 Hello, and how are you doing? Welcome to another exciting and thrilling episode of Ibachi Talk. Go to the tech star here. With my good old buddies from the healthcare field, I got Rick's the fundmeister, Larry J. Smith, I've known you for decades, I remember when you had hair. Anyway, grab yourself a libation to pull up, and we're going to talk about healthcare. We've kind of been thematic over the past number of weeks about healthcare and why it's so damn expensive and so on. So the theme we're going to talk about today is like, what can you do to lower your cost of healthcare? So, and there's a lot of things you can do. And we've got two people who've been in the healthcare industry. How long have you been in the healthcare industry? Forty years. Forty years. And you've been in the healthcare industry? I've probably been in the same. Forty years. More than I can count. I've been in it about a dozen. So I'm the baby here. So you're going to educate us. So it's great to have you here. So Larry, just get a little bit of background so our viewers know who you are. Like, you know, obviously you grab a coca-cocoa, I can tell by the accent. Right. Now starting out, I've been in healthcare since, since before Medicare basically, since about 1970s. And I came here in 1982 to work in Queens and then went away to Texas and San Francisco and then came back and worked at Straub and then went to Seattle for a while and now I'm back here. And you've always been in the healthcare from a financial standpoint, right? So you're not a doc. I'm not a doc. You're not a nurse. You're not a clinician. I'm an accountant. You're an accountant. Right. Okay. So you've got that. And then Mr. Rower, do you have something similar background or how does that work? Actually, yes. And Larry and I, you know, intersected a couple of times as well. And over the years, and a number of healthcare providers, including Queens, Geyser, Queens, Kaiser, Queens again, Queens again, somewhere in San Francisco, in the San Francisco Bay Area. And then I was a Medicare auditor was actually, so you got a lot of, so we're going to talk to you today about how you as an individual, how we can, we can somehow lower our healthcare costs. Yeah. Because I can't count on government to help me lower my healthcare costs, guys. I'm sorry. I've given up on them. I was thinking about it just before the show and, you know, my Medicare monthly bill went up by nearly 30% this year. Whoa. See? Yeah. I mean, it wasn't just in just, you know, the non, non Medicare. And do you get a discount for not using it? Because I don't hardly use healthcare. No, I don't. No. No. No. No. So anyway, so last week we talked to Larry. So throughout this chart we showed last week about the rising costs of healthcare insurance premiums. And I'm looking forward to your commentary on this. So this is, this is like last week we talked about this is like, look at HMSA for large businesses, small businesses, individual Obamacare plans, Kaiser and all the increases. So why the hell is all this stuff going up in price? Which I can, one of the questions I have is that these premium increases were approved by the state health insurance commissioner. Okay. So the state health insurance commissioner approved these increases. Right. Yes. So why doesn't the insurance commissioner push back and get the quest, get the answer to the question of why they increased? Yeah. Why? What if the insurance commissioner said no? Yeah. What if the insurance commissioner just said, no, you can't increase it. That's right. You have to get better at what you're doing. That's right. You're asking us to take better care of our health. What do you take better care of your company? That's right. And because healthcare as we've all discussed and know is extremely complex. Yes. So going into these premium calculations is the fact that the population is aging. You've got health, the drug costs that are going up substantially. You've got still uninsured people. So there's a lot of things that go into the pot that impact the healthcare costs. But those premiums were basically set by the insurance companies. And so the question I have is, did the insurance commissioner, who's kind of responsible for knowing all these things, then what has that insurance commissioner, an insurance commissioner in Hawaii ever said no to a premium increase? Right. And I don't know that quite. I would venture to say, I would put at least a Guinness on it that the answer has been they've never said no. Well, I wouldn't go that far, but I think that they have probably pushed back and lowered it. But have they lowered it significantly, that's the, I think that's the question. So where are all these... But I think you raised a great point, Larry. And it's the head scratcher to me too is why? We know that they've gone up, we've read that in the paper. I haven't read in the paper the why. Exactly. Exactly. And you guys have been in this business for a long time, and you understand the underlying pieces that happen. So I'm going to just hit you with some statistics and numbers that will help us maybe, help understand maybe the why. I'm not sure. But throughout the slide where I got, the medical data is expected to double every 73 days by 2020. So medical data, this is the data, the medical data is being gathered right now. Every 73 days it's going to double by 2020. So in 2020, medical data related to whatever is happening around this country is going to double. Where the hell is that all going to be kept? Who's going to keep it? Exactly. The gorilla in the house is epic. Yeah. Yeah. Because now I think the reason the data is doubling is right now you still have a lot of data that is in paper charts in doctor's offices. Yes. All of a sudden people are going to be pulled yelling and screaming into automation. And then somehow figure out how then to pull together that data and that's why there's the increase. The increase. So they think in 2020 that more of the MDs or your primary care provider will be off of the paper chart and onto an electronic chart. And I think people are moving to there much more than when Larry and I first started in this. But you know it's more the ancillary pieces around you know that are part of the pie. But there's so many of these pieces. Yeah you bring up a really good point too is that it's going to explode but who's going to keep it and how are they going to keep it safe. And how are they going to authenticate that the records are correct. That's right. Correct. So that's why I go back to blockchain. I mean talking about it. No but I mean it's so true because everybody. I want to put everything in Epic. By the way Epic is the 800 pound gorilla in the house here. For those for the viewers Epic is the electronic medical record of choice for most hospitals in the country. If you can afford it that's the one where you go. Epic you know there's Cerner is another provider and I can't remember who the other also Renz are. But you know Epic essentially is the 800 pound gorilla in the house. Most healthcare providing organizations use it. They've got your medical record all around the country and you mentioned something earlier we're going to bring up really is that so let me just flip to the next slide and this will lead me to the next piece of the data part. So technology is one piece. So the other slide is the average person is likely to generate more than one million gigabytes of health related data in their life that's 300 million books and we're not talking Filipinos here. There's a 300 million book so first of all why are we gathering so much information that may be rising the cost. So we got all of this happening now too. Where are we keeping this? Who's paying for this? Well as a hospital CFO when you got the annual budget for the IT department the cost over the last four to five years was huge because you needed more data storage capacity. But still that was kept in your hospital and like then one of the challenges you have is how does that data get to some national repository of all that stuff. So there's we go back to the you when we started beginning. When we started beginning of the shows they got what can you do. So why don't you tell me about this application. You just told me about when we were having lunch that I didn't even know it existed. Yeah because Gordo asked me to talk about what as an individual you can do. And so first just thinking about health care costs if you look at it from an age of patient perspective kids in their teens and their 20s and mid 30s don't really consume that much health care unless they have babies or or they break fall break their leg on a skateboard or do those stupid things. And then is they you know you get into your 30s and your 40s you more and then when you trust me get into your 50s and 60s 70s significantly more. And so in looking at what can you do as an individual to control your health care costs it the extent of what you do depends on your age and where you're where you are in that continuum. And so I think maybe if you're you know you're under the age of 30 you don't have to worry so much. If you're over that the first thing you need to do is you need to get a primary care physician. And everyone should have a primary care physician that you would go to and probably at least annually. Mine yells at me because I don't. At least annually. He's always on my case. And so and so then but then but when you're selecting a primary care physician I think you need to now ask questions. And to me you can and actually the good thing is now you can pretty much go in line online you can find where the where this physician went to school and where they did their residency and their internship and what their specialty is interest on. Which is good. So you got to do you know you got to do that much research but then I think when you talk to your talk to a potential PCP that you would want to use you need to ask them if they have an electronic health record. If they're still doing it in paper records. You need to go find another dog. They're still doing paper. Or they have a computer some kind of you know small computer system that's just in their office I think you need to look elsewhere. Because the first thing you want to ask them if they have a record you want to ask them if you as the patient can access your record and understand exactly what is in there's something I never thought about asking. You need to know what that doctor wrote about you. And that some doctors get really sensitive about that. But then a bigger thing is we look at the total cost of health care and we look at your total care is is that data then shared with other hospitals other providers and other specialists and is it shared across the state but also across the country if you travel. Or yeah if you if you go into another another state and so and if we say epic is the 800 pound gorilla in this in the room in this area and if you go to a health care provider that's using epic for the most part it's almost I would say in Hawaii almost everybody. Your record is there. So why not let me take my record with me wherever I want to go. That's right because I think you know what you need to be worried about is if you do travel and you're in Chicago or you're in Dallas or somewhere on you know somewhere and something happens to you you want the emergency room physician that sees you to be able to go on to his computer or her computer in the emergency room and look at your record here in Hawaii right to understand what you might have allergies to to understand maybe what just has happened you medically hear what med you might be on what in what lab test you have so that the results of those tests yeah which you can see without having to do the test again so again right lowering the cost I go to Chicago I drop into Chicago and they say oh we got to run all this blood work yeah but if I was already at my PCP a month before why not just look at that there wait or you can even if you you know if you if you've had lab work in the last two or three months and then you go into the emergency room with something weird going on they can look at what were your normal lab results back here in Hawaii and what are your lab results in that emergency room and they can being a clinician they can say oh this is gone Kahflui so there's something wrong over here I know the leading causes of Kahflui or Kapokahi which is the local as the governor said during the nuclear blast how much I mean you got someone how much I mean anyway so anyway so yeah so yeah so pretty much if you're talking you know here most of the major health care systems and a lot of the physicians are on epic which is a software company and then their product is called my chart okay my chart so hold it right there because we're gonna take a break so so we just talked about how you can take your medical record with you wherever you go right and I want us I'm gonna post to you viewers that are watching this how many of you know about my chart and we're gonna talk about that in a minute when we come back after this break Larry Larry J Smith expert in health care not from a doctor side from the finance ricks the fundmeistered more money than who knows we don't go there anyway this is stink tech Hawaii raising public awareness match day is no ordinary day the pitch hallowed ground for players and supporters alike excitement builds game plans are made with responsibility in mind celebrations are underway ready for kickoff MLS clubs and our supporters rise to the challenge we make responsible decisions while we cheer on our heroes and toast their success elevate your match day experience if you drink never drive I'm Ethan Allen host of a likable science on think tech Hawaii every Friday afternoon at 2 p.m. I hope you'll join me for a likable science who dig into science to get the meat of science dig into the joy and delight of science will discover why science is indeed fun why science is interesting why people should care about science and care about the research that's being done out there it's all great it's all entertaining it's all educational so I hope to join me for a likable science welcome back and welcome with us here today Angus and you've got you've got some information for us on a new you know you're the health care you know I'm trying to make thematic and I want to make sure I get the right kind of health care you know I like your new haircut you're trying to copy me lad look at this nice look at this we got the people ahead right here looking good on you all right we're off here you know what I mean we'll see anyway you know I figured out I got my I got my own my own health care a drug that takes care of me you know Gordon's got to take general because in a whole but and you gotta get them around but I got my new drug and I got a picture of a hero got me last easy demonstrating for me it's called strudel this is what I'm gonna do from now when I go to hell it's gotta screw it all it cost too much money I'm just gonna show up whatever I want and if you don't think that I mean I'm gonna assume that's it that's my health care solution for that one assume or screw it all you can find it in stores close to you anyway you say every show but you're free where you be hello ha screw well well thanks very much thank you it looks like that's that's I'm not sure if that's working for you but you're happy I'm happy it seems you figured it all out anyway we took a break and before we took a break you've mentioned this on my chart so so just to give you so how I'm not knew nothing so we're having lunch and Larry says to me well I just go to my my chart app and all my health care records are there I went what my chart what's this my chart and we go right there in the restaurant I go I download the my chart app and I got to go through some processes but so see what that is so my chart is an application this part of this mate this epic system it's free by the way it's free and and the whole idea is my chart is your record and this is the way you interact with your physician your providers it's the way you can go in and understand what's happening with you and so it's a great application and what happens is after you get my chart and get used to it when you need a prescription refill when you need just to ask your physician something like a dog just bit me should I come in then you can do that by my chart and usually physicians tend to be very good or the physicians staff in responding back to you with a center refill request to the pharmacy and giving you some stuff or they'll say I think you need to come in so is but then you can also what I like about it is you can go in and it gives you all your lab work so if you went like last week I went in had lab work done on Thursday on Saturday I get a email that says your lab results are in go to go to my chart and check your lab results and so you can go in my chart and see your lab results and you hit a button and then it will trend your lab results over that you've been in the particular system right and the key thing especially when you're going to have to talk to your doctor it shows you what the acceptable range of outcome is so you're sitting there looking at your lab work and you're seeing the trend and all of a sudden if you go over the acceptable range you know that you and the doctor are going to have a serious conversation which and so so that's that's available and that's on me so then that's we go back to what can you do that's what can we do as an individual prohibit the situation where a catastrophic event is happening because I'm paying attention to what's going on with Mike right right so this in and also I think the other thing which which now gets into where is all this new data coming from and then you expanded information that's out there one of the things you need to hold your physician's feet to the fire about is the quality of the documentation that's put into my chart because this is also the same this is the documentation in your health record right and so you want that physician to be as precise as as he or she can be in documenting what what you discussed and what you found when you when they looked at your lab work and they had the discussion with you in your office visit right because when you do show up in Chicago and it's a big emergency you want that doctor Las Vegas are most of our residents when you have the heart attack after winning the jackpot that's right you want to make sure that that chart is complete and that everything that's going on with you be it diabetes or weight or alcoholism or obesity is documented correctly and and completely in that chart and you can you can see that and hold your doctor accountable because the the reason there's beginning to be more data is doctors recognize they need to put that in because now the the government and the people who are compiling data right want improved documentation correct so you can have the researchers one exactly and the drug companies one that's right go back to the blockchain and right but all of it but all of that's happening out there that data is extremely valuable and we talked about from a hacker standpoint a medical record is like 45 bucks right now if someone can hack and get your medical record and if it's a credit card it's like three cents so this gives you a sense of how important that data is and so that's and that's one of the things that's happening is you know there maybe there's there are statistics that people are sicker or that whatever what the really what's happening is I think physicians in in where I've worked before our younger physicians were learning to improve their documentation to get it in that chart well they then I would think that the result would be I would get better care exactly I wouldn't have to be waiting as long right much of it could possibly be done online exactly without us having to go into the office so now we're looking at different these are all different ways that we can manage the cost and bring the cost down and then also the insurance commissioner saying no yeah because you can see because you're basically you know you can finally answer the question is the population of patients getting sicker or less sick and why yeah and and so that's that's one reason you know that's one reason for having it and the these efforts by you know you talked about you know the there's now this new venture with Amazon and Chase Bank Chase Bank right and Berkshire Hathaway going to create their own insurance company right and I love it they're going to collect data yes and and so they're they're going to want to monitor and Medicare already is monitoring for Medicare patients how sick you are and there are waiting factors that are applied to different conditions and so when your insurance so as far as what your insurance premium will be and how you do all of that sort of stuff if you have the good clinical documentation there are now processes that will that where the insurance companies in Medicare can say we're going to pay the providers based upon how how ill you are how sick you are right and that's documented and real not surmised in the chart it's in the electric truck yeah one of the companies that that I've been following is a serious computer solutions they've stood up a lab in Southern California and they've got a lot all kinds of technology including they have a an epic stand up there and they can they can simulate a 2,000 bed hospital and all the records associated with that and and it tied it with Watson Health and a whole bunch of partnering with IBM and and such over there so I'm excited about that too because again it's about what they can create that will allow us to control what we can do to control our outcomes right and it but it all gets back to if you see the doctor and the doctor doesn't record the information I got my yellow notepad here and that record it so it can be compiled and then that data can be pulled together to impacts premiums it impacts all kinds of things how they get paid well and also ultimately the research that goes into how are we cared for because if we have that information we you know we can we can study that and get to better out right better care better out and you bring in and you bring in things like Watson Health and I would encourage our viewers to go online and just check what Watson Health is happening in that particular space because there's medical journals that come up every day there's no way as your PCP your primary care physician can read every medical journal that comes out every day on causes of high blood pressure cholesterol whatever those kinds of things are but the technology can help them do a better job in diagnosing and yeah prescribing what needs to be done and then getting to it faster and then cutting kind of cutting-edge technology now with Epic is once they have the improved documentation Epic now sets up a log so you're you have your primary physician and that physician would have a nurse practitioner that would help them and they would have your data and based upon your data it would give the nurse practitioner a work list every day that says oh Gordo based upon his age and his clinical issue needs to come in next week for lab work or for a physician visit so it's proactive yeah which is some of the stuff that Amazon is yeah that Amazon is trying to get to that you know they already Epic has the functionality to do that so you can have a nurse every morning that sits down and says I have a panel of a hundred patients and out of my hundred patients there are high-risk patients so when do you get older right for example and have a lot of complexities that nurse can sit down in the morning and say I've got a here's a list of 20 patients that I need to contact today and the system tells me what I need to ask them to do wow and then and they can pre-stage so they don't eat the night for the night before you're gonna have these particular lab tests done plus we're not going to overlap test you we're just going to do the ones that you need to have right not we think you need to have so that's the that's the real cutting edge now of that technology where you have the where the physician's office is going to be proactive so let's go so we only got about a minute change so let's go back to the you so this is our message to the viewers on this is a what do we need to do I downloaded the app I'm getting the app I just did it at lunchtime today so I'm getting set up on that he should be but go into and you can go into pretty much the website of any of the three big hospital systems in Hawaii in Hawaii right and you can I bet you can find my chart or apply for my chart on that website right and there's there's a access code number that you've got to get from the hospital you put that in and you're pretty much there you're pretty much there and now your chart now and that the beauty of this this means your chart follows you wherever you go yeah yeah think about this ladies and gentlemen so when you're getting on your round trip when airlines like to go to Vegas you got your medical record with you when you're going there which it's like that's pretty amazing yeah and if the cost of my chart I looked online it was it it was nothing it was free 99 so that's on us right I'm getting mind I'm I'm completing mine today now my doc's gonna start yelling at me because I never show up for about two and a half years that'll happen yeah he's gonna be like I'm gonna start getting emails your need to come in this week because your health profile will say that at your age and with your complexity of diagnoses right this is the the right thing not to do not excessive but the right thing to do the right thing to do and bring you in so it's so it's it'll reduce health care costs over time is the best thing for you and it'll get the the whole country the data we need to improve health care in total yeah so you ever had something to this no because I well I've used it and you'll been on the mainland and had to go to an emergency room and I had been in in the doctor you know like three days before and in the ER the doctor could pull it up knew everything that it happened me just three days before 2,500 miles away yeah so this is on you ladies and gentlemen this is on this is the point this is on you you need to go and get yourself your record set up you do with your bank accounts and everything get your records start up start managing your records and we'll start to figure out ways to lower the cost of health care Donald Trump's gonna take care of drugs because he said so last night in the state of the Union so we got that taken care of and then get say got through it all so he's happy and then and and then we've got to start you know encouraging people to start saying why are my premiums going up like you would said earlier Larry like why you know the insurance commissioner needs to say no we've got all this records that show that people are managing managing I'm managing our health care record yeah exactly that's it okay cool okay well thank you guys you're gonna get a solo club solo cup 148 all right this is your second in a series they're not in link so that way you can't double dip and overcharge when you're selling them on eBay or Amazon anyway Larry I love having you on the show and I want to have you come back and we're gonna talk more and more about health care over the we're gonna be thematic over the course of the year thank all of you for watching we'll see you next week and like we say at the end of every show one two three how are you doing that was a nice week