The Employer Edge: Data to Action

Tom Richards (Moderator): Good morning, everyone. I have to admit, I'm a little humbled to be moderating these sessions with these two amazing change makers. You've both had a big impact on health care and on data and transparency, and your accomplishments are pretty impressive. In fact, I was joking with Janine yesterday that we could have filled the entire thirty-five minutes if Janine had just stood up here and read your CVs. But thankfully, we decided not to do that.

Tom Richards (Moderator): We definitely want to get into a conversation around data and transparency—and then the actions that people can take. But before we do that, maybe just a little background. I suspect almost everyone has heard of and knows about the Health Transformation Alliance, but maybe for the couple that don't: Rob, can you just describe a little bit about what it is and, most importantly, what impact has HTA been able to have working with the seventy-plus employers?

Rob Andrews (Panelist): I will—and thank you for the compliment. One thing at HTA that we're trying to do is understand who really gets the job done, and it's the women and men in this audience. The nice things that you said, I truly appreciate them, but health care happens when the CFO walks in your office and says that her husband—who's gotten a certain brand-name drug—now has to switch to a generic, and "why did you do that to him?" Or you hear that the daughter of the head of procurement can't get an appointment with her OB, and "why did you let that happen?" And that thirty people couldn't get their radiology appointments honored at some lab in Cincinnati because it didn't happen.

Rob Andrews (Panelist): It was very nice what you said about what I've done, but that's how health care gets done, and we really do respect the work of that. And the reason I bring that up: that's who the members of the HTA are. They are CHROs and comp-and-benefits and health benefit leaders for about eighty-four companies across the United States, all of whom have self-insured plans. Those companies provide health care benefits to over five million people. The companies actually spend over forty billion dollars a year now doing that.

Rob Andrews (Panelist): And we exist for two reasons. The one is that we have this stubborn belief that you don't have to choose between cost and value—that if you understand what value really means, it drives cost down in the long run. No one looks for the cheapest mammogram for their spouse. You look for the best care for her. And so that's what we were trying to do.

Rob Andrews (Panelist): And then secondly, I didn't tell that story offhandedly. The world is filled with whiteboard people who want to tell you how health care could be changed easily in a couple of hours, but they've never sat in the chair of the person who actually has to do it. And we're honored that our board members and our governance comes from men and women like you in the audience who actually have to deliver that value. So what we try to do is a lot of listening—and then take what we learn when we listen and go negotiate with the intermediaries who you deal with: carriers, PBMs, data companies, point solutions, et cetera. I thought Congress was complicated. In some ways, that life is a lot more complicated, but it also gets more done.

Tom Richards (Moderator): Yeah. True. Thank you—and I agree. It's amazing. Just about every portion of our life, there's a pretty direct correlation between quality and cost—and in health care, that's not true. It's a scattergram. But anyway, Aneesh, I know you've seen health care from the employer side, from government, from health systems, obviously. Why do you believe that employers are uniquely positioned to help drive some of the change that's needed?

Aneesh Chopra (Panelist): Well, I live at the intersection of the public sector and private sector, and my view—my philosophy—is that if we improve the handoff, there's a lot of handshaking in Washington about making things better when we can hand off effectively between the two. So in that spirit, we have a uniquely private-public health care system, and that to some is "the bad." Some argue we need to have a single payer. But for me, there's an entrepreneurial energy and a problem-solving mindset that comes from what we currently have—if we can work better together.

Aneesh Chopra (Panelist): And so to me, I view the employer community as the community that, if we can organize in a more coherent way, can be an unlock for some of the changes that the system needs overall. We've got a lot of energy happening in the government programs—Medicare, Medicaid—but the employer program remains one that has, for good or ill, a lot of room for creativity and innovation, with a lot less micromanagement from outside.

Aneesh Chopra (Panelist): And so in my context, I spend today around opening up as much data as possible. The government did its part: all the data held by Medicare and Medicaid is publicly available. You can use that to figure out who the best doctors are on X, Y, or Z services because information on over two hundred million Americans is publicly accessible. But it's not the case in the employer community—that remains opaque.

Aneesh Chopra (Panelist): And now we're starting to see data sharing. President Obama launched the Blue Button initiative—that was one of my babies. That was the idea that the consumer, under HIPAA, has the right to their health information, and that you should be able to honor that right at the time with, like, a computer download. And today it's like a Face ID swipe until you can get it on your phone. And that is the world that's coming—and I'm very excited about having this conversation this morning to bring all of you along.

Tom Richards (Moderator): Awesome. Thanks. Rob, when we were preparing for this session, you highlighted a letter that I personally was not aware of—that I think was fourteen state financial officers wrote in mid-December to the Fortune 500 companies. And in that letter, they basically said they have these large public investment funds—they're the fiduciaries for that—and they asked the Fortune 500 companies to conduct a payment integrity analysis because they believe that it was going to "control costs, mitigate risks, and protect shareholder value," which obviously then was going to impact the returns on their funds. Can you tell me a little bit more about that letter? And then, importantly, why is that important—if it is—to the folks in the room here?

Rob Andrews (Panelist): I didn't know about it either, and I was having a discussion the second week of January with one of our board members who leads the HR function at a major corporation. And I took it as an implicit "or else."

Rob Andrews (Panelist): So the letter is written by the state treasurers and CFOs of—I think it's sixteen states—who are the men and women who guide the pension investment assets for those states, and many of them hold shares in publicly traded corporations. So they wrote to the CEOs of the publicly traded corporations and said: there's a lot of waste and conflict of interest in health care. You need to be paying attention to it because if you do not, we think it's going to materially affect shareholder value.

Rob Andrews (Panelist): The letter stops then, but I've read enough of those letters to know the next line was, "or else there's going to be some active shareholder activism or multidistrict litigation," or what have you.

Rob Andrews (Panelist): My thought about that is that this really is the choir that we would be preaching to. The fact that you are here shows that you are already cognizant of the importance of these fiduciary problems. I don't say that to be obsequious—I think it's true that you wouldn't be sitting here at this conference if you weren't thinking, "Wait a minute, couldn't there be a better way to be sure that under our fiduciary obligation we're getting real value for what we're paying? Shouldn't there be a way that we can understand what we're paying—how it fits into the market or not?"

Rob Andrews (Panelist): So I guess my thoughts for the ladies and gentlemen in the audience would be: the fact that you're here shows you're already aware of this. Your peers who aren't here, though—who are thinking, "Well, we've been running our plan for years and years and years and the carrier and the PBM and the consultants all take care of this"—I think could be in for a rude awakening.

Rob Andrews (Panelist): What this reminds me of—it has the echoes of what happened in pension plans about fifteen or twenty years ago. There was this massive shift from defined benefit to 401(k)s—defined contributions—and it was kind of a free-for-all where the investment advisers often profited at both ends of the deal. They made a fee for managing the investments, but then they made money from the investments to which they steered the retiree funds.

Rob Andrews (Panelist): As you will probably recall, there's a lot of litigation about that. There were efforts to change that in a regulatory way, and the world changed. There are now sort of two types of advisors, right? There are conflicted and non-conflicted. The consumer knows which one he or she is choosing.

Rob Andrews (Panelist): I think that's what's going to happen here eventually. I see this as a portent for this: that if you're not aware of these conflicts and these problems, you're going to have difficulty. There isn't necessarily a prescribed answer, but if you haven't looked at the choices and been cognizant of the consequences, I think it's going to be a problem. And again, I think the fact that people are here today shows they're intuitively aware of that.

Aneesh Chopra (Panelist): Can I just quickly piggyback on that? I want to share a little anecdote. In 2009, President Obama got into office and signed, on day one, an open data directive. And my colleagues in the economic team told me that this fiduciary issue was costing employees potentially trillions of dollars collectively in excess fees paid—right—hidden for their retirement.

Aneesh Chopra (Panelist): Two kids in San Diego thought this could be an opportunity for a business. So they flew to Washington and basically asked the Labor Department, "Can we pull every ERISA filing from every employer?" About thirty thousand filings—because embedded in those forms were the fees paid to the 401(k) plan people. And the librarian at the Department of Labor said, "Okay, you can physically get the files, but there's a five-cents-a-page Xerox machine—have at it." And so weeks and weeks would go by, and they were manually trying to get the data.

Aneesh Chopra (Panelist): We did this open data order. I had no idea what that would have meant, but the librarian said, "I have all of those on a CD-ROM. The president just said make it available open. Would you like that instead?" So they quickly ran it, and it turned out that if you had under a few million dollars in 401(k) dollars—small companies—you could pay upwards of ten percent fees when the market average was one. So basically, it was a huge tax on small businesses when they disclosed all this publicly available data.

Aneesh Chopra (Panelist): This is part of a three-part story that I wanted to communicate as we get into this discussion today, given what Rob outlined about the "or else" in the letter. There are some basics that that letter is asking you to do: look at the data for anomalies. Like, if you're just not doing the basics—you wouldn't be in this room. You're doing the basics. You've got to do the basics.

Aneesh Chopra (Panelist): But there's this equivalent of the two kids in San Diego saying, "What data is hidden that, if I could crack it open, is going to help me understand the problem?" You are not alone in wanting to crack open that data. When we in the Obama years did this, President Trump's team is doing it now. This is the most bipartisan part of the health care reform effort. It's called the CMS Health Tech Ecosystem.

Aneesh Chopra (Panelist): And we talked to Sue last night. Apple signed the documents—Google, all the cool Silicon Valley people signed everything—to bring their technology tools to bear to help make the data more useful. But we, this community gathered, could engage in shaping the kind of data that you need. And then, obviously, the third layer—the ultimate—is quality: using this really on a daily basis. So when you're trying to get the scheduled appointment to see the radiologist for a thing, you know exactly where to go and what to do.

Aneesh Chopra (Panelist): This is the kind of call to action. It could be a threat in the form of the state letter, or an opportunity—because people are welcoming you to be a part of the open data movement.

Tom Richards (Moderator): Yeah. It sounds like it is both, for sure. Maybe, Rob—just continuing—or Aneesh, just continuing down that path: the letter, to your point, had a lot around kind of audits and just doing the basics, and certainly around cost and price. But there's also something in there around transparency—around price and quality. Can you talk a little bit more about the transparency piece? I know that's near and dear to your heart.

Aneesh Chopra (Panelist): Yeah. So herein lies the challenge. We have two data systems in health care—and Cliff lives this every day, and you'll hear from him shortly. There's the administrative side: here are some diagnoses, and here are some services that I did—pay me. And it's kind of a blunt instrument because you don't really know the underlying clinical status of the patient and the detail around what was done.

Aneesh Chopra (Panelist): So, quote-unquote, to "audit it for price and quality"—that's an easy phrase to say, but impossible to calculate because you're using a really blunt data set to answer the question: Was this justified? Or were there alternatives that were better? If you read any of Cliff's cancer guidelines, you cannot test whether you're meeting the guideline on any of that administrative data. Impossible.

Aneesh Chopra (Panelist): So the second data set—and this is where my friendship with Glenn started—when we digitized the medical records and put the EHR incentive program, the thirty-five billion, we're now largely on the other side of that capital deployment. There is now a clinical data trail of lab values, of more underlying notes, and what happened and why, in context.

Aneesh Chopra (Panelist): So for every one of the claim systems that you see—you're fighting to get in your battles with your TPA—there's a whole other, much larger pool of information that could be both helpful to you in the price and quality audit world, but also to the individual employees to get them to the place that they want to go.

Aneesh Chopra (Panelist): That piece, at the moment, is not active in the employer. How many of you today—raising your hands—get medical records that you can link to your claim systems in assessing pricing quality today? Just raise your hand if you can link both for your populations. And the answer is obviously: you can't.

Aneesh Chopra (Panelist): As of today, data interoperability prohibits employers from querying for these things because it's only meant for doctor-to-doctor treatment. But as we'll get into later—maybe now—CMS is inviting employers and health plans to say, "Hey, look, you can come into the data-sharing pool. If you contribute your claims data to doctors and patients, then they will make information available back to you for payment integrity and for evaluating quality." So now quality and price is a verb, not a noun. That's the opportunity.

Rob Andrews (Panelist): One of the reasons we're so excited about that opportunity—and the work that you started, and that, frankly, the Trump administration and Biden continue—this is the one issue in Washington where there is something close to bipartisan unanimity that there ought to be more transparency. We really like what the administration is doing. I may have made some news there—Democratic—we really like what the Trump administration is doing, but we really do on this.

Rob Andrews (Panelist): And here's one of the things we're trying to do with it. Everybody knows the GLP-1 challenge is enormous. It's at the top of everybody's list. We are producing this year for our members—and our partners like Transcarent; Transcarent is one of our partners in making this work—a report that will look at, think about a credit score for a moment, where someone is rated high to low in creditworthiness.

Rob Andrews (Panelist): We're going to create, based upon our access to EHRs and claims and demographic data for about a million people, an efficacy score for GLP-1. What's the profile of the patient in terms of their comorbidities, their claims history, their age, their gender, their zip code—which tells you a lot about their income and race? What is the degree of efficacy likely for the GLP-1s—for some at the high end and for the low end?

Rob Andrews (Panelist): Now what this does is give you the ability to start to think about maybe who should be covered and who shouldn't. It raises some questions about how you could control costs.

Rob Andrews (Panelist): Now, I will tell you that when we started to go after that data, I was six-five and had jet-black hair—and made the rounds to the carriers and to the PBMs—and said a thousand times: this is the employer's data, not yours; and the employee's data, not yours. They're the ones who are the fiduciary, and if you're telling them they can't know what is going on, you're telling them they can't do their job.

Rob Andrews (Panelist): It took a long time, but when you get a critical mass of companies together, the answer became yes. And we have agreements with all the Bookers and all the regional Blues and with the PBMs that we can do this. And this should be the norm, not the exception. All of you should be able to do this.

Rob Andrews (Panelist): What a Hobson's choice you've been put in: where you're the fiduciary who has a legal responsibility to be sure that every dollar you spend is appropriate and reasonable, but some of the people with whom you operate won't show you enough data to figure out what you're spending and whether it's any good. That's a real catch-22 that you should not be in.

Rob Andrews (Panelist): And I do applaud what we're seeing with the ecosystem project. I think it'll move us closer to a day when you can see that, which then quickly leads to: Okay, now that you know this, what do you do with it?

Rob Andrews (Panelist): And it's why we're enthusiastic about Transcarent. Transcarent is one of the few organizations I've seen that has the depth and the financial breadth to take on a project like this, but that is not tethered to the health care status quo. It really is an organization—and Glenn personally is so driven by better outcomes. So one of the reasons why HTA is a partner with Transcarent is because we see that shared orientation.

Tom Richards (Moderator): Awesome. I appreciate it. And it's a great example where, kind of getting those employers and other constituents together, you can actually drive action. I know HTA has done a lot of that. Do you have another concrete example where you've been able to kind of drive change—either regulatory or through actions?

Rob Andrews (Panelist): Well, I mean, it's astonishing. A lot of you know it: maybe one to two percent of the claims that go out the front door are obviously wrong. It's OB-GYN appointments for fifty-eight-year-old men. It is six ambulance rides the same day for someone. And the carriers will—some of them are good at it—they'll tell you that we've got a detection unit that does fine with this. But we've had some partnerships with some other companies that have looked at this and found that, yeah, between one and two percent of the spend probably shouldn't have gone out the front door in the first place.

Aneesh Chopra (Panelist): That's a lot.

Rob Andrews (Panelist): And that's a lot of money. And the other thing we've seen at the other end is this thought that, "Well, our allowed amount for this service is nine hundred thousand dollars, but we got a three million dollar invoice. What's up with that?" And, you know, some carriers are good at helping you answer that question, negotiating that down; many are not.

Rob Andrews (Panelist): And we have certainly availed ourselves of a situation where we get clinically adept, competent people—unlike me—clinically adept people who would be able to go to those providers and say, "Wait a minute. This doesn't add up to three million dollars. And by the way, if we have an allowed amount cap in our contract, why do we ever spend more than that? What's the justification for that?" So those are things that we are doing together with our members.

Rob Andrews (Panelist): The other thing that we are hugely conscious of—I'll say it again—yeah, from the outside it looks really easy to do something like that. I know it isn't. I know your carrier resists the data sharing; you've got to fight with them about it. I know that you may not get the resources necessary in your budget to bring in some outside help with that. And again, I know you probably have seventeen other things you've got to do today to make sure people's bills get paid and appointments are honored.

Rob Andrews (Panelist): So we get that, and our philosophy is to try to be an easy button. We have banned the use of the phrase in the HTA, "This is easy to do," because nothing is.

Rob Andrews (Panelist): So what I just said is not easy to do, but a lot of our members are able to do it. And again, the reason we're so happy with our partnership with Transcarent is we see that same mindset. You guys are really all about "How do we get this done," not "Let me give you a forty-page PowerPoint about why we can't." So that's what we like.

Tom Richards (Moderator): That's awesome. Thank you. You know, as I think about health care, data is a double-edged sword. I mean, there's so much of it—terabytes and terabytes of it. A lot of it's messy. To your point, it's now starting to get digitized and organized a lot better. But even so, how does one balance the new opportunity to get at that data with the practicality—taking action? I mean, I could imagine just getting lost in all the options in the data. How should we focus on that—both the consultants and employers in the room?

Aneesh Chopra (Panelist): Yeah. There are nouns and verbs, and I want to separate the verbs because I think that's where—if we could spend a few minutes to educate you all—about how you can actually take better advantage. The noun is exactly right: it's the fastest-growing category of data. When you go to the AI companies, the reason you see them all-in on health care is health care remains the largest tranche of growing data that they really haven't yet trained on—for all kinds of privacy and security reasons. We'll get to that discussion in a minute.

Aneesh Chopra (Panelist): The verb is the most important thing. If you access data through a BAA contract with one of your carriers or TPAs, you are subservient to their terms and conditions, and there's only so much you can carry that boulder up the hill. You're always going to have restrictions and constraints. Absolutely.

Aneesh Chopra (Panelist): The reason why I'm encouraging you to be a part of the CMS Health Tech Ecosystem is you're changing the verb. You are no longer asking to be a downstream BAA support—subject to whatever the terms are. You're saying, "I want you to have my carrier—the claims data that you have—available through the Health Tech Ecosystem."

Aneesh Chopra (Panelist): This allows me—whether through your carrier, or through Transcarent (who's our partner), or whomever—to interact with the data on the following three terms:

Aneesh Chopra (Panelist): Number one: patients who Face ID securely can get access to their own data. So your own employees should be able to get your carrier data plus their own medical records combined when they think about scheduling to find the right doctor.

Aneesh Chopra (Panelist): Two: when your employees' doctors want to make sure they're coordinating with another doctor, this allows the doctors—who are active on a national provider directory—to be able to trust each other to share.

Aneesh Chopra (Panelist): And three: for the first time, you'll be able to access, any time you want, clinical information to measure quality and payment integrity after every encounter by default—without you negotiating any of this with your carrier or TPA. All you're asking them to do is to contribute your data—be a participant in the verb, the Health Tech Ecosystem—that unlocks all these use cases, which are not subject to the downstream BAA rules.

Aneesh Chopra (Panelist): This is a big mindset shift, because if you take data and then subsequently give it to your point-solution partners, they're constrained by what you're constrained by—by what they impose on you. That's a verb that puts you in a terrible place to get things done.

Aneesh Chopra (Panelist): So, to benefit from all of this increased data liquidity—and thanks to AI, we can actually make sense of these large pools—to ask the question: Did my employee get the protocol for high-quality care? And Snezhan has written more protocols than anybody, so we could even test this in the context of what Transcarent is doing to navigate.

Aneesh Chopra (Panelist): So this whole concept unlocks if you get the root cause correct: that the data flows through something that's an open framework that allows for these downstream uses. At the moment, no employers are on this at all.

Rob Andrews (Panelist): No—and the reason is we are locked in this duopoly of who controls EHRs. We all know the two companies that do that, and then there are the carriers. But the litmus test that I use—I think it's so important to keep your eye on what winning looks like. This is a hard victory to win, but here's what it looks like:

Rob Andrews (Panelist): I want the day when any one of your plan members knows as much about the doctor who might take their daughter's tonsils out as they do about their phone plan. If you were thinking about switching phones from Verizon to T-Mobile, you can find out how much storage you get and whether you get new phone equipment. I mean, if you ever want to ruin a weekend, call one of them and ask them to spend the time talking on the phone—because they'll spend twelve hours telling you about their phone plan. But if your daughter has to have her tonsils out and you're a little nervous about that—like a mom or dad would be—good luck trying to find out anything about the surgeon.

Rob Andrews (Panelist): Now, my daughters are thirty-two and thirty-one. The thirty-two-year-old is a doctor—she's a physician. The other one is a movie director in LA. We say about the movie director: either she's going to pay all of our bills for the rest of our lives, or we're going to pay all of her bills for the rest of hers. But they have one thing in common: they're very different young women, and they absolutely expect and demand that their lives can be run at their convenience in a digital space with massive information.

Rob Andrews (Panelist): So before they buy a pair of shoes—and they buy a lot of shoes, which is one thing I don't understand—they buy six pairs of the same shoes, try them on, and send five of them back. The UPS guy knows me by name when I'm taking the returns back.

Rob Andrews (Panelist): But anyway, if you said to one of them, "I'm sorry, but the OB with whom you're going to work, we can't tell you how many C-sections she's done"—they're not going to tolerate that. They're going to expect that they know as much about the OB doing the C-section as they do about the phone plan. And they'll say, "Well, how come you can't do that for me? I work here at XYZ company—how come you can't?" I know why you can't: because it's David versus Goliath. But David's going to start winning.

Rob Andrews (Panelist): For that reason, David is going to start winning—and that's what winning looks like: knowing and having the ability to make that choice.

Rob Andrews (Panelist): And by the way, anybody who's afraid of information in the marketplace—that probably tells you they're not very good. I mean, you know your businesses—you guys are in retail and food distribution and tech—and you want data about your company because you're good at what you do. That's how you pick up customers. If a health care purveyor or the supply chain doesn't want to do that, I think it tells you something about it. If you didn't know better, you'd think they were trying to hide something, right?

Rob Andrews (Panelist): You would. And one other thing: I get that I have zero competence on judging a good cardiologist from a bad one. I never want that day to happen. But I do want to see clinically competent people using risk-adjusted data understand patients that have problems versus—yeah, I want to know what they think. I really do. And the generation that my daughters are in are not going to tolerate anything less than that.

Tom Richards (Moderator): Well, I'm really glad that I convinced Janine not to spend the thirty-five minutes reading your CV because the time seems to have flown by—and hopefully it's productive for the audience. Maybe just in the last couple minutes here: any, for both of you, any parting thoughts for the consultants and the HR, CHROs, and benefit managers in the room, in terms of things they should be worrying or thinking about?

Aneesh Chopra (Panelist): I had one curveball because on the flight out here, Dr. Oz and CMS made an announcement around how they want to handle work requirements. So I'm a little bit off topic, but in the same—raising my arms—I want to ask you guys the following.

Aneesh Chopra (Panelist): If any of you have kind of entry-level workers who are on Medicaid expansion that are subject to work requirements: basically, what the administration said is they're looking at, like, hundreds of millions of dollars of administrative expenses just to prove that they work for you and they've made the eighty hours.

Aneesh Chopra (Panelist): There are vendors that literally charge eight, ten, twelve, twenty dollars per transaction just to prove that information—because that information is proprietary. It's secret, but it's in your payroll systems.

Aneesh Chopra (Panelist): So I am working as hard as I can to try to get a few employers who are willing to work with their HR systems to open up that data—so the ease with which you can pull it in, in this "ChatGPT for health" kind of experience, to be able to pull their proof of work and income. If any of you want to reduce this administrative waste, I would welcome your participation—and it's in the same spirit of the Health Tech Ecosystem. So you could be a part of solving the work requirement headache while benefiting to get that data liquidity going. So that's my parting thought. That was all because of yesterday—so that wasn't part of our prep.

Tom Richards (Moderator): Great analogy, though. Thank you.

Rob Andrews (Panelist): What I would ask you to do—and this is hard—but within the culture of your company or your organization, stand proudly for the proposition that health benefit leadership is a growth center, not a cost center, properly understood. I know you've got to scrape for headcount and for resources—and, you know: cut, cut, cut—but collect stories like this one.

Rob Andrews (Panelist): A couple summers ago, my wife and I went to adopt a rescue cat. This little guy—his family had been bought by an owl trainer, and the owl trainer was using the kittens as target practice for these owls. This one little guy somehow survived.

Rob Andrews (Panelist): So we're ready to adopt him. We go to the PetSmart. There's a nonprofit that facilitates the adoption, and the woman who's volunteering for the nonprofit and I strike up a conversation. "Do you do this for a living?" "No, no, I stay at home. I'm raising four children." I said, "You're a busy lady. What does your husband do?" "Well, he works at—and I think they want me to say this—American Express," one of our members. So my ears perk up. "Does he like his job?"

Rob Andrews (Panelist): "He really does. As a matter of fact, last year he was offered a better job for more money in another company and said no." I said, "Really, why is that?" "They have great health benefits. We have a ten-year-old son who's autistic. He really gets great care from Amex, and I wouldn't want to leave for that reason." Wow.

Rob Andrews (Panelist): My first call Monday morning was to a guy named David Koschoff—God rest his soul, he died several months later—who ran the benefits program at American Express. I said, "David, you're going to love to hear this story." I'll bet every single one of you from an employer could tell a story like that.

Rob Andrews (Panelist): Make sure the C-suite and the CFO understands that story because it would have cost twice as much to replace that guy with a replacement if he had left AmEx. You are not a cost center. You're a growth center, properly understood—and I think you should tell those stories. Amen.

Tom Richards (Moderator): I love that. What a great way to end. Excellent. Rob, Aneesh, thank you so much.

Aneesh Chopra (Panelist): Thank you. Thank you all.