approach it

communities they may approach it

communities they may approach it healthcare way different than the doctor

healthcare way different than the doctor

healthcare way different than the doctor might approach it and we’re gonna have

might approach it and we’re gonna have

might approach it and we’re gonna have to take some of those things into

to take some of those things into

to take some of those things into consideration in much of my medical

consideration in much of my medical

consideration in much of my medical practice my patients would accuse me of

practice my patients would accuse me of

practice my patients would accuse me of experimenting on them often you might

experimenting on them often you might

experimenting on them often you might start a medicine your doctor might start

start a medicine your doctor might start

start a medicine your doctor might start a medication on you let’s say you’re

a medication on you let’s say you’re

a medication on you let’s say you’re taking something for cholesterol might

taking something for cholesterol might

taking something for cholesterol might start you with the low dose and then

start you with the low dose and then

start you with the low dose and then progressively increase the dose over

progressively increase the dose over

progressively increase the dose over time well my patients would say doc why

time well my patients would say doc why

time well my patients would say doc why are you doing that like don’t you aren’t

are you doing that like don’t you aren’t

are you doing that like don’t you aren’t you really smart and then you go to all

you really smart and then you go to all

you really smart and then you go to all these schools or should you know which

these schools or should you know which

these schools or should you know which one works and how much I say well no we

one works and how much I say well no we

one works and how much I say well no we have to sort of test your tolerance

have to sort of test your tolerance

have to sort of test your tolerance every individual responds differently

every individual responds differently

every individual responds differently well we often found that when I said I

well we often found that when I said I

well we often found that when I said I had a medical practice my patients

had a medical practice my patients

had a medical practice my patients thought that meant I was practicing on

thought that meant I was practicing on

thought that meant I was practicing on them so these are things that you got to

them so these are things that you got to

them so these are things that you got to think about as you as you deal in

think about as you as you deal in

think about as you as you deal in different communities you want to

different communities you want to

different communities you want to understand what are the mints the

understand what are the mints the

understand what are the mints the cultural mores that influence how they

cultural mores that influence how they

cultural mores that influence how they think about medicine what are those

think about medicine what are those

think about medicine what are those things and we have to really think about

things and we have to really think about

things and we have to really think about acknowledging those now it’s not just

acknowledging those now it’s not just

acknowledging those now it’s not just South Side of Chicago where this occurs

South Side of Chicago where this occurs

South Side of Chicago where this occurs when I went home as a young

when I went home as a young

when I went home as a young doctor and I begin to talk to my own

doctor and I begin to talk to my own

doctor and I begin to talk to my own family I found that a lot of what I was

family I found that a lot of what I was

family I found that a lot of what I was seeing in Chicago I saw it in Washington

seeing in Chicago I saw it in Washington

seeing in Chicago I saw it in Washington Georgia so it turns out that these myths

Georgia so it turns out that these myths

Georgia so it turns out that these myths are largely there they’re around and

are largely there they’re around and

are largely there they’re around and what’s important for the medical

what’s important for the medical

what’s important for the medical community is that we address those when

community is that we address those when

community is that we address those when we are trying to meet patients where

we are trying to meet patients where

we are trying to meet patients where they are to get them on track now I’m

they are to get them on track now I’m

they are to get them on track now I’m solution-oriented

solution-oriented

solution-oriented give me a problem I want to find it so I

give me a problem I want to find it so I

give me a problem I want to find it so I found I’d sort of studied all these

found I’d sort of studied all these

found I’d sort of studied all these problems over 15 years and I said you

problems over 15 years and I said you

problems over 15 years and I said you know what I’m gonna start a company

know what I’m gonna start a company

know what I’m gonna start a company we’re gonna solve this I’m gonna do it

we’re gonna solve this I’m gonna do it

we’re gonna solve this I’m gonna do it so first we start with individual issues

so first we start with individual issues

so first we start with individual issues we want to understand what is get in the

we want to understand what is get in the

we want to understand what is get in the way of a person accessing care we talked

way of a person accessing care we talked

way of a person accessing care we talked about all the different obstacles that

about all the different obstacles that

about all the different obstacles that might impact a person’s approach to

might impact a person’s approach to

might impact a person’s approach to healthcare then we have to think

healthcare then we have to think

healthcare then we have to think systemically what are the system

systemically what are the system

systemically what are the system barriers that are in a community we

barriers that are in a community we

barriers that are in a community we talked about barriers and access in low

talked about barriers and access in low

talked about barriers and access in low resource communities we have to

resource communities we have to

resource communities we have to understand those we also have to

understand those we also have to

understand those we also have to understand the disease burden in those

understand the disease burden in those

understand the disease burden in those communities because we want to be well

communities because we want to be well

communities because we want to be well equipped when we go in to help and

equipped when we go in to help and

equipped when we go in to help and intervene and meet people where they are

intervene and meet people where they are

intervene and meet people where they are that we know what they’re dealing with

that we know what they’re dealing with

that we know what they’re dealing with the science of that is called population

the science of that is called population

the science of that is called population health you understand the broader

health you understand the broader

health you understand the broader community and then you can really hone

community and then you can really hone

community and then you can really hone in on the individual and be effective so

in on the individual and be effective so

in on the individual and be effective so you armed your staff with great tools

you armed your staff with great tools

you armed your staff with great tools they’re able to go out and really make a

they’re able to go out and really make a

they’re able to go out and really make a difference disease and burden is

difference disease and burden is

difference disease and burden is important understanding where you are

important understanding where you are

important understanding where you are what’s going on in that community

what’s going on in that community

what’s going on in that community there’s a community in Chicago called

there’s a community in Chicago called

there’s a community in Chicago called Humboldt Park it has the highest

Humboldt Park it has the highest

Humboldt Park it has the highest incidence of diabetes in the city well

incidence of diabetes in the city well

incidence of diabetes in the city well before you go into that community you

before you go into that community you

before you go into that community you really need to understand how do people

really need to understand how do people

really need to understand how do people think about diabetes in that community

think about diabetes in that community

think about diabetes in that community because when you go in you’re going to

because when you go in you’re going to

because when you go in you’re going to want to be armed with that information

want to be armed with that information

want to be armed with that information so that you’re your starting point makes

so that you’re your starting point makes

so that you’re your starting point makes sense for where you are mental health we

sense for where you are mental health we

sense for where you are mental health we talked a little bit about it before

talked a little bit about it before

talked a little bit about it before really important it is if for most a

really important it is if for most a

really important it is if for most a chronic condition so it bears a nice the

chronic condition so it bears a nice the

chronic condition so it bears a nice the same respect as diabetes and high blood

same respect as diabetes and high blood

same respect as diabetes and high blood pressure and high cholesterol emia

pressure and high cholesterol emia

pressure and high cholesterol emia because it’s going to require ongoing

because it’s going to require ongoing

because it’s going to require ongoing contact with the healthcare community to

contact with the healthcare community to

contact with the healthcare community to support that person to get what they

support that person to get what they

support that person to get what they need and also it can

need and also it can

need and also it can ask other conditions and make people

ask other conditions and make people

ask other conditions and make people less likely also to seek here for

less likely also to seek here for

less likely also to seek here for conditions that could easily be treated

conditions that could easily be treated

conditions that could easily be treated and managed so we take all this

and managed so we take all this

and managed so we take all this information and we can move forward much

information and we can move forward much

information and we can move forward much more effectively managing that dollar

more effectively managing that dollar

more effectively managing that dollar that we’re spending on health care and

that we’re spending on health care and

that we’re spending on health care and getting better outcomes I much rather

getting better outcomes I much rather

getting better outcomes I much rather spend the money upstream on prevention

spend the money upstream on prevention

spend the money upstream on prevention and treatment of these conditions then

and treatment of these conditions then

and treatment of these conditions then downstream losing a foot going on

downstream losing a foot going on

downstream losing a foot going on dialysis I’m suffering from let low

dialysis I’m suffering from let low

dialysis I’m suffering from let low exercise tolerance etc when your heart

exercise tolerance etc when your heart

exercise tolerance etc when your heart starts to give out now at the company we

starts to give out now at the company we

starts to give out now at the company we started we went really local we believe

started we went really local we believe

started we went really local we believe healthcare is local right that’s what

healthcare is local right that’s what

healthcare is local right that’s what we’ve been talking about communities

we’ve been talking about communities

we’ve been talking about communities what do you see in communities how do

what do you see in communities how do

what do you see in communities how do you best understand him so we locate

you best understand him so we locate

you best understand him so we locate employees locally we hire from local we

employees locally we hire from local we

employees locally we hire from local we train local healthcare is local so we’re

train local healthcare is local so we’re

train local healthcare is local so we’re going to build capacity in those

going to build capacity in those

going to build capacity in those communities by hiring people from them

communities by hiring people from them

communities by hiring people from them to participate in improving the health

to participate in improving the health

to participate in improving the health of their own communities for its

of their own communities for its

of their own communities for its creative partnerships where do members

creative partnerships where do members

creative partnerships where do members and patients go we want to be everywhere

and patients go we want to be everywhere

and patients go we want to be everywhere they are that’s churches schools other

they are that’s churches schools other

they are that’s churches schools other not-for-profits that are in the

not-for-profits that are in the

not-for-profits that are in the community doing great things technology

community doing great things technology

community doing great things technology is important our folks are enabled with

is important our folks are enabled with

is important our folks are enabled with technology that allows them to in the

technology that allows them to in the

technology that allows them to in the field they’re in a certain community

field they’re in a certain community

field they’re in a certain community they can pull up a zip code and say aha

they can pull up a zip code and say aha

they can pull up a zip code and say aha this community has this percent of

this community has this percent of

this community has this percent of diabetes this percent of hypertension we

diabetes this percent of hypertension we

diabetes this percent of hypertension we also know about the place they’re in we

also know about the place they’re in we

also know about the place they’re in we can look and see ha this community has

can look and see ha this community has

can look and see ha this community has six churches 35 liquor stores three

six churches 35 liquor stores three

six churches 35 liquor stores three playgrounds right we know what people

playgrounds right we know what people

playgrounds right we know what people are dealing with is you don’t want to

are dealing with is you don’t want to

are dealing with is you don’t want to tell people to go exercise if there’s

tell people to go exercise if there’s

tell people to go exercise if there’s really nowhere for them to go right so

really nowhere for them to go right so

really nowhere for them to go right so you want to know your community our

you want to know your community our

you want to know your community our folks are digitally and technically

folks are digitally and technically

folks are digitally and technically enabled to be able to do that so while

enabled to be able to do that so while

enabled to be able to do that so while health insurance is important and I

health insurance is important and I

health insurance is important and I agree it is a great starting point

agree it is a great starting point

agree it is a great starting point our folks may not be completely enabled

our folks may not be completely enabled

our folks may not be completely enabled and equipped to take advantage of what

and equipped to take advantage of what

and equipped to take advantage of what that access offers so we hope we want to

that access offers so we hope we want to

that access offers so we hope we want to help them out we want to begin to coach

help them out we want to begin to coach

help them out we want to begin to coach them on yes these doctors are in network

them on yes these doctors are in network

them on yes these doctors are in network this is where you can go and begin to

this is where you can go and begin to

this is where you can go and begin to engage there he wasn’t one to go with

engage there he wasn’t one to go with

engage there he wasn’t one to go with you

you

you we’ll send someone with you so that you

we’ll send someone with you so that you

we’ll send someone with you so that you can get the care you need it’s much

can get the care you need it’s much

can get the care you need it’s much better to invest upstream then to have

better to invest upstream then to have

better to invest upstream then to have to go downstream and spend money on a

to go downstream and spend money on a

to go downstream and spend money on a foot that’s not working on a heart

foot that’s not working on a heart

foot that’s not working on a heart transplant etc many things if we deal

transplant etc many things if we deal

transplant etc many things if we deal with them upstream we then have a health

with them upstream we then have a health

with them upstream we then have a health care a health care system that is much

care a health care system that is much

care a health care system that is much more efficient effective and hopefully

more efficient effective and hopefully

more efficient effective and hopefully cheaper for all of us

cheaper for all of us

cheaper for all of us obstacles we have to deal with them and

obstacles we have to deal with them and

obstacles we have to deal with them and think about them so while being think

think about them so while being think

think about them so while being think the forward progressive next-generation

the forward progressive next-generation

the forward progressive next-generation payer and provider who providers who are

payer and provider who providers who are

payer and provider who providers who are rendering these insurance products that

rendering these insurance products that

rendering these insurance products that we’re aware of these obstacles and we’re

we’re aware of these obstacles and we’re

we’re aware of these obstacles and we’re ready to coach in place our members and

ready to coach in place our members and

ready to coach in place our members and then we can take it global I think that

then we can take it global I think that

then we can take it global I think that the science of community is something

the science of community is something

the science of community is something that we can take all over the country we

that we can take all over the country we

that we can take all over the country we learn about communities we can go all

learn about communities we can go all

learn about communities we can go all over the world

over the world

over the world implementing improving and hopefully

implementing improving and hopefully

implementing improving and hopefully saving lives if we’d had a system like

saving lives if we’d had a system like

saving lives if we’d had a system like this when I was coming up I think I

this when I was coming up I think I

this when I was coming up I think I might still have that molar and the

might still have that molar and the

might still have that molar and the people I thought that my parents you

people I thought that my parents you

people I thought that my parents you know who knew who are dying early might

know who knew who are dying early might

know who knew who are dying early might still be alive thank you

still be alive thank you

still be alive thank you [Applause]

[Applause]

[Applause] you

”

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