Exhibit A

Last September I spoke at our Transform Symposium about the power of conversation. In that talk, I mentioned that there was a significant amount of research out there to support my thesis that a healthcare delivery system focused on fostering good conversations would in turn be better quality, more efficient and more affordable. All the things we say we want our healthcare system to be. In anticipation of Transform 2010 (which is going to be amazing!), I thought I would post some of the evidence, in the form of articles, I've come across. It's pretty fascinating. Once you open yourself to the idea, you really do see the value of conversation everywhere.

1. Placebos are Getting More Effective (Wired)

First the volunteers were placed randomly in one of three groups. One group was simply put on a waiting list; researchers know that some patients get better just because they sign up for a trial. Another group received placebo treatment from a clinician who declined to engage in small talk. Volunteers in the third group got the same sham treatment from a clinician who asked them questions about symptoms, outlined the causes of IBS, and displayed optimism about their condition. Not surprisingly, the health of those in the third group improved most. In fact, just by participating in the trial, volunteers in this high-interaction group got as much relief as did people taking the two leading prescription drugs for IBS.

2. Medicare Says it Will Pay, but Patients Say 'No Thanks' (NY Times)

What happened instead was a complete surprise. After seeing the clinical trial's results — no lengthening of life for most patients and a nearly 10 percent mortality risk from the operation itself — many patients and the doctors who refer them to surgeons seemed to lose their enthusiasm.

..."It's difficult to sign someone up for a 50-thousand-plus operation with an 8 percent upfront mortality risk," said Dr. Mark Dransfield, a pulmonologist at the University of Alabama at Birmingham. And Dr. David Mannino, a pulmonologist at the University of Kentucky, says that after he began presenting his patients with the Medicare study, they invariably declined the operation."We talk about risks and benefits and they say, 'Let me try pulmonary rehabilitation instead,' " Dr. Mannino said.

3. Letting Go: What should medicine do when it can't save your life? (New Yorker)

But, either way, they received phone calls from palliative-care nurses who offered to check in regularly and help them find services for anything from pain control to making out a living will. For these patients, too, hospice enrollment jumped to seventy per cent, and their use of hospital services dropped sharply. Among elderly patients, use of intensive-care units fell by more than eighty-five per cent. Satisfaction scores went way up. What was going on here? The program’s leaders had the impression that they had simply given patients someone experienced and knowledgeable to talk to about their daily needs. And somehow that was enough—just talking.

4. Health Insurer Pays More to Save (NY Times)

In one case, in Texas, a nurse whose salary is paid by Cigna discovered that a diabetic patient was missing check-ups and not filling his prescriptions because he had lost his job. He was insured through his wife, but without his income the couple could no longer afford to pay his share of the cost of prescriptions or the co-payments for the office visit. The nurse worked with the doctor to find cheaper medicines for the man and arranged for him to pay back his share of the cost of office visits over time.

By getting this patient’s diabetes under control, the insurer very likely avoided paying what could have been a $500,000 or $1 million claim to treat a heart attack or start kidney dialysis, said David Toomey, Cigna’s general manager for north Texas, where the insurer is starting to experiment with such programs.