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it's been more than four months since seouland tokyo reached a landmark agreement on japan's wartime sex slavery.while time is ticking for the few elderly women who are still alive,... seoul says there'svisible progress in the implementation of the deal.as our kwon soa reports... a newly established foundation will offer financial compensationto korean victims, both the living and the dead, of japan's enforced sex slavery leadingup to and during world war ii. one of the main points of the landmark dealreached on december 28th last year... between south korea and japan... on the so-called"comfort women" issue, was to establish a foundation run by the south korean government,...through which the japanese government would

compensate the victims of the japanese military'swartime sexual slavery program. now, more than fourth months later,... seoul'sforeign ministry has laid out a time frame for that part of the deal. "if possible, we are aiming for the foundationto be established within the first half of this year,... and for that we are pushingto launch a prepatory committee within this month." a ministry official told reporters tuesday...the ministry's northeast asia chief,... an official from the ministry of gender equalityand family... and others recently visited individual victims across the country... toexplain the implementation of the deal.

among the 29 individuals,... five of whomwere consulted over the phone,... 26 were said to have been positive about the creationof the foundation. but the number excludes the women who liveat shelters for comfort women,... who have generally been the most negative about thedeal. according to the official, the one billionjapanese yen, or roughly 9 million u.s. dollars, provided as compensation will be reservedfor the surviving victims and those who have died.the funds won't be used to construct a building for the foundation... and the administrativecosts will be kept as low as possible. "but, the government will still have to meetwith all of the 44 comfort women alive today,...

to listen to their own wishes,... as that'swhat counts the most. kwon soa, arirang news."


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in many ways our clients are a lot likeus. while they initially come to us for investing and wealth management services,we often develop a relationship. we really get to know them and understand whatreally motivates their decisions and we find we share a lot of the same corevalues. family is such a big part of what we do. every decision we make is not justaffecting ben beck or jim bode; it impacts our clients lives – theirfamilies. there is nothing we take more seriously than that responsibility. fitness and health is huge -- a huge part ofour lives and our clients lives. to be financially independent is important butyou have to be around, and that's one

thing money can't buy. it's your health andthose things are interrelated. when we think about why our clients work with us we understand that the overall returns on how much money we make themis extremely important, but the real reason they work with us is because theytrust us. we build properly diversified portfolios of individual companies, notproducts personally for each of our clients and over the long term what thattranslates into is not a cookie-cutter one size fits all investment portfolio,but a highly disciplined methodology that helps clients achieve their financialgoals, because the one thing that i canguarantee investment world is that the

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companies operating around the world need to engage third parties to conduct and sometimes facilitate their business.but in today’s world, working with the wrong third party or business partner could result in legal action, regulatory sanctions, financial losses and serious damage to your company’s reputation.problem is, many global companies are finding it difficult to perform effective due diligence on foreign agents and third parties. that’s where kpmg can help. our third party risk management program utilizes a proven four step technology enabled approach that’s …… efficient, scalable and can be fully customizable into your overall compliance program.we begin by helping you identify the universe of third parties that should be subject to further review based on your compliance and risk management objectives. this is a challenge as they often exist in distant markets on disparate systems.


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going through a car accident is an emotionalup and down roller coaster, ride and experience. when you are going through it, it's amazingto have somebody that's there, who really can just take care of it. because in hindsight,i couldn't have done it myself. i would have gotten taken advantage of by the other side.it's worth it to get somebody who knows what they are doing and can negotiate on your behalf.everything that they have done, has been for me and i really appreciate that. when yougo through an accident, so many people you find give up on you and you don't matter anymoreto them and that wasn't the case with bachus and schanker. i just feel like they went theextra mile and they were just very nice to work with. once kyle personally took overmy case, it was handled and my stress went

away. bachus and schanker will make it somuch easier on you, taking stress just off your shoulders and allowing you to live theway a person should be living. thank you very much and i am very pleased with the way theyhandled my case. nobody else would have handled my case the way that they did. i did my researchand i asked around and nobody but nobody ever said anything bad about bachus and schanker.bachus and schanker did not give up on me. they just keep pushing through and let meknow that we're on a team and that they are there for me, to support me and help me inanyway i need. they are going to get you through it and so that's why i would say call them,give them a chance to take your case. go to bachus and schanker.


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effective july 1, 2012, patrick canning hasbeen named managing partner of the chicago office of kpmg llp, the u.s. audit, tax, andadvisory firm. prior to overseeing the firm’s chicago office,canning was managing partner of the firm’s boston office. he has more than 30 years ofexperience providing audit services to many fortune 1000 multinational companies in avariety of industries, including food, beverage and consumer products, retail and electronicsmanufacturing sectors. he joined kpmg in 1981 and was admitted to the partnership in 1990.he is also a member of the firm’s emerging business opportunities council. for the complete article, please go to big4.com


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resources they’re part of our every moment. we need them... to live life to the fullest. to accomplish our greatest achievements. to build the future. but transforming raw resources into amore useful form remains an ambitious undertaking. the challenges are sizable and the stakes are high. at bba, our determination and our passion are up to the task.

where there are resources, we see solutions. we’re a pan-canadian consulting engineering firm. for over 35 years, we’ve applied our advanced expertise to help industrial clients transform problems of the highest complexity into practical, innovative and sustainable solutions. trusting relationships are based on integrity. we work collaboratively with our clients from a range of industrial sectors to maximize their return on investment. we like to say that our footprint matches our client’s footprint. with offices from coast to coast,

we focus on local presence to be near our clients, unite forces with them and provide unparalleled service— as only an agile, flexible team can do. whatever the size or type of project our industrial clients count on us for multidisciplinary engineering services and to manage their projects, but they also count on our experience, knowledge and technical skills for highly specialized services. these are always delivered in the manner that best meets our clients’ needs. whatever services we provide, bba designs sustainable and effective solutions that minimize environmental impacts.

our strengths? we have a command of field expertise while meeting the highest standards of health and safety. we stay at the leading edge of proven technologies. we provide the best return on investment because we do it right the first time. we understand that our growth is tied to the long-term relationships we nurture with our clients. we are bba. we have been a trusted partner of industry for over 35 years.


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it’s just more fun like overall, like, inlife, when you're not stressed about money. right. you know, it’s not like we’re, you know,rich people here, but we know where our money’s going, (laughing). my dad did a great job at building a successfulbusiness. working with my family is a lot of fun, imean, a bunch of mechanics getting together. we have a great time. when we first got married we lived in thistiny, little apartment and we had no budget to speak of.

we didn't really know what we were doing. i got scared when i started to think aboutthe future. welcome to this special day in the life ofbethany and jon. jon and bethany, it’s my privilege to knowyou both, and to be part of this special day. well he was, jay is a special breed of person. on october 12th, 2014, i had the privilegeof conducting their wedding ceremony. come on in… bethany asked me at one point, “could yoube our financial advisor?” and i said, “sure, i’d love to.”

so you guys, the house looks great. well our first financial goal after gettingmarried was to buy a house. before we got married you know. i didn't plan for the next week let alonethe next 5, 10, 15 years, so we met with jay and talked about you know. where do you think we are financially? and so, we set up a budget, we talked abouthow much they needed to save. jay saw our financial situation as promising,very promising. we did not.

i can’t recall, whether it was the firstreview or the second review and they brought in their numbers and i looked at them, andi said “you can do it.” and bethany cried, and jon cried and theni cried. we're in a house now that we were able to remodel, we have a dog, the baby’s on theway and we’re not scared. i truly believe that he could take any budget,any income and still make it work. when a plan actually comes together, thenyou know that we've done our job, and it’s just the start for this couple. it is really encouraging knowing that we’vegotten a head start.


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all right. today, we want to talk aboutinvestment banking, which is different from commercialbanking. and today we have a guest, jonfougner, who took this course almost 10 years ago and hasbeen working in investment banking since. i'll introduce him in a fewminutes, but i wanted to start with just the elements ofinvestment banking, and then i wanted to talk about changesin it that came about after

the financial crisis of2007 through 2009. ok. the topic is investmentbanking. and that is a term, a20th-century term, that first became big and important, i'dsay, in the 1930s, but preceded that by some years. and it refers to a business ofhelping other businesses create securities. if someone wants to issuestock, they go to an

investment bankerto help them. or if you want issuebonds, you go to an investment banker. it can be a corporationthat goes to the -- for-profit, it can be anon-profit corporation, it can be a government. i suppose even an individual,who is incorporated, can go to an investment bank. that's the investmentbanking business.

now it's different -- it shares something with theconsulting business, because investment bankers serveoften as consultants. a company will come to aninvestment banker with a problem, and they want to raisemoney by issuing new shares, for example, tosolve that problem. but if it's a good investmentbank, they will do more than just issue shares for them. they'll talk about their wholecorporate strategy.

so, in that sense an investmentbank looks like a consulting firm, but they don'tdo pure consulting. that makes the distinction. maybe, they're in many ways afavored consultant, because they bring money. you can talk to a consultant,who will bring you no money, and another consultant,who has his hands on money somewhere. and that helps a lot.

the advice and the moneytogether help a lot. so, investment bankers aredifferent from traders, because usually they deal withcreating something -- about making a corporation ora government -- making it work, enabling them todo something that they want to do. and then, being realistic aboutit, and coming up with the money to do it. and so, that's how investmentbanking differs from

consulting[correction: trading]. and it differs from commercialbanking in that a pure investment bank does notaccept deposits. you can't go to your investmentbank and say, i'd like to open a savingsaccount. they don't do it. i'm talking about a pureinvestment bank. but let me just give yousomething about this business. i'm going to come in a momentto pointing out that most

investment banking businessesare not pure investment banks. but let's talk about what apure investment bank does. it does underwritingof securities. that means -- suppose you're a company andyou want to issue shares. you need someone to go to batfor you, someone who knows the kind of people, who mightbuy your shares, and can vouch for you. so in some sense, it'sa reputation thing.

the investment bank has contactsamong people who make big investments, and they managethe issuance of your new shares, and that's calledan underwriting. if it's the first time you'reissuing shares, it's called an ipo, or ''initial publicoffering.'' so, you're a private company, it's just youand a few friends own the company, but now you want to gopublic, you would generally go to an investment bank,and talk to them about how to do it.

and the investment bank wouldsolve that problem for you by doing an underwriting. so, traditionally there's twokinds of underwriting -- also, there's also somethingcalled a ''seasoned offering,'' and that means, fora company that has already gone public, and it already hasshares traded, so that the shares are seasoned, but youwant to issue more shares. so, you can go to aninvestment bank to do that, as well.

there's two kinds of deals. there's a ''bought deal,''and then there's a ''best efforts.'' with a boughtdeal, the investment bank buys your shares. they go in and say, you know, weknow that we can market for your shares. we will buy them ourselves andresell them on the market. a best efforts offering is one,where the investment bank doesn't buy it and doesn'tpromise anything.

they say, we'll makeour best efforts to place this offering. so, those are the basicthings that they do. the methods that they use areregulated by the securities and exchange commissionin order to make -- the sec in the united states,and regulated similarly in other countries. so, that's the basic investmentbanking business. so, if you're thinking of whereto place yourself, i

think investment banking suitsvery well people who are -- it's not good forautistic people. if you're autistic,be a trader. then, you just get on the phone,and you buy and sell all day, and you can be rude,and you can have coffee stains on your shirt, and you don'thave to know anything about classical music. ok? but investment bankersare a different --

i see jon is laughing. tell me, what you knowwhat classical music. i assume that was a part ofyour training at goldman. he says no. it's a whole differentindustry. so, if you go to the symphonyand look around, you'll see lots of investmentbankers there. but you won't see any traders. you nod on that[pointing at jon fougner],

maybe. we talked about moral hazard. i think that an important partof what investment banks do is, solve a moral hazardproblem, and that problem is, that companies, who issueshares, don't have a reputation. and so, what do i care, i'llissue shares, right before we're going to go bankrupt. we know inside that we're goingto go bankrupt, so hey,

let's just see, if we can milkthis company, before the public knows it, andissue shares. that's a moral hazard. and the investment bankis in business to prevent that moral hazard. they do the due diligence, theycheck you out, and then after that, people aremore trusting of you. so, i think investment bankingis built around trust, it's establishing trust.

so, that's how it differs froma lot of -- that's why it's important that these people becultivated and impressive. they tend to be well-spoken. i can ask jon, whether he agreeson all this, but it's my impression, you can tell whenthe investment bankers walk in the room. they dress differently,they look differently. i don't know what it is. it's something about reputation-- it's what it's

built around. the investment bankingindustry -- let me just -- since i'm talking about thenature of investment banking and since we have a goldmansachs representative here. i put on your reading list abook as an optional reading by charles ellis called thepartnership, and it's a history of goldman sachs. goldman sachs was an investmentbank until just

very recently, and we'lltalk about that. they're still in the investmentbanking business, but now they're officiallya commercial bank. it's an old, venerable firm, andgoldman sachs emerged in the early 21st century, as,i think, the most highly respected and esteemedinvestment bank in the world. amazingly successful, andamazingly well-respected. ellis wrote a book justa few years -- ellis is on the yalecorporation.

he's a distinguished businessmenand author himself, and he wrote a bookabout goldman sachs, which is largely admiring. like, how did this happen? how did this phenomenon ofgoldman sachs come about? and i suggested -- i didn't assign -- i suggested, you read onechapter, which was called principles.

and it says something aboutgoldman sachs, and it refers to, in that chapter, thechairman of goldman sachs, john whitehead, in the 1970swrote down a list of principles that guidegoldman sachs. and ellis seems admiringof these principles. not everyone would agree. it's a matter of taste,i guess, if anything. whitehead is now -- i just looked it up --

he's 88 years old, and isretired from goldman, must have retired some years ago. what kind of an organization? ellis says, that the thingthat struck him about the organization is loyalty. but that's not alone, thatpeople feel a strong loyalty toward their company. that's not on whitehead'slist. so, whitehead's list.what is his first

principle of goldman sachs? "our client's interests alwayscome first." these sound a little bit like bromides. i'm sorry, but i read themthinking, it is the most successful investment bank inthe world, so maybe there's something beyond -- i think, there is somethingbeyond platitudes here. second, "our assets arepeople, capital, and reputation." that's a coincidentwith what i said.

"uncompromising determination toachieve excellence." well, everybody says that, so maybewe'll discount that. "we stress creativity andimagination." well, those are sort of bromides, maybe. then, whitehead issuedsome guidelines -- this is also in thatchapter later -- for goldman sachs employees, andthese seem to be a little bit more candid. ''the boss usually decides, notthe assistant treasurer.

do you know the boss?'' that'ssomething i've learned from my own interaction with people -- the boss really does decide,and goldman sachs goes for the top. and maybe this is obnoxious, idon't know -- they don't want to talk with underlings. ''you never learn anything whenyou're talking.'' that means, be a good listener. ''the respect of one personis worth more than the

acquaintance with 100.''''there's nothing worse than an unhappy client.'' theone thing that -- i don't if it's on whitehead'slist -- but i think it says somethingabout investment banking, and that ellis says, is thatthey shun publicity. they don't want to be in thenewspaper, they want to be known by the president. they want to be known bya few prominent people. they're kind of socialclimbers, in a way.

but it's all built around somebasic principles of service, and they want to be talking tothe top guy, and they don't want to be in the newspaper. i'm going to quoteellis on this. now i'm quoting charlie ellis. i call him charlie. i know him. he's a friend of mine. "making money, always and noexceptions, was a principle of

goldman sachs. nothing was ever donefor prestige. in fact, the most prestigiousclients were often charged the most. absolute loyalty to thefirm and to the partnership was expected. personal anonymity wasalmost a core value. the real culture of goldmansachs was a unique blend of drive for making money and thecharacteristics of family, in ways that the chinese, arabs,and old europeans would well

understand.'' so, i'm giving you a flavor ofwhat an investment bank is. you might be repelled by it. you know, is making moneyso important? and if you are repelled by it,you probably don't want to work for goldman sachs. on the other hand, they'rekind of respecting some economic principles, right? working for a firm like this,you can make huge amounts of

money, and then at theend, you can give it all away to charity. and that's the new capitalism,right? so, what's wrong with that? what are you going todo with all this? if you make $100 million, whatare you going to do with it? you're going to giveit away, right? i mentioned at the beginning, imentioned andrew carnegie's book, the gospel of wealth.

maybe that's, what thisis all about. on the other hand, some of themdon't give it away, and some of them live lavishly. different people have differentimpressions of this business -- but i want to make sure i havetime for our guest and i'm sort of running out of time. i wanted to talk about what hashappened in the crisis. there's so much to sayabout this topic.

maybe, i should talk firstabout the first crisis. in 1933, the us congress passedthe glass-stegall act, which forced investmentbanks -- it prevented investment banksfrom doing commercial banking, or commercial banks from doinginvestment banking. it split them in two, and itsaid you have to decide, are you a commercial back, or areyou an investment bank? the glass-steagall act was theact that created the fdic, the federal deposit insurancecorporation, the first

successful national depositinsurance act in the world. and part of it -- it makes sense-- if you're going to insure the commercial banks, youbetter watch what they're doing and prevent them fromdoing dangerous business. so, the dangerous business wasinvestment banking, and they forced companies to decide. so, j.p. morgan, which was doingboth investment banking and commercial banking in1933 had to decide. what is it?

investment banking orcommercial banking? so, they picked commercialbanking, and that means, they fired all their investmentbankers. so, these guys regrouped andthey formed an investment bank, called morgan stanley. stanley was a yale graduate andmorgan was, i think -- not j.p. morgan, it washis grandson. morgan died around 1911. and so, those were twoseparate ones.

j.p. morgan, commercial bank. morgan stanley, investmentbank. but since then, we've repealedthe glass-steagall act, and that occurred with thegramm-leach act [correction: gramm-leach-bliley act] of -- what was that -- 1999. well, gramm-leach[-bliley] repealed glass-steagall, andnow these businesses, they

generally do the samebusiness, both commercial and -- yes, gramm-leach[-bliley] was 1999. since then, as you recall, we'vehad a financial crisis. and in that financial crisis,glass-steagall got brought up again, because it seemed thatthe crisis was related to a number of shenanigans thatfirms were undertaking. and the government had to bailout commercial banks.

we talked about this, andit's very controversial. so, the question is, did thesebanks get in trouble, because we repealed glass-steagall? a lot of people cameon saying that. these banks were doing all kindsof screwy things that were dangerous, and we'reinsuring them, so it can't be. so, a lot of people said,we have to go back. there was some inherent wisdomin glass-steagall that we've lost. and this was debated.

now incidentally -- i didn't mention this -- glass-steagall was somehowconfined to the united states. outside of the united states, idon't know if there was any country, but as far as i knowthe u.s. was the only one that did it. so, outside of the unitedstates they had what was called universal banking. and these banks outside ofthe u.s. were doing both

investment banking andcommercial banking. they sailed right through thewhole century without being divided up. so, the reason why we gotgramm-leach[-bliley] was, that people started tosay, you know, we're at a competitive disadvantage. we americans are at acompetitive disadvantage to europe, because we can't doboth, and they have more freedom than we.

and so eventually, in 1999, wesaid, they could do both, so that the u.s. also became auniversal banking country. but then problems arose. and the problems were -- paul volcker, who was chairmanof the federal reserve board in the late '70s, early '80sproposed something called the volcker rule. and the volcker rule wasnot a full return to glass-steagall, but --

and this is now in thedodd-frank act. it's section 619. it doesn't say volcker rulethere, but that's what it is, and it prohibits proprietarytrading at commercial banks. and it also says, thatcommercial banks can't own hedge funds or privateequity [addition: private equity funds]. so, that was the volckerrule that was put in. there was also another ruleadded, which is analogous to

the dodd-frank act [correction:analogous to the volcker rule], also. and this is in the dodd-frankact of 2010. there was a senator. her name was blanche lincoln, ademocrat from arkansas, who proposed the lincoln rule -- unrelated to abraham lincoln,as far as i know. and the lincoln rule was -- or lincoln amendment, and thatis section 716 of dodd-frank.

it says that -- it doesn't prohibit banksdealing in swaps, but it said swap dealers are barredaccess to fed window, discount window. and so effectively, it preventsbanks from dealing in swaps anymore. as a result of this, goldmansachs has got to shut down -- or it appears that -- the volcker rule saysbanks have until

october 2011 to comply. so, it means that goldman sachshas to shut down -- goldman sachs had to become acommercial bank, too, so it's no longer -- it's an official commercialbank now. and because of the volcker rule,it appears that it has to shut down its proprietarytrading, which was a huge part of its profits. and goldman sachs will never bethe same again, apparently.

but it's not clear,what will happen. it depends all on how dodd-frankis enforced. i think, that the people thatare in the banking industry are going to try to claim, thatsome of the activity that was done by their proprietarytraders -- that is, people who were tradingthe market on -- true investment bankingshouldn't involve the investment banker buying andselling securities trying to make a profit.

that's not underwritingof securities, that's proprietary trading. the volcker rule says, that youpretty much can't do it anymore, unless you're a pureinvestment bank, but if you're a commercial bank, you can'tdo it anymore, and they're kind of forced to becomea commercial bank. but they're going to try tosteer around these rules, and i think that maybe they can. they'll re-define somethingthat looks something like

proprietary trading, andthen continue to do what they're doing. we'll have to see. these things are longand arduous. you know, one thing that strikesme about finance is, that it's so rules-based. there are so many laws, thereare so many lawyers, that nobody can grasp the magnitudeof the regulations that these people live under.

and you see these landmarkbills, but none of us understands them, because thereal content of them is involved in hundreds of pages oflegal documents, that never cease to amaze me withtheir complexity. let me tell you something aboutshadow banking, which is relevant here. the term ''shadow banking,'' ithink of that as coming from a term that i first heard frompeople at pimco just within the last five years or so.

or maybe it goes backfurther than that. it refers to a new kind ofsemi-banking system. what are shadow banks? these are companies that areacting like commercial banks, but they're technically not. so, they're not regulatedas commercial banks. and in many cases,the investment banks were shadow banks. i'll give you an example oflehman brothers, which was a

pure investment bank. it's now bankrupt, it's gone. it was a pure investment bank,so it wasn't regulated as a commercial bank. this was before the volckerrule, before dodd-frank, and they went bankrupt in 2008, andit was the worst moment in the financial crisis. why did they go bankrupt? well, there's a reading on yourreading list by professor

gary gorton here at yale, whoargues that lehman, like many other investment banks, wasfinancing a lot of proprietary investments by issuing repos,or by dealing in repos. what is a repo? that's short for repurchaseagreement. the banking crisis, that we sawin 2008, was substantially a run on the repo. so, here's what happened,according to gorton and others who agree with him.

investment banks, like lehmanbrothers, were not regulated like commercial banks, and aslong as they didn't accept deposits, they didn'thave to be regulated as commercial banks. so, they could do what theywant, and they were considered underwriters, so fine,do whatever you want. well, not quite, but theyweren't heavily regulated, the way commercial banks were. and what lehman brother startedto do is, to make

heavy investments in subprimesecurities and other securities by effectivelyborrowing through the repo market. what is the repo market? it's a market, in which acompany effectively borrows money by effectively sellingsome securities it owns with an agreement to repurchase thesecurity at a later date. they're short-term loans, andin fact, collateralized by some security that they own.

what it was, it was almostthe same as a deposit. they were short-term loansthat someone could withdraw at any time. the someone wouldn't be somemother and father with their small savings account. it would be some bigger,probably institutional investor. but these were acting likebanks, like commercial banks, because there could be a runon these banks the same way

there's a run on thecommercial banks. if anyone starts fearing thatlehman brothers is going to fail, they all want to taketheir money out, which means, they don't renew their repos. and so lehman brothers failed,when the housing market declined, the value of itssubprime securities declined. people, who were lending itmoney through repos, got wind of this, and they stoppedwanting to do it, so it was like a run on lehman brothers.

and lehman brothers couldnot be saved, if it weren't for a bailout. the government had alreadybailed out bear sterns, and it had helped merrill lynch, whichwas failing as well, and they decided not to baileverybody out, so they let lehman brothers fail. so now, the reaction to that is,that we can't let shadow banking go unregulated,and dodd-frank is part of that reaction.

so now, investment bankingis substantially altered by these laws. and still, of course, it's avery important business. the united states hastraditionally been the most important country in investmentbanking, but it continues that europe and asiaare also important, very important participants ininvestment banking. growing, i think. the financial crisis has putsomething of a damper on the

business for a while, buti think, it seems to be coming back. the latest news is, that theinvestment banking business is starting to look more stableand prosperous. so, what i want to donow is invite -- let me just do a briefintroduction. so, jon fougner took this class,i think it was 2002, and then, he served as myresearch assistant for a book i was writing, called the newfinancial order, so i got to

know him better. the important thing for thislecture is, that you worked for goldman sachs, and got toknow people there, and now he's working for facebook. you've heard of thiscompany, right? i thought it would beinteresting to have him back to give his impressions of whatlife was like after econ 252, of what goldmansachs was like -- at least the oldgoldman sachs.

and i think, it's interestingto hear about facebook, too, because it's a different kind ofculture, and i'm interested in culture. it's more of a tech business. i'm interested to hear, if theyhave anything like the goldman sachs principles,or they enunciate them the same way. so, i'll bring jon up, andi'll let him continue. jon fougner: very well.

thank you professor shiller. and professor shiller haspromised, that i'll be well-spoken, and well-dressed,and a bunch of other things, good, bad, or otherwise. i'm not sure, if i'll live up toany of those expectations, but hopefully i canshare a little bit about this business. how many of you are consideringgoing into investment banking?

maybe about 30%, or so. and how many of youare on facebook? and how many of you are considering working at facebook? ok, so maybe we'll adda few more to that by the end of this. the goal for the next half houris really to help you think about, whether bankingmight be the right next step for you after college, and forthose of you who say yes, to

share a few tips onhow to think about getting into the business. i'll give a little bit of mybackground, kind of a context for my reflections on theindustry, so you can take them with a grain of salt, share someanecdotes from banking during the debt boom, and thenalso give a few tips, or steps that you could take today, ifyou're interested in it. so, a little bit onmy background. junior summer, i went to workfor a large investment bank,

as professor shiller mentioned,and i really enjoyed the work, knew thati wanted to go back to it. but i had never lived abroad,because, as you all know, your junior year here at yale,there's a lot going on with extracurriculars, and so manypeople don't go abroad. i went to see charles hill -- now how many folks are familiarwith charles hill? fabulous negotiator. and i said, professor hill, howcan i negotiate to go back

to this job a year later,so i can do a fulbright in the meantime? so, he taught me all thisjiu-jitsu, and it ended up working out, and i did a year innorway, and then came back full time to banking. now, as you probably know,a lot of analysts go into banking, they do it for twoyears, maybe do private equity, hedge fund, maybe doan mba afterwards, and something like 15% might stayon, get promoted, and become

career-track bankers. when i was working on wallstreet, this was the peak of the most recent privateequity boom and the associated debt boom. and so, recruiting to privateequity had reached such a fever pitch, that literally 16months before the start date for these jobs, analysts weregetting calls from recruiters, doing interviews, andactually making commitments to joining companies.

and i knew, i was interested intech, and so i became very close to signing with atechnology private equity fund, that i admire still verymuch to this day, but i actually decided that i wantedto work in tech itself, and so the last three and a half years,as you mentioned, i've been working at facebookworking on our social advertisement strategy. so, a little bit about insidethe banking role. it may sound a little bitfunny to talk about the

investment banking division ofan investment bank, but that's what we'll do for thenext 15 minutes. and by that, i really mean, justthe part of the business that professor shillermentioned, giving advice to ceos and cfos about financing,and mergers and acquisitions. so if you see this logo-- and that makes you smile -- i see a few smiles, maybea couple grimaces -- if it makes you smile,it's a good sign that

banking may be for you. you think about two,three, four -- professor robert shiller: theydon't understand that. that's an excel logo. jon fougner: that'san excel logo. professor robert shiller:what are you driving at? jon fougner: that's an excellogo, and these are excel models, and they go on and on. professor robert shiller:you mean, they're

going to be a nerd. is that what you're saying? jon fougner: yes, if by thatyou mean you want to feel comfortable with the technicalaspect of the role, yes, absolutely. especially at the juniorlevel, where -- you mentioned some of therelationship aspects of banking, but at the juniorlevel, really your core responsibility is buildingout these models.

so, if you think about workingon that until 4 in the morning maybe two nights in a row, maybe20 nights in a row, and that's exciting to you,that's a good sign. so, how many of you have goneonline to open yale to see stephen schwarzman's talkfrom this class from three years ago? one, two. two enterprising usersof the internet. i would strongly encourageeveryone to do that.

one of the things, that hetalks about is that in banking, there's not a ton offlexibility for getting the numbers wrong. as the analyst, you reallyneed to nail the details. and primarily, what we'retalking about there, is building operating transactionand valuation models that describe your clients,and other companies, and their industry. and then, the information fromthose models, along with

research you find by hook and bycrook on the internet, from your colleague, wherever youcan, kind of comes together into presentations, polishedpitch books to help win a piece of business. so, that could be an ipo, amerger advisory, as you mentioned, and once you've wonthat piece of business, then you as the analyst really arethe organizing principal for getting this deal acrossthe finish line. dealing with the accountants,working with the lawyers,

other bankers, even competitorswho might also be working on the deal, and then,of course, your client, and whichever counter-partyyour client is selling to or buying from. so, it's a fair amountof responsibility. typical investment banking dealteam, the core team is pretty lean. maybe one each of an analyst,associate vp, and md, and if you decide to and are given theopportunity to continue

working in investment bankingon a career basis, then you will gain a little bit morecontrol over your week to week and month to month scheduleas you become more senior. but even at a senior level,investment banking is really considered an always on-callclient service profession. now, one of the advantages ofthis very lean deal team is, that there's plenty ofresponsibility to go around. so, if you raise your hand andsay, yes, i can take on some of this work, that might bydefault fall to some of my

associates, and you do itwithout making mistakes, you're going to be able to getmore and more responsibility, learn more and moreon the job. one of my favorite projectsthat i worked on was a proposed venture capitaltransaction, where we were looking at investing in eightdifferent operating companies, and because the team was thatlean, i was actually able to basically take on leading thedue diligence on these eight different companies.

professor robert shiller: beforeyou go ahead, why do the managing directorshave zero grey hairs? jon fougner: well,i'm just assuming it's all gone by then. that's a median, the mean mightbe a little bit higher. high variance. so, i would -- was that the nerdy commentyou were looking for? so, i might encourage you tothink about these roles as an

investment in your career,where what you put in, of course, is long hours -- maybe100 hours a week for a couple of years -- and what you get out, is anumber of things, including a skill set that's really valuedand respected, not just in finance, but around the businessworld, exposures to cfos and how they think aboutproblems. if you decide to continue on as a career banker,participation and success that you'll help createfor your company.

and then, of course, a networkof very smart, eager peers, like the folks in this room,who then fan out across the finance industry. so, as i mentioned, i was inbanking during the debt boom, and there was such a peak intransaction that people started calling it mergermondays, this expectation that before the bell at the beginningof the week, there'd be a $20 billion, or $30billion, $40 billion transaction that wouldbe announced.

and there was so much enthusiasmfor this sort of transaction that even financialinstitutions, which, conventional wisdom toldus, couldn't be lbo'ed [clarification: lbo stands forleveraged buyout], because their balance sheets werealready so levered, actually became considered targetsfor leveraged buyouts. and arguably the peak of thiswas, when blackstone themselves, one of the fathersof the buyout industry, filed an s1, and in fact became apublicly traded company, which

they are to this day. your final task as a bankinganalyst is to create a deal toy, when you successfullycreated a transaction. now, this particular one usedto have water in it and glittering fish, and at thetime i thought it was very pretty, but i would just inviteyou maybe, when you create your deals toys, don'tpicture your client swimming with the fishes. not the best idea.

and then, this is a safe for abank, which, of course, is logical, safes are in a bank. but this is actually anespecially fun toy, because you pull this handle here,and then actually this one opens up. that was my idea of fun when iwas a banker, so you again should take it witha grain of salt. this is a snow globe -- youshake it upside down, which is a lot of fun, as well.

but again, just in terms of themetaphor, and i have only myself blame -- maybe iwas sleep deprived -- i guess, maybe don't show yourclient's capital structure literally under water, whenyou design your deal toys. professor robert shiller: areyou saying that investment bankers have a childish side? you say, deal toys. i was presenting them asgoing to the symphony. what are you presentingthem as?

jon fougner: i can't claim, iever made it to the symphony, when i was an analyst, but anumber of my colleagues were on the boards, involvedphilanthropically with those organizations. but yes, i think that we havethis creative energy and creative spirit. i think, there's a lot ofcreativity in finance that, as stephen schwarzman mentionedin his talk, at the senior levels, when you're dreaming howto combine companies, how

to finance companies, how todeal with new regulation, as you mentioned. but at the analyst level,maybe not quite as much. so maybe, there is that creativespark, that's just trying to find its way out, one mischievous way or another. but anyway, this was the landscape, when i left banking. that was september 2007.

and then six months after that,as professor shiller mentioned, bear sterns sold ina fire sale to j.p. morgan, and then six months after that,september 2008, we saw merrill lynch narrowly avertliquidation, become the asset management brand ofbank of america, which it still is today. that same week, lehman brotherscollapsed under the weight of those mortgages,suffered a bank run, and was not bailed out, was liquidated,some of their

investment banking and capitalmarkets assets sold to barclays in bankruptcy. a week after that, what a lot ofpeople thought would never happen, did happen, and goldmansachs and morgan stanley went to the federalreserve, and asked to become commercial banks, whichtechnically they still are today, as professorshiller mentioned. now, that having been said, ifyou take charles gasparino's account of this era, thiswas the end of an

era for wall street. that having been said,investment banking continued at firms all around the world,some of these diversified conglomerates, and also at aburgeoning slate of so-called independent advisory shops. so, these are folks likeevercore, lazard, greenhill. and if you're interested inlearning about finance, investment banking is not theonly way to get into it. there are also, for example,the so-called alternative

asset managers, privateequity hedge funds. folks like kkr, carlyle,bridgewater, who i believe still recruits here on campus. and then, out where i live incalifornia, you have the heart of the venture capital industry,especially around the information technologyindustry. so, folks like kleiner,sequoia, benchmark. they may not be recruiting oncampus, and they may not even be open to hiringundergraduates, but some of

their competitors are. so, if that's interesting toyou, maybe we'll just touch on a few steps that youcan take today. obviously, you're already doingplenty of this, without anyone having to remind you. things like taking the rightclasses, doing well in them, researching the firms youwant to apply to. just three that i'll touch on. taking advantage of theincredible resource you have

in the professors here today,which you really don't want to take for granted. learning a little bit aboutyourself -- and i know that sounds touchy-feely, buti'll give a couple specifics around that. and then, of course, there's nosubstitute for trying this hands-on to see whetherit suits you. so, this is pretty much exactlyas i remember john geanakoplos --

genius mad scientist. you canfind him on open yale now, and if you have not yet taken hisclass, and it's offered next year, i would strongly recommendthat you do so. david swensen, i understandyou've had the distinct pleasure of hearing fromalready, the most successful endowment manager ever, thereason that we get to have nice things here at yale. and i just keep coming back timeand again to pioneering portfolio management, thebedrock of core investing

principles that he articulatesin that book. even if you never become aninstitutional investor and are only thinking as a retailinvestor, it's still incredibly useful stuff. and he does teach asenior seminar. and then, in addition to thisclass, as you probably know, professor shiller has a graduateseminar, which i think you have promisedto let students apply to, to get into to.

professor robert shiller:yes, i had about eight last semester. jon fougner: ok. and how did they do? professor robert shiller: that'san embarrassing thing. they did pretty well, againstour graduate students. i won't rank them. embarrassing to ourgraduate students. jon fougner: but flatteringto all of you.

as professor shiller mentioned,i got to work a little bit on the new financialorder as an undergraduate, and i juststill consider it such a rewarding experience, becausethe tenets that you talk about in this book, around how financecan be a technology for societal innovation,everything from the micro level of personal incomeinsurance to encouraging people to take more risks earlyon in their careers, to the macro level of gdp insuranceare some really

visionary ideas. i, of course, remain dismayedthat some of them have not been put into practice yet,but that really is an opportunity for all of you whoare interested in finance for idealists to think about that asa potential career option. other useful courses, of course,anything with math, probabilities, stats,econometrics, excel modeling, especially using the threefinancial statements, computer science, computer programmingis going to serve you well,

not just in investment banking,which we're talking about this morning, but alsoin those other aspects of financial serviceslike trading. now, kind of switchinggears a little bit. how many you have eitherdone myers-briggs or strengths finder? a few. maybe 20 -- maybe 30% or so. so, these are tools that i thinkhave become a little bit

more popular in recent years,which are basically psychological inventorieswhere you spend an hour answering multiple choicequestions, then they literally spit out a profile of howyou like to work. obviously, there's no right orwrong answers, they're really just preferences. it's a pretty modest investmentof your time -- maybe an hour each -- to gain insight not just intowhat you're good at, but also

to helping you articulate topotential employers really what you can bringto the table. and then, of course, where therubber meets the road, is actually applying for thatinternship or that job, and getting your foot in the door. career services on campus area fabulous resource, but because of that they are veryscarce resource, because almost everyone is using them. so, if you want to find jobsthat don't get 200 other yale

resumes coming in their frontdoor, you want to look a little further afield. so, you've got things like listsof investment management firms, from institutionalinvestors, american banker, hedge fund research. there are plentyof these lists. and i'd say, don't be shyabout cold calling, cold emailing -- just kind of be persistent.

we touched on professors here. i am incredibly grateful toprofessor shiller, ray fair, david swensen, folks who havehelped me in my career, even at this extremely early stagein my career, and it was really just because i asked. and i would encourage you todo the same thing, because once you've left campus,it gets a lot harder to get that help. and then the alumnidirectory --

how many folks have been usingthe alumni directory to reach out for jobs? maybe 15%. i'd encourage you to do so, andall i would add to that is, think about what you sharein common with the people you're reaching out to, thinkabout whether you can reciprocate the help that you'reasking for, even if that might not be obvious now,because they're established in their career and you'rejust starting out.

i had a student in this classreach out to me three weeks ago interested in advice, andi was happy to share that. and actually, he ended up beingreally helpful, helping me understand in where you allare in your decision making process and your careerright now. so, there are always ways thatyou can help, and you'll find a much more welcome hand ifyou're about to do that. and then lastly, recruiters. these large, so-called ''twoand 20'' funds, the

alternative asset managers,typically use third party recruiters to find the talentthat they want to interview. and they are typically targetingcurrent banking analysts and associates, butthere's nothing to say that, if you have a strong finance andtechnical background as an undergraduate, that you couldn'tactually get on their radar and try to use themfor a placement. the only caveat i would add tothat is, that you want to be really clear and confident whenyou speak to them about

what is that you'relooking for. because if you go in therewaffling, asking them to sort of be your mentor and yourcareer coach, they're really not going to get that senseof confidence for you, and they're not going to want toput you in front of one of their clients, who are theasset management firms. professor robert shiller:we're having questions in just a minute. jon fougner: oh, great.

yes. [side conversation] professor robert shiller: we'regoing to open it up for questions in a minute, butgo ahead and interpose. student: it could probably alsocome at the end, i was just wondering, whois keith ferrazzi? jon fougner: how many folksare familiar with keith ferrazzi in the room? some people are -- theirarms are getting tired.

maybe 20%. so, keith was the youngestever fortune 500 cmo. and he's a fellow yalie, newyork times best-selling author, written a lot about therole that relationships play in business. and you hear this wordnetworking, which, i think, all of us now get sort of a sortof unctuous feel around. it seems very, sort of,superficial and self-serving, and what he's really helpedelucidate is, how the basic

tenets of psychology -- and in this respect, he remindsme of professor shiller -- applying the basictenets of psychology to how you actually build real,meaningful business relationships, and breaking downthis artificial barrier between relationshipsand business. because business isrelationships. as professor shiller mentioned,one of the things that investment bankers try todo is, establish senior level

relationships, because it'sultimately individuals, not entire companies, who aremaking decisions. so, just to share a couple ofanecdotes about my transition from banking, after banking, asi said, i knew i wanted to work in tech, and i veryfortuitously got a phone call from a lifelong friend of minearound that time, who was an engineer who had startedworking at facebook. and what he convinced me was,that i could help him and his colleagues change howpeople communicate.

i was pretty sort of anxiousabout this, pretty intimidated by the prospect of beinga business guy doing engineering. and what he told me, and iultimately think this proved true, is that you don't have tobe an engineer in silicon valley to have an impact, youjust have to be able to think rigorously like anengineer does. i think the training, thatyou're doing here at yale, and then the potential training atinvestment banking, both have

the potential to serve youwell in that respect. so, what we're trying to do atfacebook is get people the power to share and make theworld more open and connected. pretty simple, in principle. and our strategy for doing thisis mapping out what we call the social graph. now, we didn't create this. this exists out in the world,all we're trying to do is draw a mathematical representationof it, and that's basically

who likes whom, andwho likes what? and then, we push informationas efficiently as possible along the edges ofthat ground. so, this is kind of where ispend most of my day, not just over here in farmville, but alsoover here in ads-land. and what my role is called is''local inbound product marketing.'' so, to kind ofparse that out, what we mean is basically, i go and talk tolocal businesses, restaurants, plumbers, understand what theirpain points are, what

other advertising products theyuse, what they're trying to accomplish as a localbusiness owner, and then basically synthesize that withdata analysis, and ultimately present it to the engineers asa case for what we should build next. so, these are questions like,what do the ads that you see on facebook look like? how should they interact withthe rest of the product? how can we target them tomake them more relevant?

a whole bunch more. the real guiding precept hereis that, it's basically what henry ford said, right? he didn't want to build thefaster horse, even if that's what his clients might haveasked for, he wanted to build something that was dramaticallymore useful, and for him that was a car, and forus it's something that we call social advertising. i am happy to chat a littlebit more about that during

questions, if folksare interested. so finally, just to kind ofcompare these two roles, and how one might have prepared mefor the other, i think the three things from banking thathave served me best working on internet products are: one, thiscross function of process management, which is aubiquitous part of the business world. two, building polishedpresentations, this one notwithstanding.

and three, being resourcefulabout tracking down data points to help make theright decisions. on the other hand, there's someparts of the job that were totally new. thinking from the mindset of thecmo, the chief marketing officer, rather than the cfo,the chief financial officer, just the pace of theenvironment, banking is fast-paced, but the rate atwhich products evolve in the internet is dramaticallyfaster.

and the fundamental job itself,which is basically creating new products, buildingthe business case for them, validating that case withdata, trying to actually mock them up -- and i assureyou, i'm not good in photoshop -- and then actually use thosemocks and that case to inspire engineers and product managersto want to build them. so, it's an environment thatis much more ambiguous. the yardsticks for whether ornot you're going in the right

direction, especially inthe short term, are not nearly as clear. but if that's actually somethingthat's appealing to you, then i strongly encourageyou to check out jobs around silicon valley, and especiallyat facebook. so, you can actually go tofacebook.com/careers -- quick plug -- to check out about theinternships and the full time jobs that we have available.

so, professor shiller, did youwant to use the rest of the time for questions. professor robert shiller:well, yes. i'm opening it up to allof you for questions. ok, you have a questionback there. student: before you did yourjunior summer in investment banking, how did you evenknow you wanted to -- jon fougner: i caught some ofthat, and then the screen caught some of it, so just bearwith us for one second,

and then i'll beright with you. you said, before i did my juniorsummer, what did i do? student: before you didyour junior summer. or how did you figure out thatinvestment banking was the field you wanted to be in? jon fougner: well, you know, iknew that some of the stuff on the right hand column of theroi chart was stuff i was interested in. i was interested in thetechnical side of the work,

working on math, basically,but also interested in the relationship side of it, thestrategic side, thinking about basically how you helpthese companies vet the company decisions. and during the first week oftraining, one of the partners of the firm came in -- and we use this term partnerkind of as a term of art, because, as the professormentioned, it's no longer a partnership --

but he came in and said, whenour clients want to do really important things,they come to us. and when they want to thinkabout important things, they come to fill-in-the-blankname of top tier consulting company. and that kind of action, andactually physically seeing the results that you create inthe world was really appealing to me. and i hadn't done strengthsfinder yet at the time, but i

did it subsequently, and found,not surprisingly, that that's where my psychologicalreward structure was kind of geared towards. professor robert shiller: yes? student: so, peter thiel, whowas the first investor in facebook, and is currently ontheir board, is now offering 20 people under the age of 20each $100,000 to drop out of school for two years and starttheir own companies. and since you actually work forfacebook, i was wondering

what you thought of that. jon fougner: yes, i thinkthat's fascinating. and obviously, i don't workwith peter thiel. look, i think, whateverwe can do to promote innovation is great. now, if you're sitting here inthis room and you're saying, well, do i want to take thisrisk of sacrificing this signaling device of this collegedegree, and also potentially sacrificing somestructured classroom

experience, in order to rapidlyaccelerate, how quickly i got into entrepreneurship, i don't know. that's a personal decision thatis for you to make, and i don't really have anyopinion on it. ultimately, for me it'll comedown to, do these companies actually end up doing reallycool things and building really cool stuff? professor robert shiller: andi'd add, it isn't as risky as

you might think, because yalewill take you back, if it fails in a couple of years. jon fougner: one of our veryearly employees was a yalie, who had had an undergraduateexperience somewhat like you're describing, where, ithink, he had actually taken some time off to workon startups. i think he came back, finishedhis degree, and is now a partner at benchmark, oneof the firms that i had on that slide.

professor robert shiller: well,while they're thinking, can i ask you -- i emphasized the core valuesat goldman sachs, and it strikes me that facebookis totally different. maybe i'm wrong. can you tell me, what are thecore values at facebook? if i were to read that listthat i just gave you from goldman sachs, how would itsound to the facebook people? jon fougner: yes, so i thinkthere are similarities and

differences. i think, each of us has a coreconstituency, who we wake up thinking about them, go to bedthinking about them, probably dream about them, and know thatwhether or not we serve that constituency will determinethe success or failure of the company. and at goldman thatwas the clients. and at facebook, our number onefocus is the users and the user experience.

and we care a lot about ourpartners, we care a lot about our advertisers, we care alot about everyone in the ecosystem, but ultimatelywe know we have to serve the user as well. so, each company, i think, hasalmost a maniacal focus on serving one core constituency,albeit they're different. now, in terms of the day-to-dayexperience, i do think they're quite different. i think that whati'm doing now is

quite a bit more creative. professor robert shiller: you'renot doing spreadsheets. jon fougner: a littlebit, but -- professor robert shiller:you're doing it, still. jon fougner: yes, not as much. and i really love the creativeside of the work. if you think back to stevenschwarzman's lecture, where he mentions that there's noflexibility for getting the numbers wrong, i mean certainlywe feel the same

way, all the analysis needs tobe correct, but there's almost an ominous tone, when he saysthat, whereas the way that we operate is knowing that we haveto move really fast in order to continue to innovate,continue to stay relevant. and so, that means thatsometimes you make mistakes, and it's no secret that we'vemade mistakes, and some of them have been big mistakes. and we just try to minimizethe number of times that happens, try to fix them as soonas they do happen, and

just be honest about them, andadmit them when we make them. professor robert shiller: can iask a question of the class? you set the example. how many in this class areengineering majors? not many. like 5% maybe. what about science majors? that looks like 10%. see, you're kind of in anengineering company, right?

i mean, i don't know exactlywhat facebook is, but is there some kind of division here? why aren't there more engineersin this class? jon fougner: that sounds likea question for the class. professor robert shiller:well, i can't ask them, because they're not here. jon fougner: all the engineers,who are not in the room, why are younot in the room? professor robert shiller: buti mean, is there a big

cultural difference? i mean, are engineersprejudiced against us finance people? you're there, so -- jon fougner: look, i thinkthat product design and software engineering is at theheart of the company, but as i mentioned, i was prettyintimidated going in and saying, huh, i'm going tobe a business guy here. am i not really going to beable to have an impact?

and i think the things that areimportant for the business people are: one, to rememberwhat the core mission of the company is, which for us isreally all about the users. two, to have a sense ofwhat is feasible. so, you don't actually have toknow how to write the code, or even necessarily how to mock upthe product, but if you're making recommendations that weshould build things that are simply technologically notfeasible, you're going to waste people's time and losecredibility pretty quickly.

and then, three, i think, whenyou do the analysis, engineers are going to want to see asrigorous analysis as possible, quantitative analysis whenthat's relevant, when that's possible, and to the extent thatyou can bring that to the table, i think that's helpful. if you think about the businessworld at large, one of the things, that's justgoing to be increasingly important, is the ability todesign, conduct, and interpret statistically significant,valid experiments.

and this sounds like a prettystraightforward thing, that you might learn by maybesecond or third year of college, and yet you get outinto the business world, and you'll find that many of yourcolleagues, whether they're coming from mbas or otherbackgrounds, may not actually have that background. so, being able to bring thatsort of rigor to the table, whether it's at a consumerinternet company or an industrial company, anythingelse, i think is very helpful.

professor robert shiller: youknow, i'm thinking, maybe i should change the name ofthis course to financial engineering. that would bringin the others. because to me, engineering andfinance have a certain connection. they're both designingdevices. i think, we have anotherquestion. student: have you thought ofgoing back to graduate school,

and how do you see that playinginto a career like jon fougner: yes, i have thoughtabout going back to graduate school. i think that all of us wantto be lifelong learners throughout our career. there's a number of waysyou can do that. graduate school isone of them. another is, going intoindustries where you're just confident that everyone you'reworking with is really smart,

and they're going to push youhard, and not settle for mediocrity, so you just knowyou're going to learn by that pressure and that osmosis. and then, i think, there'ssome kind of simple, structured things thatyou can do, as well. i threw a slide up of a couplethat you can do in the comfort of your own living room-- the meyers-briggs and strengths finder. but then also, you can leveragehaving a workplace to

do things like peercoaching, career coaching, executive coaching. so, i kind of take a somewhatagnostic point of view as to which of these tools i'm goingto use at any given time. i just know, that i constantlywant to be challenging myself and constantly want tobe learning more. professor robert shiller: ok. student: i've heard a lotabout issues with click-through rates on varioussocial networking sites, so if

you could talk about, what youthink the putative value of facebook should be, and whetherthe current valuation is appropriate. jon fougner: yes, so, i'm happyto share a little bit about click-through rates. i'll probably defer on thequestion of how much the company should be valued at. is everyone familiar with whata click-through rate is? no, not everyone.

so, this is justa simple ratio. let's say, you show an ad somenumber of times to users on the internet. it's the ratio of the numberof times the user clicks on that ad to the total numberof times you showed it. so, if you show an ad 100 times,and you get one click, you have a 1% click-throughrate. and if you think about, well,why are people advertising? in marketing there's kind ofthis concept of this marketing

funnel, which is a little bitsilly, but it actually conveys a useful concept. up here is everyone in theworld, and then here is the people we can actually makeaware of our product. and then here is the people whowe can actually make have an affinity for our product. and here is the people who wecan actually make consider purchasing our product. and then people who actually buyit, and then repeat, loyal

customers who buy itmore and more. so, we get to a narrowerand narrower pool. and what marketers areconstantly trying to do is, push people through this funnel,so they can actually start with someone, who may notknow about the product at all, and then actuallyget them to buy it again and again. so, marketers use a varietyof different tools. online advertising is one, butthat represents maybe 15% of

the market, but it's arelatively new one, and there's plenty of others that goback decades or centuries. things like television,radio, print. these different media playdifferent roles in getting people through thismarketing funnel. and if you think about, whereonline advertising originally grew up, it was reallytowards the very bottom of this funnel. of, ok, i am looking for a blueipod at the best price,

that i can either order onlineor that it's within five miles of my home. so, i search that on a searchengine, i see a list of vendors, and in that case, it'sreally important whether i click through, becausethat's basically the determinant of whether or notwe get them through the next stage in the marketing funnel. if you think about facebookadvertising, that is one of the roles that it can play, butit can also actually play

throughout this entire marketingfunnel, where we have a reach of 500 millionpeople, and then you can target within that. and then you can use things likesocial context, telling you that your friend mightreally love a product, to help build your affinity for it, onthrough this whole funnel. so, for some of it,click-through rate is relevant, for other of it,click-through rate really isn't relevant, and you need tothink about other sorts of

measurement. things like companieslike nielsen do. like polling people and askingthem, ok, you saw this media, did it increase your likelihood to buy this product? or did it make you aware of themessage, that the brand is trying to convey, that youweren't aware of before? i think, it's one of a numberof metrics that go into assessing the health of thebusiness as a whole.

professor robert shiller: ithink we're essentially out of time, but let me just say,click-through rates and marketing sound profit-oriented,but it seems to me they have a socialpurpose -- one thing is that capitalism isbeing transformed by this kind of thing, because it getspeople to buy things that they really need. it's like your strengthsfinder or needs finder. and i have to applaud facebookand other companies.

finally, i'm going to invite youback in another 10 years. this was great. jon fougner: thanks.


List Of Financial Consulting Firms San Diego


chairperson mathur: good morning, everyone.i'm going to get the pension and health benefitscommittee started.first order of business is roll call. committee secretary jimenez: priya mathur?chairperson mathur: good morning. committee secretary jimenez: george diehr?vice chairperson diehr: here. committee secretary jimenez: michael bilbrey?committee member bilbrey: present. committee secretary jimenez: ralph cobb forjulie chapman? acting committee member cobb: here.committee secretary jimenez: ruth holton-hodson for john chiang?acting committee member holton-hodson: here.

committee secretary jimenez: rob feckner?committee member feckner: morning. committee secretary jimenez: j.j. jelincic?committee member jelincic: hello. committee secretary jimenez: henry jones?committee member jones: here. committee secretary jimenez: grant boykenfor bill lockyer?acting committee member boyken: here. chairperson mathur: the second order of businessis the executive report. ms. boynton. deputy executive officer boynton: good morning.just a brief update on our health plan implementation inpreparation for the january 1 launch of our new plan year.the implementation activities are proceeding

well. there is no doubt that it's been anenormous challenge. and again, i would like to extendmy sincere thanks to the state controller and his stafffor their commitment and -- continual commitment towork with us through a significant number of challengesrelative to our systems and their systems and the plans' systems.but all of that is going well and we look forwardto an entirely eventless launch of our -- all of our newplans, and our new processes into the new year.the other thing i would mention is there's

-- asyou all have seen in the press over the past couple ofweeks, there's -- although we had thought that the aca wason a fairly steady path to implementation, that has provento be a little bit more elusive. the major change, ofcourse, being the question of whether or not individualpolicies would continue to be issued that are not incompliance with the essential benefits for the aca. it'sa very tumultuous time in the health care deliveryindustry.

all of the ceos, all of the providers thati speak with are entirely committed to ensuringthat they are ready, and that they are implementingthe triple aim and been redefining the care delivery system.that, however, is an enormous charge. if you justthink about that we spend about $7 billion this year inhealth care. even if all of that went to only one provider,trying to change a $7 billion industry is one thing.and then you magnify that across the entire state, withthe overlay of

the federal government payment systems ontop of that and all that goes with it, there's a lot goingon. i can say though that without -- to an individualall of the delivery system folks that i talk with say weunderstand the message. we know health care has to bemore affordable. we are working toward it, but it willnot be something that happens quickly, so -- and i thinkthere's an overlay of distrust amongst partners in somecircumstances that makes it more complicated. sohospitals hear loud and clear that delivering

care in ahospital setting that doesn't need to be there isn'tfinancially viable for us. so they are going through a struggle, someof them, on whether or not to surrender entirelythat sort of line of business. they are, in some circumstances,intentionally purchasing brick and mortar outside of thewalls of the hospital to be able to continue to providethe quality service that they have been providing fortheir patients. that activity can be viewed withsuspicion. it is, by some. the same is true

on the otherside of plans acquiring physician groups or plansacquiring -- it's a time of tremendous change. and i'dlike to say that by january 1st we're going to be clearand solid and know exactly where we're headed. i thinkit's at least a couple years before we have any realsense. we're very encouraged by the changes at the-- the apparent changes that are under considerationat the federal level related to medicare reimbursement,because

frankly until we get a little bit of a changeon the medicare side, we've got an industry that'svery bifurcated in how they are receiving paymentwithin california.so no answers at all from me today. but i justwanted to acknowledge that the industry, i am encouragedby the words that i -- you know, by the actions and thewords that i hear and the actions that i see from ourindustry partners, and that we will be making change. itmay not be as fast as all of us want it to

be, but i dobelieve that it's on a path that really can't be undone atthis point. so that's good. that concludes my remarks.chairperson mathur: thank you very much. i seeone question from the committee. mr. jelincic.committee member jelincic: with the open enrollment -- i assume we haven't finalizedall the numbers yet. but in rough terms, how manymembers did the new plans pick up?deputy executive officer boynton: we don't havethe final numbers yet. generally, the plans

picked upabout the amount that we had expected that they would,that we factored into our risk-adjustment method, when wecalculated -- when we did our risk adjustment. sooverall, they're fairly close to what we thought that theywould be. there are a couple exceptions where -- andwe'll be working with those plans as we move into ratenegotiations this year to see what may be causing that.committee member jelincic: and -- deputy executive officer boynton: and therewas

good movement. there was more movement thisyear than we had last year. so that's a very positive development.we would like to see more, but we all know thatthe hardest part in anything -- any kind of a change likethis is getting people to actually open their openenrollment material and doing something with that, outsideof some sort of a, you know, a forced migration activityor a hundred percent positive enrollment. they're-- getting people to take an action on these things isvery hard.

committee member jelincic: thank you.chairperson mathur: thank you. agenda item 3 is the minutes. what's thepleasure of the committee? committee member bilbrey: i move approval.chairperson mathur: moved by bilbrey. vice chairperson diehr: second.chairperson mathur: seconded by diehr. all in favor say aye?(ayes.) chairperson mathur: all opposed?motion passes. agenda item 4, consent items. i see no requeststo take anything off consent. agenda item 5 is the extension of the pharmacybenefit program manager contract. deputy executive officer boynton: thank you.kathy donneson will present this item. i do

want toconvey to the committee and to our constituents that we donot -- i will say flatly, we do not believe that the cvscaremark implementation has been flawless. the discussionthat we are having should not be taken in the context thatwe think that all of the performance has been spectacular.there have absolutely been problems. we are workingdiligently with cvs caremark and they are working verycooperatively with us to resolve those issues. but i just want to set -- be frank with youall

that this is not to say -- the item beforeyou is not to say that we think everything is hunky-dory,because we absolutely do not think that that's the case.chairperson mathur: thank you. ms. donneson.office of health plan administration chief donneson: good morning, madam chair, membersof the health -- pension and health benefits committee.this agenda item is an action item to extend thecvs caremark pharmacy benefit management contract for twoyears. calpers began contracting with cvs caremarkin

2012 under a three-year contract with theoption to extend for one to two years. the contract was implementedprior to the passage of board resolution number92-04b, which allowed competitive contracts to be awardedfor five years.cvs currently provides pharmacy benefits for over350,000 ppo basic and medicare members, and in 2014 willprovide pbm services for anthem blue cross, health net ofcalifornia, sharp healthcare, and united healthcare. calpers staff, cvs caremark, the new hmo plans,and the state controller's office have been

workingdiligently on implementation activities since the hmocontracts were awarded in april. member communications, micro sites, evidence of coverage bookletshave been developed. pre- and post-implementation auditsand performance guarantees will allow calpersto effectively monitor the performance of cvs caremark.if the contract extension is not approved, staffwould need to release a pbm rfp, which would take aminimum of 18 months to fully execute. in thiscircumstance, staff would request a one-year

extension toallow time for procurement and implementation. if the two-year extension is approved, staffwill initiate development of the rfp in late 2014with an anticipated contract award in late 2015.extending the contract for two years would costapproximately $29.5 million in administrative fees. ifcalpers is required to procure a new pbm, theadministrative costs would be unknown and may not be lessthan the current fees for cvs caremark. this could resultin higher hmo and ppo premiums.

staff recommends extending the contract fortwo years to december 31st, 2016 to avoid memberdisruption, improve existing programs, and provide qualitypharmacy benefits at a reasonable cost.that concludes my presentation. are there anyquestions? chairperson mathur: thank you. we do haverequests to speak. mr. jelincic.committee member jelincic: you know, it could becheaper. it could be more expensive. we won't knowwithout doing an rfp. one of the things that

was pointedout is that members who have become familiar with cvscaremark operations may be adversely impacted. i wouldpoint out that those who have become familiar with themand really dislike them would be positively impacted.but we -- i think the bigger issue is we actually have a workload issue. and you made referenceto it at the beginning of the analysis. and so i wantto at least throw out the question do we have sufficientstaff, are we committing sufficient resources? you know,if we're not

doing an rfp because of a resource constraint,then maybe we need to look at a staffing issue as well.and so i just want to throw it out and get yourcomments on it? deputy executive officer boynton: we haveadequate staff to process the routine workload ofdealing -- working with cvs caremark, with the statecontroller's office, and with our plans, and with ourmembers as issues arise and need attention. the additional workload of an rfp is significant,and that would require that we would bring in supportiveresources on the outside, so that they don't

impact thedaily operations. committee member jelincic: when was the lasttime we had a normal work flow in your unit? i mean,we've got through long-term care. deputy executive officer boynton: yeah, iwas thinking about that the other day.committee member jelincic: we've gone through, you know, the long-term care. we've gone throughthe new rfps, the new plans. things have not beentypical. and i'm just wondering when you anticipate a normalworkload? deputy executive officer boynton: well, 2014will start to level out. 2015 will only be

the -- only bethe pbm rfp and the routine plan operations. so thenwe'll -- we will be able to, over the next two years, ithink really settle into understanding what does ourworkload look like. committee member jelincic: thank you.chairperson mathur: thank you. this is an action item. what's the pleasure of the committee?vice chairperson diehr: move staff's recommendation.committee member jones: second. chairperson mathur: moved by diehr, secondedby jones.any discussion on the motion?

seeing none.all those in favor say aye? (ayes.)chairperson mathur: motion passes. we'll now move on to your information agendaitems. item 6, policy engagement on national pensionissues. and i believe we have our federal representativeon the phone, mr. tom lussier. mr. glazier.deputy executive officer glazier: good morning, madam chair, members of the committee. robertglazier from external affairs. you're correct, tomlussier is standing by on the phone and will join meat the end for

any questions that you may have.this is an informational item. and it summarizes for you some of the federal pension issuesthat tom and i have been discussing over the past few monthsduring our board updates. most importantly though, itdescribes some of our current and future efforts to proactivelyengage and educate appropriate legislators and otherstakeholders on these important issues.i believe you're familiar with each of these topics, so i won't go into detail. tom hasalready captured them well in a memo for us. but iwill remind

you as tom and i have pointed out severaltimes that due to the current environment and the attentionto bankruptcies and unfunded liabilities recentlyin washington d.c., the public profile of theseissues has been heightened and can easily be linked toincreasing the risk to public employee pension systems, whichis why we've brought this forward again.as a result, i want to spend just a moment highlighting some of our engagement strategiesthat we are implementing to deal with these potentialrisks, in

addition to the activities that are alreadytaking place. first, we plan to expand further the calpersvoice, if you will, by developing a communications networkand engagement strategy, which would create a coalition ofcalifornia retirement pension systems, where we couldcollectively send letters in agreement to members ofcongress to share with them issues of particular mutualinterest for us. this is a process that nasra currently usesacross state retirement systems. and we've alreadyreached out to sacrs, and they are interested

inparticipating with us. second, we are engaging with senators feinsteinand boxer regarding the concerns that we have with senatorhatch's safe retirement act. third, we're developing a document that canbe shared with the california delegation to summarizethe steps which calpers has already taken to strengthenthe sustainability of our plan, plus the pensionchanges that have been already enacted here in californiato illustrate that federal intervention is not necessaryin state

pension policy.lastly, we'll continue to support and push ournational coalitions through nasra and nctr to engage inthese issues as well. that concludes my summary, and i'm availablefor questions as is tom on the phone.chairperson mathur: thank you. any questions from the committee?mr. jelincic. committee member jelincic: we spent a lotof time talking to regulators and politicians.would it be helpful to have more board member participationin that?

you know, to the extent that it's really anitty gritty mechanic bill type analysis, i think staffis the appropriate level, because quite frankly wedon't know what we're talking about on those issues,or at least i don't. i won't say that for everybody on theboard. but a lot of these are policy type issues,and i'm wondering if it would be helpful to havemore board participation in those discussions?deputy executive officer glazier: it really would depend on the issue and the point intime what kind

of efforts that we're engaging in. sometimesthat might be appropriate. other times, like you say,it's much more of a staff-to-staff level engagement. so wewill always consider that, and look at that, but we appreciatethe board support, because that is helpful whenthe board does engage at the right place and the right time.committee member jelincic: and then on page fiveof eight, we identified some of the people who areconsistently taking shots at us. what are we doing tofind out how many of our vendors are supporting

those whoare taking the shots? deputy executive officer glazier: i don'tknow that we have specifically looked at whetherour vendors are supporting others in political ways, ifthat's what you're referring to?committee member jelincic: yeah. deputy executive officer glazier: but wecontinue to engage in the areas that feel are appropriateto make sure that our voice is heard and that we'reexplaining our position. committee member jelincic: i mean, if ourvendors are not pursuing our interests, we

ought to have adiscussion with them. i mean they can make whateverpolitical donations they want, but we ought to at leasthave the discussion. thank you.chairperson mathur: thank you. mr. jones.committee member jones: thank you, madam chair. yeah, robert, in reference to j.j.'s commentabout board involvement, if, at some time in the future,that becomes necessary, a model that i recall worked severalyears ago is that we -- the president had noticed ameeting with --

in conjunction with the cii, and as a resultof that, several board members were able to attend.and they fanned out to different committee chairs inwashington, you know, whether it was health issues, whetherit was finance issues. and, you know, a trio of boardmembers met with the chairs of the various committees.and, at that time, it appeared to be very, very effective.so that's something to think about also.deputy executive officer glazier: that is definitely something.chairperson jones: and i've shared this with

thepresident, by the way. deputy executive officer glazier: yes. tomand i have discussed those opportunities as well.thank you. chairperson mathur: i have a question. i'mnot sure if it's for you or for tom. to what degreeare -- is congress asking us to weigh in on the acaand the roll-out and some of the issues that are arising asa result? deputy executive officer glazier: it woulddepend on the issues, but either tom or ann could probablytell you more specifically the various opportunities

thatwe have. deputy executive officer boynton: yeah. wheni was back in washington recently, i did meetwith congressional staff specifically on the issuerelated to the medicare payment reforms that i mentioned,and the proposed -- bipartisan proposal related tothat, which we think is very, very positive movement. andi will turn it over to mr. lussier to discuss other interactionsthat he and his staff have been having on the aca.mr. lussier: thank you, ann, and good morning

everyone. at the moment, we haven't been askedto weigh in on any of the most controversial issues.and i think that's good. we have been asked, and as annjust indicated, we are actively engaging with thesenate finance committee around the whole str repealand payment reform legislation.as you probably know, there has been a significant bipartisan bicameral piece oflegislation advanced, that they are desperately lookingfor broad based support, and they're very grateful thatcalpers has

expressed a willingness to be actively engagein that conversation. ann has committed to do that,and we're just going to continue to sort of be responsiveto whatever they ask us to do that you all arecomfortable doing.and as the proposal gets more specific, i suspectthe engagement will also get more specific. right now,they're looking for general support for the themes in thecompromise legislation. and as far as i know, ann andyour health staff are very comfortable in

providing that.chairperson mathur: okay. thank you. i see no further requests to speak, so thanksvery much for being with us, tom. mr. lussier: thank you.chairperson mathur: we'll move on to agenda itemnumber 7, customer service and support performance update.deputy executive officer lum: you'd think byknow i'd know which one of these turns it on. goodmorning. donna lum, calpers staff. this morning i have an information item, agendaitem 7, which is our quarterly performance agenda item.and just before i get started, i wanted to

share a coupleof quick numbers with you. so if you consider 256,882,that is the number of inquires that we received for bothretirement and health during this past quarter. weprocessed over 10,000 service requests -- service retirement requests, and we also processedover 11,000 services retirements.and so i wanted to share these numbers with you,because i think it's a remarkable number of statistics andworkload that our program has handled in just one quarter.and i believe that these raw numbers illustrate

oneimportant aspect of the effectiveness of our programs, andthat is providing service to our customer service and justthe shear volume of productivity that the service agentshave been providing. so as we move forward with the agenda item,i just wanted to also convey to you that i'mvery pleased with the dedication of our customer servicerepresentatives and the teams and their performance. ouroptimism is quite high as we share this information withyou with regards to what you can expect in

the upcomingquarters. that being said, as noted in the agenda item,we do have a couple of areas that are not yetperforming at the levels in which we desire. those areasare related to membership determinations and service creditpurchases. however, although those areas are not performingat level -- at the expected levels, i do wantto assure you and reassure you that with our backlog eliminationplans that the staff have been working on, we doexpect that in

the next few quarters we will see measurablegains in these areas.the agenda item also lists a number of updates that we have on projects that are part ofour service delivery transformation roadmap. and so, asnoted in the agenda item, we've recently completed a coupleof surveys that we have implemented for members who aredoing service with us on line, part of our member self-service.and the intent of these surveys is to give ussome feedback on their experience, their on-line experience, so as we go forward and developadditional and

new functionality, we have a good baselinefor the types of things that are working well on memberself-service and those areas that we can improve upon.in addition to that, we've continued to roll-out what we call our core competency training.and these trainings are designed to support our employeesby providing them with timely and effective trainingto reinforce what we consider to be very strongcustomer service skills and job knowledge, in additionto what they have.these training skills -- or these training

classes again provide, what we call, bestpractices in a number of enriched areas where we believeour staff will continue to greatly benefit as we continueto expand upon our customer service skills.we have been making modifications to our interactive voice response system, that'sthe ivr, when members and employers call into the contactcenter. we've worked with a vendor who has done an experiencestudy with customers, a variety of stakeholders, andwe've begun to make some design elements to streamline theexperience on

the ivr.so with implementation expected to be released atthe end of the fiscal year, we do anticipate that ourcustomers will have a much more satisfactory experience inutilizing the ivr. in addition, i'm pleased to say that we'vecompleted our overview of the results and surveys from ourretirement planning fair. i think, again, i'd like tothank many of you that were able to attend the fairs. itwas a success. we did see an increase in the attendance.some of the survey statistics that we got

was 91 percentof the customers that completed the survey indicated thatthe retirement planning fair was very much worthwhile. wehad 96 percent who said that the date and the time and thelocations were very convenient, and 90 percent indicatedthat the sessions that they attended met their needs andexpectations. and then finally, 93 percent of the surveyrespondents indicated that they would recommend theretirement fairs to others. as far as the contact center update, i'm againvery pleased with the performance that we're

seeing in thecontact center. we held steady at a one minute or lesscall wait time during one of the most busiest times thatour contact center experiences, and that's with openenrollment in the month of october. overall, we'recontinuing to see a number of different improvements inthe contact center. but mostly, i just wanted to again to sharewith you my pleasure with the experience that weknow that our members are receiving with the responses they'regetting

and the closure rate of the inquiries thatare happening at the point of contact.and then also at the employer forum, i shared with you that we were rolling out a new employerresponse team. and monday -- or the monday followingthe employer forum we launched the new team. and in lookingat the results of the team and the types of callsthat have been coming in over the past three weeks, i amreally pleased to note that our employers are utilizing thatemployer response escalation method of contacting usfor the right

reasons.we were concerned that we would receive an overwhelming number of calls coming in havinghanded out our flier to over 600 employers.the vast majority of the calls coming in i thinkwe've averaged less than 10 to 15 calls per week we havebeen able to bring closure to, which are some of the morecomplex issues. more than 80 percent of those are beingclosed in less than 72 hours. so again, i think it was a great success forus to assemble that team, put the processes inplace, and

again ensure that the experience that ouremployers have with the most escalated inquiries are beinghandled. overall, our metrics continue to improve acrossthe board. and i do feel that our performance over thepast quarter was very strong. and as i mentioned earlierin my presentation, i anticipate that the upcoming nexttwo to three quarters we'll really see things level out ina higher degree of performance in those underperforming areas than what we've seen in the past year.so that concludes my presentation, and i'm pleased to take any questions you may have.chairperson mathur: thank you. mr. feckner.

committee member feckner: thank you, madamchair. thank you, donna, for your report. and i too amvery pleased with the nice turnaround you've seen in thecall center et cetera. my concern is on your two redstatus issues. and it's -- i don't want this to be anegative. i want to focus on a positive, as we've donewith other things. although there is a backlog, youdidn't say how big the backlog was, which isn't really thepoint. the point is if it's a staffing issues, then ithink you need to say that. we need to find

a way to worktogether to make sure that we staff accordingly, becauseeven to get to these levels, in my opinion, 90 days and120 days is our goal is not acceptable to me.now, as we get better in things and we move farforward, i mean when you start looking at doingsatisfaction surveys right below that, i can't see anyonewho would be satisfied with taking four months to get ananswer to a question. i can buy a house in half the timethan it takes me to get a member determination.

we need to find a better way. and if it'speople time, et cetera, then we need to focus onthat and maybe help give the help that you need to get tothat point, because we were in a better spot before. andi wanted to see us get there before.but beyond that, i want to be able to have rational discussions on these goals, becauseas we've seen in society when you set a goal, once you getthere everybody celebrates. they relax. we shouldn'tbe relaxing when we're four months away fromgiving somebody

an answer. i mean, four days would be somethingwe should shoot for a goal.so i get we need to have short-term goals, but tojust say that 120 days is a goal we're looking for, ithink is a disservice to the members. so if we can do abetter job in helping you staff accordingly, then i wouldlike to be able to do that. deputy executive officer lum: thank you.chairperson mathur: thank you. mr. bilbrey.committee member bilbrey: not on the report. ijust wanted to make a quick comment. i've

been visitingthe local regional -- or the regional offices, some of them. and i just want to say thank you tothe staff. they've been very informative. it's excellentto see what happens in the field and what's going on.i can't stress enough about the power of attorney. i happened to be in one of the offices,and a member came in who was actually going straightto the hospital to have surgery. she was in latestages of cancer, and came in to get her affairs inorder. so the

staff was right there immediately taking careof things while i was in the office. so i just wantto commend them for the amazing job that they do each andevery day. deputy executive officer lum: thank you.chairperson mathur: it is wonderful. we have really dedicated staff.mr. jelincic. committee member jelincic: yeah. i was insan diego recently for the california state retireesboard meeting, and a number of the members cameup to me and said, you know, the calpers office is justaround the

corner. we marched over there. and they werereally polite and very helpful. and so i want topublicly acknowledge the san diego office doing a goodjob. mr. jones.committee member jones: since everyone is givingkudos. (laughter.)chairperson mathur: it's a great bandwagon tojump on. committee member jones: anne stausboll andi visited the san diego regional office, andwas -- we spent

a lot of time getting input and taking theirrecommend -- anne was taking their recommendations forpossible changes, et cetera. but the staff was veryengaged. a small office, but very engaged. and so i justwanted to know that was a good outing for us also.deputy executive officer lum: if i could just comment quickly on the regional offices. ido go out to the regional offices as well as the leadershipand the -- and i visited several in the last two weeks.and echoing your comments, they are doing a fantasticjob out there.

and they do appreciate the visits that theyhave from our executive team and from the board membersas well. one thing that i would also, just to add ifi could, in response to mr. feckner. and youare right, we do revisit our baseline metrics and the goalsthat we set. the vast majority of them are set at 100 percent.the ones that we have that are set less typicallyrequire constraints that are more out of our control,but they're not at a very low level.we are going through the process now that

againour performance has begun to rise to reevaluate some ofthose metrics. the service retire -- or excuse me, theservice credit purchase backlog, again in january we hadover 30,000 items. we have less than 4,100, and primarilydue to pepra and the elimination of arsc, so they'remaking great progress there. to answer more of the question related toour membership determinations, what you're seeingin the backlog there, and this was the first timethat it came up

in our report, is because we put a focusedeffort on getting to the most aged items. you didn'tsee this come up in a previous report as an area of concern,and that's because we concentrated that effort and we'remaking good progress.what we're having to do there is really interact with the employer to get information timely,so that we can do the determinations more timely, butthat's a process thing that we're having to work onwith the employers. so i don't believe that it is astaffing

issue, per se, at this point. it was justa matter of our -- where we focused our effort and thengoing forward. the 120 days is something that, again, aswe evaluate our performance metrics, we can lookat it and how to improve upon the processes to get thatreduced as well.chairperson mathur: okay. thank you. we'll move on to agenda item number 8, long-termcare new product update. deputy executive officer boynton: we havetwo long-term care items to present to you today.the first

is focused specifically on the long-term care4 product, which will be available beginning next month,mid to late next -- mid to late december.and then the second item is to talk about followup from the valuation discussion we had last month.office of health plan administration chief donneson: good morning, again.madam chair and members of the pension and healthbenefits committee, this agenda item is an update on thebenefit and pricing options for long-term care 4.calpers ltc program and actuarial staff used

thecalpers program market study that was conducted by mercerin february 2012 as the source document for modernizingthe benefit design for ltc4. the benefit design and rateswere approved at the february 2013 board meeting, andrates were developed consistent with a long-term caremargin of 10 percent. the process was completed for the base planand optional benefits. and the resulting rateswere compared to similar long-term care industry carriers.actuaries from two external consulting firms

reviewed the assumptions. underwriting requirementswere reviewed as part of ltc4 pricing to ensureguidelines are current with long-term care insurance industryand to provide comprehensive screening.in the open application for ltc4, coverage willbe extended to adult children of california publicemployees. the major difference between our currentpolicies and ltc4 is the elimination of the lifetimebenefit period and the facility-only coverage. attachment 1 of the agenda item provides thepricing for ltc4. and attachment 2 provides

the benefitdescriptions for both calpers plans and the partnershipplans administered through the department of health careservices. i'd like to explain a little bit about thepartnership plans. the california partnership forlong-term care policies allow participants to keep assetsand qualify for medi-cal in order to receive additionallong-term care services. the amount of assets medi-calparticipants -- or medi-cal office will disregard is equalto the amount of the benefits the participant

actuallyreceived. the ltc for partnership plan has the samebenefits as the calpers ltc4 plan. the partnership planbase benefits include a daily benefit amount ranging from$170 a day to $400 in $10 increments, but the benefitperiod is for one to two years, with an limitation periodof 30 days versus our calpers plan that has 90 days.the partnership plan policies must include a fivepercent compound inflation protection rate in the baseplan for participants under 70. and for those

participants 70 years and older, the participantcan choose either five percent compound inflationor five percent simple inflation protection. also,the optional restoration of benefits is not allowed underthe partnership plan. so those are some of thedifferences between ltc4 and the partnership plan.turning to attachment 1, i'd like to walk youthrough the materials that we've prepared for you toexplain the pricing. pages one through six identify theltc4 pricing assumptions. this is how the

prices weredeveloped by our internal and external actuaries. pagesseven and eight compare the ltc4 new product to ourcurrent ltc3 product. and so page seven illustrates thedifferences in the benefit design, daily benefit amounts,and then some of the additional benefits that are in ltc4that are not in ltc3. pages 10, 11, and 12 provide an example of3-, 6-, and 10-year premiums for a policy thatincludes a $200 daily benefit allowance for age bands 40 through70, as

well as the pricing of the optional benefits.page 13 is an example premium for base and optional benefits for a 50-year old participant.the table also illustrates premiums associatedwith the benefit design for married participant discounts.pages 14 and 15 illustrate the premium and benefitdesign for 3-, 6-, and 10-year policies compared to thejohn hancock product and the federal long-term care program.this concludes my presentation. are there chairperson mathur: thank you.dr. diehr. vice chairperson diehr: good morning. on page47 i'd asked in the briefing that this footnote

1. thisis -- sorry. this is 47 of the board books. it's 13 ofthe item. marital discount applies when both spousesapply. if both pass, a 25 percent discount applied.if only one spouse passes, a 10 percent discount is applied.so as i understand both apply, one of them is denied,so they don't get. the other one gets a 10 percentdiscount. and i don't -- i don't understand why there shouldbe 10 percent cheaper for that person than if theyjust had

applied as a single person. what do we knowabout it if your spouse doesn't pass and you do that makesyou less risky, i guess is the answer?office of health plan administration chief donneson: right. yes. if they pass underwriting,they -- depending on the age at issue, that will, youknow, be associated with a risk. but the single policyholder does not get to have a discount.so you're right, if both pass, it's 25 percent. if oneof the two passes, it's 10 percent.chairperson mathur: but is that meant to incentivize people to apply?office of health plan administration chief

donneson: yes.chairperson mathur: that's really what it is.it's not based on the risk? vice chairperson diehr: so my understandingthat if you're in poor health, it's pretty hardto fake good health. but if you're in good health, youcan fake poor health. so you and your spouse apply. yourspouse wants it. you don't. you get the doctor to giveyou something, and a note that says we're surprised thisperson isn't already in long-term care. and do you geta 10 percent

discount, is that right?anyway. okay. i have other -- (laughter.)deputy executive officer boynton: the most nefarious, yes, can find a way around ourunderwriting. (laughter.)vice chairperson diehr: well, people figure these things out.i have other questions because when confronted with numbers, i cannot help myself. i haveto calculate them and divide them, but i will ask you off-linebecause they -- everybody else would just -- theireyes would roll and things like that.(laughter.)

vice chairperson diehr: so i'll send an emailto you and you get the actuaries to respond.office of health plan administration chief donneson: yes.vice chairperson diehr: thank you. i think that's it.chairperson mathur: thank you for saving the rest of us.(laughter.) vice chairperson diehr: you're welcome.chairperson mathur: any further questions onthis item? mr. slaton.board member slaton: thank you, madam chair. this is on page 14 where you're doing thecomparisons to

john hancock and the federal program. didyou look at any other long-term care, because when i lookat these numbers, you know, obviously our price is-- i don't know how the federal program is designed, but itcalls into question the numbers are so low in certaincases that it makes me wonder if it's actually a valid programin terms of its self-sufficiency.but on the -- we are less expensive than john hancock. did we look at other commercial providersto see where we lined up, because there's quite adifference

here?office of health plan administration chief donneson: although not illustrated here, whenoliver wyman did the market study for us, we didlook at pricing across a number of different carriers. itincluded genworth, metropolitan life. so we used thesefor illustration.board member slaton: right. so do we fall inthe median or where do we call compared to the -- i'd muchrather see a comparison to commercial than the federalprogram, because i just think that they have

maybe asharper pencil. office of health plan administration chiefdonneson: actually, the pricing falls within about themid-range of other carriers that are not shown here. andthe difference between the federal government pricing andour pricing relates to the discount rate they use, whichis six and a half percent versus our 5.75 percent.board member slaton: okay. all right. thank you very much. thank you, madam chair.chairperson mathur: thank you. i see no further requests. you've done such a good job withthe agenda

item, nobody has any questions.we'll move on to agenda item number 9, long-term care financing options.office of health plan administration chief donneson: this agenda item is an informationitem that describes options that can be considered topreserve the long-term care fund sustainability and stabilizepremium rates for current participants. the presentationof the 2013 actuarial valuation in october demonstratedan improvement in the long-term care program'sfunded status, which showed a -- the valuation showed a marginof 19.66

percent, which is 9.66 percent higher thanour threshold 10 percent margin.the valuation did provide example or evidence ofthe effectiveness of the 2012 stabilization efforts thatwere adopted by the board. the actuarial calculations supplied in the 2013 valuation are based ona number of assumptions about very long-term participantdemographic and economic behavior.for example, as shown in table 2 of the agenda item, when the discount rate, which is currently5.75 percent, is changed up or down by a half percent,the

approximate impact on the margin is a plusor minus 10 percent.the conversion rate for participants eligible tomake an election for the 10-, 6-, or 3-year policies in2013 was 28 percent, which was higher than the percentageassumed during the premium increase determination. because the actual conversion was not evenlydistributed across all ages and was concentrated moreon ages where fewer savings could be achieved, the impactof the margin is less than might be expected. however, the28 percent

conversion did improve the margin by approximatelyfour percent.as shown in the table on page three, going forward in future conversion rates with theassumption that is used, the impact to the margin wouldbe plus or minus one percent.as noted on page four and five, a return of fivepercent going forward reduces the margin significantly from the current level. that's a five percentdiscount rate going forward. we recognize that thepending rate increase is very difficult and presents avery challenging

decision for many policyholders, but we suggestthat the committee wait until we have another fullyear of fiscal experience before re-evaluating the currentlyapproved rate increase.that valuation will be presented to you in october 2014, at which point we believe wewould have adequate time to revise the rate increasebefore the 2015 implementation.that concludes my presentation. are there vice chairperson diehr: a key table is thisone on page four, board book page 55, the rateincrease at the

five percent. so this is october. as i understandthat's almost a year away. i guess i'd like to -- thisis a very key table, i think, to show the impact. andi guess, at that time, i'd like to see with -- you know,columns with different assumed instead of the five percentwith five -- i don't recommend going over 5.75,but some variations in there, so we can -- thank you.chairperson mathur: good idea. mr. cobb.acting committee member cobb: i'm looking atthe -- at the table showing the lct1 population

and lct2and how many members are on claim. and i was kind ofstruck by just how many more lct -- you know what -- sucha larger -- a much larger proportion of lct1 members onclaim than lct2? and what accounts for the difference inthe claims experience? office of health plan administration chiefdonneson: well, ltc1 was introduced in 1995. and i thinkwe would have to look at the age mix and demographics ofthat population, and then fast forward to now to look atthe claims. ltc2 was introduced at a later

date.deputy executive officer boynton: we can follow back up with you on some experience studyaround the difference between the two.acting committee member cobb: okay. thank you.chairperson mathur: thank you. mr. jelincic.committee member jelincic: yeah. i just want toremind everybody that while it may be too early to make adecision, we did make a commitment that the savings wouldget passed back to those who got their premiums jerked upthe most.

chairperson mathur: i don't think we did makesuch a commitment. i think we said we would look at it.but it will -- we will revisit in the future years.okay. i see no further requests to speak, sowe'll move on to agenda item number 10, leading practicesin maternity health benefits. (thereupon an overhead presentation waspresented as follows.) deputy executive officer boynton: thank you.as the presenters get settled, a little bit ofcontext of why we're doing this now. we're trying -- we aremaking a

concerted effort to present to you and tothe constituents in an open setting to engender better dialoguepotential benefit changes that we are considering asstaff that we feel have gone -- you know, that we've gotenough information about the viability of that kindof a change, so that we want to sunshine it before we wouldbring it to you for consideration of adoption relativeto the rate discussion. we think this is a much more transparentway for us to present to you and to constituentsbenefit

design changes that will necessarily impactthem in their daily lives.so with that, mr. mckeever. health policy research division chief mckeever:good morning, madam chair, members of the committee. doug mckeever, calpers staff.this is a great item to bring before you, becausefrankly, it's one that is kind of near and dear to me,given the subject matter. and it's one that has and isreceiving a lot of national attention and discussionrelative to an individual determining whether or notthey're going to have a birth of their child

pre-39 weeks,and that's really what we're talking about. and let me put it in a little context andi'll use myself as an example. having twins sometimeago who were pre-39 weeks, but it wasn't a voluntaryelection. it was something medically necessary. and dueto the health of the mom and the children, they needed toenter this world a little bit sooner than we had hopedand expected. but what we're talking about today is notthat type of a case. it is more in line with whathas seemed

to become more prevalent today with the statisticsnow at a little bit about 30 some odd percent nationallyof those deliveries that are taking place pre-39 weeks.and it's voluntary. it's based upon either the mommaking a choice that they want to have a baby in a certainmonth or a certain day or a doctor who is deliveringbabies and happens to have a vacation scheduled thatnext week. and so for the convenience of that doctor, thec-section is scheduled. these are some of the types ofactivities that

occur with these pre-39 week deliveries.but the issue here is really to the health of themom and the baby. and when you do have an electivesurgery pre-39 weeks, either be it a natural or ac-section, certainly with a c-section the complications goup and the health of the mom and the baby are at risk.and so the discussion today is really looking atwhat are some of the discussions taking place across thecountry to deal with this particular issue? and so i think what you'll find is that, asms.

boynton mentioned last month, in the let'sget healthy california study, one of the areas that theytalked about was payment reform in the area of maternity.and when a pre-39 week delivery occurs, if it is notmedically necessary, are there different ways that weas purchasers can pay for those types of deliveries or notpay for those types of deliveries.so there's a lot of discussion in this space thatis cited in the agenda item. particularly one of themost, i think, interesting is what south carolina

isdoing, in which in the medicaid population they havebasically indicated that if it is not medically necessaryand it has not proven to be such, frankly there is nopayment made to the provider or the doctor in the cases inwhich someone has had a baby pre-39 weeks and it is notmedically necessary. that's one option that's currentlyout there that's being locked at. there's blended payments that are currentlybeing looked at as well. rather than paying foreither a

c-section or a natural, there's a blendedmethod of paying for what they just say as the birth.and so what calpers is doing is we're researching and analyzing all of those various optionsand determining whether or not we ought to venture into thatworld of changing our payment method in this space.and again, i want to reinforce, this is really not an issueof cost savings. although cost savings will becomeapparent if we change our payment models, because if yougo into the nicu there's huge costs associated with babiesgoing into a

nicu.but the issue here is not really based on cost,it's based on the health of the baby and the mom. that'swhat's driving this conversation. there will be acorresponding health -- cost benefit on the back end.now we're fortunate today to have dr. sonia soohoo with us from kaiser permanente. she's going toprovide you with a brief presentation on what kaiser isdoing in this area. and then obviously she's here toanswer any questions that you may have.

doctor.(thereupon an overhead presentation was presented as follows.)chairperson mathur: welcome. dr. soo hoo: good morning, madam chair, membersof the board. sonia soo hoo, kaiser permanente. it's my pleasure to talk to you today aboutthis very important health issue. and over thenext 10 minutes i'd like to talk about what we at kaiser permanenteare doing to address this.but before i begin, i want to say that having babies is common. and i'm going to do a littledemonstration here. so i want you to raise a finger ifyou've had a baby, if you had baby?

now, i want you to raise a finger if you havea spouse, wife, who has had a baby.now, i want you to raise a finger if you've beena baby. (laughter.)dr. soo hoo: so raise a finger if you're still ababy. (laughter.)dr. soo hoo: so having babies is a universal experience and it behooves us to make surethat we make this experience a good one and a safe one.now, here's the thing about maternity care. wehave women in the workforce, and they're in

key positions,right? look around, we've got women in key positions, andthey have babies. but here's the thing about maternitycare, there's a lot of moving parts. so there's prenatalvisits, there's ultrasounds, there's a bunch of labs, andthen finally you're admitted to the hospital for yourdelivery. so it's simple, but even in the bestcircumstances there's a lot of steps. so i've been anob/gyn with kaiser permanente for 20 years. so i've beentaking care of calpers members who are pregnant

for areally long time. and there's three things about where iwork. first of all, we're integrated, so our doctors andour hospitals work together to take care of the patients.we cooperate, and that's a big thing. second of all, we're prepaid, so we have areally big focus on prevention and safety.and the third thing is sort of newer, but we'vegot an electronic medical record, so all the parts cantalk to each other. --o0o--dr. soo hoo: so where i work, we deliver a

lotof babies. and about two percent of your calpers membersdeliver with us, 9,000 babies. a lot of babies. so thankyou. now, volume matters when you have babies,because if your labor and delivery sees a lot of deliveries,they know -- they've seen the bad things that canhappen and they know what to do in an emergency. andin an integrated system, we can learn from the experienceof this big volume having babies. so the littlequote that

someone gave me is that we deliver 92,000babies in 2011, 50,000 in california alone, which is the sizeof oregon. --o0o--dr. soo hoo: so i want to say a couple of thingsabout two worrisome trends in maternity care that's not sogood for the health of the mom and babies. first of all, i think there are too many cesareansections instead of normal vaginal deliveries. and secondof all, i think there's too many pre-term deliveries thataren't really medically necessary. --o0o--dr. soo hoo: in other words, delivering babies

just for the sake of the convenience of themom or the doctor is not a good idea. we can take bettercare of moms and babies. and like doug said, whenyou take better care of moms and babies, you actually reducecosts. so let's talk about cesarean section, and -- sothere's three things.--o0o-- dr. soo hoo: well, let me say cesarean section,you make a cut on the abdomen, you make a cut on theuterus, you deliver a baby through the abdomen instead offrom down below. and doug said don't get so

graphic onthe down below. (laughter.)dr. soo hoo: three things about c-sections. therate is rising. so when i was an intern, the cesareansection rate, so the number of sections per 100 deliverieswas about 17 percent. now, it's about 33 percent. so adoubling nearly in the 20 years i've been practicing. andthe thing is there's been no improvement in the health ofthe babies or the moms over those years of practice.and there's a vast variation between hospitals,

and even between countries, in c-section rates.so you go to one hospital and it's a 50 percent c-sectionrate. you go to another one it's 17 percent. then yougo to brazil and it's 85 percent.so i want to look at the data. --o0o--dr. soo hoo: and you know people are saying, well, what's causing this? and there couldbe a lot of things. it could be maternal age. it couldbe maternal obesity. maybe mom requests a c-section. maybepeople are afraid of med mal, but let's look at thedata here.

yeah, that one. that one.okay. so about 25 percent of women delivering atkaiser permanente hospitals have c-sections. and if youlook at the california average, it's about 30 percent.and then you look at for profit hospitals, and it's a good34 percent. the national average, at this time, was about30 percent. now, normal births have shorter hospital stays.they cost less, and moms get better quicker. and we knowthat with repeat c-sections that's related to morecomplications and more hemorrhage, so we really

want tolook at the rate of initial c-sections. now, there's a couple of weird things thathappen with fee-for-service medicine and deliveringbabies. the first one is that you're paid more if youdo a cesarean section. if you're the doctor, if you're thehospital, you're paid more in fee-for-service medicine.the second thing is you don't get paid unless youpersonally do the delivery. okay. so it seems a littleunfair if you're the ob, i think. you're spending allnight with this woman in labor. she finally

deliversvaginally at 3:00 in the morning, and they do deliver at3:00 in the morning, and you achieve a normal vaginaldelivery and you get reimbursed less than if you had justdecided to do the c-section at 6:00 pm the night before,called it a day and gone home to your family. it seems alittle weird. so let's look at the data for calpers momsdelivering at kaiser permanente. --o0o--dr. soo hoo: so you're rate, and these are yourdeliveries, is about 28 percent with a background

of anational rate of about 33 percent. so where i work, wehave a hospitalist, a laborist they call them, in thehospital 24/7. and their sole purpose is to look afteryou during your labor and delivery. and i'm paid thesame, whether i deliver you vaginally or you deliver byc-section, and so is the hospital. --o0o--dr. soo hoo: so the next one is vbacs. and thatstands for vaginal birth after cesarean section. it turnsout that you can safely have a baby vaginally

after havinga c-section. you have to have requirements at thehospital so you do it safely, but you can certainly do it.and our professional organizations are recommending thatwomen be offered that trial. if you offer a vbac, that's another way ofbringing down the c-section rate. so let's look at thedata. so i think this data shows that if you want to beoffered a vaginal birth after cesarean section, youprobably better be at a kaiser permanente hospital. whydon't others do it? i would say the same incentives

areat play. so now let's talk about 39-week deliveries.--o0o-- dr. soo hoo: so what's the story about 39weeks, right? so 39 weeks. it turns out with babies,the last thing to develop are the lungs. and you haveto make the this stuff called surfactant that helps youinflate the lungs when you're born and then you have tobreathe air. and we used to think, oh, get close to 39weeks. it will be fine. but it turns out it's not, so expertswith the

american college of ob/gyn as well as themarch of dimes said you must get to 39 weeks or the babyis not going to be mature and end up in the neonatal icu.so sometimes there's medical reasons to deliver before 39 weeks, like doug's story, but they'repretty rare. and we know that if we do these earlydeliveries, it's going to increase the risk of infantmortality and all also raise the risk of postpartum hemorrhagefor mom, and mean that babies end up in the neonatalicu, and it costs about 17 percent more, mostly due tothe longer stay

in the nicu for babies that are deliveredprematurely. so you're thinking why does this happen? whyare we delivering into prematurity. well, it'sabout convenience. doctors want to schedule at theirconvenience. patients asked to schedule at theirconvenience. so we induce labor or we do the electivec-section before 39 weeks, and so we get these prematurebabies. so where i work, we have an electronic medicalrecord that acts as a stop, so if one of us tries toschedule it under 39 weeks, the process says

wait aminute. here are the dates. you're under 39 weeks. youhave to go talk to the chief of service. so electronicrecord knows the dates, have a process that says thisisn't a good idea. here's what you do. and the datashows that hard stops are really the only way to bringdown this rate of under 39-week deliveries. so with us it wasn't always like this. youknow, acog came out with a recommendation in about2009. and so we measured our rate in 2010, and you cansee up there it

was about 12 to 15 percent. and that's whenwe sat down as a group and said, huh-uh let's set thisset as a goal. and so we educated the doctors, we educatednurses, we educated the patients and then we all geton board to understand that this less than 39-week deliveriesare not safe for a baby. and then let's look at thedata. so 2010 is about when we measure it first,and it's 12 to 15 percent. we put in the hardstop, and 2011 it's now four percent.now, the joint commission that looks at safety

inhospitals have a 2010 goal of five percent. no one isthere. so then the 2020 goal is now five percent. and wewere pretty proud of ourselves. and at first i was onlygoing to put the four percent. but we keep doing whatwe're doing and now we're down at one percent, so it canbe done. and it's simply better care. so fewer peoplein the nicu, fewer babies with immature lungs.i benefit when my patients stay healthy. i coordinatewith the

hospitals, and then we use this electronicmedical record to make these things get done.so those are the two ways to reverse these dangerous trends. normal vaginal deliveriesover c-sections is the norm. and no more of thesepre-term births, less than 39 weeks, when there's noreal reason for them.--o0o-- dr. soo hoo: so i think there are a lot ofways to get there, and doug mentioned a couplethem, bundled payment, performance guarantees. this is theway you did

it with us. and i'd say the moral of the storyis delivering a baby at a time and route that'sdetermined by convenience only is not a good idea. no babydelivered before her time. thanks so much for the privilegeof taking care of your moms and babies.chairperson mathur: thank you. deputy executive officer boynton: just a followup. as dr. soo hoo indicated, the pre-39 week inductions,we have other hospital systems in california who are doinga very good job also have a near zero rate. that'sgetting a lot of attention. we feel like that's

sort ofon the right track. the question of vaginal versusc-section is the core of what we will continue to discusswith you and be, subject to your direction, considering inour rate discussions with you. i was talking to a young mom recently -- imean, it's not just the hospitals frankly that haveall these perverse incentives on how we deliver babies.i was talking to a brand new mom recently, and she-- the baby is great. she's doing -- the mom is doinggreat. but the

mom says to me, "you know, i had a c-sectionand i recovered so fast, and i got an extra twoweeks off because i had a c-section. and i'm so totallygoing to do that next time".and what's that -- that's a driver from the waywe as a state handle our disability insurance which coversmoms. so we've got an incentive that gives her two extraweeks with her baby for getting a c-section, which is notas good for her and not as good for the baby and costs usa lot more, instead of just giving her an

extra two weeksno matter what, set that the same time. so we've got -- systemically, as i mentionedearlier, we've got a -- at the beginning of our committeemeeting, we've got a lot of systemic issues that have tobe addressed. the amount of time we have on sdi beingone, but there are ways that we can begin to think aboutimpacting the vaginal versus c-section rates. by the way,we approach our reimbursement to the hospitals themselves,and it's -- we've talked about it with some of thehospital groups and the physician groups.

it wouldn't bean easy thing to do, but we do think we can get toessentially a blended rate that's, as doug mentioned,lower than a c-section rate, higher than a vaginaldelivery rate that would begin to provide for thosehospitals who aren't already progressing themselves thatdirection and additional incentive to allow the moms to gothrough the -- a vaginal delivery, if at all possible.doug, did you have anything you want to add? health policy research division chief mckeever:no.

deputy executive officer boynton: happy toanswer questions. chairperson mathur: well, as someone who'sbeen pregnant twice in two years -- the past twoyears, i remember very well the education and informationi received around my pregnancy and delivery.and i feel very fortunate, because i was actually partof something called a centering program. i don't know ifyou have that at kaiser, but it's where a group of womengo through their pregnancy together. and what it hasdemonstrated is

also a marked decrease in complications, etcetera, but also in cesareans and other interventions.so i think that is something we ought to be encouragingmore broadly across hospitals and medical plans.i also find it very perplexing that women wouldwant to deliver their child earlier. as hard as it is tobe pregnant, and it can be hard, particularly in the lastfew months, it is much harder to be a mom of a newborn.and i tell you, you might be carrying a lot of weight whenyou're pregnant, but you're caring that kid

all the timeafter it comes out. so it is just -- it's hard work beinga parent of a newborn. all right. well, we have other members ofthe committee who wish to speak, but i just thoughti'd share those personal stories.(laughter.) chairperson mathur: mr. slaton.board member slaton: thank you, madam chair. first of all, i've never had a baby.(laughter.) board member slaton: but my wife has. we havea year old and a 29 year old. so that's -- youknow, go

back to those years. and, you know, the firstone was by c-section. and by wife really wanted to havea vbac. and there was such pressure to have another c-sectionthat she literally stayed home till the last moment,and luckily, successfully we had a vbac. but i think weprobably took more risk than we probably should have, butshe was 41 and she believed that had she gone into the hospitalearly, she would have ended up with a c-section,because she might not have progressed as fast as the standardswould

have permitted or would have indicated.i'm intrigued by the figures. and, to me, thetwo numbers that are -- that really stand out in yourpresentation, first of all, the one percent for early.and i think that should be a standard that we should tryto get to for calpers members. you've proved that thatcan work and that you have successful outcomes by gettingthere. so i think that's a measurement. the other one is the 25 percent. that's the2011 number for c-sections. i still find that numberto be

high. and do you have any data going backbefore modern insurance policies and the issues we've hadwith doctor's liability coverage, so forth, that would indicatemaybe that 25 percent number is still high eventhough you're lower than the california average? would youcomment on that, please?dr. soo hoo: yeah. where it ought to set, whereshould the standard be for vaginal delivery versusc-section no one really knows. you know they tried to setit at, i think it was, 17, 15 percent in 2010,

and thatcame and went. and so now people are talking 24 percent,somewhere around there. and then you have to be careful how you measureit and all, because it's -- you know, it's complicated.but it's driven by a lot of factors, a lot of factors,like i said, twins, older moms, that sort of thing. but alot of it also is this gray zone where you're watchingsomebody in labor and, you know, do i call it and do thesection? do i keep going? board member slaton: but you feel the numberbeing at 25 percent that you are from a -- obviously

as aprofessional, as a medical doctor, you know, that, fromyour viewpoint, kaiser is kind of where it needs to be.dr. soo hoo: yeah, i think we're 25, 28 percent. and i think that better care floats all boats,so that if it gets out there that the way to go isn'tc-section after c-section after c-section and patients areeducated around that, then they pressure doctors. they'renot saying, oh, let me just do another c-section, becauseit turns out if you keep doing all these c-sections, the chancesthat the

placenta then grows into the scar, and youhave this postpartum hemorrhage, that's a disaster andthat's the leading cause of death in california rightnow. and that's increasing over the years.and see, that's the stuff that people don't knowwhen they're thinking, okay, i'll just come in for asection. i'll get two more weeks off of work. i couldschedule when it is. i just go in, have the baby, and outof there. i don't have to labor. but you don't hear theother side of it. if you're going to have

more kids, thenthese other things. board member slaton: so outside of kaiser,if we reached a 25 percent number, you'd feel we'vegotten to where we need to be.dr. soo hoo: yeah, i'd feel pretty good about 25percent. board member slaton: okay. great.dr. soo hoo: i don't like this 33 higher, higher, higher. i don't like that trend.board member slaton: okay. thank you very much.thank you, madam chair. chairperson mathur: i do think women in theu.s.

are really scared about delivery. you know,we are told horrific stories. i tell you when i was pregnant,every other person told me a terrible story abouteither delivery or babies. it was just -- it wasremarkable how all of a sudden i became a target for thesestories. but i think that might be part of what's drivingwomen to c-sections is they are just terrified of the painof delivery. and it's not comfortable, but anyway thereare other ways to handle pain, too. ms. holton-hodson.acting committee member holton-hodson: at

themoment, is there any performance guarantees that we haverelated to this or is this when you come back -- when youcome back in january and february when we're having thesediscussions will that be the first time we're reallythinking about sending the message to our providers thatwe really want to see the needle moved on this?health policy research division chief mckeever: ms. holton-hodson, we currently have performanceguarantees in the contracts for this area. acting committee member holton-hodson: andwhat

are those guarantees?health policy research division chief mckeever: i don't have them at my --acting committee member holton-hodson: i mean what sort of benchmarks are we asking peopleto meet? health policy research division chief mckeever:i don't have them at my ready, but we'll be happyto share those with you. acting committee member holton-hodson: okay.great. thank you. chairperson mathur: thank you.mr. cobb. acting committee member cobb: it's interestingthat dynamic between the incentives that the sdi benefitpresents and -- you know, and then the push

towardc-sections. before i came to calpers, i worked in thepolicy area at edd in the sdi program, and we looked atpregnancy, duration. and back then in 1995 dollars, oneweek of additional benefit for a normal pregnancy wasabout $150 million a year. so their motivation is thecost impact to their program significant. so i think that the solution to -- the solutionwe'll have to find it on our side of the equation, butcertainly kaiser is proving that it can be done.chairperson mathur: thank you.

mr. boyken.acting committee member boyken: thank you forthe presentation. something you said kind of piqued myinterest. i've heard it before that in addition toconvenience, one reason for increased c-sections is fearof medical malpractice, but it seems like -- that seemscounterintuitive, based on what you're laying out in yourpresentation about the increased likelihood ofcomplications. but could you explain that, what's therationale that doctors have that --

dr. soo hoo: so i think it's driven by onething, electronic fetal monitoring. so we have this newtechnology -- well, it's not so new anymore, but thistechnology that comes out where you can watch a baby'sheartbeat every minute that she's in labor. and we putthat on, and it's become universal, even though we've seenno increase -- decrease in cerebral palsy or any realimprovement in baby's health. but you watch the heartrate, and when the heart rate drops, sometimes it meanssomething, sometimes it doesn't.

but if you're sitting there as the physician,you're thinking, okay, i'm going to read this as a badheart rate. let's go ahead and do the c-section. i'llnever get sued for doing a c-section too often, but i willbe if i don't. and so that's where i think the med malcomes from. acting committee member boyken: thank you.chairperson mathur: well, i think you've seen this has generated a lot of interest fromthe committee. i think there are some opportunities here.i know you all have already been thinking about them forvalue based

purchasing or other options around maternity.so are you planning to bring something back to the committeeat some point?deputy executive officer boynton: yeah. we will -- based on your interest, we will furtherdevelop some concepts that we will begin to discussrelative to how that might be implemented in a benefit,so that we can incorporate that into our rate conversationsthat are coming up incredibly quickly.chairperson mathur: very quickly. deputy executive officer boynton: in a merefour

months.chairperson mathur: good. well, we will look forward to hearing more about that.deputy executive officer boynton: thank you. chairperson mathur: all right. i see notfurther requests to speak, so we will move on -- we arenow at the end of our open session agenda. agenda item number 11 is public comment. ihave no requests to speak. does anyone from thepublic wish to comment at this time?seeing none, the open session is adjourned.



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