Good morning traders and welcome to the book map live trading webinar. This is Bruce at book map and Hold on just a minute All right, so We're gonna go through live analysis here like we do every day Except for Wednesdays and Thursdays where we have live trading by stocks trader on Wednesday with J trader tomorrow Thursday with scoppelsini futures trader and they will Go through their way of reading order flow the book map education these webinars These live analysis webinars are educational course That's what it all revolves around. So you have the course and then you have the live analysis So you can apply what you've learned from the course. You can ask questions. We will look at Trading opportunities We will look at how to manage those trades, but this none of our rooms are trading rooms It is so you can apply What you have learned from these traders and from us here at book map And you can apply that to anything. All right, so order flow is applicable to just to any trading strategy So you're gonna be looking at details in the order book in the auction and be able to very Successfully apply that to your trading strategy to get more insight All right, so let's go through the disclosures and then I'll demo that for you We'll look at candlestick pattern for example right off the bat And we'll go through how that can give you an edge by understanding what's inside that candlestick Candlesticks are very opaque. Okay, I'll demo that just a second general disclosure all book map limited materials Information and presentations are for educational purposes only and should not be considered specific investment advice nor Recommendations the risk disclosure trading futures equities and digital currencies Involve substantial risk of loss and is not suitable for all investors past performance is not necessarily indicative of future results All right, so let's jump in here. Let's take a look We had 830 data here and look what happened. All right Guys, this is again even even fundamental releases. Good morning, Dustin And let's see here in discord Who else is out and about? Sorry guys? I'm good in discord, right? Yeah screen is up and oh Oh, sorry guys in discord. I've been talking and I you didn't hear So anyway, we're up and running now and Was just talking about our education and what we're going to be going through here today How to get an edge with the order flow? All right, and this is applicable to everything. All right, so yeah Thanks, Doug No sound Lip reading is a real skill these days Okay. Yeah. Yeah. All right. Let me go through the risk disclosure one more time for you guys I just need to do this. It's a General disclosure all book map limited materials information and presentations are for educational purposes only and should not be considered specific investment advice Nor recommendations risk disclosure training futures equities and digital currencies involves substantial risk of loss and is not suitable for all investors Past performance is not necessarily indicative of future results. All right, so We were just talking about what this is what these webinars are And how order flow Can be applied to any strategy and that is our goal here So that we have J trader tomorrow's trading stocks and his strategies guys we have Later after this webinar right after this webinar Doug. I mean Tom B. He'll be looking at volume profile And trading or looking for opportunities is we don't we don't trade We don't have trade recommendations. That's not what this is about. You're not going to learn. All right, you what you want to do is is absorb some of the content in here and Hopefully it's helpful for you and that you can apply it to your trading method And we'll go through that example with a candle with candlesticks this morning So so anyway, Tom B. We'll go through it with volume profile Doug will go after that In our discord room guys, we have so many we have a full lineup now in our discord room Doug's going to look at order flow around his options strategies Hey, he'll be looking at the underlying stocks And he'll be trading those but he's looking at options strategies very unique and No one else I've seen is doing something like this so I Really encourage you to come check out these other rooms that we have on our discord channel All right, just look for book map on discord. I think it's right on the home page there if we go to book map com Yeah, right here. You'll find the link right at the top Discord room if you don't see it there click on the more button and then under community Discord chat room right here. Okay? All right So let's move on Okay, so Well, look at the big move here, right now you can just get information right off of this right off the bat You're getting transparency that you just I just don't see in other platforms Look, it's just it's it's just fact Other platforms aren't going to show this Look where the liquidity is. Okay, there's liquidity in these areas right here one two three Look at the data release here. Hey, it was the PMI information this morning, right? We had the Purchasing managers or for production right or the Producer price index. Okay, so the Before the data release 830 look at everyone pulling their liquidity. Why did it come up into here? Because that's where the liquidity is And why did it kind of stop in here? Well, even though even though it did not trade in here Okay, I don't see anything that traded in here In fact, let me add a new column In here make it chart range nothing traded in here But what it's I this is just really kind of weird to me Not only did it not trade but why did the best bid or best offer? I'm sorry. The best bid came up here. So there's a there's the the best offers actually Down here. So there was some transactions in here, but anyway, nothing traded up here trades happened afterwards here about 12 or 13 seconds afterwards Some happened before as well and some stops were triggered before and This is what unfolded in the marketplace Okay, and for these seconds in here, I don't see any transactions whatsoever All right, and let's just zoom in a little bit and yeah We don't see any here. Just massive spread and then some some start to trade in here Okay, so now where did price go after this? Well, people came in after after the number liquidity down down here at 4 4 0 2 0 Then for 440 and then 450 high liquidity here also 60. Where did we go high liquidity at 450? 4050 Okay, pull back more liquidity in here And then we can see the back and forth in here Okay from all of this price action in here Okay from where they started to buy or where they started to transact in here guys This is order flow Why did price come back down to here? It's because of these transactions It's as simple as that And let's take a look see how it just dipped below then it bounced back up above Dip back down into high liquidity here at 20 which was here before the number as well even a little bit lower 15 Okay, and then they come back in the book here. They are tested and price bounced Okay, now price is kind of moved on from all of this data in here and Although this line is still important here. We see really price bashing around Accepting above stopping everybody out here the stop runs Trading back down below and then trading back up above another beautiful stop run above here So they're just bashing people around Stopping them out on either side of this line here at our 4027 or so alright, so and I don't see any follow-through at the moment. It's just back and forth in here Here's our 930 cash open Accepted above stop below Just like we were just talking and And then yeah right now what's going on? Well, let's let's take a take a look here All right, so we're down below this but I see a lot of buying in here and Boy that's about it. I mean, there's really not a whole lot going on here at the moment to be honest in this order flow Okay, so even though that we see this buying coming in. Well, we need to see buyers come back in again Okay, you can see the sellers came in and dropped it really quickly here Okay, but we're looking to see for buyers to come back in and test back up to 48 4028 or maybe for 4030 here now if they cannot We're looking for sellers down at the bottom edge here at 4024 and Then they'll we should be able to see price slip down to 22 and 20 And now I just don't see anything in the order flow telling us right now Okay, so here comes some selling now, but look at the selling. It's it's not not very much And look at the offer here at 26 Okay, it's not it's not really much here to take a look at okay, so and we see price just kind of You know doesn't really react too much to it here. There's some more selling. All right Let's see it sellers. Let's see if you can drop it down into 22 And you know, these are small moves here but You know, we're just trying to trying to read the Players on these small moves right now However, these small moves here can be All related to the higher time frame.  Jay Jay C. Beep PPI Yeah Really important one really forward-looking Economic release, you know, so you can understand what the purchasing managers are doing And that gives a lot of insight Let's see does liquidity. Good morning, Tony. Does liquidity on both sides usually? Indicate consolidation I Example stain stay away No liquidity on both sides just means that it is pretty balanced in here And then we're looking for some sort of imbalance in here right to Kind of disrupt that the balance Someone maybe has some sort of insight or you know, they're they're searching for stops or whatever it is That's why you get you know moves to the outside of the range And then come back into the range because it does not accept outside the range Hey, there's there's You know not enough players that agree that you know, it's worth Accepting outside of the range and going higher. Okay, so we can go through this example. This is actually a really good question Okay, so the here here we go see see how they look at high liquidity here at 24 and a half Okay, so there's an imbalance there now, right? Well, look what happened sellers took them on All right, so now that's the event that we're interested in this 24 and a half here Okay, we're gonna be zooming in now. This is small time frame or low time frame here But it doesn't matter. This is the same stuff on the higher time frames as well Okay, so we went a little bit lower still more selling pressure now if we get buyers back up above here Then we should be able to get them to slip it up into 26 or maybe even 27 and a half Okay, so this would be kind of a trap here And then now we're looking to see if we get our buyers up here and then the move higher up into 27 and a half Okay, so what and see see that see the imbalance starting to come in a little bit there on the bid as well Not much, but a little bit right see it right there and then we're looking for this move into 27 and a half Okay, so this was the key right here into read and I'll see them pulling here watch them Take it a little try to take a little higher here 28 Okay found some sellers up here now Okay, so this was high enough here to find some sellers drive it back in into them into the mean here basically at 25 Okay, so it's always this this auction and this balance in here or Inbalance watch look for the imbalance see how the liquidity is here now okay, so Where would balance be it would be between these two areas of high liquidity would be in the middle here Which is our high volume node here at least in this view. Let's see Yeah, yeah, it's the high volume node for the For the session here, maybe it's no maybe it's up here 35 Anyway, it's a high volume node. That's for sure What and and just understand what a high volume node means just means is price is accepted in in this area So if you understand that it price is accepted in this area because it trades a lot in here Well, then areas outside of that acceptance means that if there's nothing new in the world here Or you know traders don't think differently of the product or the instrument then You're looking for a mean reversion Okay, so now this this came out of the blue here All right This is just a lot of sellers all of a sudden coming in and now see what they're doing though They're driving it away. Okay from this area here Okay, they drew it they drove it down to 20 our 40 20 area Okay, looks like there's more selling here. Well, let's see them drive it down to 15 Now watch this down at 15. We're probably gonna find some buyers.  This is like Truly like anything in in in the real world that you know, if there's a sale on Sandals or soap or you know, whatever it is at the supermarket avocados Then you know people are gonna this is where you're gonna find demand. Okay supply and demand All right, so and this always this kind of back and forth Okay, so what? Anyway, like so we we didn't even get down to 15 We already saw buyers come in and pick pick it up a little bit here And let's see if we might get our more sellers in here make it down to 15 now Impulse move pull back impulse move Okay, so trying to see because looks like looks like sellers want to drive it away as Heavy more selling than there is buying here And so let's read this auction All right, well that you can see them at 20 here See how they were on the on the bid here at 20 now They're on the offer here at 20 and also here look at this player here High liquidity here pulls adds lower pulls adds lower pulls adds lower etc Okay, 162 on the offer there and it's transacting. It's finding some buyers Okay, not enough though. So we got some selling They're still in here. All right, so let's see if sellers can come in here Right around at this 19 level in a 19 and a quarter and then they'll drop it into 17 and maybe 15 And we'd be looking for that. That's a possible scenario Okay, another scenario is well, maybe we do find more buyers up here at 20 take these guys on And then trade back into 22 and our 25 level Right, so we got to go through those scenarios and this is this the second scenario is what's what's unfolding here We did find those buyers. Okay, we're already back at 22. I'm still looking for them to take it back higher back to here 25 and There it is Okay, so there's your mean reversion trade. I mean that's pretty picture perfect Guys I was looking for Well, it was a scenario, right? It's we never know but the scenario was strong move pull back strong move And then a move back into 25. Well, the buyers didn't didn't Have that or the sellers didn't have it to drive it lower here We already see the buyers driving it right back in Okay, now we're getting enough buyers here. They'll probably drive it to the other side of the range here at 28 Okay, looking for it. We're already above this point of control and we're still finding buyers Okay, well, they will explore the outer edges here of the range. So maybe this is where price is too high for For more buyers Okay, I'm looking for a stop run above here. So we'll get buyers up up here Right, but it's gonna be Not people entering or buying because they think it's worth this they're they're buying because they're covering Okay, and then maybe it will fail and come right back into 25 Right, these are some of the scenarios here. Here's our stop run, right above our range Here's the test of the outside of the range still looking for a little higher here Let's get up to our 30 level here And we'll see it's probably some more stops now the question is Up here is this High enough for sellers to think well, yeah, I don't agree with that price And then trade it back down to 25 Okay, or maybe even a little bit lower Still finding buyers Still looking for 30 All right, does that make sense? I mean, this is I think this was a pretty good example We're talking about auction market. There's our 30 Okay, and we're still finding some buyers All right, now I would just anticipate a move right back down to this liquidity here as well Okay back down to 27 basically maybe 26 Interesting look at that on the bid heavy heavy liquidity here on the bid Larger players in here trying to see this is the skew in the auction that we're talking about before Right look at this bid in here now. It's a it's a battle in here There's high liquidity up here at at 31 and a half as well Okay, I think these guys are probably going to pull that liquidity, but we'll see They transacted Okay, they stayed in the book and transacted and what about this guy now? The large lot trackers showing about 200 of these contracts here is one individual actor and another actor up here holding about a hundred and 20 or so 100 Yeah, thanks. Thanks a W. Black like yeah the it it's This is auction market theory It's in its don't let the you know the name like Auction market theory sound all complex and and and scare you away. It's really simple stuff It's just an auction and in common sense How is the book map different than than jigsaw? Oh, there's so many different ways so Well first off I think there's there's other products out there And this is there they just they don't have the accuracy and I mean, I've seen them and the There are other many other copies that that that are out there and One of the big distinctions with book map is the way that we can zoom in Or the way that we collect the data basically Zooming in is is nice and it's amazing to see this down at microsecond or nanosecond resolution You know that's great, but it's truly at the most binary levels This is how the auction works This is what's unfolding Okay, and look at look at how these are spaced apart We don't know if this is like, you know, maybe an algo selling or someone came in and just hit the bid Hard and then it's just you know finding liquidity and trading and then finding liquidity and trading But doesn't matter what what matters is everything is recorded here. It is extremely accurate the Other products that I've seen out there they they just they don't even come close The they the data here is aggregated by tick at best So that means that see look at this in here see between these transactions here Well between this one and this one. I don't see too much happening But here between between these transactions in here and these are all the transactions. They're all in here Okay, but see the train changes in the heat map Okay in here as well Okay, this is updating here where tick data will not update like this So you're seeing changes in the order book without any transactions a tick data has to have that transaction take place Or, you know tick movement take place And it is it's not showing you the details in the auction. This is very very accurate That's a big distinction and that's due to our past Our past is comes from algorithm or algorithmic trading and we were able to We're not able to read the performance of our our algos Uh, so we developed this visualization for it Uh, and then we showed this to other Traders they liked it and they said if you made a platform out of that we would buy it So we did and we've just added so much more along the way So we do have uh, as you can see in here a very professional dome Now as well that's equal to any other dome or even exceeds it in in my opinion Where is it here? The dome pro here it is Okay Uh, the lot of a lot of nice features in here that other domes don't have Hi Stefan, um Yeah, well volume profile, um paresh like here's our dome Guys, if you if you're interested in this and comparing it to others You know here, I can show you where there's more information on this. There's videos We have a work there's a kind of a webinar on it a couple of different webinars on it as well It is a very detailed, uh, and there's a lot going on in here, right, so But comparable to any other product and then some All right, so now volume volume profile. Yeah, okay. We have some volume profiles in here And for the chart range and session range Uh, but the heat map uh, and the way that we're recording this data is a big distinction between us and others This kind of accuracy in here. You're not going to get Uh, be able to understand this auction at this level You're not you're just not going to be able to get and that matters because like this is the way it's recorded um, and then Uh, and then plotted so, you know, uh If it's not recorded Properly, uh, then the data is not going to be proper. Okay, it's gonna there's going to be discrepancies So that makes a big difference Okay, we have stops in icebergs being able to see like for example right now that move down here It ran right into stops down here. Okay at uh, you see 102 here and two two different transactions and then But there's another one a little bit below it here for 221 transaction. That's pretty detailed information Okay, we have all sorts of add-ons that others don't have You can see in here in the add-on section I mean there are here. I'll even show you here is probably better From uh, well you can go through here at bookmap.com and and get these questions answered We can go to the knowledge base here Okay, and you can go to the add-on section in here all sorts of add-ons in here Here's another big distinction between us and others is we have an api It's a java based api And you can code your own We also there's now a bridge to python. So you can code your own add-on indicators It's level zero and level one api what does that mean Level zero means you can actually make a a connection to uh an exchange All right, so if you're interested in that level one means the add-ons within bookmap Okay, those are A few big distinction. We have a replay mode Okay, that is not available as well and We have all sorts of filters for the volume for the And all these different add-ons in here as well Okay for the heat map for for the volume all sorts of filters in here uh, we have the cumulative volume delta in the sub chart and uh, and I mean this goes on and on um, I would Hey go I would Encourage you go try uh Give a trial a book map for a month and and compare it To others and see what you like and what you don't like Okay, another thing is our education. Okay, we have all of this educational course Um as well as uh the discord Okay, we we have um people presenting From 8 30 in the morning east coast time until the close All right, so we have all sorts of different traders in there Um one's a crypto trader at 8 30 rain And then we have these advanced webinars. We have scoppelsini. We have j trader Then we have tom b then we have dug options with dug And then we have the algo boys the algo boys are from 230 to the close Okay, so lots of stuff in here So we have a robust support and community uh Gnom, um, yeah, I I I would suggest that you use rhythmic data with uh, and you can you can connect to your Uh, this is again another another advantage trading from uh book map from the from the either the dome or from the the uh chart and heat map uh And and managing those trades in many different ways uh, so the um Yeah, get the rhythmic data Uh, well depends on the price of the rhythmic data can be 39 bucks a month if you just trade the cme Instruments not the you know crude oil and gold and and bonds and all that kind of stuff, but just uh, like the es nq uh, russell Uh, and then euro dollar etc. Those are all available Uh for 39 dollars a month from rhythmic Okay, and then you could also just get the book map global version Uh for uh for 50 bucks. So it'd be 80 bucks Okay. Yeah. So that's that's how much it would cost you. You can get it. You can get it for 80 bucks altogether per month Okay, and then you're also going to get all of this education that comes along with it Okay, and community All right guys, I look there's a lot of comparisons and you know, like uh, if you go here, uh down to Uh compare these uh, uh different uh products in here click here Just read through it. You'll see the differences compared to others out there all the different add-ons All the different core even the core features in here. I mean very very different Okay, we come from a different uh different background All right as well as all the other things that I mentioned. Anyway guys, let's move on And and get into this this data in here, uh and price action. Um, so Yeah I need to cover those things.  Um, because look what we missed and that's what we're here for Uh is to uh read the Live order flow and give insight to where price might go Due to understanding the order flow in here All right, so what we saw this move to the downside We're looking for the mean reversion back to This area in here where it dropped from Uh, and then we were looking for the move back up into 30 up here, which all unfolded Okay, and we saw it in real time and we were looking for it to unfold Uh now we got some back and forth in here price went a little bit higher up into where Look where it dropped from here right Into it 34 lots of buying up here Lots of buying unable unable even the buying in here looks good. Now. This is kind of a hard read. I think up here Because this is a strong move here Not so strong here not strong Okay, a pullback not a whole lot of selling Okay, and then strong buying up in here But they failed to get back up above they failed to even make a higher high here Okay up into the swing here or this swing, you know from the high high of the cash session here Um, they failed to do it Or not not from the high of the cash session went a little bit higher Um, so what did we get all right? So well if it fails Okay, and then look at all this cluster of um I know this is hindsight guys, but we go through it in real time all the time Uh, here's our failure Okay, and then look at this whole cluster of buying Look at the sellers starting to move it away. Look at the retest back to that cluster and that swing in here Hey, and then more sellers here great more sellers here looking for them to come down to the bottom of the range take some off uh, and Well, what happened we came all the way back down to where? This high volume node at 40 25 and it bounced So there's another beautiful range bound trade back into this high volume node here Okay, and again, it's not technical stuff. You might not like volume profile But this is giving some insight of value of the instrument. Where is the most traded level in here? Hey, well, we can look at it Right and we we we can look at The volume profile is giving us some insight in here Hey, this is another one of value up here as well Okay around this 31 area And what about outside down here? Yeah, I just I just don't see a lot of volume there Okay, so look at the profile It's not it's pretty ugly p-shaped profile, but there's just more trading up here basically Okay, maybe you don't like volume profile fine. This is what I was uh, um Uh wanted to do from the very beginning was go over candlesticks Hey, there's a five minute candlestick chart Okay, let's look and see what's inside the candle Okay, because without it. This is what we get and we'll take we'll take off stops and icebergs for now too on chart Okay, so here's our candlestick chart All right, so let's try to read the candles. Here's our data Here's our pullback And and we just went through in detail like why these pullbacks took place Where and then once you understand why you can start to look for order flow trading or behavior of others Uh to react to these areas in here Looks rather random in here by looking at the candlestick chart All right, so uh, we know there's some wicks and selling up here. We came up here And it and it failed once here. Okay. It did not make a higher high I did not make a higher um or a lower uh low here either Okay, so we did not make a higher high here either. So we're you know on the candlestick in the range We're not getting too much out of it here We do know that there's some selling pressure that came in and they just traded back down to 25 okay We would assume there would be a bounce in here and maybe trade back up into maybe 30 Or this kind of high volume node maybe back up to about 34 Okay, and retest that here. All right. So that's our candlestick, right? And we see the buying pressure come in already All right, so where where might it go? Well, we can look at the profile to give us some insight But let's look and dig deeper here. Okay. Let's look at the price action This is a great area 32 and a half for it to come to Uh, let's look at the volume dots and then let's look at the heat map. Where is the liquidity? Okay, well, it's here at 31 and a quarter and also here at 33 Basically, okay. So inside this candle look at the buying pressure. All right. Let's see them try to trade it back up into These areas we are just talking about Uh 31 and 33 They were we're almost at 31 already And let's see if we can get some more buying up here Okay, due to our candle our wick our rejection off of this level in the candle and seeing this buying within the candle Okay, and then looking for this as the target of liquidity 31 and 33 Okay, and we know that the buying is not bad. It's not bad in here Okay, so There's more selling over here You can see it in the dots. You can see it in the bars Okay, but uh, uh, still looking to see if we can get buyers maybe off of this again here Let's see right off of here Right again. We're pinpointing these areas here Right here There's structure in here as well. Hey, there's this kind of back and forth and this is our breakout here Right, so here's our pullback Now we're looking for the move back to to top and to 31 and 33 Okay, now let's go over the opposite scenario. What if that doesn't unfold? What would it look like? Right and we'll look for one of these scenarios to unfold Okay, so our primary scenario is 31 and 33 our secondary scenario is sellers back down below here Why here because this is where those buyers came in Maybe maybe 20 yeah around 26 and a quarter 26 and a half Okay, see that see the there our first move is already unfolded still looking for a little bit higher here Now, of course, this is smaller time frame stuff. It doesn't matter though. This is all the same It's all fractal on higher time frames Okay, so now Hasn't come up to 33 yet, but it came up to 30 are 31 You can take some off there you can reduce some risk If you see more buying coming in and bid really looks great as well You know and you can get into another position as well, but still have part of the first one to open You know, there's all sorts of ways to manage it and scale in or scale out of your position It's up to you Right, we're just going to read the order flow and give insight to where it might go next Now our secondary scenario is actually starting to look pretty good as well okay, so If we if we get our selling down here around this 27 And then we'd be looking for a move to back down to about 24 and a half well Doesn't look guys gonna look like it's gonna unfold. We got on the bid here. We got our buyers coming back in So we're back to that primary scenario here. I liked this selling in here. That's why I mentioned it They're right in here and here And this is not a whole lot of buying but they were able to bring it right back up to 31 Okay, it traded to our Not not 33. It was 32 and three quarters. That's where that liquidity was right here And and that did transact Okay, we didn't really quite zoom in and get the the proper level here. I said 33 But it's it's really this liquidity. I was looking for Okay, that's the target and that that has unfolded Okay, now look at our secondary scenario here Okay, looking good. All right, so back to 24 20 25 is a high volume node, but look at liquidity in here. It's more down here Uh 24 Okay, bottom of the range here bottom of the candle does well All right looking looking good. I mean it looked good once it started to push through here Hey, I know it it it bugs me like once it It's already moving here But we covered the scenario and what it would look like and this is exactly what it would look like So it basically did both of the things we were looking for First was the move up. I thought we'd get the move maybe down here But we got one more push up And then now we got the move back down. Okay, so both scenarios actually played out here Uh and uh and it's still pushing lower here. So let's see if we can get more sellers It's just can't can't uh speak quick enough So sellers came in and pounded it down to 20 and and transacted Okay, so what and that's where these buyers originally came in on that. Uh, we saw this move unfold Can I back down to 20 look at the offer in here? Okay, so more sellers. Let's see if we can get down to our 15 level now. I like it. I like it Because of this offer here and I'm not seeing any buyers in here. So where are the buyers? They're down here at 15. No one else is interested right now Look at this Right, this is again understanding the auction in here. No one else is interested in buying right now Sellers have this in control here Okay, so we're looking for 15 Okay, moving price away from this area here Right now that's what we're looking for and you need big selling. Okay, you need a strong offer Okay, and and the the reaction to this strong offer is more selling market selling And then then we should trade to 15 Okay, it looks like we're getting a little bit of covering right now Okay, I don't see as as new buying coming in here, but I do see like, uh, it's kind of just slowing down right now Okay, that offer is strong Here's another reason why we're slowing down right here. Well You can look at your volume profile. Sure, but it's the swing here All right, do traders want to take it below the swing Do sellers want to take it below the swing? Yeah, I think they're gonna here. Here they go All right, let me get back to some questions here Yes, those were iceberg orders earlier that we saw um Chris So any of you guys if you still have questions about the price scene and all that kind of stuff where you want to compare it to different Different products out there. Um, I gave you the references and then also just reach out to support at bookmap.com Uh, they they have the materials for you As well guys, there's our move into 15. Okay, and uh Let's see this still looking for more selling pressure Uh Let's see we might get we might get some buyers come in here And try to move it back to the first one would be this little knob or nudge or Whatever it is here this kind of uh volume profile here and and it makes sense This is this is where i'm going to go into volume profile, uh a bit Yeah, okay, the visual is nice Here, but it's really it well all it means is this trading activity in here and where it dropped from here This is where the sellers moved it away. So if we get buyers to come back in that's where we're looking for them to retest it Right, which looks pretty good 19 Okay, so, you know, we don't have to you don't have to really study your auction or your Yeah auction market theory nor your volume profile Uh market profile type of stuff just understand the meanings of them. All right, let me get to some questions here in Uh in youtube. We've got a lot of questions Yeah, see captain price already knows as well about the limitations on other products and and their heat map I mean i've seen them and like they just These kinds of details in here are Offer a lot of transparency If that makes sense, let's see about uh theta badger about 30 Uh breaking and then they flip the order book Yeah, yeah, absolutely. I mean like this is this was our secondary scenario in here, right? And then we were just looking for a move back down to here, you know the high volume node, right? Just to hear bottom of the range basically But this is you will note this um, this is something to really look at again and again and again like You know how we were looking for well, we were looking for just the move up into these levels here, right 31 and 30 3 which was basically it it was the liquidity was truly at 32 and 3 quarters and that did transact We were looking for those moves only for now Okay, now it's still even in your candlestick in here It's still made a lower high in here And these guys are kind of on the hook here All of this all of this buying here above our our line here at 27 and a half 28 That we we put in here early on in the webinar And you know due to the the data and what was Transacting around the data release So here's what happened at 30 Okay, well, basically It's still in play looking for the the kind of um The move higher in here But this is where the sellers came in and they're moving it away quickly, right? And they trade it back down into this level kind of where it broke out from the bottom of these ranges in here And we're just looking for that move back down to 25 Right the high volume node around here 20 25 Now and we got that that that was pretty easy. I think for the sellers to to to take care of But look at the selling pressure continue Okay, you'll see this so many times. This is the the kind of false move And then this here due to all that buying in here looking for the reversal They are getting stopped out on the way down So it's not a flip of the order book The the order book flip is a very different thing. It's This isn't really a good example either, but they're on the bid down here and they flipped the offer side and you know, basically Dissuade any buyers from coming in here whatsoever to try to trade it back into these areas Okay, so that's that's what an order book flip will do And in essence, that's what this did here. We were looking for that move into 15 as well Okay, now I'm missing the move back Um, because what what happened? Well, these guys pulled their liquidity. We're at the bottom of the range We're not getting more selling. We're getting buyers coming in And they just very successfully moved it right back to our high volume node again All right, and let's see. Let's see Okay, if they can even bring it up higher here not just 27 but back to 30 Okay, it looks looks pretty good. Look at them on see now look at them on the they're on the offer here Now they're on the bid here So, you know really choppy environment in here, but you know, we're reading the order flow correctly uh, and just looking for these smaller moves to kind of First unfold and going through our scenarios in here what this look like All right, this this guys is just make some sense here instead of like, um Having to memorize some candlestick pattern and then not knowing if it's going to work or not You can just read the the transactions in the limit order book within the candle You can still trade your candles the way that you usually trade them However, you're going to get so much more insight to Seeing what's really between the candles here In the order book and in the volume Okay, so this move to the downside here. We're not we're not looking at at buying down here We're looking for this move to trade down into 20 which happened very quickly But then we're looking for the next move because of the order book and the heavy selling we're looking for 15 And we got that I mean, you know, it's not bad. Right. It's not bad. That's so that's a 10 point move from 25 to 15 Uh, and then we saw some of these other moves in here, too so the most important thing that that um That I find when reading the order flow is remain objective and and and use common sense In reading the auction going through those scenarios when you go through the scenarios Uh of what might unfold then you're prepared for it when it starts to unfold All right, what it might look like And just go through the same process we're going through in here Okay, so you can add this to any straight any trading strategy whatsoever The more objective I find Uh that I can be reading the order flow the more likely that move will unfold Or not unfold and if I'm not looking for for it to unfold Right. So if we don't see an edge, hey, we don't see an edge. That's that Or sometimes the last Yesterday we saw many times where it's like, well, I don't really quite see an edge At that time It may you know, we'll still give a reading and give some insight where we think it will go You know due to the the scenario, but uh, how many times would we see it like like right now for example? Well, yeah, it should go lower, you know, we're finding sellers try to trade it down into here and they're pulling So 18 would be the next level, but it's The the offer here It's not actually that bad, but a lot of times it was really dark in here Okay, so what does that mean is it's it's very similar to When it was really dark in here for this data in here, it's very easy for price to slip up into these areas okay, so you know that's when uh We don't have the the greatest read now. This is actually looking pretty good to see them They are on the offer here. So we are still looking for this 18 Okay, so we're getting some insight here from the order book Okay, and they're they're actually taking it right back down to 15 And now see how it's a little darker in here now. So watch this Okay, if we can get buyers back up here at 18, they should be able to make it back to 20 Okay, so you look at the the reaction to this liquidity at 16 and a half. We found buyers Okay, and we got a quick move back up. We didn't come up to 20, but we we came up to 19 Okay, now sellers look like they want this liquidity here So they'll likely trade it and then trade through it down to 15 And there we go Okay so I know these are quick moves, but guys it's just reading the order flow like the reaction to this was buyers And then it just kind of pooped out up here Uh, we came back down looks like they want this they did and then if they do want it They should be able to trade it a little bit lower Okay, and it's still going lower here Okay down to 14 Okay, it should be able to hit 13 There we go. There's 13 Okay, now Well, let's see if we might get some buying interest in here. I don't see them quite yet Uh, and we'd be looking for them right around here at 14 and three quarters And then they can move it back to maybe this uh 18 level here And now see see how we may not get that in here because look at the look at the offer You know, it's not that dark, right? We see them pressing down a little bit in here Okay, that's why we want to see them pull here on the offer add on the bid and we want that reaction by the aggressors to be more buying Anyway, the candle here. Let's just read it. Yeah, we're down below these areas and uh, yep, still looking for it to go lower basically Uh, oh seven And then maybe the figure 4000 All right, the candle is uh as moving back down into these swings here. Oh five looks really good as well All right, we're finally getting a trending move here Uh, paresh. So the dome is it's um a separate product or there's a dome also here in the in the columns if you want So you can you can get both um The dome in the columns is is really powerful as well Uh, jay, you have the global plan. Uh Do you need to play extra for stops in icebergs? You can get you can you don't need global plan is fine To get stops in icebergs with the global Is let me show you So go to go to bookmap.com Okay, and then go to the more button here Uh, you know, this is kind of the walkthrough here features connectivity pricing education Crypto the more button though, there's all sorts of stuff in here. Okay, so knowledge base for example um Our discord chat room our forum, you know a lot of good stuff in here. Um But let's go to the bookmap marketplace here Okay, and we'll click on that and we'll go to the marketplace This is the bookmap marketplace in here. Uh, and then uh, you should see, um stops and icebergs Okay, you can just do a search for it or mbo bundle We'll just do a search for mbo. Here it is mbo bundle All right, you can see it's 134 a month. This is an add-on that we created This marketplace here is for anybody's creations Uh using our bookmap api So if you're a programmer in java or python now, you can create an add-on and sell it in here if you like Uh or create it for yourself and don't sell it in here Um and uh, so we created this one in here For our our global and global plus. So let's click on it You can read about it in here And uh and more about it in here Okay That's where you'll find it All right. Now what you will need to have is a couple things One is you need to have rhythmic data Okay, so that's you cannot avoid that and you have to be trading cme group futures So um that you cannot avoid either All right, so those two requirements are necessary the about the um Um Global or global plus does not matter um, so Let's see First what we're talking about here on uh stops in icebergs in the sub chart This is iceberg buying in here. So it's trading its price is going down But into Someone on the other side kind of like a they're kind of like a limit order Uh Only the tip of the iceberg is in the order book and and fills Uh, but then it immediately shoots to the you know to the order book the next tip of the iceberg Uh until it's all filled okay or canceled All right, so uh, yeah, there's some iceberg buying in here right in here Okay, so I hope that answers your question okay, and Other questions in here All right guys, you can see it. This is uh kind of kind of rejected down here, right? Is it enough to trade back into the mean here back to 25 to 28 or even even 35 up here I don't see it yet Yeah, okay, paresh you're asking for the link to the the webinar on the dome. Sure. Uh, all right, so go here uh book map on youtube Uh scroll down you'll see it right here under features and components playlist click here view full playlist Okay, and it's the one on top now. This is the overview here Uh of the dome There's we did a 60 minute, um Or you know a long video uh on on it as well So let me see Whoops That's not what I wanted hold on Yeah, here it is way down here Okay, so at the very bottom scroll down all the way to the bottom and you'll see the dome here Okay, it's an hour and 40 minutes All right, so yeah, I'm just going to give you the link here to the uh overall Uh playlist okay and go to that playlist and you'll find it in there No, uh paresh there's not there's just a free version of book map. There is no um trial We did trials in the past. It's such a headache. It really is the free version is great Uh, you have uh delayed data for stocks and futures and crypto is free for one Uh crypto market And that data is free so the and that's live So That's great. It gives you an excellent overview of what book map is all about the next step to take it further Is try it for a month get some data and see if you like it Very very simple and straightforward. I mean there's all sorts of you just wouldn't believe the the What a headache it was with that trial period um And people gaming the system and like oh god Yeah, is that all they got Captain price this is this is a good point. We are super super feature rich guys We have all sorts of things and we have more coming out as well I mean just this weekly You know have something coming out. Uh, you'll find out more about it. It's a really really powerful product Okay, and that'll be part of global plus Okay, that's one of the add-ons you'll get with global plus So you're looking at a flip at 22 Yeah, yeah, kind of like yeah, and they traded here looks like right they traded into that high liquidity Okay, so the it's always the question about like do we still find more buying or more selling? Okay, like they absorb that these sellers up here And that there was still more buying pressure. All right, but now we're starting to find some some sellers Welcome, uh, Barcelona Ishmael You like that just pooped out. Yeah Peter I've been using peter, uh, so But we'd we'd move on from p to give peter a rest Uh, Stefan you want to look at my stops in icebergs setups? Sure Okay, let me show you that right now um The on chart or the sub chart here. Let's just show that first Very very simple. I like this setting very much works great for me. It does not work great for scott. He doesn't like it Hey, I like the summation. It's like cumulative volume delta and just note that none of the the vertical axes here are aligned Okay, and I like that so I know that they're not the same here Uh, but I do get the graphical representation here That this is a pretty big accumulation of of iceberg orders in here and I know that I also know this is a pretty big stop run here Right, so I get that kind of context down here By looking at this view scott likes to see the spikes. He's just looking for the big big spike And then he wants to zoom into it Uh, I like to I like looking at the context, um between these two lines in here to give me some insight All right, and then the on chart Very powerful, um Pretty pretty amazing the details that this on chart indicator shows is pretty amazing um I I find it amazing that you can um See this kind you have this kind of transparency in the market So while you use the automatic threshold here for icebergs 148 or greater So we're going to see just discrepancies between these these two is sub chart and on chart because I'm making a filter here Okay, so just so you know that Yeah, here here were those uh Other icebergs in here. So they were executed Uh for 748 down here, and that's this this line in here So pretty big Uh, we're not missing anything right now. It's just back and forth in here And in a pretty tight range So we'll continue on with the questions Okay, Stefan did any more questions on that? on the settings I I I really like that. I think it's very intelligent what the developers did with that automatic automatic threshold setting. I like it Chris no comment We might I'm not sure. Um Let's see adam, um Would you like to make some modification on the add-ons any chance? Ah, okay The open source no, I don't think so. Um I think you yeah, I think the api is closed on on the dome on the dome pro Uh, however, if you want it if if you're looking for making add-ons like for example, um You know you you wanted to make uh, um some trading strategies Uh, then that's that's very simple. You can do that. You've been able to do that for years. Uh in book map All right, guys. I'm gonna caught up there in youtube. Let's see if there's anything over in discord Yeah, yeah, chris chris. That's really good. Um analysis. I would agree Um in discord, you're talking about a trend up strategy in a consolidation period right now Um, yeah, absolutely So, I mean it's still kind of a bigger move to the upside And that might start to unfold right now Hey, we're just seeing a move back up Um, so let's let's take a look here now. What do we have? All right, and let's take a look at the market structure in here Okay, well, we have back to this 25 level which was that that node in here that we saw which I think it's not the the point of control any longer Well, we have a point of control indicator so we can show that Yeah, it actually still is Okay, so it kind of went up here and went back down here Uh, all right, let's zoom out a little bit more Yeah, I mean this could be like a just some massive bull flag. In fact, um You know, it's it's tested these lower levels in here after the after the data I didn't really know what to make of the data this morning.   Um But you know, the data is not bad and and like this dollar strength is Is an inflation. I mean like, uh You know, it's it's odd to see the euro, uh Below parity there Okay, and the pound just getting getting pounded. Um, all right. So anyway, yeah market structure wise. Yeah I would agree with this chris. Uh, but let's take a step further and look at the bigger picture here I mean guys, we're still getting these like crazy mean reversion trades back and forth in here outside edges being bought up or sold Uh, and uh, let's take a look at our candlestick chart. Okay guys, this is the same process Exactly the same process we're doing in here on this analysis as we are doing in here When we're reading microstructure Okay, and understanding that this is exhaustion here looking for selling to come in and drive it lower But where did it drive it down to? Down into where these buyers came in That's where we found buyers and they traded back up into here If we get enough buying in here and there's a flip of the order book there Which we won't see on the candlestick chart, but then it should go higher, right? Um, if we get more buyers up here Uh, so I mean it is really the same analysis in here We're understanding this as like, you know, like a double bottom in here or whatever And then buying pressure. All right, so let's take that to over to here Uh, and look at the daily chart here on the uh look by period of a month um On the daily chart. Wow. Okay. Well quite a few wicks up here or one big wick up here All right, so well that's some selling pressure or some profit taking up there All right, and uh, well, we're back down into right into the this this uh range here um Well that right at right at 15 or right where this top of this wick is so You know, although the data was the move to the upside um looking at this in here like this gives us a different picture chris, so uh, you know Uh, let let let's let's move from that because the the daily is not telling us too much Except that we know this is all bullish in here a string of days All bullish all of it all the way back down into here, uh, which is back on the um Oh, this is a four hour. Sorry about that Because the daily bars weren't working yesterday. There we go. Here's our daily bars Okay Yeah, so back here on november 9th But you could you can even go all the way back to here where this move started. Okay, so that would be october 13th Okay, strong move pull back strong move. Maybe it comes up into here You know 41 50 Up into this wick up here All right. Now the hourly here is in the middle and yeah, it's just back and forth Uh, that uh, well, I'm sorry pull back And then a move back up Uh, so this is bullish in here And uh, what about our 15 minute chart here? Here's where we opened Cash open and it's just kind of dribbled off to the downside here Okay, but it opened up high it gapped in fact and then it filled the gap Not seeing much here on the 15 to be honest Um, not much at all Okay, so not yeah Don't so that 15 minute chart's not telling us too much that hourly chart wasn't telling us too much Yeah, dawn that this is hello. Um, this is one of the um Advantages of of the bookmap desktop version Okay, we we've developed it quite a bit further than the thinkorswim version Uh, so we have all sorts of uh add-ons That are are really really nice It stops in icebergs being one of the most important ones If you want that then you'll have to get the the bookmap A desktop version Johan, how do you confirm to enter a trade? What do you look? What do you wait to see in bookmap to confirm many things? Okay, but uh, you know, we're looking for Um, some sort of edge in here in the order flow Uh, and usually is a combination or a context of strong volume and strong order book Right and a lot of times it just hits us over the head Uh, and uh, it it's just you know, the participants are telling us in here Uh, where price might go Okay, so right now boy, I just don't see much of all of anything in here. There's buyers buyers sellers buyers Trying to buy again come up to 20 25 point of control Anyway, we went through the process Johan on on many of these um in many of these examples Uh, and then you know, how how can you look to get in? Well, there's There's so many different ways to trade That's that's one of the reasons why You know, I'll be happy to go through um You know how how I trade or how I look at it or many different ways of looking at it Uh, it's not a trade recommendation room so You know and what you're going to take away from this and learn from These webinars is a lot more than just like, you know buying or selling Once you understand the order flow and you start to look for some of these things in the order flow That's when you can look for the the move to unfold to the areas you think Uh, so we were looking for something strong in here. Like I said strong Well in here here, we had strong book on the offer strong selling Uh, we're looking for a move into 15 Okay, and we kind of kind of got in there a little bit late. Uh, we uh, we're up here and then and then I think I kind of Answered a question or something and and Uh, this the setup is this one The move back down from the sellers back down to point of control and through it Uh, and actually pointing control is still up here Okay, well anyway this high volume node here at 25 We see this move so many times if you do not see any sort of like on the on the bid here, uh activity Or you don't see a slowdown of sellers. They're going to press right on through The bottom into high liquidity on the bid Which is exactly what it did and then you see again in here strong selling And then strong offer here Not enough buyers to even tangle with it looking for the move into 15 Okay, how would you get involved? many different ways I would have probably gotten in with a market sell in here Uh looking to take some off maybe down here at 20 Uh, and then definitely a target at at 15 Right, especially with this strong offer in here That was our target And we don't know it could have you know might have been kicking myself like many times This was my target. I'm just looking for this liquidity here. It may have come down to 4000 at that time though All right. Well, it didn't Okay, uh, it came back down into about this 10 or nine but um And then it's just been chopping around ever since we saw some other moves in here. We saw this one I think to the upside Okay, again two point of control and through it. So we're looking for the other side of the range Which was it was this 30 level in here Okay, so what we were looking for that All right, and and we go through the scenarios in here what to look for what would it be like because we know that they're We're looking for this kind of mean reversion trade Right, so you'd be looking for your buyers in here. I would have probably been in somewhere around here or here Um, it's a small move but takes them off at 25 and that they pushed it through the point of control Same move same same setup basically So we're looking for 30 other side of the range, which was 28. I think And then 30 so there's two setups there Okay, the that I recall there were some other little little trades and or trade ideas Uh as well All right candlestick guys, what do you see here? All right, if now I would I would marry here like you know your um Together, uh the large selling dots here together with this structure Could not make a higher high looking for sellers in here Hey to trade into and through 15 and maybe on down to 10 and maybe um lower Right now, what do we have here? So now this is where that's what I'm looking for but I don't like it right to answer, um The question uh for with don I think was no yohan Um, here's why we talked about this earlier. Well, how strong is this offer in here? It's not so strong. It's pretty dark in here So this can just go back and forth in here between 25 or 23 and and and 15 Right, so is that is it higher probability due to the order flow in here? No, it is not higher probability So we're not necessarily we're taking that one off the table Okay now look at our candlestick now. Well, aren't we glad we we saw that and noticed that in the order flow Okay, that that would have gotten you in the hook here on the sell side Right And now it looks like it's going to pan out actually but we'll see we'll see maybe it won't Right. I still I just don't like it. Uh, stay away from it because we're not skiing but we're seeing Participants in this auction here What's in between the candle and what's happening in the current market? Uh, is uh, it's not so clear What their position is So we stay away Okay, that's the few different ideas for you. Oh, you're welcome Uh, let's see When book map has new add-ons that come with book map Yeah, you will need to go and update them yourself the add-ons Uh, bri and and where to go is uh, you you'll probably be, um, alerted But uh, go to the book map marketplace. Um, I'm sorry Go to the knowledge base. You you will be alerted in in an email As well all right about it. Um, so, um There it'll be on social media. It'll be here in discord and everything So you'll you'll get the message. Um Anyway, you can also go to the knowledge base here under the more button And go to the add-ons section in here and then here are all the add-ons when there are updates in the add-ons Just, you know, come in here Uh, read the installation here click on that and then you'll find the uh, the add-on the direct link here Uh, to the add-on Okay, click on that and you'll see it downloads right here Hey for stops and icebergs All right Good question Guys, look at this, right? So this is a total failure of that candle pattern In here Getting people to you know, and that look at how that candle kind of closed in here Uh, it it went down below it, but um Look at the buying coming in right? We didn't like it in here kind of and we missed it We missed the move here. Um Well, let's let's go and look at it in retrospect here Um, so we didn't like it likely I I thought likely we'd still trade through it down to kind of uh, oh eight down here Okay, because there's a little bit more selling in here. Uh, the structure is still negative Uh, now what ended up happening strong buying come comes in and disrupts the whole thing Uh, and then they come back up to the top of the range here Uh, and uh through our 25 level And almost to 30 Basically to well to 29 Yeah, I probably would have missed this one too to be honest. Um, here's why Again strong buying that's great. Well, you know, maybe maybe to write it up to 25 or so maybe Uh, but just because of the strong buying And they are pulling they pulled here at this area here and they did add a little bit on the on the bid in here As you can see Okay, so that that's not actually bad in here All right, uh, and then looking for that move up into you know, this liquidity here may maybe 25 Um, you can see what it did it came to this liquidity here at 29 Okay, and they're they're filled so now we're looking for 30 And there's 30. Let's see if we can still get more buying here. This is strong So now what does the bid look like? It's not bad So let's get to 32 and maybe 34 and 35 here Now let's zoom out Okay, um Now let's zoom out to look at some of our levels in here. This is where we dropped from here Okay, so actually this is this kind of Gives us a little different picture Okay, still strong buying So This is where it failed though and this is where sellers have been in control for this whole time Right, but uh, yeah, I'm actually looking to see if we get more buying and still and trade higher here I like 34 above the swings up here This is their chance. Okay, so let's read it in here Yeah, they're on the bid here. That's good Okay, we're up pretty high though So, you know, we're gonna find our sellers trade it back down to 25 here Okay, Daniel. Yeah Yeah, so you you had a stop hit because of Some of the liquidity it looks like I'll give give book map a try. See if uh, see if you can All right guys. Well, let's uh We went through a lot of different things in here. We went through some candles Reading the order flow. We're looking at in a pretty choppy environment in here Um, uh, we're looking for some specific moves to hit some some areas of liquidity Uh, and then at that point, we're just kind of reassess Answered a lot of questions good questions in here the We talked about the data release here And some fundamentals as well It's been a very choppy session, but some good moves as well um typically the choppy sessions like You know, like yesterday a lot of them we kind of stayed away from Uh, and some of these you we you know, we're looking for the move to unfold. Uh, so Uh, so yeah, our european close here x caliber and Yeah, not not really sure what I think of it Uh, right now, um, I kind of like this idea of the move to 30 But you can see the mean reversion guys are back in here already moving it back to 25 I might bounce off a 25 look for that and then back up into the top tops of these wicks up in here Okay, or candles All right, so uh, guys if you like this, please give us a like Uh, show some love for the education here come to our discord channel um Tom b is up next uh go over you can go over and watch his webinar It's on discord as well as here on youtube So, uh, you should be redirected right over to it. We've got options with dug at 130 p.m And uh, and then algo boys at 230 p.m to the close Uh, very different traders very different insights All three of them lots of stuff going on in here guys Uh, great community. So, um, yeah, I If you're still intrigued, um, then jump over to our discord and go check it out Uh, there's there's a lot of stuff going on over there All right, and that you can probably get a lot of questions answered Answered there. All right guys. Yeah, thanks for coming everybody and, uh, We will catch up tomorrow with j trader and go through some live trading with him on stocks Thanks


This study found that liver transplantation, LT, has a better prognosis than liver resection, LR, in patients with intrahepatic cholangiocarcinoma, ICC. Patients who underwent LT had a higher five-year overall survival rate than those who underwent LR. Additionally, patients who received neoadjuvant chemotherapy prior to LT had a significantly higher five-year overall survival rate than those who did not receive it. These findings suggest that LT may be a viable option for patients with ICC, although more studies are needed to confirm these results.


You're on video. The artist has placed the debris under the fallen birch dot in a certain orientation. And that was documented, photographically documented, after the artist placed these fragments on the floor. And my job is to. That would be my phone. My job is to make sure every Monday after a busy and busy visit that the debris is maintained in the same orientation as how the artist has placed it. So I am re-debrying the debris, replacing pieces that may have been moved out of place. Awesome. Thank you. Thank you very much for this impromptu interview. There's fallen birch dot right there.


Aloha. Welcome to Think Tech Hawai'i's Movers, Shakers and Reformers. I'm your host Carl Kampanya. This is our Politics in Hawai'i series. And I'm thrilled today to have you join us. We want to talk more. We've been talking a bit about politics of health care. And we're going to continue that conversation today with Dr. Stephen Kemble, who does a number of things for the state, actually. He was a member of the Hawai'i Health Authority. He's a past president of the Hawai'i Medical Association and is currently a member there as well. He is one of the people that has worked on the policy side, I'll say policy side, certainly the path forward to what we can do or what we could have done in this state and now trying to figure out, help us figure out what we need to do now and what we need to do to move forward. So with that in mind, thank you, Dr. Kemble, for joining the show. You're welcome. So, okay, let's start at the beginning. HHA, the Hawai'i Health Association? Authority. Hawai'i Health Authority. How did that get it started? Where did that come from? Okay, you really need to go back to the 70s and Aqwan Makorath, who was in many ways the brains behind our Prepaid Health Care Act. That's here in Hawai'i. Which is here in Hawai'i, passed in 1974. It includes an employer mandate and you all know that anyone who's employed 20 hours a week or more has to get health insurance from their employer here. That's the Prepaid Health Care Act. It required a full benefit package. It required no deductibles and no more than 20 to 30 percent co-pays and it ensured that a broad percentage of the population was covered by health insurance. And that was in 1974? 74. In 2008, which is before the Affordable Care Act, we had the best benefit package in the country and among the lowest health insurance premiums in the country by having that kind of broadly based system. What was our percentage of insured or percentage of uninsured? We were running in the low nineties. In the low nineties of insured? Including Prepaid for Employer-Based Insurance, Medicare, Medicaid, VA, all of those. It was in the low nineties. So we were in the low 90 percentage of total insured for the state using our prepaid health care system that we had. Okay, Aqwan really wanted single-payer universal health care system with one payment source, consolidate the financing, simplify it, but leave the delivery of care private and independent. And she and another group, Health Care for All Hawaii, pushed for creation of the Hawaii Health Authority. She died in 2008 and the legislature passed the bill to create the Hawaii Health Authority in her honor right after her death. And it includes a mandate to be in charge of overall health planning for the state and to design and guide a universal health care system covering all residents of Hawaii. And that got passed, lingo vetoed it, and the legislature overrode her veto. So it became Hawaii Law, HRS 322H. So that's an important thing. So first of all, 2008, the legislature of 2008, Hawaii State Legislature passed the bill. It got put to Governor Lingo at that time's desk. She vetoed it. Now this doesn't happen very often, but she vetoed it and then the Congress overrode the veto so that it became law. So now, so that means that the Hawaii Health Authority was legally, according to Hawaii Revised Statutes, HRS, a law and it was to be empowered. Yes. And Lingo refused to appoint anyone to it. When Abercrombie got elected, he did appoint Hawaii Health Authority. There are supposed to be nine members all appointed by the governor, three directly by the governor, three from a list submitted by the Senate President, and three from a list submitted by the Speaker of the House. Abercrombie, one of the initial ones he appointed dropped out. So we ended up with only eight, but we functioned as a board laying out basically a roadmap for how to get from where we are to a universal health care system that would be as cost effective as possible. We submitted three reports to the legislature at the end of each of the years that we are functioning. The second year, the legislature gave us $100,000 and Abercrombie took it away and gave it to a separate group, which he convened to implement the Affordable Care Act called the Hawaii Health Initiative. Okay. Or Transformation Initiative. Chronology. 2009 is when it, wait, back up. 2008 is when it went through. 2009 is when it became law, but no one was appointed. 2010, Governor Abercrombie came in, made the appointments in 2011. In 2011. Yeah. So then from 2011, 12 and 13 is when you had eight members. Yes. And it was, each year you gave a report. Yes. Now, 2011 is when you initially got the 100,000? No, 2012. So the first year you got nothing. Right. First year, thank you. It was all volunteer. All volunteer. Yeah. Second year you got $100,000 and what was that money for? It was supposed to be for administrative support. Administrative support. To hire an administrative assistant, somebody who could help with research and lobbying, things like that. We had somebody who was willing to do it for a salary that was be doable within that budget. But the Affordable Care Act passed in 2010 and Abercrombie convened the Health Transformation Initiative and he didn't have any money in his budget for it. So he went to the health insurance companies for funding and they ran the Health Transformation Initiative and it was following the expectations of the federal law in Washington. Now, everyone is familiar with things about the Affordable Care Act like expansion of Medicaid and no preexisting condition exclusions and required benefits and those kind of things, which are good. But the other side of the law is payment and delivery reforms. And this is what the transformation initiative was focused on. And it has, it's based on the theory that healthcare is so expensive because there's too much care being delivered because there's an incentive under fee for service payment to deliver more and more unnecessary care. This assumption has never been true in Hawaii. We had, as I said, in 2008- Has it been true in other places? In pockets here and there. Places like Miami, maybe New York, but they're, most of the country is not true. It's certainly not true in Hawaii. Are there provisions that could be put into? Yes, there are other ways to deal with those pockets than what they did. So they are trying to move the entire healthcare system away from fee for service towards systems that pay doctors in hospitals in ways that give them an incentive to deliver less care or to deny care. And this is the system we're in now, the managed care system that's being implemented now. HMSA has jumped on board this, Medicare has jumped on board this. So they're both trying to push doctors into changing the way they get paid so that they're paid upfront for an episode of care or for a population and they make more money by delivering less care than that and they make less money if they deliver more care or they have to owe money back if they deliver too much care. So it's trying to put it in the center of on doctors to deliver less care. Does that that feels to me like the doctors are working for the insurance company then? Yes, they are in the insurance company has taken the insurance risk that they are responsible for and put it on the doctors. Oh, so it's the definition of insanity. You have all the responsibility but none of the authority. These models, because there is an incentive to skimp on necessary care and there's also an incentive to avoid taking care of sick people. If you're paid upfront you may as well avoid anyone who's going to be too complicated because the cost is going to be on you. So to counteract those they have pay for performance where they're going to measure every detail of what you do. You have to document in much more detail than before, report it to Medicare or HMSA. They're going to develop quality measures which are not really very valid because healthcare is too complex for that kind of thing. There's too many exceptions, too much individualization required. There's no box. Yes, but they're going to develop measures anyway and if you do well on those measures you get paid more and if you don't do so well that you get paid less. Those measures depend much more on the patient than the doctor. If you're dealing with poor people, sicker people, more complex people, you're going to get poor ratings on those measures. So you have an incentive to only treat rich people and avoid poor people. So then they have risk adjustment where they're going to use all that detailed data to give you more if you're taking care of sicker people or poor people to compensate for that. But those risk adjustment formulas are very flawed also. What this means is a huge administrative burden is being put on doctors. There's a study recently that found that they looked at internal medicine, family practice, orthopedics and cardiology and they found that each practice was putting in over 16 hours a day of physician and staff time trying to deal with quality measures. They were spending 40,000 per year per doctor to deal with quality measures and the doctors are spending twice as much time focused on their computers. The majority of the time focus on their computers as they do focusing on the patient. This is not a recipe for quality care. It's so bogged down it's becoming impossible to practice medicine. We're losing doctors hand over fist. Everyone over 65 wants to get out. Is this one of the complaints that people have about our health care system today in general? Yes. And is this something that for when people are complaining about it and they look to the Affordable Care Act or Obamacare is they're still complaining even with the Affordable Care Act? Yes. Because the Affordable Care Act did not do anything to accommodate or to change or modify the managed care system that we're currently under. It reinforced it. It reinforced it. Reinforced it. Okay. And there's a separate law, the macro law, Medicare access and chip reauthorization act that was passed two years ago that sets this in concrete that really pushes these new payment models to get away from fee for service and pay doctors by capitation. Capitation. Explain capitation. Capitation means you're paid a certain amount of money per capita per individual and you have to deliver care within that budget. Okay. Okay.  Whereas the Affordable Care Act doesn't really allow anyone or the insurance companies to exclude sick people. Insurance companies can't.   So then if I have a pre-existing condition, I have to go through, okay, my insurance company is required to cover. Great. But now I have to find a doctor willing to take me out. That's right. And that could be a problem. There is a an organization called Crown Care in Hawaii. That's a physician finder service. And they did a survey a few months ago and found that 31% of our primary care practices are closed to all new referrals. And to me that means they're looking to get out of practice. And another 16% are closed to Medicare because of these macro law changes. And administrative burdens that they impose on practices. That's interesting. If you're over 65 years old and you're faced with having to spend 40,000 a year in higher staff in order to comply with all these things, you're going to say, I'm close to retirement on. I'm not going to do that. I'm getting out. And that's what's happening to our doctors. Is that do we have a doctor shortage then? Or do we have one pending? We have a 20% shortage as of a year ago projected to increase to 25 to 30% by 2020. And it seems to be getting rapidly worse. So would changing the system, changing Obamacare, the Affordable Care Act, changing us away from the managed care back to a well for Hawaii? Well, before I go there, what's the difference between the prepaid system that we had and the Affordable Care Act? What's the difference there? The prepaid Health Care Act had some of the features of the Affordable Care Act, like the employer mandate, broad coverage, required minimum benefits. All those things are good. It functioned under a fee-for-service environment. So our doctors were paid all fee-for-service before the Affordable Care Act. Yet we had among the lowest health insurance premiums in the country the best benefit package in spite of a high cost of living. So we were doing very well under fee-for-service before the Affordable Care Act. So we were not, so Hawaii was not under a managed care system then? There were some attempts to impose managed care in the 90s that came in and then they backed off on that.  So Hawaii, up until the Affordable Care Act, was fee-for-service, was not, was prepaid fee-for-service, had nothing to do with managed care. So therefore, and we had in a low 90% of coverage of number of people insured and so forth. So that was excellent. And then the Affordable Care Act comes in and that changed things. We had to take a break and we're going to come back and talk about that from that point on. So thank you for joining us and thank you for Dr. Kemble for joining us and helping us learn more about this. We'll be back in one minute. Thank you. I've got the Beagle Sisters here with a healthy tip. We encourage you to enjoy the food you eat this holiday season and keep it local and healthy. Yeah. Eat the rainbow. Eat the rainbow. And if you need any produce, come to the red barn on the north shore. Hi, I'm Chris Leetham with The Economy in You and I'd like to invite you each week to come watch my show each Wednesday at 3 p.m. Aloha. My name is Danelia, D-A-N-E-L-I-A. And I'm the other half of the duo, John Newman. We are the co-hosts of Keys to Success, which is live on Think Tech Live Streaming Network series weekly on Thursdays at 11 a.m. Aloha. Aloha. Aloha, Kako. I'm Marcia Joyner and I'm inviting you to navigate the journey. We are discussing the end of life options and we would really love to have you every Wednesday morning at 11 a.m. Right here. Aloha. Welcome back to Think Tech Hawaii's Movers, Shakers, and Reformers, Politics and Hawaii Series. I'm your host Carl Kempanya and welcome again our guest, Dr. David Kimball. Stephen Kimball. Dr. Stephen Kimball. Sorry. I have a brother named David. Okay. We were just talking about healthcare here in Hawaii and how Affordable Care Act came in and actually changed what was a very good system. Let's start by saying, okay, so what changed? What changed when Affordable Care Act got implemented here? Well, there is a push to change the way doctors are paid from fee for service to new payment models such as capitation and bundle payments that try to put the insurance risk on to the doctor. So they're paid a set amount per patient or for episode of care, and they make more money if they deliver less care and can keep the difference. That's capitation. That's capitation. Okay. So that has been... That's being pushed on us by CMS and by HMSA right now. CMS is Medicare. Okay. Federal Medicare program. Okay. So that's one of the changes. The other part was forcing us to transition to this overall managed care system. Well, because capitation gives an incentive to avoid sick people and to skimp on care, there are counter incentives that are included in the law, which is pay for performance and risk adjustment that requires all this detailed data collection and the administrative burdens that go with it. Okay. As a result, okay, let me ask this question then. Before the Affordable Care Act, we were in the low 90s of people insured. Where are we today? In the same range. In the same range. So the Affordable Care Act didn't increase in Hawaii the number of people insured. Not much. With our Medicaid program, we used to cover 200% of federal poverty level. The Affordable Care Act only requires 136%. So we actually dropped the level, but it expands it. It's based on income only, not assets. So those who had maybe they owned a house, but had limited income became eligible for Medicaid if their income was low enough. So it was a mixed bag with Medicaid. Got it. Okay. But we ended up roughly in the same range. So then in that regard, wouldn't we say, and this is the beginning of a question, a line of questions here, in that regard, wouldn't we then say that Hawaii is better off repealing Obamacare? Well, we were for the small business, the business, the commercial employer-based insurance model. We were better off before Obamacare. Medicaid is a mixed bag. The individual market, we're better off with Obamacare. So those who are working- The individual market is better. Yeah. Who are sole proprietor or don't have insurance through their job. They're working less than 20 hours a week. Those people had a hard time before. You could not get decent coverage. Now you can get- What was the cost to have that kind of coverage, though, for yourself? Well, before- And did Obamacare impact what that was?  For Obamacare, you could only get insurance that had very skimpy benefits and make it affordable. So it's almost useless if you got sick. With Obamacare, the benefits are better, but now you have very high deductibles and copays. As an anecdote, and we'll jump into a couple of things after this, as an anecdote, I heard someone tell me the other day that one of the changes that needs to happen with Obamacare is they need to change simple things that would make a lot of sense, such as males do not need to have insurance to cover birth, but the Affordable Care Act currently provides- I don't know what they were suggesting, but I don't know if you have any information on that and what they're thinking about in that regard. If you follow that to its logical conclusion, that means healthy people could buy very cheap policies because they have a few health problems and sick people would have to pay through the notes. And the extreme of that is the whole insurance system falls apart. Everybody's on a self-pay basis. If you have no health problems, you have no expense. If you're sick, you can't possibly afford it. And that's where that leads. That's not what we want to achieve. The way you get cost-effective healthcare system is maximize risk pooling. You get everybody included, spread it across the whole population. It keeps the cost reasonable. Which is what we thought the Affordable Care Act was supposed to be doing, because it's the rule of big numbers. You have more people involved, so therefore, you're spreading it out. That's what we thought the additional 20 million people was going to be able to keep those numbers down. It did some of that, but didn't go nearly far enough. Yeah, well, and that's where it needs to be tweaked and fixed. Right. We're in the middle right now of having that happen, having the Affordable Care Act repealed, whether it is piece by piece or in wholesale. So the state of Hawaii has to figure out what that means for us. And thankfully, this morning, Senator Jill Takuta, the chair of Ways and Means, said that she believes that healthcare is a very, somewhere in the top priority list to be addressed this year. That's excellent news. I don't know what that means yet. We need to see what that means. So my question to you is, with the pending repeal, knowing where we were and where we were pretty happy, and knowing what the Hawaii Health Authority was supposed to be doing back then, or what it should be doing now, what do we need to do? How do we, as a state, need to address it, and how does HHA help us address that? Okay. There are too many questions at once. The current focus of trying to control healthcare costs is trying to control utilization, which is what managed care is. Okay. Or you say, okay, it's too expensive. We need to find ways to restrict care. The problem is that it's restricting benefits or how much you're going to pay for care, whatever. It doesn't restrict the burden of disease and health problems that are in the community. So you're just crippling the ability of the care delivery system to deal cost effectively with those diseases by putting all these restrictions in place. It actually is cheaper to let everyone be covered for whatever is medically necessary and keep the administrative costs down instead of trying to restrict utilization. But both managed care and the reforms in the Affordable Care Act and MACA are focused on trying to control utilization. And the result is rapidly increasing administrative bloat. There's supposed to be a feature in the Affordable Character limit how much insurance companies spend on administration. But the insurance industry negotiated with the Obama administration to count medical management as healthcare, not administration, so they can spend all they want on obstructing care and they can call it healthcare. Well, what if we tweak that? What if we go back and tweak that? So what I would do is to focus on administrative simplification as a way to save money in healthcare, not trying to control utilization. And to do that, you start by trying to make pay for both doctors and hospitals as incentive neutral as possible. So if the doctors say, just pay for their time. And if they have achieved a certain level of expertise, they get a certain hourly rate.  But whether you're talking to a patient, doing a physical exam or doing a procedure, you're paid the same flat rate for your level of expertise. Your incentive then is to do what's right for the patient. As you are trained, coordinator of the Hippocratic Oath, all of that. If pay is incentive neutral, you do not need all these layers of incentives and counter incentives and micromanagement and all that stuff. Just makes it complicated. Just get rid of it. So you make the pay neutral and then you get rid of all the micromanagement and the second guessing by third parties and all that stuff. We could save 20 to 30 percent of our healthcare costs by doing that. That's huge. That's huge. Healthcare is 20 percent of the Hawaii state budget. Okay. So we could save 20 to 30 percent of our medical costs of 20 to 30 percent of our total budget. Total budget. Yes. By focusing on administrative simplification and incentive neutral pay. Okay. So that is, okay. So that's what your answer to the first question is, what can we do? That's something you're saying. That's what we can do. The next question is, what could or should HHA be doing? So this is the HHA three reports outlined essentially the game plan I said. Let's get rid of the micromanagement, make pay neutral incentive neutral, simplify the system, streamline it and get the administrative waste out of it. That is the proposal that HHA has put forward three years in a row. What we need. Waiting for someone to listen. We need, yeah, we're waiting for someone to listen. We need the governor to agree that this is a necessary thing that we need to do this. We need to get the legislature to support a bill to reactivate the Hawaii Authority fund it, give us some administrative support, let us do our job and we need people appointed to it who are concerned for the cost effectiveness of the whole system and aren't being put into sabotage. Let me add some to that though. We don't need a bill. The bill's already there. Yeah. But we don't need a bill. No, we need a bill to fund it. No, we don't. We need a line item in the budget. Okay. Because it's an HRS because it's already a law. The budget, so Jill Takuta, Senator Jill Takuta, Representative Sylvia Luke, we need to ask them and everyone from the finance and ways and means committees to say, hey, let's put some money in a line item for the budget for this law that's already on the books. So we don't actually need a bill for that. There are a couple of tweaks to the original bill, which is the HRS 322H. One is it says that the members will elect one of themselves to be executive director. They should elect a chair, but we should be able to hire an executive director to do the administrative functions because it's a volunteer board. So I would like to have that tweak. And there's also a requirement in the original bill to deliver a report to the legislature by December 2012. That needs to be extended and we need a budget. Okay. So it's HRS 322H. 322H is what's on the books right now. We want to tweak it. We're asking that we tweak it so that we're able to elect a chair, but then hire an executive director. So there's a budget amount that needs to be given for that. So that's the bill is requesting that that hire be in place. Okay. Got that. Understand that. Okay. It's a mandatory, but the mission of the HHA should stay exactly as it is. Which is to create, I'll say this and then you correct it, to create or provide the pathway towards single payer, universal health care? It doesn't have to be single payer, it has to be universal. You can have an integrated delivery system where you have all the doctors and hospitals are included. They all get paid the same regardless of the source of funding for a given patient. The same benefits, the same, you know, formulary, the same prior authorization policy. So the delivery system is unified, but you can have multiple funding streams. So you can have the current insurance companies feeding into that budget. You can have Medicare and Medicaid feeding into that budget. And so you could have insurance companies in what's called a multi payer or an all payer system where there are several payers, but they use the same delivery system. You have to unify the delivery system to get the administrative savings. Okay. Okay. So already that, so we need to empower the Hawaii health authority with some funding. We need to get an executive director. We need to get that bill in. We need to be talking with our legislators. We need to be getting the governor, with the governor's opinion is on this and try to have a conversation with the governor in order to get us moving in the direction, to get us back to, to begin with back to where we were with Obamacare, perhaps maybe we didn't need it here anyway, but to get back on track so that more people are covered with better coverage. So, okay. I unfortunately have to say that our show has come to an end really quick. Thank you so much. Very welcome. A lot of information. I hope it was beneficial to anyone who couldn't listen and watch this. And certainly helped me. I appreciate that. So thank you for joining us. Thank you for joining us. Think Tech Hawaii's movers, takers and reformers politics in Hawaii series. Thank you to the staff, the crew, everyone here helped make these shows happen. So we'll see you next week. Take care.


We'll say this one is they're going to be the quartile. This one needs another argument a comma and we'll put a one next to it quartile one and Then this is the median which could be quartile two formula or the median for function tab Selecting the data. There's the median and then equals quartile Number three selecting the data this needing another argument therefore a comma and Quartile number three the three next to it and then the max when we maxed out on the calories so the max Selecting the hold on a sec Something happened. This is the max and I got a hit shift nine I could do that to get my function ready to roll and then select in my data So that's when we ate a whole bunch of calories apparently. I don't know I was just drinking drinking bacon fat or something Anyway, then we have the standard deviation on this one equals the Standard and we're looking at the population data at this point. Let's take the standard deviation for the population P and select that and then this will be equal to the stand the variance for the population and We'll pick up that. Let's just do the same thing for the samples Just to pick those up if it were a sample standard deviation Sam and variants variants for the Sam and This is going to be equal to the standard deviation for a sample and This will be equal to the standard deviation For a I'm sorry, this will be equal to the variance Variants for a sample the AR dot s Okay, so there's all the stats that I get them right this time. These are the population population this is for a sample Versus a sample if I look at this one by the way home tab number group And I add some decimals just to see Some a little bit of a differentiation between the two calculations. Alright, let's put some blue borders around this I'm going to select our data and we'll go to the insert tab fonts group hit the bucket drop down if you don't have that blue it's in the more color in the wheel standard side and hitting that wheel and Okay, and then we'll go to the font drop down put some borders around this whole thing Let's let's put a histogram in it now. So let's take our data the calorie data Insert tab up top charts and hit the drop down, but not too hard. Don't break it and then go to the histogram So there we have it So there's our data. It's fairly fairly centered data a little bit, you know skewed to the right here But there's our pictorial format of the data And so now let's do our standard deviation calculation using and our variants using like a table format So we get an idea of what's actually happening with those because they're a bit more complex calculations. So we've got the variants there There oh, hold on a sec variant now. I hit the cap lock variants and I'm going to copy my formula over here So there's the formula. I'll bring it down to like 12 on the font. Let's do 12 font Now you can type in that formula remember with the inserts tab hitting that any equation and then I would use the ink Thing so that you can actually kind of type it in here or hand write it in here Not type it in here. That's the point and it'll start to do your formula up top So I'm going to make this one orange as Well and we'll make this black and white up top for the header black and white Okay, and then we're going to say this is going to be the standard Deviation Form you lie And we'll put that in place making that 12 on the font as well Orange in it making it orange. That is that's what we do. That's what orange in it means when we orange it and so there it is okay, so We can see that these two are related of course because this this whole bit here for the variants Sigma squared is the same thing as what's under Here on the standard deviation and then we're going to take the square root of it to get the standard deviation So let's do that calculation on more of a manual method Which although there's a whole lot of data points here is still pretty easy to do So let's just copy this whole thing I'm going to copy from column a to column b selecting those two columns right-clicking and copy and Let's put them on over here in column R. R and s are So we're going to say control V or just paste it. Let's make a skinny queue column skinny queue and Then we'll just do our standard kind of thing here. So here's all of our Individual points represented by X X I so we're going to go from one all the way up to however many of them There are and of them that is so we're going to say this is going to be the mean So we're going to compare all of them to the mean and If you're if you're over the mean We're going to be mean about it and say that you're getting fat because you're over because you have You have more calories than the mean