Please put together a warm
Georgia Tech welcome for B.B. and.

THANK YOU THANK YOU THANK YOU.

Good afternoon.

Kevin and.

Thank you very much for
the kind words and very warm welcome.

It is a pleasure to be with you as
Kevin's introduction suggested my

connections to your campus are more than
I had suspected before the invitation to

participate in the Williams lecture came
to me my family has retired and building

a wonderful renaissance here in Atlanta
in the southeast and really enjoying it.

I have many business and professional
connections here as Atlanta is a major

commercial hub and importantly it has some
fantastic educational institutions and

is doing exactly what the the lecture
series is focused on leadership and

entrepreneurship which are at
the core of what we do.

In my work day to day and all the core
of the things that I hope to inspire and

perhaps challenge you a bit on today.

So I feel very much at home and
thank you very much for your kind words.

I want to also extend my thanks
to Mrs Lorraine Williams and

her family for
the initiative to sponsor the lecture

you know very often particular when you're
a student of buildings and chairs and

professorships are always
named after people.

And most of the time you've not met
the person or have the opportunity to know

exactly why one hall at Georgia Tech
might be named one thing or one

room might be named the other but what's
nice about I think the Thomas will or

Williams lecture is you learn
a little bit about his life and

family through the legacy that
Mrs Williams is continuing.

And the values and

priorities that both she as well
as her extended family represent.

So it's not just good to be here for
all of the professional and

educational reasons I started with but
it's also good to know that the values and

momentum and next.

Integration of encouragement
that Mrs Williams is trying to

sustain is represented in all
of your bright cheery faces.

So thank you for having me.

And coming in such generous numbers.

I didn't have the opportunity
to to meet Thomas Williams.

But I know a few things about him and

recently cations I've had the opportunity
to meet people extemporaneously and

postpartum and that is the case today
we know that he was a businessman very

committed to finance and building both
employment as well as financial strength

both in banks as well as the southeast
region in particular we know that he spent

a lot of time in the chamber of commerce
working as a social sector in the public

sector building the city and the area you
live in not just building a business for

its own purposes and we also know that
he had an eye on the social scene.

There are choices when you
look through the resume and

I'm sure all of you can google and be on
line much more efficiently than I can but

there are choices in chairing the United
Negro College Fund a wide range of

institutions that both he as well
as his family continue to support

that some of which are very visible and
high profiles like those De Salvo went

through some of which are silent and
completely behind the scenes and so

having as a role model and
having as an inspiration for

this particular impacts lecture someone
who was active in the private sector and

very successful in that consciously
chose to also work in the public sector.

Ben Thirdly thinking
about the social sector.

How can I use that choice of
the area I'm working in and

the platform that's been created for
me to make a difference.

Beyond my immediate business or
my immediate foundations.

So we all stand on tall shoulders when
we are invited to give lectures and

speeches and
I know that the three different spheres

that Thomas Williams worked on is exactly
ones that are meant to inspire you.

Today.
So

paled a little bit of attention
the next time you go into a hall.

That's named after someone notable in.

Georgia Tech's history because you
may learn a little something and

be inspired by it the way I have been.

My spark my focus in my professional
life has been health care.

I've worked in the health care industry
since I began graduating from college I

was fortunate to find a sector that I was
inspired by you have to imagine yourself

graduating from Georgia Tech and finding
yourself in a remote village in Senegal.

Beside the banks of a cause amounts
river and working as a solid or

rural midwife with virtually no
healthcare or clinical training.

Much less so than some of the doctors and
bio technicians and

neurologist who are in your health
care program here at Georgia Tech but

through that I found a real challenge and
a spark for

not only things that were happening in
the U.S. but also the global agenda.

I found in an area that
was both important but

also very vibrant in terms of its
business opportunities and a passion and

an area that I've been working
in in the seventeen or

plus years since I've been been
out of my business studies and

so I'll talk a little bit about
the contradictions in health care.

Not only why it's been motivating and
personally inspirational to me but

also why I also think
it offers some lessons.

No matter what discipline you may work
in an area you may find inspirational.

The reason why I think it is because it is
that important is because it is an area

that is filled with contradictions and
I'll walk through three or

four of those contradictions today.

And then maybe a little bit controversial
or a little bit challenging and

we can take questions at the end of
the first contradiction that I found very

attractive about the health
care space was that it is

space that is getting younger and
older at the same time.

Getting both younger and older at the same
time if you think about markets like India

or China the demographic wave and
growth of the population.

Growth of the burgeoning middle class.

High percentages of people for
example in the Middle East twenty five and

thirty percent under
the age of twenty five.

These are countries that are awakening
that are on the move in terms of their

swelling of their demographic profile
Also G.D.P. and other correlated outputs.

But their young vibrant societies.

Even as we think about events like the
Arab Spring or some of the obvious that to

stick for more established emerging
economies like India China and Brazil.

The fact that the emerging markets
hold a burgeoning youth population and

youth culture means that there is
a huge need around health care.

My start in health care came as
a midwife working in rural Africa

starting at the very very start
of prenatal and infant care.

But that continues all the way
through to ensuring that those young

people are healthy and
able to take advantage of these

exciting opportunities that are trying
to be built at the same time.

The expanding need and
burgeoning demographic of youth.

Globally.

Also is one that's aging.

At the same time.

In most developed economies.

They thought around health
care that comes first to mind

is how do we deal with
an aging demographic.

As baby boomers and other generational
shift move through Western Europe Japan

the US Of course you see a huge cost and

complexity around how do we care for
aging parents how do you care for

the responsibilities of people who
are living longer have higher expect

rightly higher expectations of quality of
life in as they age the terrific outcomes

of medical technologies and innovation
that means people can live longer do more.

And at the same time manage the cost and
complexity that brings

to any economy the health care budget is
probably looking at all the secondary

costs over twenty percent of
the economy and the cost of caring for

people as they get older is one that all
of us will bear not only individually.

But also collectively as we
go out into the workforce.

Whether it's undergraduate engineering or

indeed the business school
that you may be coming from.

The US is that it's interesting
capsule of that contradiction.

It's the only developing economy
that is actually getting younger.

And so my challenge is you think about
some of the responsibilities and

burdens of the U.S. healthcare
system as they have to manage both

of those spectrums due to our continued
openness and structural immigration.

The average age in the U.S. continues to
stabilize or become a little bit younger.

That's fantastic.

In terms of economic renewal and all sorts
of other positive benefits of that but

it also means that there's a huge health
care cost and complexity related to that.

Similarly we're also getting older
with the baby boomer generation and

many other expectations of longer life and
so the US has a uniquely and

very large scale challenge to deal
with as it gets both younger and

older with lessons to learn probably
both from some of the efficiencies and

scales of emerging economies and
some of the technological advances and

hard choices of finance that
developing economies are facing today.

So first compelling and
interesting as we get younger and older.

The second contradiction is is
there's less a contradiction but

more a characteristic of
the health care space and

one I think of many attractive industries
that you might be considering in that

it does touch on all different sectors.

I described earlier for you.

Life in which we were able
to touch in finance and

public private and social sector that's
one that's very obvious in the case

of health care that it is.

Particularly in a market like the US.

Strongly typified by what they
sixty to seventy percent private

sector coverage private sector service
provision private sector financing and

that's a real strength of the.

Market.

It leads to more competition
more innovation more

business ideas services labor models but
it also leads to more complexity and

more cost the U.S. continues to enjoy I
think the word is I'm not quite sure.

One of the highest ratios of health care
expense for any developed country and

in this week particularly this election
season and with previous debates you

know it's an unsustainable a high
level and so the costs for

the high quality outcomes that we enjoy
in the US is an unsustainable cost.

So with that.

Opportunity.

We also have the complexity and
the cost burden that comes with that.

Is not however entirely.

A private system.

Over thirty percent of the people in
the US are covered either first or

last resort by public funding and
public systems.

So although the U.S. has held out
it's probably the strongest and

most vibrant example of a complete
Titian based health care system.

It is also one where
still one in three people

at some point in their point
the health care system.

Rely on public provision of health care

be that the Veterans Administration's
Medicaid or Medicare back up insurance and

all the other things that you're
used to reading about in the papers.

So it's a largely private system but

not entirely a third is a large
proportion of any economy.

I told you that you were going to have
your weekly allowance your first paycheck

you had to give a third of it for
one purpose.

You would say wow that's
a huge proportion right.

I remember my dates of starving student
and so the proportion that is still public

and it needs to be properly and and
responsibly managed is still very high in

the U.S. although it's touted as a largely
and celebrate as largely private example.

Outside the U.S. The tables are turned.

In Europe where I've been fortunate
to live and build my career and

family for the last fifteen or so
years is largely public funded systems

much more like Canada as a nearer Mexico
is in their reference where seventy or

eighty percent of the.

Provision services and financing for

health care are publicly
managed very different.

Structure and financing of the system and

in some economies particularly
in Western Europe similar and

very good outcomes overall very
different philosophy and approach but

a hugely successful model and one that
is even viewed particularly in the U.K.

If you were able to see part of
the opening ceremony of the Olympics even

viewed as a cultural institution and a
part of the values and ethos of the nation

as well as a business opportunity as
the life sciences strategy of the U.K.

begins to market the N.H.S. and some of
its managerial success to other countries.

So a system that is
largely publicly funded.

But again not entirely.

The U.K. has over twenty to twenty five
percent private provision of health care

particularly in insurance sector and
is learning to diversify and manage as.

The public purse and public budgets
come under increased pressure

there is the lots of talk I'm sure
over the course of the last months and

weeks over the eurozone crisis and
the pressure on European budgets and

that's no different in the U.K.

France Germany etc Greece perhaps being
the most extreme but all want to continue.

If you really look into
the fundamentals of the drivers and

it means that the ability to fund
something as revered as an entirely public

health care system to the same standard is
also something that comes under threat and

so the encouragement of more private
sector individual coverage and

ration benefits is
something that's happening.

So a sector that surface has all
the characteristics of public private and

social sector but when you look at the
mechanics of how the service provision and

funding happens both in the U.S.
as well as in other markets.

You see a suite of contradictions in
the economy has to be able to do both

the public scale provision of health
care as well as private markets for

health care very very well.

The third contradiction around
health care is that it is both in.

Situational good if you will as well
as the individual one institutional

in the sense that many many
elements of the health

care costs are built into all of the
normal parts of G.D.P. and economics I'm

sure your business and health care courses
as well as your manufacturing courses and

others have highlighted that if you were
working at Ford or General Motors or

G.E. Healthcare diagnostics you'd see
the largest component of any car or

large medical device.

The largest cost component is labor.

The second largest cost component is
actually health care when you account for

the cost of coverage of the people
their pension accrual time off work for

not properly caring for prevention or

diseases interruptions because
of their children schedule.

The cost of covering families and
when you accrue all of that

into the cost of our goods and
services as a business economies.

You see that the cost of health care.

Both direct in something
like insurance and indirect

in terms of something like time off work
when you don't have a good care model for

your parents or for
your children is very very high.

And so it really is something that that
a scale that both publicly as well as

privately is a real institutional concern.

I've already commented on outside the U.S.
how the vast majority of governments

are publicly funded systems and
so it's a much.

How do you say less controversial
that it's an institutional good.

That's managed and managed at scale.

There are interesting blended models My
husband spent several years working at

Starbucks and one of the things that they
found as they were beginning to market and

expand and put I think a shop.

I was going to say in every building but
then there's one in this building.

So you probably already know that but

as they were standing in scaling
their operational model.

They found that as they
recruited employees

the one of the biggest attractions for

working at Starbucks was their health
care benefit profile that a very simple.

Normal benefits package but because they
provided full health care coverage for

even part time work.

So if you worked.

I think say sixty or eighty percent of
my husband will correct me on the hours

they provided full benefit coverage.

It meant that they were able to use
that as a competitive advantage

to recruit a more stable workforce.

They got more part time moms they got
more seniors who wanted some work but

not a rigorous schedule.

They got more serious minded students who
were working their way through school and

they found that it changed the whole
complection of their workforce and

who they were able to attract
simply because of the premium

that's placed on health care coverage and
benefits.

So again an institutional issue but
one that's got very direct and

immediate individual consequences.

The individual side of health care
is one at one level that's obvious.

If any of us received a phone call today
to say that our sister or parent or

godmother or niece or friend were ill.

We did.

Scuse ourselves from the lecture because
it's something that just takes immediate

focus and precedence and that is how it
should be that gives it its urgency it

gives its vibrancy for
me it gives its relevance.

But it's also individual in the sense
in the vast majority of economies

outside the US It is also
an individual payment.

It's called a self pay or self funding
market where the basic very minimum

government package many many people
sell find in self pay for health care.

I can see looking across the audience
that we have a very diverse and

international student body here.

And so you'll know in places
like Mexico China Turkey.

That self pay you decide yourself
do you pay for the doctor.

Do you pay for a pharmaceutical medicine
or maybe and over the counter product

an alternative therapy or nothing at
all is a choice that many individual

families have to make at a much higher
level of their discretionary income than

we do here in the U.S. So imagine
an economy like Mexico's or take Brazil.

If you will that is already spending
somewhere between let's say nine and

twelve percent.

Of the global G.D.P. on health care and
then for individual families.

You might then spend in your after
tax income another fifteen or

thirty percent depending what the needs
of your family are it's very real.

It's very concrete.

It's very immediate and
that that individual decision of each day.

Do I make that tradeoff gives health care.

M R A A relevance and

a saliency and importance that
that I find very compelling but

it's a contradiction because you want to
provide a vibrant private and public good.

That is by its very nature and
scale spend institutional But

at the same time is extremely individual
in terms of health and wellness for

each of us and for
many many people in the world.

It's actually a very important economic
decision about where they spend and

how they allocate their
individual share of health care.

And then the final contradiction I would
highlight for you is really about.

The how the business market is
structured being both concentrated and

very consolidated in some ways and
fragmented concentrated and fragmented.

The concentration part is actually
some of the most exciting parts of it.

If you think about how real
innovations in healthcare services and

provisions and improvement and
outcomes are achieved.

It's because people specialize they

don't study things in general
they choose to study business.

You don't study things in general you
choose to study engineering you don't have

a things in general you
choose to study orthopedics.

Pharmaceuticals certain types of research
etc specialization as is the case in so

many different industries leads
to a huge depth of insight.

Economies of scale economies of scope and
typically much much better outcomes and

so if you look at some of the most
exciting models in global health care they

have at their root a lot of engineering
and operational principles specialisation

using this principles not quite the same
way as running a factory in LA.

But a much more efficient way of managing
health care they are even Di Hospital is

one that's quite well known for
its cataract surgery where entrepreneurs

students and business people began to
set up specialized hospitals in cataract

surgery in India and they specialized
only in cataract surgery the different

types of surgery specializing through
different teams in theatres and

working on volume to build experience and

technical expertise and if you ever needed
a cataract surgery you could do much worse

than going to the our event in terms of
the outcomes that they get as well as

the ability to scale the need that
across a population that's need needed.

The operating principles
have been used in Canada.

They've been trialed in scale
that Hopkins and Mayo Clinic and

of course are being used in other emerging
economies where there is an overwhelming

need around this particular type
of surgery but that that logic

the business logic of specializing along
the value chain concentrating what we know

about healthcare to get better outcomes
has been a huge driver of advancement.

You also see concentrations
in how the different

parts of the business structure system are
structured for example here in the U.S.

with integrated delivery networks or
I.D.'s Has anyone ever heard of an idea.

You know.

It's like a Permanente or

what's a health care plan here in Georgia
that where you have both the doctors and

the nurses as well as the hospitals
all linked together in one network.

So sometimes if you have health insurance
you can go to one set of hospitals but

maybe not another because they've got a
relationship together and those are called

integrated delivery networks to take what
is fundamentally a fragmented system and

build more concentration and
specialization around it

doesn't sound like much of an innovation
it sounds like common sense but

it's been a very big contributor
to more developed economies

health care systems thinking about how to
take the health care system we've got and

get better efficiency and
better results out of it.

So.
It's another example of the within

the business system as opposed
to within the disease area

of where specialization concentration
makes a big difference.

The fragmentation is the obvious part.

If I asked any of you to
find your health records.

Would you be able to find my
health record with spread across.

Cleveland Ohio Japan Montgomery Alabama

Boston Massachusetts London.

And probably some fringe locations
I should have been on constantly

Europe as well we don't have one
integrated health record it's not

efficient like you can track
yourself on Linked In or

or Facebook where all of the interactions
are are automatically tracked.

I think in the future will probably more
likely carry our health records on our i

Pads than we will to be able to find them
in the in the health care system where

technology will leap frog and
give us the ability to have one record but

the point is it will be on your i
Pad It won't be in one hospital.

You'll be responsible for
it and each one of us will be

going through the process of when you
meet a new doctor explaining to them what

your medical history is hopefully with
more accurate enough to date information

that you will be the power of one you'll
be the only one who really has it

will be a highly highly fragmented system
and working through that fragmentation.

How do you manage that.

How do you find opportunities to improve
on that is extremely important and so.

Whatever the business area
you're choose to to work it for

me it was health care inspired by an
almost accidental introduction quite early

in my career you want to find one
that's got contradictions for you.

That's got really naughty weighty problems
to be solved at McKinsey we like to focus

our minds our energy our institutional
capability around the toughest problems.

The things that if we solve
them if they make a difference.

It'll make a difference at a very large
scale for a large number of people.

Not be contradictory problems.

That look quite difficult to solve that
have some of those contradictions that

we talked about in health care older and

younger at scale at the same time
public social private all valid.

All needing expertise and
a high level of function.

Institutional and individual really
relevant to your daily lives but

also really relevant to
the global economy and

the national economies in
which we all live and work.

And one that has opportunities for
improvement.

Whether that's managing through a very
concentrated and consolidated view

of where an opportunity might come or
managing the fragmentation and

finding opportunity within that
really complex knotty problem that

if we made a difference on them
would really move the needle and

so the combination for me of health care
is a topic as I've talked about so far as

well as McKinsey as a place where you can
both specialize but still have a range.

Has been a very exciting platform in which
to work with a wide range of private and

public sector clients.

Whatever area you might
choose to to work and

one I'd argue that health care
will be a relevant thing for

you to be knowledgeable about and aware of
and understand the economics of whatever

business area or
engineering area you may choose.

But I'd also assert that it's not
health care for you as it's been for

me find something that's got that spark
a passion in it something where you see

knotty intractable problems things
that are obvious to solve things there

is not an easy path to go through it can
be anything ranging from a sustainable

resources thinking about how do you
really embed social responsibility

as a business agenda.

It could be issues around.

How do you.
Man you how you look at jobs at scale and

the flipside of that unemployment
particularly youth unemployment which is

causing so much turbulence around the
world today something that's relevant for

you something that that a genuine
core Colonel meaning for you because

when you work in an area with those types
of contradictions and difficulties.

It will give you the energy and focus
to continue to pursue your passion and

want to drive that for
Excellence in scale.

Any area that you might go in if you're
graduating as an undergraduate or graduate

student is going to be challenging but
choir travel lots of trade offs and

rigor and I can tell you that you need
to have a passion for what you're doing.

As a mother of two children I can tell you
that very often I say to myself what I was

doing with my daylight hours.

Given that I spend eighty
percent of that time working

as opposed to with my husband and family.

It needs to be something that's really
important that has some things that

are unclear on the horizon that are not
yet solved that are worth the time

personally and professionally and
really make a difference.

So that's one challenge I'd offer you.

Secondly is the carpet idea is the phrase
to seize the opportunities you're at

a point in your professional lives where
you really are on the cusp of lots and

lots of choices and new opportunities.

It's very easy to mistake these
days with the global economy and

the difficulty that I know some
students as well as professionals have

been finding the right opportunities for
work and getting started and getting

experience it can be very very difficult
but I'd encourage you to be optimistic not

pessimistic the types of problems that
health care and many other areas.

Offer the scale and

scope of those challenges in
the global economy is immense.

And your ability to bring energy talent
new creative ideas create wealth

creates opportunities for others to
work across sectors is almost limitless.

And so if you're seeing the glass as half
empty as opposed to full I don't courage

you to challenge yourself one have I find
an area that I'm really passionate about

because you're passionate about
something the glass is always half full.

You're always saying what
more can be done and secondly

what else can I do to gain experience
in that area just to get exposure.

We're chatting before the lecture
about something as simple as for

a student who's interested in medical
products visiting in a theater or someone

who's injured in engineering actually
looking at where the five most complex or

most expensive projects have been
built in Atlanta in the past

with something very simple that shows
a curiosity even gave them an interest

that of course differentiates you in the
recruiting process but more importantly.

If you really think about why why
am I doing it why it's important

what do I have to add.

So please see the glass is half full.

Not because the job
market is it is easy or

that finding your passions in life is
straightforward but when you find it.

It's always worthwhile in
the earlier you find it.

I just think about it as more time you
have to work on building that area.

I got a little bit lucky I've been
lucky in my relationships in love.

I found that early.

I've been lucky in my passion work I found
that early and been able to benefit from

some really strong and effective mentors
to give me courage went along that way

so I don't know what type of
try sector athlete you might be

whether it be the private sector or
the public sector or the social sector but

I encourage you to find an area
that's got all of those dimensions.

So that you can really expand on
the platform that can sell who and

all of the faculty and administrators and
alumni of Georgia Tech are providing for

you I'll leave I think about twenty
minutes or so for questions and look

forward to hearing your thoughts reactions
and challenges to my comments today.

Thank you very much.

Any questions.

OK no questions.

Yes please say your name and
where you're from.

The faculty member here.

Thank you for an excellent presentation.

The question I have is how do you
think the National Health Service

would be applicable in the U.S. market.

Well as I mentioned in my comments I think
that we have a little bit of a false

polarization that the U.S.
market is a free market

private sector that drives all
the innovation efficiencies.

Benefit and cost and

that's a better model than more socializer
let me call it publicly managed system.

Similarly that the beverage system and
the other socially or

publicly manage systems in other
economies are structurally better they're

not necessarily They just chose to
set up their health service and

provision a different way
than we chose to set it up.

I think the learning is around that thirty
percent that I commented on in the US

economy that no matter what your
individual view is about how

health care should and could be provided
and finance we still have thirty and

probably a growing proportion of the
population that is going to be directly or

indirectly sooner or
later under government management.

Now it's still a fully paid and
full fledged US taxpayer.

Even after fifteen years of proceeds I can
promise you that what I want that to be

is more efficient and
more effective with better outcomes.

Regardless of how it's structured so
I do think there are some lessons for

how a care network's
outcomes management and

pathway management are structured in the
U.S. where we structure things very much

on institutions as opposed to long
care pathways is one big learning.

I think the second is in terms of
having much more outcome metrics

around the finances health care is not
a sin is not a business that lends itself

an individual level to financial
discussion but at an institutional or

corporate level it absolutely does.

And I think more rigor and transparency on
how we manage that makes a lot of sense

and more incentives for individuals so
that each of us makes better choices.

Particularly if you're going to be in the
public system I'd much rather pay a little

bit for a type two diabetic to get
the right care and support early than

the cost and
complexity of the complications

foot officers etc Whatever they are there
late in the healthcare process.

They're bad for the patient and they're
expensive right to buy the choice between

those two outcomes I'd
always choose the former.

And regardless of what we think about
one health care plan or another one.

Coverage model or another thirty to forty
percent probably within the next ten years

of the US population will need
to be publicly managed and so

I think there are some great
lessons from not only the N.H.S.

but also from some more innovative and
younger emerging economies.

When you don't have the money to spend
on health care that the U.S. U.K.

Canada and other markets spend
you make different decisions and

I think some of the innovations we see
about access to care and modular and

early prescreening and training are things
that could be applied in the U.S. as well.

Built a professor of the practice
here in the shell or

college teaching health care management
after a forty year career in the sector.

Yes and I agree with with your
contradictions and thank you for

bringing them to a sense of
just another contradiction.

And that is my interest
in the quality cost

ratio relationship at the end of life and

we do a very poor job and it seems to me
if we would really focus on improving

the quality we would realize these
incredible gains of decreasing the cost.

I know of no other relationship where you
can focus on improving the quality and

end up with a lower cost if you have any
examples of how that's managed in Europe

lessons that we can learn.

Absolutely.

One of the great ironies is that
no matter how fit you are and

how much preventative work that you've
done and I'm sure most of us in this

room are feeling well and
are with ourselves and healthy.

That's my hope for you but
the reality is for

most average life spans in the last really
twelve months of life and increasingly.

As conditions like dementia and

others come into play the last five or
seven years of life are a quantum

ten fifteen hundred times more expensive
than all the health care you have humility

only in your life before small babies cost
a little tiny bit things are pretty good.

It's through for the average healthy
person and then towards the end the trade

off of what's the right level of care and
outcomes for people who are later

in life and in the in the last months
of life is one of the hardest ones and

it's one area where particularly in
the U.S. system of his profession jests

the cost ratio relative to the quality
of outcomes you get is really inversed.

Now when you say that at an aggregate
level and institutional level.

It makes sense you think to yourself.

We should follow care pathways we
should use a much more transparent and

efficient ratios like the quality
ratios that are used in the U.K.

that before care is decided upon.

Helps physicians decide
what's the right and

appropriate course of care and discusses
that through with patients and families.

So an institutional level I think
you can move the needle on it.

I think the problem becomes for any
individual when you're presented with that

individual tradeoff of should
we pause in the treatment.

Now or

decide on a lower cost less complex path
of care that might have a better outcome.

None of us individually
emotionally feel that way.

We always want do the right thing for our
onto our mother or child and so the push.

And sometimes the systems
push to have more inputs

that don't necessarily reduce improve
outcomes is a very significant one.

There are lots of innovations in this
space though I do think that when you look

at the quality system in the U.K.
There are also a number of other.

Particularly for drugs and

medical products assessing the quality
outcomes how much benefit.

Do you get for this intervention
have made real progress in more

social life systems where you could
implement them at scale the one of

the challenges in the US is even if
Kaiser Permanente or the Georgia

state health plan had an interesting
innovation it's still very hard to scale.

So I think there are some ways to
get to better quality that also

typically come in.

Or cost but getting people to accept
them on an individual level is hard and

secondly scaling those interventions
particularly in the US system when

it has all of this fragmentation
is also very challenging.

Please please stand.

My name's Chee I'm a false
you're biomedical engineer.

You have friends as you
say that after graduation.

You're right or fortune to seize the
opportunity like in the house car sectors.

You haven't installs of all like
one stop to duties right now

in the house car sectors because I'm about
to graduate and you won't see what's the.

Thanks.

We all want jobs but the the seriously.

You know you are more purposeful and

more clear than I was when
I was sitting in your.

You in your seat when I was finishing
up you said your undergraduate studies.

When I was finishing my undergraduate
studies I didn't want to study anymore.

And I sort of just wanted a break from
cranking out the thesis papers and

reports and so forth and
I also had a desire to try and

live and work in a different culture as
well as to contribute something back.

I was very privileged to have
very strident parents who secured

a very excellent education for
myself and my brothers and

I wanted to contribute to people who
maybe didn't have those advantages and so

I joined the Peace Corps actually.

And that was through
the assignment really serendipity

divide intervention was assigned to
health care and found a passion that

I was really purposeful about but it
wasn't hugely directed at the beginning.

So I guess my first common reaction to
you would say if you're not as clear that

health care is what you'd like to do or a
certain area of structural engineering or

manufacturing or
technology innovation that's actually OK

there's still lots of room for exploration
while still building your experience.

The second thing is within health care.

I really think that the the playing field.

It's very very open.

It's an area that needs improvement
on almost every dimension.

So if you're a tech geek and you're really
into innovation thinking about how you can

have both devices and
services that leapfrog existing systems.

I'll give you two different types of
examples in one case for sonograms So

the the prenatal screening
you do when you're pregnant.

It's very hard to get access to that in
some rural environments G.E. Healthcare or

Siemens or Philips are companies that make
very very sophisticated machines that

are probably present in every medical
center and hospital in the city but

they're very expensive.

They're very high tech and they probably
over deliver on the requirements

needed for an average pregnant woman.

They innovated with the help of Nokia and

other mobile technologies the ability
to use the camera and no different or

better than the camera probably or maybe
even worse than the camera on your phone

to do two D. sonograms So
two dimensions not four no sound.

Not all the bells and whistles if you have
the opportunity experience a sonogram for

health reasons most typically
pregnancy but other reasons as well

you get a quite a kind of it's not
quite three D. like the movies but

it's quite you know multi dimensional
experience the high quality image.

And they took that makes to simplify
that they said what do we need to do

to be able to use it in rural
areas on mass accept or

into the used mobile technology for
two D. sonograms.

Driven out to mid-size cities and
rural areas and use that

technology leap technology entrepreneurs
and tech geeks from the high tech world.

Nothing to do with health care at all.

Innovating something that provided
at a much lower cost point

the ability to catch complications
early and reduce improve quality.

As well as reduce costs at
scale multi million population

scale and so whether technology
is the area or interested in.

Or finance the insurance or
reinsurance disability insurance

the pension costs around health
care if that's your area.

There's a huge amount
of opportunity there.

It's a system that has huge amounts
of fragmentation and inefficiency and

if you're a business minded student Any
time you see fragmentation inefficiency

that normally means there's an opportunity
to build a business so I think it would be

the platform is almost limitless To
be honest with you on health care.

It's just about taking a nation and

finding the people that you trust
that you want to build with or

maybe joining a company where you
can learn enough to apprentice and

build that experience base but I would
just encourage you to jump right in.

Don't overanalyze it.

Please.

I do then this is a second year M.B.A.

student Shelly and
thanks for being here today.

You mentioned about the house here
back to being very fragmented.

And also the train of moving to was
integrated a housekeeper network.

And I think that's kind of the viewing
the house here more as a team and

being an episode of
the in a silo events and

also with the help of
the electronic house recall it's so

I just want to ask what do you think is
the challenge in terms of the implement

integrated house networking in the public
sector for example you know logically.

Compared to in America which is more
kind of a private sector dominant is.

I think the challenge is the same in both
environments because you know our how it's

organized or funded the episodes
the pathways the journeys each

of us take as patients is very similar.

We're garlics of the system
you're operating in and so for

me the biggest challenge
is around the information.

How do you capture track and manage the
information so that I as a clinician or

as a health insurer or
I as a parent can make a better decision.

And have that information
prevent it presented to you and

efficient reasonably accurate and just in
time way that's why I do think that I was

sort of joking about your health record on
your i Pad but not really because I think

the technology leaps and
our own willingness and ability to manage.

All kinds of other
information independently and

well there's all sorts of issues about
privacy confidentiality the security of

the systems etc But I do think
the biggest issue to actually getting

more episode based more pathway based
more patient based really in the end

view of health care whether
it's in a public system or

largely private system has to do with
the information technology in the data and

I think we'll leapfrog this problem as
opposed to restructure the systems.

Integrated delivery networks are just
piecing together fragmented parts of

a system and putting them together in
a more logical way with a common set

of business systems and
economics around them

grouping things together helping them
having them work more like a system and

it's information that allows you to do
that so that for me I think is the most

fundamental challenge the solutions
technologically exist.

It's more the decision making and
the quality of management leadership

that's needed to be able to
have systems move forward.

There are a few nations Norway Iceland
that have concentrated Singapore that have

the concentration the populations and
the money to be able to officially build

you know and
National Integrated Health Network.

I think the biggest failed
project in the N.H.S.

in the last ten years was
the electronic health care.

Record initiative.

You know it is it is it is a very very
difficult area to figure out how do you

have accurate and better information
that will lead to better outcomes reduce

costs and and better reach better access.

OK when I was being so serious.

Today.

My question is kind of
similar to your question.

Which is you know you mentioned about

you know how you can view
electronic medical records.

Using an i Pad or your phone or whatever.

So I know there's a lot of.

Initiatives and this.

You know been going on
from the private sector.

And what about the government.

So who's actually leading this so

used federal government like trying
to build a whole of the records.

You know from my previous work
experience in health care.

You know came across that you know
the government institutions initiative.

And my other question is
since you worked in the U.K..

I came across some article
some time back that U.K. is.

In this kind of initiatives
like health care records and

then the U.S.
So what do you comment on that.

Thank you.

First as a a context
around electronic health

records because the publicly
structured systems.

Have the benefit of sixty
seventy eighty ninety percent.

Indeed one hundred percent even if you
have private coverage you can still go to

an N.H.S. facility they have the ability

to manage across the system your ability
to at least have transparency and

track that information and have even legal
access to the records is much much higher.

And so if you're the government of
Singapore or Norway as particularly

forward examples in the use of city
state or national health records.

You're able to access the data and
drive that forward and the N.H.S.

is indeed pioneering at
scale efforts to try and

do that it has been I think
the effort has been applauded

the progress has been very slow
the technology solutions are very complex.

There's all sorts of politics involved and

I would not say if I was candid with
you and or my personal opinion.

We're any closer to a true electronic
health record in the U.K. than we were

five or six years ago despite some fair
amount of money being spent towards that.

But chances that they'll get to that
sooner though are probably still.

Higher than the US because of the
structural fragmentation of the market.

So I think in the US where you have so

many already established private
providers insurers and systems.

Integrated networks will build some scale
people will be able to use their own

insurance typically provider and my health
record might be a Kaiser Permanente or

pilgrim or whatever plan I'm covered or
it might be held by the government for

example if I was a veteran or on
Medicaid or on some sort of mix funding.

So the U.S. I think will be harder
to to accomplish that same goal

because fundamentally our marketing is so
fragmented and has already such a high

proportion of private provision that
I think the solution will have to

come through integrated networks through
that system you're not going to change

the root system of our tree if
that makes any sense to you.

Where is the root system in the U.K. or in
Germany is actually structured differently

but the technology solutions and
the difficulties of implementing it.

That kind of scale is
still quite difficult.

The best progress has
been made in regions.

So if you think about Italy as
a country of twenty regions or so

or or or Germany

having various states maybe thirty thirty
five of them the best examples electronic

health records working have been at the
regional level in a European context and

if you start that way you're creating
a new health system like Eastern Europe or

many sub-Saharan African
countries starting from scratch.

You can sort of build it
correctly start from zero but

we're not starting from zero.

So there are some good examples and

I think they'll even be many celebrated
examples within the US system but

most of those are linked to delivery
networks where you're already

gathering the patients providers and
economics in one pool.

But it's a very thorny area and
one I think that that

a lot of different solutions will
have to ultimately co-exist.

Thank you.

Please your degree.

I'm in and by my.

Nicol engineering and
my question is do guiding healthy result.

What are your thoughts on that in one
regard to the cost of healthcare and

a lot of people go to places
where they can afford it and

second is regulation
prevents it in cutting edge

technology from getting to people
because it's done in the paperwork.

You differences in clinical trials and
what are you comments on that.

Well.

One is fantastic encouragement for
you to continue your work.

You know we need a lot of work at the hard
edge being the scientific edge of

engineering medical science and
many other disciplines and that work

not just the development commercialization
of ideas but also the research.

How do you cure newsies
as develop new ideas and

new approaches is extremely important.

So I really applaud your and

probably many other efforts here to
get multiple areas of expertise.

In engineering biomedicine
business except to be able to

solve some of these very
intractable problems.

Secondly I think the issue of how do you
bring the new technologies that those

great business medical and
socially minded minds and

people bring forward is one that
you have to one appreciate while

it's very easy to criticize regulation it
is very important that you've got a global

standard in approach on these things and
those things do take an enormous amount of

time I think the F.D.A.
is very recently announced move to try and

streamline its approval process for
medicines that and

build the devices side of things in
a way that's a little bit less complex.

We hope that they're successful in
that and it probably could take years.

As implied by your question
off the time to market for

some of these new technologies.

Probably a good thing right.

The strike the stringency of regulation is
a good thing but also doing it faster and

getting more of the innovative
technology to more people faster is also

a good thing.

However the technology access though
comes at a very high cost and

the density of technology in the U.S.
market is one of its great strengths and.

Terms of access of people
feeling very well cared for but

it's also a huge driver of cost and
complexity.

And when you add other things like
the let you just nature of the U.S.

and the importance of health care and
getting it right.

So you get the extra diagnostic don't you.

That's what we all would want individually
but institutionally it's not necessarily

the best pathway it's not the best way
to manage an episode and so I think not

only the approval of the technologies but
thought about how do you best deploy them

as opposed to the latest and best
technology always being the best solution.

Sometimes to the sonogram is good enough

sometimes to the sonogram is going
to nuff and it is very unusual

particularly in the US concept to think
about those kind of tradeoffs and

almost impossible if you think about
individually but institutionally we can't

and and society as we can't
afford the cost of health care.

No one looks at the U.S. with depending
on your numbers fifteen eighteen

twenty percent of our direct and secondary
G.D.P. tied up in health care and thinks.

I'd like to have that please.

It's structurally a real drag for
the economy and

it doesn't always even produce the right.

Outcomes or cover everyone.

So we have to find a way to deploy that
technology in a way that doesn't just add

costs and concentrate it in
pockets of the population you

have to think about the technologies
that drive access and also

some technologies that if I put it really
simply will have more limited availability

placed on worse second here and
be a student here.

How do you and public markets how
do you deal with the problems

of price discovery as you shrink the
number of payers in the system in the U.S.

we see it in education we
see it in health care.

Typically it just tends
to drive the price up.

I mean it isn't as public funds
are insurance companies take on that

burden more and more of paying I have no
real skin in the game other than my twenty

dollars for my co-pay and so
I really don't care how much it costs.

So how do you.

How do you deal with out in
the public in a public good market.

Well there's that individual as well
as an institutional approach that

individually I think we all have
to have more skin in the game.

If I put it bluntly.

We may pay our premium through the type
of employer we have except for A but

if you have a health care.

Requirement that costs
one hundred dollars and

you have a ten dollars
co-pay versus a zero cap a.

Do you think about it differently.

Assuming that one hundred dollars
is a material amount of money.

In other cases you have people who pay
the ten dollars their employer might

pay the next fifty and then they're a
veteran and so the public sector pays for

the last thirty or forty or
the infinite cost that may come.

Depending on what point of
the care they're in and

so there is even a when
things like co-pays and

partial payments or partial benefits are
introduced there is still a huge amount of

in transparency about the real cost and
complexity of health care and I do think

that it is a worthwhile incentive to have
more transparency so that at the very

least people know the cost of what it
is that is being delivered to them.

My mother in law had carpal tunnel
syndrome you know that thing that

happens sometimes when you stay
up late working on papers and

you type a lot your hands start to
hurt your ankles right in there

never happens to you I'm sure but
it is treatable.

If you is very severe and

I think her procedure while it
was zero cost her individually.

When you price that out fully right
the cost of every intervention clinics etc

It was over one hundred thousand
dollars for I think what was a ten or

fifteen minute procedure and
I'm not saying

her insurance should have covered that or
that that was a real total cost.

I'm just simply saying more transparency
on costs and tradeoffs and sometimes for

individuals a little bit
more skin in the game.

I think could be a healthy thing for

incentives many many other health care
systems have a self K. component.

It's very hard to introduce
retrospectively in the U.S.

market and
certainly politically very unpopular.

But it is something that I do
think will help people think and

pause a little bit in terms
of the individual decisions.

Now institutionally we've got a slightly
different issue which is the true.

Positive benefit to
profits even profits for

most suppliers private sector suppliers.

Has disguised.

So it we did a piece of I think in
the last couple of years we've done

a longitudinal piece at McKinsey looking
at the cost of healthcare in the structure

of P N L's by the different segments
of the industry globally and

what we found is that for some parts of
the industry particularly in some areas of

suppliers the price components made
much of it for very important and

innovative medicines was
extra extremely strong driver

of profit particularly the pharmaceuticals
industry the generics industry

the devices industry that doesn't mean to
say that the premium hasn't been worth it.

It's simply to say that going for

we probably can't afford to pay it in
the same way that we have in the past and

so the lack of price transparency
which is something that governments

in Europe and other single payer economies
where you have at the end of the day one

customer one big strong consolidated
customer are moving on a very very swiftly

particular with a budget crisis means
that that formula is changing and

the shape of P L's in the particular
in the private sector

of the industry are really changing to
be much more growth leverage P. and L.

it's still hugely important still very
attractive industries still hugely

creative I'd still put a pound or a dollar
in that segment but it means could behave

a little bit more like high tech than it
has like other industries in the past and

that probably for society as a whole
is a good thing although one company or

another may do better or
worse which company

which ideas which rolled is better worth
coming down to lots of you in this room.

The ideas that you put forward how
competitive your business ideas and

new innovations leveraging technology and
ideas.

So I'm not a proponent of just
free price transparency and

regulating prices on things like
pharmaceuticals etc because the vast

majority of health care costs are actually
labor but if you look at a P. and L.

of a hospital for example supplies
pharmaceuticals medical devices etc All of

that's probably twenty percent twenty
three percent something like that.

The rest of it is really how you
manage the labor the process.

How do you manage people through
the system that's where the great

inefficiencies are so some pretty
straight parents is probably needed.

Overdue if I'm candid with you when
the numbers support me on this one and

where we particularly U.S.T. to catch up
with a lot of other people think about and

buy health care but the real solution for
unlocking more value out of the health

care chain and getting better outcomes
more outcomes more health care for

the same or less money probably lies
in how we manage services not so

much in how we manage prices on drugs or
devices.

We have two more questions.

So let's take one from the really
the only one from me and

I'm Alexandria and I'm a senior in
invention engineering you smoke alley

about being very fortunate
early on in your career and

I was just wondering if you can speak to
some of the challenges or one of the main

challenges that you may have faced is and
you became director and McKinsey.

I've worked at McKinsey for
seventeen years now.

I didn't join to stay seventeen years I
can promise you that I will witness in

the audience to that effect.

I joined for a couple of years of
experience because I wasn't quite sure

what I wanted to do after business school.

I knew I was interested in health care and
I knew I had student loans to pay.

I knew I wanted to at that time live in
Boston and I wanted to go to a place where

I could keep learning and kind of think
about the full range of opportunities and

consulting management consulting
was a very good choice for

me the the job that I do today many years
later is very different than the one

I started with it's similar in the in
the effect in the sense that we work very

closely with clients on really important
issues the scale the scope the ambition.

What I hope to accomplish is different but
I still feel like I'm helping people and

helping companies to improve and

don't have to be super specialized
If I see tell you a secret about it.

McKinsey still is a place that allows you
to dabble in the private the public as

well as a social sector and really
celebrates impact making a difference for

our clients in those areas.

I think one of the challenges
however is is choosing really where

you want to focus and make a difference.

It is very easy to think about.

What alcoholics are the candy shop
approach learning a little bit about lots

of different areas but it wasn't until
I got very pragmatic advice to really

focus not on health care which is sort
of as wide as this room at one level.

But really getting very deep in certain
areas and beginning to specialize and

standing for something in knowledge areas
that really really made a big difference

for me it was a particular challenge which
is something I realized little bit later

in my career that I think if I had learned
earlier would have made a difference.

So that was one learning the importance of
knowing something about something standing

for something with clients standing for
something with your colleagues.

I think the second observation relates
back to the title of The Talk About It

takes a village in the analogy I was
simply trying to draw as it takes all

different talents all different types of
people all different types of leavers

to be able to prove something as complex
as health care and in my time it took

a wide range and a real diverse number
of mentors all very different from me.

Who were able to give me a lot of
challenge and kind of hold up a mirror

sometimes about when things were
really moving forward and when things

weren't in be open to that advice not
being defensive not feeling like my M.B.A.

you know a finished up Georgia Tech I can
do it just being open to learning and

reminding yourself that humility and
having a learning culture we're fortunate

in the privileged at McKinsey that
something we value very highly.

That's not always valued sometimes
it's tough being a new trainee and

it was one on the totem pole and you don't
always appreciate what your bosses boss's

boss has to say you feel like that guy in
the office you know sort of the person who

is the least valued in the environment
all different environments can can.

Can exist.

But what I will say is that having
good mentors people who coach and

develop you provide really good
timely advice and sponsors.

It has made a huge difference for
me again it's not a challenge.

It's something that when I look
back on it it made a difference.

The difference was you know a mentor a
sponsor by the way in my mind is a mentor

can divide good coaching advice they
can be a role model positive or

negative negative but a sponsor is really
someone who knows you well enough that

they're willing to work together
with you to create opportunities and

I'm grateful to the diversity and range of
the mentors who helped me sort of find my

focus and in the last thing I
would say that was important.

I don't know if it's a challenge again
is maintaining balance you know I

work in quite a time consuming and

mentally consuming environment and
industry.

I love the intensity of what we do and
the sense that through our healthcare

practice at McKinsey we're
making a difference.

Globally on something that I feel is
important in the will outlive my small

contributions to it but
balancing that with the rigors of.

A young family your personal
priorities working out and

all the different things that you'll
balance as you return if you were turned I

should say to the professional
environment or some of you enter it for

the first time is something
that particularly for women.

We have to keep in mind I know that when I

was speaking with
Lorraine Williams earlier and

the organizers of the lecture overall they
were very excited to have in this fourth

lecture a woman giving the presentation
because the complection of business is

changing the good thing is fifty percent
of the world are still men too right.

We actually all have
the same same pressures.

But it's much easier perhaps
now to talk about them and

I think that will be a benefit
to both men and women but

that has also been a real shot challenge
my children are still quite young.

But I'm fortunate to have a very good
partnership and managing that through and

a job that is stimulating interesting
motivational enough and a passion for

me and health care.

That's worth some of those trade offs.

Gosh that was that was great and.

Thank you so much for being here.

My question has to do with your focus

here on the institutional level and
on the individual level but

we didn't touch very much on
the organizational Yes Well and

I suspect that as working for McKinsey
you know just like the mother church of

affirms an incredible you
know brand what are the.

Some of the quite the organizational
questions that you've worked on.

And how do you work those
organizational issues

into a more integrated

solution even if the organization doesn't
know that's what they should be seeking.

I suppose in any solution that
we develop for our clients.

There's two parts to it there's the what
and then there's the how the what and

the how the what is what we major
on of course the problem solving.

How do you actually think about
quantifying the value chain or the twenty

year longitudinal analysis that I think
we haven't found existed anywhere but

yield a number of insights and
has been an important reference point for

many of our clients who
are breaking new ground and

new insightful analysis
contributing to decision making.

Moving the ball forward impact
really changing things being

proud to see your client in
the news that in a positive way.

Or if they're hard decisions that
they're taking those hard decisions in

a straightforward and

honest way and that is a lot of the what
of the problem solving and certainly for

people who are early in their career at
McKinsey that's the great gift of their

time at the two three four years you might
spend at the firm and why Consulting

is a great broad base to to learn from
as are many other other areas but for

me that's one of the main advantage
that the much tougher part is the how.

You know when you are working particularly
senior levels many of my clients have

seventy five one hundred
thousand employees.

And their issue is how can I take what
might be three or four simple ideas or

even obvious solutions we need to
three pathways differently to get

better outcomes at lower cost like that's
not such a radical idea but to get moving

that across a set of clinicians moving
that through how patients are scheduled

moving that through fifteen fifteen
hundred fifteen thousand hospitals and

the N.H.S. with a million plus employees
as the largest employer in the U.K.

perhaps in the world.

It is a daunting task.

Just in the how.

So what you find is one you simplify and I
think I've gotten older I don't know about

wiser but maybe more time constraints
our advice to clients on the what to get

simpler it gets more distilled and more
clear not only for communication purposes

but because as living organizations we can
only focus on doing one or two things.

Well collectively at any one time.

The second thing I would say is thinking
much more about what are the two or

three interventions that you could
make that make a difference in whether

the how works.

Clearly talented appointments having the
right people on the issue makes a massive

difference even if all the systems and
processes and things don't work and

then secondly being really prioritized
about which things to focus on so

organizationally focus not only just on
what you need to do to drive the business

solution or the social solution if
you're getting the save for vaccines

the the global vaccines fund doesn't
have to be a private sector analogy but

focusing on the what is what that
content of the answer is one thing but

focusing on the how are the two or

three things we as an organisation
are going to do differently.

One might be putting the right
people in the right place.

I've got a client that has changed.

Eighty percent of his management team
quietly over the past three years because

fundamentally he felt refresh was needed
but standing up day one as a new C.E.O.

one announcing we need a talent refresh
isn't really motivational is a right.

So working on the lever
sometimes in public.

Sometimes behind the scenes.

Secondly focusing on two or three ladder.

All processes but

normally not more than that that can
drive change across the organization and

then the third thing I'd say is remember
that you still have to leave room for

tailoring everyone's not going to sort
of do things a cookie cutter way and

it may be that in India vs rural
US versus rural Brazil a slightly

different solution is needed and
if more of the answer gets implemented.

Even though there might be
a little bit of variance.

That's probably still worth it.

So simplifying I would say is
the main theme in a lot of our

organizational work today.

The dice are coming to
Georgia Tech to the.