At What Cost? Facing the Healthcare Crisis Head-On

Laurie McGraw: Let's talk about the cost of health care. So this conversation is going to be a bit of storytelling. We're going to start with a story, and it's going to go really dark, really fast. We'll talk about the reasons. We'll talk about the whys.

Laurie McGraw: We'll talk about things that you are all familiar with, but Ellen in particular is going to paint a landscape for us of the cost of health care—what has been happening, the reasons. We are then going to ask Ellen what's on the horizon and what's coming, and where the good news is. And it's going to get darker. It's going to go lower. We're going to feel a little bit bad. And then with Janet's help, we're going to start to paint some ideas for what we can actually begin to do about it.

Laurie McGraw: This session is about providing practical solutions for leaders to make bold moves and change the landscape that we are all in. We'll leave some time at the end for this audience to not just ask questions, but also to share your own practical solutions as we learn together how to fix this broken healthcare system. So that's where we're going. So, Ellen, I want to kick off with just—in terms of your perspective, whether it's the recent survey that you put out—what does the landscape look like in terms of cost, and what is the why behind it?

Ellen Kelsay: All right. Well, thank you for having me. It's a pleasure to be with all of you today. And many of you are familiar with Business Group on Health. Many of you are members of the Business Group on Health.

Ellen Kelsay: And so my remarks are going to be grounded in both, certainly, our survey data, which Janine referenced as we were coming up on stage, but then also just a lot of anecdotal conversations that we have with all of you, as well as your vendor partners that come into our office and convene with us all the time on a whole slew of different topics. And so, to paint the picture, it is a bleak one.

Ellen Kelsay: We have been hearing a lot over the past decades about health care costs rising. This year has seemed to be so much worse than past years for lots of different reasons. Certainly, our survey data is showing the highest trends that we have seen in over a decade: nine percent.

Ellen Kelsay: But what's even more, I think, sobering—when we looked at that nine percent and then our survey data over the past decade leading up to that—when you look at the trend, the care trend. So, like, you could trudge along every year and say it's six percent one year, seven percent, nine percent this year, and how bad that is. But when you look back over a decade and say, holy cannoli—sixty-two percent over a decade—that is really sobering.

Ellen Kelsay: And then when you look at kind of what's happening—what's fueling that—there are factors in there that are not necessarily new. Some are new, but they're just getting more acute. So we look at the top drivers of health care trend, what the conditions are, and it's things like cancers, musculoskeletal, diabetes, obesity.

Ellen Kelsay: Behavioral health was the first time in the top drivers two years ago, and we saw it peak even more in this past survey data. And then you also just see pharmaceuticals like GLP-1s, the impact of really high-cost specialty medications. So that's just kind of the backdrop of what's driving that nine percent.

Ellen Kelsay: Also, it should not go without mentioning: we just have fundamental delivery system flaws, right? We've got a lot of inefficiency, a lot of waste and abuse. We have a lot of redundant, duplicative services being delivered to the population. We have a lot of clinical inefficiencies that are occurring, a lot of fee-for-service, and not really high-value-based care being delivered. So we just have the fundamental flaws in the delivery system overlaid with those conditions and very expensive—although valuable—innovations in the pharmaceutical landscape.

Ellen Kelsay: I think the backdrop, too, though, is people are getting sicker. They're not getting better. And we heard in the early remarks about patient experience and outcomes and cost. It's really sobering to think that the next two years—I have said to you, and we've been preparing for this—it's going to get worse before it gets better. That population health—all those conditions I just mentioned—are not going to abate anytime in the near future. And then there are additional headwinds that are coming that are going to make this current landscape even bleaker in the next couple of years' time before, hopefully, we come out on the other side of it.

Laurie McGraw: So we're going to get to some of that bleaker stuff. So, Janet, maybe just through your multiple years in terms of leading benefits at McKesson today, but others before that, can you just talk about the experience of having to deal with whether it's trend increases or where those drivers that actually you saw in the people and the populations that you were caring for?

Janet Sullivan: Yeah. I think it's been a journey. And to your point about it being up and down as far as the trend—I think I said to you guys before we came up here—at McKesson, we've been, I don't want to say lucky because I think, obviously, we did a good job managing our spend, but we have seen relatively low—compared to national averages—relatively low trend: three, four, five percent.

Janet Sullivan: And so this year was the first year that we are up there with the eight and nine percent averages. And so really trying to understand where is that coming from, and realizing that we're going to have to change our strategy. Things that have been working for us in the past, we're going to have to think about things a little bit differently going forward.

Janet Sullivan: So I think at McKesson, we have spent quite a bit of time focusing—which I think has paid off for us—on our healthy population. Not just our unhealthy population, right? So I think it's easy to say, okay, high-cost claimants—what do we do? Let's put in programs to focus on them.

Janet Sullivan: We actually spend time focusing on programs for our healthy population to keep them healthy. So, for example, we contribute up to $1,500 per year off of your health care contributions if you do certain healthy activities, right? And I mean, these are not like, “Read this article and you get points.” These are: get your biometric screenings, get your preventive exams, make sure that you're exercising, that you're tracking your sleep—all of those things that we know have good outcomes.

Janet Sullivan: So we're focused on the healthy population, and that has paid off for us up until this point. And now, like I said, we're realizing that things are changing. And to your point, Ellen, there are different factors in place, and I feel like things are changing daily. It's not—maybe it’s been gradual—and then there’s something new. And so trying to keep up with that as a benefits professional can be difficult.

Janet Sullivan: So to hear that it's going to get worse before it gets better is kind of scary. But yeah, that's just from observing it as a professional. That's kind of my landscape.

Laurie McGraw: Janet, can I just ask you to comment on—and we talked about earlier, and you heard in the opening remarks from Glenn—that preventative talk about longevity; everybody's all in. So how were you able—with preventative care, this is more than just a step counter or something like that—how were you able to drive the engagement that led to results from before?

Janet Sullivan: The $1,500 a year incentive off of your health care contributions is huge. We have 85% of our employees who are engaged in our wellness program, because—and that doubles if you have a spouse covered—so it's $3,000 a year if you have a spouse covered. So that, I think, has driven engagement.

Janet Sullivan: But also, we're very focused on—we're a healthcare company. We are a healthcare company. And so I think our employees are paying attention when we ask them to do certain things, or when we promote our programs—they are listening.

Janet Sullivan: And we have a frontline population that is harder to reach. They don't have emails. And so my team goes out to our distribution centers and talks to our employees.

Laurie McGraw: So we're feeling kind of sad in terms of the costs. And so, Ellen, make us feel worse, please.

Ellen Kelsay: It does get better, but it gets worse before it gets better. And there are a couple of things that make it worse.

Ellen Kelsay: I think as all of us work in our own companies and you're balancing this really health care cost affordability issue set against what's going on in the macroeconomic environment, the political environment—there are a lot of things happening that put pressure and compression on the total rewards budget within organizations.

Ellen Kelsay: And so as an employer is trying to decide—and as the C-suite, CEO, and CFO are trying to decide—where to make investments: do wages get cut? Do benefits get cut? Does hiring get cut? It's really forcing a reckoning with strategic prioritization within many of these companies. There is no more room in the balloon to squeeze, right? It's about to burst.

Ellen Kelsay: And so whether that's continuing to invest in health and well-being, whether it's pulling back on wages, whether it's not doing much hiring, whether it's potentially doing layoffs—there are big, big business decisions that are being impacted beyond just the health care plan. Like, big business decisions that have some negative implications on employee expectations and the employee value prop of working at many of these companies.

Ellen Kelsay: So you have the C-suite getting more involved because of the health care cost in what is going on with health and well-being programs. That is not a bad thing. That is a very good thing to have engagement with your C-suite.

Ellen Kelsay: You also have, though, kind of outside of you—like the day-to-day jobs that we all do in managing the health and well-being programs—you have things that are happening at the federal policy level: cuts to government funding on Medicare, Medicaid. When that happens, many times the hospital systems or entities that have received that contraction in funding look to the commercial market and the employer market to recoup their losses, right? The classic cost shift that we know already happens. Commercial payers pay two to six times Medicare rates already. We're going to see that probably escalate because of the contraction in funding from the federal government on Medicare and Medicaid.

Ellen Kelsay: The other thing that I think is good ultimately, but in the near term potentially harmful from a pricing perspective on employer payers, is all this investment in technology. I have talked to many—hospital systems will tout all the wonderful efficiencies they've gained from AI and technology. And I've said, “Well, what have you done in terms of your pricing with that efficiency that you've realized?” And it is deer in the headlights. They're not doing anything to address their pricing.

Ellen Kelsay: So in the near term, they're investing in all this technology, deploying technology, hiring AI experts to innovate in this space. They're gaining the efficiencies. They're not reducing pricing. But they've got costs now that they've also got to pipe into their pricing somehow. Ultimately, AI is wonderful. I'm not here at all to say that that is a doom-and-gloom scenario, but the investment in innovation in the near term is bearing a price, and we're not yet seeing the offset in the cost.

Ellen Kelsay: So I think those are two things that are definitely—from the funding perspective and then the investment in technology perspective—going to impact pricing.

Ellen Kelsay: And then again, I think you all do this every day: you have employees who work for you who really value all that you offer to them in terms of the health and well-being programs. Some of those programs aren't working, and you probably have to make hard decisions to remove some of them. So back to this calculus of: you, the employer; the value prop; what employees benefit from; what they think is value in their eyes; what you think is value in the strategic plan design perspective—there's going to be a reckoning there of some probably forced decisions that may create some noise within your workforce.

Ellen Kelsay: So I think just from a managing-change perspective within your programs and how you communicate to employees, there's going to be some challenges ahead of you on that front too.

Laurie McGraw: Well, in the number of conversations that I've had—the number of people in the benefits space who have talked about, with choked voices, that they've needed to put more cost shift onto their team members—those are agonizing decisions. They know absolutely what those choices mean in terms of somebody not being able to afford their medications. And so what you're saying is there's more hard choices in front of us, coming sooner than we might plan for them.

Ellen Kelsay: Yes.

Laurie McGraw: And so, Janet, have you seen—whether it's you, your peers that you collaborate with—those hard choices that are newer than what you've seen over the past decades that you've been doing this?

Janet Sullivan: Yes, for my peers. For us, I think I mentioned we're kind of at the early stages of that. I will say that this year, given our trend, we are looking—you know, I mentioned shifting our strategy—and really looking for ways to reduce cost.

Janet Sullivan: And I think looking at our contracts, right, and looking at: do we have the right vendor partners in place? How much are we paying? Are we getting the right service?

Janet Sullivan: I will say that we have developed a scorecard for each of our programs and vendor partners. We have on there things like cost and utilization and employee satisfaction and return on investment, and we can clearly see which areas are red and which areas are green.

Janet Sullivan: And so, to your point about making those difficult choices, when we're looking at programs—if people are not participating and we're spending a lot of money—and if we're looking at which programs do we want to cut or which vendors are we going to go out to RFP on, that is one way that we have been able to have data at our fingertips to help us with making those difficult decisions that you're talking about.

Laurie McGraw: Right. But we're also going to talk about the now. So let's come out of our valley a little bit, because this is a leadership conference. We've talked about—Ellen, you had your quote up, and you told me I was polite in terms of bold moves that are necessary.

Laurie McGraw: So we've experienced sustained cost pressures going on well over a decade now—sixty percent in aggregate. These are significant, and so we're at this point of inflection. Something is different. Bold moves are required, yet bold moves are hard.

Laurie McGraw: And you mentioned—and I heard in a number of conversations—“Wow, I'm having a lot more conversations with my CFO.” Sometimes we're prepared for those conversations; sometimes that's made with a little bit of wincing and sort of like needing to wear a flak jacket, whatever it might be.

Laurie McGraw: So in terms of making bold moves, let's talk about what the opportunities are. What does innovation really mean? How bold do we need to be? Maybe, Ellen, you could start.

Ellen Kelsay: Yeah. I mean, it's funny—this word “disruption,” and disruption and bold and the connotations there. Bold feels very brave to a lot of people, and disruption feels very like, “Oh, God.” Like, “I don't want to disrupt—that's bad—and people aren't going to like it if I do something that's negative.” I've been trying to—in a lot of our resources—reframe what disruption means.

Ellen Kelsay: Disruption does not have to connote bad or negative. Disruption is a path to better. And I also think we all need to be really honest about: let's not fool ourselves that the current state isn't already highly disruptive. Right? It is highly disruptive. So if we do nothing, we are disrupting, which is not what we want to do.

Ellen Kelsay: Right? We need to change to move to something better. And so this frame about bold and doing things that are hard should be viewed as positive, not negative. We have to do it. And no, it isn't easy. I don't mean to imply that there's low-hanging fruit and let's just do the things that are easy.

Ellen Kelsay: It is hard to do things—to push to a different place of discomfort within your organization; to have a conversation with the CFO that maybe you've never had that conversation with. I think it is using data and being really informed about why you think you need to make changes in the places you feel need to be changed, and then having a very solid business case internally about that. And then also, in terms of your communication and change management campaign to your workforce about why you're doing those things.

Ellen Kelsay: So I think around just context around bold and disruption, I just wanted to offer those thoughts.

Ellen Kelsay: There are so many things. And what bold means to one employer is different to another employer, right? So you've got to decide what bold means to you—your culture, your philosophy, your budget, whatever it is—what your tolerance is as an organization for bold, what your trend has been, how much longer you can tolerate that, what additional headwinds you might be having in terms of your claims data.

Ellen Kelsay: So there are a range of things you can do that are bold. I don't know if you want me to go down the list right now. If you want to come back to that, we’ll come back.

Laurie McGraw: But I do want to go to—so, Ellen and I had an inspiring women conversation yesterday, which was really informative to me. And you talked about your red/yellow/green philosophy. And what I took from that is just that bold meant being in a state of yellow. Not red, panicked—like I've gone so far that I am unclear about what I'm doing. But if you're feeling like you're just sort of making similar tweaks, that is definitely not bold. You have to be in yellow. You have to be. I'm speaking for you.

Ellen Kelsay: Yeah.

Laurie McGraw: Is that what I was really impressed with? You have to be yellow, and you have to be uncomfortable with those choices. Yes?

Ellen Kelsay: Yes. So I was sharing with Laurie—there's kind of just a leadership philosophy on red, yellow, and green.

Ellen Kelsay: And if you are in green, that just means things are too easy. It's too comfortable. You're complacent. You can do it in your sleep. You wake up from the next day to the next day kind of doing the same thing. You're very comfortable with your team, comfortable with the decisions.

Ellen Kelsay: If you're in red, you are panicked. You're overwhelmed. You are not probably making smart strategic decisions. You don't have clarity around why you're making these decisions. You're probably really stressed all the time about: are you doing the right thing?

Ellen Kelsay: Yellow is where we all need to be as leaders and as very bold change agents. We need to be in yellow. It's uncomfortable. It is pushing us to a place that's slightly outside of our comfort zone—maybe a lot outside of our comfort zone—but it's not terrifying. Like, you're not in red, but you're uncomfortable, and you know you're doing things that aren't easy. Right? But that is where most of the growth comes, both as a leader. You're challenging yourself. You're learning. You're testing your own limits.

Ellen Kelsay: But then, as you're developing a strategy in terms of your benefits offerings, you're also challenging the status quo, pushing the limits. And so we need to all be more in yellow, and less in green, and out of the red. We started in red. I don't want us to be in red.

Laurie McGraw: Let's get to yellow. And bold is yellow. Janet, you're very experienced at being in yellow, and you have described yourself as a data hound—in terms of data driving your decisions. And so what is the type of data that you're looking at to be in this state of bolder changes that you think might be necessary at McKesson?

Janet Sullivan: Yeah. So data drives all of our recommendations that we're taking to our executives. We're making a recommendation, and we're going in with “here's why,” and it's all based on data.

Janet Sullivan: We did a conjoint analysis last year, in 2025. So we have fresh employee feedback, which to us drives a lot of what we want to do. Understanding what is important to our employees is probably the best data point that, at McKesson, we can have—because McKesson, we care. I mean, we really care about what our employees think and want.

Janet Sullivan: So the whole being-uncomfortable and disruption piece—it's trying to sell our executives that to get where we need to be, we have to be a little bit uncomfortable sometimes. But I would say employee feedback data is important to us.

Janet Sullivan: We also have the scorecard data that I mentioned for each of our programs. Benchmarking data, obviously, we refresh annually as well to make sure that we understand what our peers are doing in the marketplace and making sure that we're not falling behind. And then I would say claims data, obviously. Where are we spending most of our money? What programs do we need to be thinking about? So all of those data points drive our recommendations and decisions.

Laurie McGraw: And Janet, what about the people that you work with? There has been new, important interest from different areas of the C-suite in this decision-making. And so as we think about taking new actions, who are the people that you gather as your allies within your organization that might be different than what you were doing maybe ten years ago?

Janet Sullivan: Yeah. So we—and you were talking about Nimesh—so we have a Global Impact Office at McKesson, and that team is out in our communities doing a lot of great work. But there are a few people on his team who are community health workers within our organization.

Janet Sullivan: And so we have had a focus on health equity over the last couple of years and really trying to understand where there are pockets of our population who may not have access to health care and things. So we've been partnering with that group to really be able to ensure that there's education. We're sending our vendors out there to talk to our employees. We're sending out mobile mammogram teams and things like that—so really trying to help that population. So that's one group that we have spent a lot of time really connecting with.

Janet Sullivan: Our change management team—we, when I first got to McKesson (I've been at McKesson for two and a half years), we actually have this monthly meeting with all employees, and our C-suite answers questions. We call it “Unscripted.” They're going unscripted. And you can send in a question anonymously, so you can imagine the types of questions that come in.

Janet Sullivan: And 50%—and I'm not exaggerating—50% of the questions were around benefits or total rewards: pay and benefits. And so I realized very quickly: we're not communicating the right way. We have great programs at McKesson. We are investing hugely.

Janet Sullivan: We created a brand—a well-being brand—so that everything that employees see related to their benefits falls under this brand: the same colors, the same look, the same name. And it's working. I mean, now you go to an Unscripted call and we may have one or two benefits questions. And so it has taken us a long way working with those teams to help us.

Janet Sullivan: So a lot of times, I think, as benefits professionals, we feel like we have to do it all, but there are teams within the organization who can help.

Janet Sullivan: And then lastly, I'll say: because we're in the healthcare space, we have access to pharmacists, to doctors, to folks that know health care. And so we utilize that. We leverage those relationships and those partnerships with folks within our organization to say, “Hey, GLP-1s—we're seeing such an increase. What should we be thinking about? Can you help us look at our data?” And so just partnering with those groups as well.

Laurie McGraw: Well, it's so many different groups. I mean, at a larger organization like McKesson, not all employers have that opportunity with those different teams. But what you heard from Transcarent—part of the reason that experience is number one in our thinking. So we have a very lofty ambition, taking 20% of the cost out, but it starts with creating an experience, because making it easy is a whole lot of hard work to make that happen. It just absolutely is. I'm glad you called that out.

Laurie McGraw: Ellen, if you could just talk about—knowing all the different employers that you both advocate for, as well as survey and work with—who are the different people that you suggest people gather together, get input from, differently to make various moves in their strategies than, again, just the past several years? What should they be doing now?

Ellen Kelsay: I think in terms of internal stakeholders, certainly having a very good relationship with your financial team—whether it's a CFO or somebody else within that organization—finance, C-suite. In addition to that, CHRO, obviously; CEO, depending on the organization, if that's appropriate.

Ellen Kelsay: I agree with: if you have a clinical team—many of you are in industries where you might have a clinical team—connecting with them. Communication and change management.

Ellen Kelsay: The other stakeholder group that I think is increasingly becoming more and more relevant for two reasons is your internal informatics team. We have a lot of employers who are really trying to understand their data. Some employers are building their own internal data teams. Others are leveraging their informatics teams internally to assess the data and reporting that they're getting from partners, and then ultimately to hold those partners accountable.

Ellen Kelsay: So I would say if you have internal informatics teams—whether you're building one within your own function or you've got one as an organization—partnering with them to assess what their capabilities are and how their capabilities can better lend themselves to what you're trying to do in terms of managing your own data in terms of the health plan would be helpful to you.

Laurie McGraw: What if you don't have an existing sort of good, close working relationship with your finance team? Where do you start?

Ellen Kelsay: Reach out—cup of coffee. I mean, clearly, the data speaks for itself. I would imagine any finance team who's not paying attention to this is going to want to know what's actually happening.

Ellen Kelsay: Health care is often, in many companies, second to payroll in terms of expenditures, right? So I would posit that most of your finance teams probably have a hunch of what's going on, although they may not realize the extent of it—and, again, that it might get worse before it gets better.

Ellen Kelsay: So it's to their best interest to be connected to you, to know what you're thinking, to help you make the business case to the CEO if that's what needs to happen. So have them attached at the hip with you, and reach out if you don't have that relationship. And just give them a few nuggets from our survey, and you'll probably get their attention pretty quickly.

Laurie McGraw: I've also heard a number of people talking about their newfound relationship with their general counsels in terms of fiduciary responsibility—and that's just another stakeholder that has become increasingly part of their regular meeting cadence of people they're talking to. Can you talk about that?

Ellen Kelsay: Yeah. There's obviously been a lot going on from a compliance perspective. The fiduciary lawsuits are not new, but seem to have been really picking up steam over the past couple of years—probably a couple of overzealous plaintiff's attorneys that are making a name for themselves, and are in the press, and aren't shy about naming big employers or putting billboards outside of Lockheed Martin's plant. I live in the DC area, and there are billboards right outside of their corporate headquarters with the plaintiff's attorney's name and number.

Ellen Kelsay: So I won't go down whether or not I think there's a whole lot of legitimacy to some of those claims and lawsuits—there's a lot of devil in the detail around ERISA and fiduciary requirements. But employers are in a hot seat, right? We just talked about all of the drivers of that. Health care costs are getting worse. You are fiduciaries if you're a self-insured employer. We have ERISA that has some enforcement mechanisms that haven't been fully deployed.

Ellen Kelsay: We have new legislation pending—certainly in the pharmaceutical area—that is proposing some hefty fines, not only on your PBM, but on you as employers. And so there's legislation that is also being proposed that could create even more legal exposure, potentially, for self-insured employers. And so for all of those reasons, general counsel needs to know what's going on.

Laurie McGraw: Yeah. Ellen, I didn't want you to take us back down the—we were starting to come out.

Ellen Kelsay: To come out.

Laurie McGraw: We were starting to come out. So let's rein it back a little bit. I want to ask one more question, and then I do want to open it to the audience for whether it's questions or your own practical advice in terms of things that you're doing to develop your bold strategies within your organizations.

Laurie McGraw: Before I do that—Janet, if I could just ask you: advice that you would have for this audience in terms of new things that you might be doing that are working in terms of developing the strategy for McKesson—advice that others can maybe apply in their organizations?

Janet Sullivan: I think that having a roadmap is important. I think in the past, it's kind of that shiny, “Oh, this is new,” and so everybody jumps on it—and then, “Oh, this is new.”

Janet Sullivan: And I think that for us at least, we've taken a step back and said: we're going to use data—what do our employees need and want, what's important to them, what are we seeing in the claims data—to drive our decisions rather than just—you know, I think I would go to Conference Board and collect all of these different things: “I want to do this, and I want to do this, and this looks exciting.” Is this what our employees want and need? Right? Is this important to our employees? So really using that data to drive your decisions, I think, is important.

Janet Sullivan: I think doing RFPs—and we have 30 programs, so in order, it’s important. And talking about our fiduciary responsibility: to make sure that we're getting the best deal and the best service for our employees, I think that's important. So I would say if you've been with a vendor for a very long time and haven't done an RFP, I would say that's important.

Janet Sullivan: And then I do agree with building those connections as well within your organization—finance and legal and communications and all of those things—making sure that you're connected. I think that a lot of times we just feel like we have to do it all ourselves.

Janet Sullivan: And I even liked—I just made a mental note about the analytics team, because I'm sure we have great analytics teams. I don't know who they are. So that's something that I've taken away from this conversation and said: I need to go make a connection. So I think making connections within the organization is important as well.

Laurie McGraw: We're going to close out this panel. And, Ellen, I'm hoping that you can just give us some closing comments. You brought us into the valley of despair, and we stayed there for too long. If you can just bring us to the future that you want this audience of leaders to band together on—what does that look like?

Ellen Kelsay: Yeah. I love the quote that Glenn had up: “If you want to go fast, go alone. If you want to go far, go together.” And I think this is really a moment of collaboration, and having really honest conversations internally with all the stakeholders we just talked about, but then also externally with everybody that you partner with.

Ellen Kelsay: And my silver lining in all of this is: because things are the way they are—and we've talked about the valley of despair—I think there is a sincerity and a willingness to have conversations across partners, within partners, partners with you as employers, and a sincere desire to do better and to be better. We've moved beyond lip service. But I think it takes pushing each other and having those really honest, hard conversations to get to the other side and to be bold and to be disruptive.

Ellen Kelsay: And so: have the conversations, do the introspection, and collectively we will get on the other side of all of this.

Laurie McGraw: Well, I hope that we all learned something and took some practical, bold advice. But the important thing is continuing the conversation in this room together. I want to thank Janet Sullivan and Ellen Kelsay for this very, very important conversation. Thank you so much.

Janet Sullivan: Thank you.

Ellen Kelsay: Thank you.