Ladies and gentlemen, I'm not sure if this thing is working Let me see here. I'm in my mobile office and Internet I'm up under a tree So my internet been struggling This whole time so this might not be working. I do not know if I'm on here or not So y'all could see me, huh? So I want to do a um talks with Tony go through a few talks with Tony for a little bit on here Talks with Tony on the inbox kind of do this live and then later tonight. I'm at practice right now So I got to go in a little bit but later tonight. I will be Doing just like a live Q&A for the bless tribe. I think I said at 8 30. I'll be home But until then I'm gonna try to get some of the talks with Tony because I've been Missing some of those. So let me see here. We're gonna come on up here So, yeah, I appreciate y'all for joining me now. I'm gonna see if I can go in order with some of these email Some of these emails See here Hi, mr. Gaskins This says not my season but still wondering make sure there's enough detail This is so weird for me This is a little tough for me because sometimes people write me who 20 sometimes people write me who 50 So sometimes to get a little tough for me, you know speaking to such vast age differences Just say hi, mr. Gaskins I previously inbox you a couple of months ago regarding a situation I had with my ex boyfriend I believe you titled the episode young and looking for love my question for you today is why don't men approach me? So I might have to go to the next one because that's you can't really answer that This one says the house was it a mistake? Hi Tony, I hope this email finds you well. I started following you in 2017 after a breakup It wasn't until 2019 that I got serious about changing my life. I am doing the work in getting knowledge I appreciate you more than you know, and I pray that God will continue to bless you and your family beyond measures I would like to add that I have a wonderful life slash Relationship coach that I found on my mentor dot life. However, I would like a male perspective on my current situation Trish is her coach y'all could get on my mentor dot life too now My boyfriend and I have been dating approximately 15 months About six months exclusively he is truly a great guy He's thoughtful consistent a believer family oriented, etc So far he's been respectful in my request for us to wait on to wait for intimacy until I am ready I recently purchased a new home. This plan was already in motion prior to me Meeting him. I lived in my previous home Townhouse for 11 years. I worked hard saving my funds for a down payment getting out of credit card debt, etc I disclosed my plans with him very early and us getting to know each other The home buying process was tough with the current market Finally, I managed to get under contract for a new construction in September 2021 Have I answered this question before because sometimes I'll be going through these and I get a little lost Get a little confused I disclosed my plans with him very early and us getting to know each other The home buying process was tough with the current market Finally, I managed to get under contract for a new construction in September 2021 I sold my townhouse in the same month too I was able to put down a nice down payment on my new home I was misplaced for approximately a month until my house was completed in january 2022 I stayed with my sister and her family who lived close by approximately two hours away from him I visited him on the weekends and we spent holidays together My current home is approximately 45 minutes away from him We discussed the distance but agreed that we will make it work He helped me with moving in which I truly appreciated. He's been so supportive throughout this process Lately, he's been making comments about the distance Also, he would comment on how bougie I am with my high-end appliances LOL Whirlpool is not bougie to me He even started talking about making upgrades to his home as if he's competing with me I actually like his home. My family and friends told me he would change once I moved They told me that he would start getting distant physically and emotionally I will admit that he is acting rather strange now I am 42 years old and he's soon to be 40 We both expressed a desire to marry when we first met After a year or so of dating I know that I would marry him if he asked I told him that homes get sold every day and that I am willing to compromise on where We would live should we marry interesting. There isn't much conversations about the future now I feel like I screwed up with this decision Did I make a mistake buying this home? Is it going to cost me this relationship? What does he think of me? Thank you for your time and consideration now listen I feel like uh I feel like I Might have seen this before but I don't know but You know, it's kind of hard to say if you made a mistake, but from a male perspective Yes, from the male perspective you made a mistake in the sense of the man wanting to build with you and wanting to You know, if y'all gonna go somewhere together do something together And you had a townhouse already, you know Why buy a whole house? Get all these appliances do all of that if you've been dating for you know 15 No a year No, yeah Dating for 15 months But it's only been six months exclusively So to the man it says you building your life outside of him you moving on outside of him and then you 45 minutes away So it does imply that he's not really a factor and It was something you wanted to do. It was your dream something you wanted to make happen But it sends a message and so One of the things we got to realize is that The american dream Might be your nightmare and so One message i'll say just unrelated is we got to stop feeling like You know buying a house is everything in the world And that that means success or that that mean we've made it Especially when we want to settle down with somebody and be married Because you could buy a house and the market could crash and now You don't want to sell that house because you might you might be losing $20,000 $50,000 and so now you keep the house and now you paying a mortgage on a house But yet you living somewhere else and got to be paying bills over there too Whereas when you're renting So if you're not where you want to be Then we shouldn't make permanent decisions now home is not permanent, but it's pretty much it could be Almost permanent just because of the fact that you never know how the market gonna go And a lot of people say a home is an asset, but a home really Can be a liability too And especially when you've got a mortgage because the way a mortgage is set up them payments You paying so much interest in the front end That that 30 year mortgage you be done paid twice what The price that you got the house for so if you single this for the singles If you single and your goal is to be married And you don't know where that marriage is going to take you you don't know who that marriage is going to be with Don't get pressured or feel like you unsuccessful because you paying rent Because even when you buy a home in a lot of ways you paying rent Because you paying so much interest On them Them payments so much of it going to interest for the first 15 20 years of that 30 year mortgage That you really ain't paid down much of the principal So if you move in the first five years three years You just made all interest payments for the most part and then So so when it's time to sell the house you really ain't got too much equity unless the market done gone up And and then you up and then moving now you got to move all this stuff You got to go through all of that. So it's kind of like If earth ain't your permanent place, we don't want to store up too many treasures On earth versus storing up in heaven. So if your Relationship status is not your permanent status Then you don't want to make super big decisions If you feel like in the very new near future you expecting a change or a breakthrough Now if you expecting to be where you at for 10 years, then that's different but It's a it's a lot of hype buying a house. It's a lot of hype, you know I own a house and I've own other houses It's a lot of hype. So for y'all singles don't feel like you're missing nothing If that ain't what you want to do right then I wanted to buy but you said months ago to just wait and get an apartment on the waterfront.  Hi, Tony. First. I want to thank you for your content. It is very insightful So I have a very strange situation A guy and I have been communicating with a guy And I had been communicating with on and off social media and via text for a little while After he shot his shot in my dms We had planned to meet But the day before I reached out and he never responded. So I decided to delete contact I was a bit salty about it, but decided to let it go and one day while watching the dishes I had a random but positive thought about this person Even though my previous thoughts about him were not so positive And when I checked my phone, I received a text message from him I thought it was weird, but I was curious which led me to communicate with him We would just have small talk From here and there and we aren't friends Mostly just strangers slash acquaintances Fast forward And I read him on snapchat, etc And I was disappointed because he seemed to be someone that I have many things in common with From face value, but the situation wasn't going anywhere I decided to finally let go of my curiosity about this situation and forgive myself for putting too much stock And my hope in potential I had a private conversation with god about it and within the same hour I received the text from this person again Although it had been a while at this point. I feel like I am being hoodwinked Or the devil is listening to my prayers and Somehow whispering to this man every time I am deciding to let this person exit my mind for good Of course, since the communication is so sporadic I eventually end up forgetting about this man, but I randomly started thinking about him again And one day I had a thought about the person texting me that brushed Texted me that And brushed it off because I was tired of wondering And the mind mystery behind this individual I had just already come to the conclusion that this was just some weird experience It felt like a strange case of deja vu I began to become annoyed because I was beginning to think about the person again and wondered lord Why is this person on my mind? Just said lord, I don't need him and was still hoping for the best for this person And within that same day If not the same hour That this person was finally exiting my mind. He texted me Probably within the same hour. I wasn't checking my phone. It is so strange. Tony I'm not really interested in dating or anything right now because I am focusing on my love for christ and self love But it just seemed to be a very strange supernatural type experience That I really can't even explain Now some of y'all have heard, you know stuff about this right here and Just about the I believe it was Bob Proctor Who talked a lot about just the the mind waves and the frequency And I don't know what it's if it's telekinetics or physics something I was talking about it one time and One of the a guy put a name to it But that happened to me all the time just right here that happened all the time And one of the things that we got to stop doing Is we got to stop thinking everything is spiritual In the sense of or everything is a sign everything is spiritual because we are spirit having a human experience but Feeling like everything is a sign Because it is said that The way the telephone the way Bob Proctor Teaches it he says the way your telephone You pick up your telephone and you could call somebody in china And that just sent a signal down the line down this phone lines and bouncing off all this stuff And then this person phone rang in china A few seconds later the way he described it is that's the same way the mind work And so a lot of times I will have a thought about somebody And I'll wake up the next morning and they text me So it's a lot of power in the mind that we can't really describe It's words and teachings about this stuff, but There is power. That's why the bible says such as a man think it so he is There is power in our mind and a lot of times when if you spend some time thinking about somebody A lot of times they thinking about you And I don't Understand it or have an explanation For it, but just to understand the spirituality and how God created us Before a telephone was in existence I would imagine before telephones you think about somebody the next day They might walk over to your house and say hey, I was thinking about you yesterday wanting to come visit you And so God might have just put that in the mind for that reason So there's some is you know, it is deep now, but you can't take it too serious if you know somebody is not for you Now this here ain't got no title to it Hey uncle Tony So my husband now separated wants me to split with him on the divorce process, which I refuse He said that we should come to an agreement on the amount we'll both have to give to the lawyer What bothers me is the fact that he couldn't find the time months ago to come to an agreement with helping with the kids We have two kids under four Financially and or physically he said he needed to get himself together first before He could have spoken to me about the kids I then had to put him In court in order for him to give me funds for our kids every month But so ironically he could find the time now to want to make an agreement on the money for divorce What do you think? Thank you so much for always giving us your time and helping us women to win um Well, I'll tell you this on situations like that I say if you really want to be gone, then just bite the bullet and be gone Just bite the bullet and be gone and so Sometimes it's better to pay for our freedom then To let somebody else be in control of our bail money It's like if you got it Just go ahead and do it and get on out of it Because why are you waiting just for him to pay everything you stuck in it? so And just like with the kids When when you need to be free you need to break free You got to see your kids as a hundred percent yours If you got to create a side hustle if you got to you know work a little over time if you got to save more spend less For your freedom, although it's not fair You got to do it and sometime when you show a person that you don't need them and you're not going to wait on them That's what make them get they But as long as They feel like you need them to make something happen They got some power over you. So you want to think about that uh Key of bathroom body said get your own attorney. That sounds like some good advice del one in a million Now this person wrote in to the anonymous And put her name in the first sentence I'm on now If I just was reading in one pan of tension I would have said your whole name on here and your co-workers on here Oh, that's what she's going through Hey tony god bless you my name is such and such I am 29 years old will be 30 march 1st this year. That's this email old night y'all I'm behind on these emails. I am emailing you because I have been watching your videos for almost a year now And with some help from you, I have definitely grown as a woman I have grown definitely from this current relationship. I have been in for the last five years I have been with this man who is now 37 will be 38 in october 29, okay, he's about to be 38 I met this man one night through a mutual friend who has now been deceased two and a half years We met one night and shortly after I left the country for a few months without saying anything about it I came back and that same day. I got back to the us I ran into him and we went to his spot again and it was almost as if Since then I never left. We have spent every day together unless one of us had gone to jail Y'all spend every day together unless one of us had gone to jail That's a little interesting About a year into our relationship I found Jesus Christ and received him as my personal lord and savior And I grew out of the street life And going to jail And the lifestyle alone with it Although it seems street life is all he's known He always respected our relationship and I never caught him cheating only texting a woman or to a couple years ago recently I have been distancing myself because We became homeless and he became real violent and it's been like that since then It breaks my heart and has destroyed my attraction to him, especially in bed I can't enjoy myself or feel like I'm not good enough or please him I recently started working and got us a room for rent But he hasn't got no job yet and it kills me because he had an inheritance from his dad $10,000 last year and blew it on God knows what he has no car No home no new clothes and he did the same thing again a few weeks ago With the other 10,000 he got from his dad. I had to go work while sleeping outside And him ghosting me for three days He listens to me He listens with me to your videos sometimes and you have helped him a little But I just don't know if I should stay after so many years and I'm getting old or should I stick it out getting old You tell you turn you 30 years old Nah, listen, I try to help everybody But I I struggle a little bit helping Uh, I struggle a little bit now with a man Who in his Greek life and homeless Because I have to be very careful what I say because I don't know how he feel about what does he have to lose So if I say the wrong thing and he lose you And he homeless And he done got $20,000 from his daddy dying And he them blew through that I just don't want the man coming for me You see what I'm saying?  I really in situations like that. It ain't really much I could say because That brother ain't got nothing to lose So you got to choose that's that's a personal choice right there Because a man down like that a man down bad like that.  If you y'all homeless, I guess it's a data.     God bless. I'm praying for you. Let's try Lift up y'all lift up in prayer that the Lord could deliver Because the title of this email is one in a million I don't think he won in a million sister and then if you 30 and he 38 He about to be 38 in october.  Okay Yeah, it's been a while since she made in I show hope she then made the right decision God bless you Now this one here from one of our people in africa This is an african name I need to get my african name back Try to call me tony. My name is kungta Get my name back This is somebody over in africa Hi tony. I am 23 years old and I'm really struggling with the reality of my life This what this y'all be me with this Y'all be this social media here Y'all be 16 and a half tony. I just have not hit any of my goals and dreams I'm ready to be married and pregnant And I just can't find myself. It's like listen y'all cannot take yourself that serious now That first sentence just throwed me off all the way off again Hi, tony. I am 23 years old and I'm really struggling with the reality of my life I graduated from university last year and I've been looking for employment for the last six months It is really difficult. It is a really difficult time financially. I have received job offers But those men want me to be their side chick in exchange. I have offers from Well off men all the time wanting to be my sugar daddies, but I refused all of them My morals and values will not allow me to give my body to men in exchange of money slash opportunities I listen to your videos all the time for encouragement to do the right thing and stand firm in my decision It gets difficult at times because I question if having morals is even worth it, especially in this generation It seems like everyone who is just living wild and carefree is succeeding I ask people in my life and they all tell me that I'm young and should stop being uptight and to loosen up because it's just sex No big deal. Am I doing the right thing? Please help Lord I don't know if y'all will ever see or realize why I'd be needing to break When he talks with tony or these be some questions I'm telling these really be some questions sister I do you definitely living in in in another country and this look like an african name I don't know if you're in africa or somewhere else, but I know this ain't america because we got the me too movement You're if a man try you like that in america you're gonna have so much money from that company And that company gonna be paying you to rest of your life So you somewhere else? Well, it ain't y'all ain't got no me too movement yet but I'm gonna tell you sister what I say in a situation like this you need to go to a bigger company You need to go to a court with with checks and balances in place not even middle of the way companies not these smaller companies Not each startups And if it's still like that you might need to start your own company You might need to start your youtube channel You might need to so in business or your cooking business or your drawing business or your t-shirt line You might need to tap into your creativity and start your own thing and trust the blessings on you I ain't got much longer y'all because my wife told me to get some food For my sons before I picked them up because taitan got testing he's doing his standardized testing right now So he needs to be able to get home and get straight to bed But I'm gonna be doing a q&a answering y'all questions later. Lord willing lord willing and Lord willing this one is toxic family members. Hi, Tony. Let me see how long this is Hi, Tony. I just wanted to get your opinion on this subject. I am a 66 year old female Now y'all see what I was just telling you about It's really hard not for your mind to talk to a 23 year old and then the next email talking to a 66 year old and this uh Because it's difference in the generations, you know I wanted to get your opinion on this subject. I am a 66 year old female I am the youngest of all my siblings So I grew up in a different generation than my older brothers and sisters This is kind of hard to explain because this email would be too long if I went into details However, this is mostly about my oldest sister and also Her husband my mother and father are both deceased now Most of our relationship and siblings was through my parents until they got sick and was not able to take care of themselves That is when all the biggest problems between us started She was always on me about not doing enough to help her take care of my parents I had always done things for my parents Especially when I was still single and living at home I did all the little things nobody else had to worry about Once I got married and moved out. I had two young children to take care of also Plus a full-time job She was retired and her children were adults Y'all got to forgive him. My wife texted me trying to book flights and I'm gonna kill multitasking Once I got married and moved out. I had two young children to take care of Also plus a full-time Job she was retired and her children were adults, but that's not the whole story Now that I am divorced and I have a life of my own To live I still feel like she is trying to control my life As if I am still a kid and does not have a mind of my own My brother-in-law even puts in his two cents on things that my sister speaks about Please understand usually it is nothing Nothing major for them to speak on but just wanting to be in my business I think it's because they don't have anything else to do They sit home and look for everybody else to call them visit them, etc I don't mind doing that at times. I am really easygoing person I have been a people Please are all my life and in my older years I have tried to love myself and do things that make me happy I get the impression that because I don't have a husband They feel that it's okay to have a say in what I do and when I do it Example if she calls and I am sleeping later than they think I should sleep I have common sense. I know when I am ready to get up. I know it sounds petty But that is only one example Also some serious things that happen in my life or a source of jokes for them Please give me your take on this. We all grew up in church and we know right from wrong You know, this one of the things that that bind a lot of people and that's family members and toxic family members but one thing I'm gonna tell you is Blood somebody being your blood don't mean they get the right to drive you to an early grave and I give anybody My behind the kiss It don't matter who it is If somebody can't respect and appreciate your peace Then you got the right To tell them to kick rocks with open-toe sounders And so but what you do to not be confrontational with this is just don't answer the phone so much Be busy and what you can do is you could let them know. Hey, I'm about to work on a project A big project. So I'm gonna be out of reach and out of touch A lot of times because I'm gonna be locked in and focused Your big project is working on your happiness. They ain't got to know that And so what I started to do with people like this hill? They'll text the day I won't respond for two days Then I'll tell somebody so sorry miss your text because I've been busy working on me They'll call I can't call. I don't answer the phone and text them back. Hey, can't speak right now text me And so you got to stop being available.  They jealous of your ability to be able to move and shake When you ain't got nothing going on in your life, you want to make other people life your business to give you something going on So so you're not already pegged that you just got to find a way now to not be as accessible They'll not be there. So so readily available So hey y'all I got to go my wife need me To move something around. Oh my goodness and this is what I try to tell y'all man life ain't man listen This life ain't easy So here we is my son get a grant from mit But the three flights for me hunt tating to go up there with my son for the presentation of their invention is over $5,000 and delta Aiken up the out keep crashing She went on the out and the things say the flights round trip flights Is going to be $4,600 Old raggedy app wouldn't work and then went on the computer to look up the flights And it then went up the 5600 If it ain't one thing it's another And I got to be putting out fires and so I'ma tell y'all When you the head of the household And you got to you know make these things happen. It's a lot of stress come with that And a lot of women want a husband and a lot of women want a husband that could provide But let me tell you that providing ain't easy Because now this extracurricular this extracurricular And and my son They school already cost over 30,000 a year then The club that he in didn't have the money To get the kids up there So I had to go on my network To get an investment of $6,000 a donation of $6,000 that they needed that was from my network And now it's about to cost me another $7,000 for me and my wife and my son to go up there So I'm $13,000 in Supporting my son opportunities And and listen here So it's like when they say new levels new devils A lot of time we'd be praying for stuff on that next level and we'd be praying for Oh, I want my child in a better school. Oh, I want my child to get this hill grant But to be there to support your child it costs money So on the daily you put not fires, but you know what as as a provider And a protector we not allowed to voice That stress that come with that we ain't allowed to voice that None of the kids wouldn't be going had I not raised the money for the kids And I don't even know if I got a dog on thank you card And right before that I gave the school $21,000 to redo the bathrooms And on top of that the 30 some thousand tuition now this 13,000 for this hill thing Y'all see how they add up taking care of family on this hill level of schooling Which is the opportunity that you want you want your child to get a grant from mit And have that in they roller on they resume For for college stuff, but that thing costs And then he got a dream to be a pro soccer player So five days before We get an email that he get invited to georgia We don't live in georgia So now I got to make arrangements to dry him the georgia and book a hotel And it's like these kids is expensive and that's why I always shout out single parents Single women or single men who they doing it Without no help your hat you got to tip your hat to the single parents And especially if it wasn't your doing that got you to be a single parent somebody sold your dream and didn't cash in But I got to go God bless y'all And uh, we'll talk soon. Lord willing. I'll be able to be back on eight at 8 30 when I get home But that's why I'm trying to tell y'all about my process and how I have to do stuff because when you family I'm sitting in my mobile office at my baby boy practice But my oldest boy got practice at the same time at a different field So I had to drive both of them to practice But I had to take the oldest to practice at his field drop him on 15 minutes early Then get the youngest to practice at his field and I sit here and I got to work What I'm doing right now While the youngest is practicing now I got to get off to go get up get them some food Because my wife is real tired because she was out of town yesterday with her family member That's having health complications and is coming close to the end And so she needed to go say her goodbyes just in case that's the case And so she flew out in the morning flew back that night got back about one o'clock in the morning Then had to get up at five to take the boys to school by you know, she leave at about seven But she get up at five So she tired feel like she says she feel like she been hit by a truck today So she didn't want to cook And so I had to leave to go get the food Get back to get him Then the other one got to wait after practice When all the rest of the kids getting picked up they going home He got to sit out there like like the homeless child until I get over there And I'm gonna be late to him because both of them practice on travel Elite travel soccer teams at the same time on two different fields And then I'm on here, you know doing this right here what God called me to And so that's why I tell people that's why my block finger That's why my block finger be working the way it worked Because I already be on the edge when I get to read some comments and somebody come out of my own slick Block Block I'll be about to spray my finger Hit that block button. I say Woman or man, do you know what the world I go through to make a youtube video?  Hey, God bless you and we'll talk soon I'm on the computer. So I got to figure out how to end this string.  Now, you don't know about it. You ain't on patreon though, but you'll find out about it


Okay, we're back. This is Dave Vellante. We're live at VMworld 2012. We're here in the hang space at Moscone North. Come and see us. There's a lot of good action going on here. Of course, the cube is here. This is our third year. This is day two for us at VMworld. You know, a lot of talk over the last several years about cloud, right? A lot of what we call cloud washing. Well, we're here with a company that doesn't cloud wash. They're basically serious about the cloud. They built it from the ground up. Nervonix, you know them well. Long time guest in the cube. Scott Gennaro, the CEO, and Drew Borden, who is the new chief strategy officer. Just joined the company about six weeks ago. Gentlemen, welcome. Thank you. Scott, always a pleasure to see you. We've done a number of these events. We saw you at NAB. We see you at all the big tech shows. VMware in VMworld is the new enterprise tech show. We were kind of talking about off camera. And you kind of, you got to be here, right?  Right, and, but so, give us an update on what you guys are doing, what you're doing here. I'm obviously meeting people, having a lot of business meetings, but what's going on with Nervonix these days? Yeah, so, you know, we're obviously continuing to grow pretty dramatically, you know, year on year, quarter on quarter, so we're pretty excited about that. This is one of the biggest events we do throughout the year. It's not only a great event to meet with industry analysts and people like yourself, but from a customer, I mean, this is a who's who's of customers. I was just over at our booth. It's jam-packed, you know, three or four deep of just people wanting to come by and have conversations. And it's a great opportunity also for someone like me, who travels a lot to be able to get a lot of meetings, you know, in a few days. So what are customers talking about at the booth? What are they asking you? What's the conversation like?  How do we monetize, you know, data that we basically have to keep, but we basically want to get to a point where we can potentially monetize it, right?  There's a lot of, as you mentioned, a lot of people talking about cloud.  So. Yeah, so, I wanted to talk to you about something you said was monetization. We've seen a couple of firms, three I can think of our fan, two are your customers, Cerner is one, USC is another one. Essentially, turning their IT and pointing it externally. And NYSE was another one that we had on here this week. And we've talked to Cerner and USC. That's a growing trend. And in those, the first two cases, they're using your cloud to do that. And they're using it in a private or even a hybrid setting, is that right? Right, yeah. So we see more and more large customers who are implementing private type clouds to not only utilize it for themselves, but they're also now making decisions that they want to monetize the private cloud that they've invested in. And they're going out and offering cloud services. So example, in Cerner, they're going out, they have a product called Skybox. They're out now offering to hospitals cloud services. USC Digital Archive is out now talking to USC Medical. They're talking to their students offering cloud services in addition to utilizing the cloud for their own personal use. So a lot of people doing that. A lot of service providers are starting to implement. We'll be announcing a few in the next quarter or so that have already bought private clouds that they're going to roll out their own cloud offerings. Yeah, and this is basically, these companies taking a page out of Amazon, if you will, pointing their infrastructure to specific industries and use cases and really trying to deliver a greater level of SLA for the clients. Let me ask you, you've got a strong background in media entertainment, obviously, a lot of need for archiving, digital media. We saw that at the NAB show, just an amazing innovation there. Why did you join Nirvana? Tell us a little bit about your background and what lured you to this company. Absolutely. So most of the last decade has been concerned around content collaboration for me inside the balance of big broadcast networks. And whether that was standing up the original IP streaming over the internet of our broadcasting programs or it was working deals with the Hulu's, Amazon's, Netflix of the world, what it became clear to me is that the entire process of creating that content was moving outside of the walls of the traditional studios, the traditional broadcast networks, and it was fundamentally going to where the content was being created, whether that was with the director in the field that was sending digital dailies over the wire back to a studio in Los Angeles or a post house. So it became apparent to me that in the long run, that is the convergence, which is to say it's diverging from that environment into the cloud and it becomes an entirely new mechanism for creating that content, collaborating around that content, distributing that content. And it feels like Nirvonix is a good example of being in the ground floor of that, particularly storage being the enabling factor around that. And obviously strong affinity to your world. You guys just did a deal with Fox. Obviously, that's a nice, is there any studio left that you're not working with? There's one left and it's going to close in this quarter or next because they've had a proposal, they've been evaluating our technology. But, yeah, we're excited about Fox being a new customer of ours. It's an interesting use case because, in addition to a lot of people talk about backup and archive, they actually replaced most of their NetApp devices in their locations around the US with our technology. These are big deals that you're closing. I mean, they're multi-pedabyte deals. I mean, you must start, to be getting the attention of some of the whales in the industry, are you? Or are they just not competing for this business? Yeah, I mean, to be fair, the large storage companies all compete, right? They don't have a real good solution to compete with. So, but are they participating? Yes, there's no question. I mean, as we've talked about before, I mean, we're going in trying to convince the customer to do something different. It's a whole different value. It's a whole different ROI conversation. And it's a different value proposition, not only financially, but technically from that point of view. But that being said, are we getting noticed? The answer is yes. We do know there's kill kits on us now for most of the major competitors, of how to compete with us and what to say. We've seen a few of those. Yeah, exactly. But once again, when we have something that's very different than what everyone else has, the knockoffs are usually hard to have because you don't have something to really compare apples to apples with. Well, what are they saying? What are the knockoffs? I mean, small company, okay. Small company, do they really, are they able to support you in the sense of the scare tactics of security putting data in the cloud? We used to get that through pretty quickly. The question of features, functions, but we do it differently. Do we need thin provisioning? No. You really need to understand the type of data we're putting in the cloud and what we're utilizing it for. And when you really zero in on that and you spend time understanding how we position our products and our company, it becomes very clear that a lot of the stuff that they're mentioning has to do with tier one enterprise type functionality and that's not the space we're focused in on. So from that perspective. Well, it's hard. I mean, those knockoffs don't put a lot of water. When you go to a market with IBM, you know, they're not a small company. A lot of rumblings in the market about from Dell customers, are you guys, are you working with Dell? That's not, you've not announced anything but can you talk about, are you specifically working with Dell? Yeah, so we've always had a relationship with Dell which has been a little more opportunistic if you want to call it that. But in the last quarter or so, Dell has made a decision that they're going to be rolling out and reselling our technology.  I mean, they have just an amazing distribution channel. They've played around with, you know, Caringo and Object, but the, it seems to me it's never gained a lot of traction. I think there's a lot of potential there. How's the IBM relationship going? It's great. We've gotten a lot of net new customers from it, well over 100 plus net new customers from the IBM relationship. And so, IBM's a big company and constantly getting in there and driving them to go do that. But they're very committed to cloud and obviously on the services side. So when you bring up Dell, I mean, Caringo is a great example of a point product. And there's value of having point products that do, you know, file-based type environments. But once again, we don't really compete with that product when you look at what we do versus what that product does. So we actually feel in the Dell strategy there's room for both across the board. So what's your secret sauce? I mean, how is it that you all are able to win these multi-petabyte deals? Is it the business model? Is it the mindset?  All the above, can you talk about that a little bit? Yeah, I think it's really, it's all the above. But remember, this is a company that's been around developing ITP in the space for four or five years now. And that's a, it's a non-trivial exercise to build up and operate this at scale. Then there's the operational discipline around you, how you can host and provide the level of SLA that we do. And at the end of the day, it has to be far more efficient than what the enterprise can do inside. We can operate at scale that they'll never be able to in many cases. And then I think what really resonates with a lot of our customers, besides the technical features, is the geographic distribution and replication of our content. Because at the end of the day, no matter what happens to the on-premise gear, there's always one or more, and there's more in our case as a copy, sitting in multiple places around the world. That was really what was the driving factor for NBC Universal when they decided to move their gold masters off of Universal's lot, because they had a fire that almost destroyed the original sort of archival content into multiple geographic location. And no vendor could offer them a solution on-prem that was ever going to meet that particular need. Yeah, you guys, I've talked about, often, a global namespace. And you've got a true global namespace, meaning a lot of people talk about global namespace, but it's a global namespace within a data center. That's not a global namespace. You guys have a different point of view on that. Give us some depth on that, if you will. Yeah, go ahead, Drew. Yeah, absolutely. So, it's the ability ultimately to reference the file, geographically distributed, many replicas, but there's a single way to access it, and then we'll make the decision around where to pull that file from and how to fulfill the request for it. Now, what I think is really compelling about that is that we're able to meet the customer on their terms and their file system. So there really is no change when they move it into our cloud. They take their underlying structure, and it can be as simple as copying it through some device or any number of mechanisms directly into our infrastructure, and we replicate that exactly back out to them. Now, we were talking about SLAs before, Drew, you had mentioned it. Scott, you and I have talked a lot about how you don't really compete with Amazon. But conceptually, Amazon got this whole thing started. They sort of invented the concept of cloud. You don't run into them head to head, but everybody talks about Amazon. So you guys saw this announcement of Glacier. I blogged about it, and a number of others have as well. I took the CIO perspective, and basically my premise was you wouldn't put your archives, your critical corporate asset in the Amazon Glacier. You just wouldn't. Notwithstanding that it's going to be expensive to get it out, and we don't really know a lot about it, but just the history that Amazon has had in terms of the way they've responded to failures. I love Amazon. I think it's great for certain use cases. We're customers of Amazon, but what's your take on Glacier? What's your point of view on that? Yeah, it's a good question.  And in the last week or so, everybody I have gone out and visited, I've asked them about it. I mean, we're not shy about it. It's out there, we've talked to them about it. And very similar to what you said, a five hour to just get to a point where you could potentially start downloading three to five hours, everybody we talked to of any size has said that's way too long. They're not going to put up with it the whole bit. Will they do minutes, maybe? Will they do 30 minutes, maybe? Will they do an hour? But you start getting past that 60 minute time frame to recover, it doesn't make sense for them to do that from that perspective. I think your other point is that once again, customers, when you think about either archive or even a deep archive type environment, customers still want to figure out how to monetize this data that's sitting in the cloud. So let's take rich media. Having something that you've stored for 25 years and all of a sudden now, I mean, Neil Armstrong just passed away, right? To pull pictures of the lunar landing and old footage on that in the whole bit, it's a time and point. And you've got only a maximum of a day and you can't afford to take half your day trying to pull the data off of it. It's just not worth it. But the amount of money you could potentially monetize that footage you have, if you want to call it that, could be huge if you're the first one out quickest to be able to go do that kind of stuff. So customers want a second tier in the cloud. We offer that. We have a deep cloud type archive solution that we do do. So yeah, it's great at one sense. It's interesting to do that. And by the way, if you use deduplication, you can get down to those types of levels without doing a five hour replace, move data around. And I'm an old storage guy and I got to tell you the only way to do this with disk is you either turn it off or you're having some sort of removable media. And when I was at Atachi, you never want to disk the turn off, especially not RAID type disk, because you'll be lucky if it comes back up and you never want to be able to move data. We used to say anytime a person had to get involved and that's when things got screwed up, right? I mean, machinery works fine, but when you actually get individuals in the middle of it. So there's a lot of questions about, in addition to that related around cost, what does this mean? Because at the end of the day, when you need that data, you need the data. Yeah, so you're saying you already offer a deep, deep archive service. It's substantially less expensive than your main line service. Okay, good. So you actually were first to market. We have some of our larger customers where we tier data with inside. So. Okay, good. Well, that's a trend we're watching. And, but I think you're right. I mean, people are going to want access to that critical data because, as Drew, you were saying, they want to monetize it, can't get access to it, can't monetize it. I wanted to ask you guys about this Cloud Starter Kit. Hear a lot about Starter Kits. What's that all about? I know you announced something with TwinStrada. Right. What's going on there? We have a lot of companies who have come to us and said, look, we want to dabble in the cloud. We want to play with it. We want to create a little environment where we can start dipping our toe in, if you want to call it that. So, we've created this Cloud Starter Kit. It's 50 terabytes. It's all inclusive. So you install the gateway product. You've access to the 50 terabytes. It's a pretty great ROI from a cost point of view. I think it's $49,000 for a 12 months usage of 50 terabytes. That's a great price point. And customers love it. It's great for the channel. One of the struggles you have sometimes of how do you sell the cloud, the on-compassing cloud.  But to be able to say, hey, here's a SKU that is 50 terabytes, everything you need to get started. It's getting a lot of traction, a lot of interest from it. Not only from a customer that wants to tip their toe in, but from an SMB type space and also the channel. So people are still concerned about the cloud. They're worried about security. One of the things that has always attracted me to your model is that you can go in the cloud or you can go on-premise. Your customer makes that choice. You made an announcement recently about getting off mainframe storage into your cloud. How's that going? Well, surprisingly, a lot of interest in it. And we knew that when we announced it, or when we looked at the market, but you never really know until after you announced it. Every major financial institution in Wall Street still has a mainframe. Surprisingly, nobody likes to talk about it. Yeah, I would say every movie studio runs all their licensing infrastructure off mainframe for the most part right now. So the one thing that, and by the way, I used to work in the mainframe world a long time ago. And the one thing that's still true that the cost for storage in the mainframe space is still a lot more expensive than the open system side of the house. So being able to come in and offer a tier for cloud storage or tape replacement and all the stuff we're talking about at the price points we're talking about, it's such a huge ROI and it's such an advantage. And these guys have been looking for this from that perspective. A lot of people aren't really innovating in that space, but that space has not gone away. I mean, the idea that the mainframe is dead is, you know, it's actually grown. When you look at some of the numbers that IBM has shown if you peel back their hardware numbers. So we think it's a huge space, you know, EMC, or not EMC, did a domain went after that space pretty aggressively when they were a standalone company. And we think we'll have similar success in that space. Okay, so you, is it generally available to the service? It is. And you've sold some? We haven't sold any yet, but we've got about 10 proposals out. You do, okay. And they're big deals. Genuine interest and you think you'll close some deals this year? Yeah, I mean, it's triple digit terabytes. Yeah. I mean, it's not five terabytes. It's a lot. And it's all sitting on tape today or? Tape or storage, you know, either or, but a lot of it's on tape, but a lot of it's sitting, it's just like any environment. There's a lot of data that sits out there that's probably 60, 70% of your data that you haven't touched in a year or two. And that's great, you know, a great cloud opportunity for us. Interesting. All right, Scott and Drew, thanks very much. Appreciate you guys taking time out to come in the cube. We're here live at SiliconANGLE TV's continuous coverage of VMworld 2012. Again, gentlemen, thank you very much. Thank you. Good to see you, always a pleasure. And keep it right there, we'll be right back. All right. 10 years ago, the video news business believed the internet was a fad. The science has settled. We all know the internet is here to stay. Bubbles and busts come and go, but the industry deserves a news team that goes the distance. Coming up on social angle are some interesting new metrics for measuring the worth of a customer on the web. Every morning, we're on the air to bring you the most up-to-date information on the tech industry. With scrutiny on releases of the day and news of industry-wide trends, we're here daily with breaking analysis from the best minds in the business. Join me, Kristen Folletti, daily at the news desk on SiliconANGLE TV, your reference point for tech innovation.


So Faraday set up almost exactly this experiment, except instead of a permanent magnet here, he used an electro magnet. So instead of having one coil and a magnet, he had two coils, and one was attached to a battery, and one was attached to an ammeter. And he found that he didn't get any current in the second coil when he just left the first coil sitting there, unsurprisingly. More surprisingly to him, when he connected the battery to the first coil and left it running, he also didn't see anything in the second coil, except for a little flicker when he first connected it. And then when he disconnected it, he got a little flicker again in the opposite direction. And so he was getting an electric field running around that loop, only when he was changing the magnetic field that was going through that loop. And so Faraday's discovery of this process, which was called induction, so called because the changing current in one loop induced a current in the other loop, and it was James Maxwell and Oliver Heaviside, who later went on to quantify that and really describe exactly what was going on. And it turns out that exactly what was going on was that it wasn't just the magnetic field, because the magnetic field is different at different points. So at different points throughout this entire loop, there's different magnetic fields. And even at different points of this coil, there might be different magnetic fields. And it turns out that what's important is not the field at a particular point, but the whole magnetic flux going through that loop. And we'll discuss exactly what that is in a minute. And the changing magnetic flux causes a force to act on the charges going around here. And this is an electric force. So we've got an electric field going around. And we know that if we have an electric field, that's a force-punit charge. And if the charges go around at a certain distance, then they get a certain amount of energy-punit charge. And energy-punit charge is an electric potential. So we get another potential difference going around this loop based on the amount of changing magnetic flux we have.


Good afternoon, everybody. I hope you have grasped all of the needs and priorities that I need to guide you through this afternoon. Today is a really exciting lunch, because it is the first digital health lunch of this academic year. The digital health lunch is a collaboration between the Berkman Klein Center for Internet and Society and the Petrie Flam Center to bring interesting programming from around Boston about what's going on as people try to use the capabilities of data to really push forward health. We have another event coming up very soon, so I would suggest that you check out our websites. It's available both on the Berkman website, as well as on the Petrie Flam website. So speaking of Berkman and Petrie Flam collaborations, next week on October 24th, we have a big all-day conference looking at drug pricing. We know that the topic of drug pricing has gotten a lot of press, a lot of ink, a lot of words have been spilled on that topic. What makes this day a little bit more interesting is that we are looking at the drug pricing policies, both in the United States, as well as globally, and trying to pinpoint the interaction between those two fields. So please take a look at the Berkman site, the Petrie Flam site, please RSVP, so we know exactly how many brownies to provide over the course of the day, and we hope to see you at many more of our events. So I am Carmel Schachar, the Executive Director of the Petrie Flam Center, so I have a vested interest in getting you to our events. But more importantly, I am a friend of our fantastic speaker today, Rachel Gershen, who is a senior associate at the Center for Health, Law and Economics at UMass Medical School, where she performs legal policy and analysis regarding Medicaid health reform and social services. So her specific areas of work include healthcare affordability, accountable care organizations, long-term supports and services, housing supports, language access and consumer protections. Rachel brings experience advising and representing individuals who receive public benefits, including Medicaid, Medicare, prescription assistance, SSI, and social security. Now, I want to plug Rachel's law school experience, which is how I met her. Rachel is a graduate of this school, HLS, but as well also a graduate of the T.H. Chan Harvard School of Public Health, which back when both Rachel and I were in the JDMPH program was not yet the Chan School of Public Health. I hope that makes you feel old. So if you are a student, particularly a 1L, who is interested in working in public health law, I would suggest that you keep that on your radar and come talk to either myself or Rachel. The JDMPH program is always looking for people really motivated for that. So the last couple of things that I want to plug for you before I hand it over to Rachel is that to be aware that these lunches are webcast live and recorded for posterity. So I hope you got your hair done before you came here. As well as to please continue this conversation, not only in the audience Q and A that we'll be having towards the end of the session, but also to tweet, especially if you're not in the room but you're watching on the webcast, you can tweet us at BKC Harvard, that's Berkman Klein's Twitter handle, or at Petriefarm, which is Petriefarm's Twitter handle. And with that, I won't take up too much more time, but I will ask everybody to give Rachel a warm welcome. Good afternoon, everyone. I had to check the clock. Make sure I had the right time between morning and afternoon. So when Carmela and I were in school together, it was a great class. We were four who did a JD-MPH together. And I have to say throughout my career, having both an MPH and a JD has been really helpful. Working across the boundaries of law and public policy and public health has really enhanced my experience in the world. So as I was mentioning, Carmela and I were together at Harvard Law School and the TH-Tan School of Public Health, and we were a class of four. And throughout my career, having both a master's in public health and a JD has been really helpful to bridge the divide between policy and law and figuring out how to get people accessible, affordable healthcare, and also addressing social determinants of health. So I want to talk a little bit about my organization. I'm part of the University of Massachusetts Medical School, which is centered in Worcester, Massachusetts. I'm part of the Center for Health Law and Economics. We're just up the road on Cambridge Street in Charlestown. And our function is to work with state Medicaid agencies and also with health foundations, providers, other entities to think through several aspects of health policy and health law. I tend to focus on the state's relationship with the federal government, for example, how to be able to draw down funds to fund Medicaid programs. We are often hiring, feel free to check out our website. And I also wanted to mention that we support the medical school in that we essentially act as private health policy consultants. But at any margin goes to the medical school. So that's how we function. So today I'm going to be talking about Medicaid work requirements and disability in the role of digital health. So last month over 4,300 people lost Medicaid in the state of Arkansas due to their work requirements. Under the program, if a person does not meet that 80 hour requirement for either work or volunteer activities, or if they don't meet an exemption, then they are off the program until January of next year. So three months of not reporting, then you get kicked off Medicaid until the first of the next calendar year. And I should also mention, it's also for the expansion population. So if you're on traditional Medicaid, it doesn't apply to you. These, this is the first monthly wave in kind of a raft of states who are either asking the federal government for permission around work requirements or already have received permission. So Arkansas and Indiana has been approved by the federal government. Kentucky was also approved, but you might remember there was a court case that has invalidated their approval right now because it did not meet the goals of the Medicaid program, but they are trying again with a new proposal. And there are 10 other states pending asking for work requirements. And New Hampshire is also approved. In August, three people sued the state of Arkansas challenging the state's work requirements. And one of the plaintiffs mentioned in the complaint that she had been unable to work for a year due to medical conditions and that the state of Arkansas told her that that was not enough to meet a disability exemption. So that piqued my interest in what's the process for getting a disability exemption, who's in, who's out, what's the role of digital health in making sure we get this accurate. So how can states ensure that they're exempting all recipients who are unable to work? In the media, when work requirements are mentioned, they're often mentioned in the context of people who are able-bodied in terms of work requirements only apply to people who are able-bodied, who are able to work. How can we be sure that we're exempting all people who are not able-bodied is essentially the question of this talk. So Arkansas, Indiana, New Hampshire, and Kentucky all have what's called agreements between CMS and the state when they get a waiver amendment approved. And part of that agreement says that they will exempt people with disabilities, with medical conditions, caring for people with medical conditions, and a term called medical frailty, which I'll also address throughout this talk. So thinking through the challenge of making sure that we exempt all people who are not able to work according to the 80-hour standard or whatever standard the state puts up. I think it's good to look back at the welfare program because there's similar exemptions that have happened in the welfare program around the welfare-to-work requirements that were put into place in 1996. States had a little bit of flexibility around welfare-to-work. They had to make sure a certain percentage of their welfare population was engaged in work activities, but they could exempt some folks. It didn't help their percentage. They couldn't exempt them out of the percentage, but they could exempt them from their own program requirements. A number of states decided to exempt folks with disabilities, but recent research has shown that despite the exemptions and despite screening many times during the process, people with disabilities were much more likely to be sanctioned on welfare than their able-bodied counterparts. So when thinking about disability determinations, experts will tell you that the process is nuanced, it's complicated, it's time-consuming. I worked for a very brief time as a public-benefits assistance person before law school and then in legal services after law school working on social security. I would work months on a disability claim and that would only be a small portion of a person's attempt to get social security. Takes a long time to determine if somebody is disabled. And states with these Medicaid work requirements that require you to report work or report exemptions within five days of the next month, essentially they have to speed up this process of disability exemption that usually takes months or years to get right to a matter of maybe, I don't know, weeks or months depending on their process. So can states get assistance from digital health? I was thinking through all the digital health tools and how a state might use these tools to focus on people with disabilities and be able to exempt the full population. States use, for example, data matching to make sure that if somebody is determined eligible by another agency that they are determined eligible by Medicaid for the exemption. States also use claim analytics. For example, if we're designing a program in Medicaid that focuses on a certain group of people, maybe people with high risk medical conditions or need of care coordination or care management will often use these types of data analytics to look at, for example, people who have spent at least $10,000 in medical expenses last year or who have certain diagnoses. Maybe these can be helpful. So on one hand, digital health could help identify this population. But on the other hand, there's a risk that using digital health might increase our reliance and mask some of the flaws in the system. For example, folks in the media saying that these requirements only apply to able-bodied folks if they really don't apply only to able-bodied folks. So I constructed this very simplified graph. Over on your left-hand side is able to work, and here I mean able to work according to the standards of the Medicaid agency. In the middle is not able to work, but not yet determined, disabled by an agency, and over on the right is determined, disabled by an agency. So I'm gonna talk about a few examples taken from my experience as a legal services attorney and as a public benefits advisor, thinking through how a person might intersect with disability throughout their life going towards a disability determination or going towards an ability to work. This first example is someone who is able to work at the beginning, but then experiences a pretty sudden and severe disability and fairly quickly receives a disability determination. Each node represents a moment in time, so the more nodes, the longer a process will take. So you'll see here that the person started able to work, they went towards the middle, not able to work, not yet determined, disabled because they're getting their application ready for social security administration, and then finally they're determined, disabled at the end. The red circle in the middle represents the point in time when they find a medical professional who's willing to defend their case, willing to put in the evidence, the diagnosis, all of the medical records required to prove to the social security administration that you are disabled. This example is different. As you can see, there's a lot of nodes representing a long period of time. This person eventually receives a disability determination but only after a long process. And you notice the process from able to work to not able to work, to getting a medical professional to buy in takes some time. This may be because a person has a disease that's difficult to identify, diagnose, get someone on board. It could mean that their condition is gradually deteriorating. And on the other side, from medical professional buy-in to the social security administration determination, that represents the long period of time that it often takes people to get a disability determination. The process, if you may know, if you've worked on social security cases, is typically initial decision, redetermination and appeal, and maybe some other steps after that. At the appeal stage, 40% of people get approved. So this is not a small number of folks who were missed the first or second time around. It's a fairly large number. And if you are at the hearing appeal stage, your average is about 27 months from the turning in of the initial application, which itself takes time to prepare. So this is kind of a typical process for people who've been eventually determined disabled. In this next example is a person who's able to work and stays able to work even though they have disabilities. I just wanted to have the full range, or not the full, but an example of the full range, the diverse lives of people with disabilities. Not everyone with a disability cannot work. That said, that person might still experience barriers, like disability discrimination. They might experience transportation barriers or other things in the way of being able to work. The second to final example is somebody who kind of is on the edge of ability to work. So they may be able to work one month, but not the next. When I was doing public benefits assistance, my clients who were experiencing issues with mental health or substance use sometimes felt into this category where they could work for one month, but it just took a toll on them, so they had to take a break for a while. And you can imagine this does not meet the work application process, like just because they're able to work those three months doesn't mean they're gonna immediately be able to apply, get a job and start getting paid and start meeting the requirements of the state. And also notice there's no red circle. So they haven't been determined by a medical professional disabled enough to go after Social Security. They're kind of right on that line. And then finally, this person was able to work, became disabled and did not get a medical professional buy-in and did not get a determination. So some folks stay in this middle area for a long time. And I think this middle area represents the highest risk for people who might be missed by a state trying to exempt people with disabilities. And it's the place where I'm gonna focus on when working through some digital health tools. So just wanna mention, this is not representative of everyone with disabilities. There's a lot of nuance here. There's a lot of intersectionality here. For example, women often experience medical conditions that aren't well researched in the scientific community and that can take a long time to get a diagnosed by diagnosis by a medical professional. Even if you're able to work, you may not be able to get your application in on time, find a job free of disability discrimination in the hiring process and be able to work immediately. For folks who are homeless, for example, it's been shown that it's harder for them to get onto disability than other populations. For folks who have substance use disorders or folks who do not have enough hours or don't have low enough income, all these little factors that Social Security looks at in addition to disability, they may not bother applying because they know they're not eligible for other reasons. So now I'm gonna turn to data matches. So this is kind of the first cut to try to find people with disabilities in the context of a Medicaid work requirement program. So states already use data matches a lot. Arkansas data matched against SNAP work and disability exemptions and it also, through its medical frailty exemption, also data matched through the Social Security administration process. So there is some data match going on. States could expand it, for example, some welfare states data match to veterans affairs and there's a lot of different agencies and programs that determine disabilities. So if we look at the green, is that green? At the green box, this is my representation of kind of the portion of the population who would be covered by a data match and you see it's all the way over on the right. It's not covering folks who are in the disability application process. It's not covering folks who are trying to get a medical professional on board. It's not covering folks who are going in and out with the ability to work or other processes. So it's a pretty small portion. And the consequences of Medicaid loss can be pretty big. Access to healthcare, access to financial protection, access to employment and access to disability determinations. I'm gonna focus on this last one because it shows how it's related to how you get a disability determination in the first place. Let's say for the first, going back to this example, as someone who takes a long time to get a disability determination, they're kind of stuck in a catch 22. Let's say that their doctor has told them that you really can't work 80 hours a month. That's just not good for your health.  This yellow splat indicates a break in the process towards getting disability determination because if you don't have Medicaid, then you might not be able to get access to a medical professional, to put together your medical record, to submit and get a disability determination. When I was a social security disability attorney and when I worked in public benefits, I really was grateful when a person had Medicaid or another public health insurance or health insurance in general because it meant such a big difference in trying to get their case together. On the other hand, let's say they decide to work and make those require and be able to keep Medicaid, keep going to the doctor, keep building their case. Well, then they run a danger of what's called substantial gainful activity. The Social Security Administration, when they determine whether a person is determined disabled or not disabled, they look at the work you do. They look at the volunteer work you do. And if they think that you're doing substantial gainful activity, then that's a sign that you're not really disabled enough for cash assistance. So we see here that the standard for Social Security is really high. And if you work, if you don't work, you can be in a catch 22 in a Medicaid work requirement situation. So here's another thought. Maybe in addition to having a data match for disability determinations, we do a data match for disability applications. Welfare states have done this, a few of them, especially trying to get TANF-eligible folks from welfare TANF to SSI Supplemental Security Income, which is one of the Social Security Disability Benefits. They've decided to exempt people who are in the process of applying for SSI because that gets them out of this catch 22 of deciding whether to work or not and either not being able to get medical records together or getting dinged for a substantial gainful activity. So you see, that helps a little bit. It goes past to where I imagine disability applications start, but it's still missing a lot of people. It's missing people who don't have a medical professional on board and it's missing folks who don't meet this or strong disability standard and therefore aren't going through the process of applying for disability. So thinking about who is not applying for SSA benefits. If you do applications, then you mitigate the substantial gainful activity issue, but you're still leaving some folks out because if they lose their Medicaid, then that is still a problem with the link between getting a medical professional on board, getting all the medical records together and submitting a strong application. So let's think through claim analytics. So I've worked on a number of projects where we've used claims analytics to focus on a particular population. For example, we want to help folks who have behavioral health conditions and people with behavioral health conditions are known to have a lot worse physical health. So we might focus on people with behavioral health conditions with high rates of physical health expenditures to try to integrate those services and help get the outcomes better and the expenditures down. So that's one example of you need to claim analytics. You can use a diagnosis, you can use a dollar amount for claims analytics. Also when thinking about risk adjustment, which is the process of paying managed care agencies more if they have higher acuity folks. So to make sure that managed care doesn't try to just skim the most healthy people on and try to disenroll all the unhealthy folks one way and also to be fair to managed care organizations who focus on populations that are more complex and higher acuity. One way to do that is to risk adjust, paying more for folks who have higher acuity. We've also started in the field of risk adjusting for social determinants of health, which my colleague Arlene Ash has been working on for the last few years. So that's another process, right? Where claims analytics is identifying people with high acuity or with disability. Maybe these processes could be used to help identify people with disabilities in the context of Medicaid work requirements. This is my very guesstimate of what a claims analytic procedure might do that it'll cover some people, but not all. And there's a few issues with this. There's time delay in claims analysis, making sure you have a person with the most recent claims is important when doing this. There's also claims are pretty course predictor at times, especially around risk adjustment. For example, somebody may be disabled, they may have depression and not be able to get out of bed in the morning and not have a lot of medical expenses because they're not going to the doctor. They're still high acuity but they're not getting help. So it's not showing up in the claims. Another example is diagnosis. But diagnosis doesn't talk about functional status. And here we see where states try to do a disability assumption. This happened in some welfare states where they would use diagnosis to try to figure out who has a disability. You can't tell from a person's diagnosis whether or not they're able to work. The social security process looks much more at what you can functionally do. Your activities of daily living, your activities of work, looking at your age, what your experiences are. Are you a lawyer or not? And matching it to the employment workforce and the jobs available. It's a much more nuanced approach than kind of some big data health look would do. So here I wanted to talk about one particular consequence of Medicaid loss and that's loss of access to employment. So if we think of what Medicaid does is it helps people get better in some cases. And in those cases, if a person is not able to work, sometimes they're allowed to work after. This is a recent evaluation done of the Ohio Medicaid agency. And it showed that of people who are employed, 83% of people said that Medicaid helped them get back to work. This is an evaluation of the expansion population. So the same kind of population as Arkansas and other work requirement states. And then among unemployed, unemployed enrollees, it's still 60% to make it easier to look for work. And that kind of follows a logical pathway, right?  When I was a public benefits advisor, I would see this pattern again and again where a person would be employed. They would get sick, they would try to work as hard as possible, as long as possible, but eventually they would lose their job, they would lose their health insurance with this. This was before the Affordable Care Act, so they didn't have a lot of options. So they would either be low income enough to apply to Medicaid or they would try their luck on the individual market, which with preexisting coverage was not very helpful. So people were stuck, and I think Medicaid expansion was in part in response to that stuckness of people in this country when we have employment tied to health insurance so closely and your health status influences your employment status. I think it's important to have a safety net that also doesn't rely on your employment status or else you still get that stuckness. So this is an illustration of the person in and out of the ability to work and if they don't have Medicaid, they're not able to get back. And finally, thinking about this person who has remained disabled but not able to get a medical professional online, maybe because their condition takes a long time to figure out or they just have a loss of access to healthcare, not being on Medicaid is not gonna help them get back to work. So going analog. What happens when people self-report, process for analyzing the self-report and who bears the burden of uncertainty. So this is what I know about the Arkansas process. Let me flip so I can get these numbers right. So in August 55, people applied for an exemption. So a very small portion, 45 got it. When you're applying for a work exemption, you click on disability as a barrier to work, but it doesn't define disability and I have to have a caveat here. I didn't reach out to the state of Arkansas, I just took some of their training videos to see how it would work in the system. So they may have fixed this. And then on the next page, you have to click under penalty of perjury that you're saying that you're disabled. So who bears the burden here of determining the standard of disability that they're applying. After you click on disability, Arkansas says that it'll send you a letter about how to proceed. So there's not a lot of information yet about the process, how they're planning on doing this disability determination for people who self-report. And thinking about the risk of this. Who bears the burden of uncertainty around who gets to be determined disabled and who doesn't I think is important to think about because if your risk is losing Medicaid or working, that's a hard choice to make if you're disabled. And some other data in Arkansas and 19,000 people were found to be working according to their state records. So they didn't have to report. 7,000 were matched under SNAP work or disability requirements or disability exemptions. And 6,000 were matched under medically frail, which is it's a term used in federal law to make sure that states who are expanding Medicaid have the medically frail keep traditional Medicaid. And definitions differ by state. In Kentucky, for example, if you're homeless, you can be medically frail. For Arkansas, they did a data match against social security determinations. They used claims and algorithms to determine who would be medically frail for that purpose. And they used a questionnaire where they asked, are you unable to work even part-time? Which you'll notice doesn't meet that standard of 80 hours a week. You can say that I'm able to work part-time but still not meet that standard. And I think the medically frail gets close. It's identifying a portion of the population who were already identified beforehand. But it doesn't ask the exact same question. So again, we're missing people. We're missing people who've become more disabled since the last time they took the medically frail questionnaire. We're missing people who may not meet that medically frail ambiguous standard but can't be able to work. So just another point in uncertainty. I heard Sarah Cliff talk a few months ago on a podcast and she mentioned somebody she met in Kentucky who had vertigo, was unable to work, and that person didn't know on the eve of Medicaid work requirements whether she would be disabled or not. There was, as far as she knows, she didn't know the standard or the process for being able to apply and be determined disabled or not by the state. And again, this comes with a lot of caveats. I haven't done extensive reporter-like research into what these standards or processes are. They might have gotten better. They may have a process that's only available to Medicaid recipients. So this kind of leads me to the question. Are Medicaid work requirements worth it? What are we willing to trade off to get a Medicaid work requirement? One recent article in JAMA did an analysis of SIP data throughout SIPP data throughout the nation to see who would be eligible for a work exemption or meet the work requirements. And they found that only about 0.3 to 5.4% of recipients either don't meet an exemption category or don't meet work requirements. That's a pretty small portion of your Medicaid population. On top of that, those researchers used that higher social security standard, eligible for SSI. So that's not even looking at the middle ground and looking at the number of people who would be eligible. So thinking through, you're looking for a needle in a haystack. Medicaid itself is a work support, so you might be cutting off that process where somebody gets better and gets back to work. And you have a potential for disrupting the disability determination process in general. So thank you so much for listening to my talk. I really look forward to answering questions and getting into discussion and hearing what you think about whether you think my thoughts are right or are missing the base. Thank you so much. Excellent. So thank you, Rachel. We're gonna keep her up here for questions and Dan is running around with the microphone. So if you have a question, raise your hand. But I will take moderator's prerogative to kick it off. Excellent. So it seems to me there's kind of two themes we're talking about here. The fact that our data systems are imperfect for measuring what we want to measure and then whether we should have Medicaid work requirements at all. Could you envision a situation in which we could improve our data collection systems to the point where you would find work requirements to be workable? Please excuse the pun. No, I'm not sure. I've spent a lot of time over the last few months thinking through this. And I would love to hear opinions about where I might be wrong here, but the Social Security Administration has been doing this for a number of years since the 70s and they haven't come up with a faster, cleaner process. And they are underfunded on the technology side, but I think there's an incentive to try to find a better way to find people who are disabled through some sort of big data match. And I just haven't seen it yet, but maybe I'm wrong. There's also a whole raft of other criticisms against Medicaid work requirements that I didn't get into around people with part-time work and different aspects of working while you're low income. But for this particular question of is there a technological way in the future to identify people with disabilities? I'm not seeing it yet. All right, audience questions? The issue of people's ability to work being a factor in whether they can get the assistance. And this happened in California. My question is how widespread is this? A friend who had been seriously injured in a car accident tried to go back to work and was unable to do it. And she was judged ineligible for assistance because she had gone back to work. And is this a widespread problem? Yes. And I think it's important to think of the Social Security Administration and the Social Security Fellowship. She described the situation a long time ago. So can you say for sure which government agency was and could welcome social security? Of course, of course. I think that in my experience of doing benefit help with folks, there's just a lot of people who meet the middle. And with America's work ethic, honestly, people I meet are trying to get back to work. That was when their life made sense for a lot of them. I wanna be careful about how I talk about this because there's a range of experiences you can be not working and happy. Work does not equal happiness. But I think in our culture, that's definitely the message that your work is your worth. And I think there's a lot of strong headwinds or tailwinds, whatever it is, towards a person finding work despite barriers they might experience. So the gentleman in the white shirt. Hi, great. Thanks for coming and having the talking. A lot of the framing for the process being so long and problematic seems to be about an issue of bureaucratic capacity. But other disciplines will often talk about specifically welfare requirements and work requirements as a matter of politics or a matter of putting up barriers to keep enrollments low. So to the extent that, in your mind, how much of this is a problem of capacity versus a problem of politics? And to the extent that politics is involved at all, is there any concern that increasing digital capacity will just promote, let's call them reformers, to circumvent those systems in new ways and then putting up even more barriers in ways that we haven't conceived of yet? So I might go on a bit of a rant here. Please. When we think about how America treats public benefits, access to basic housing, food, medical care, often people are put into two groups, deserving poor and undeserving poor. And we've spent a lot of time debating whether you're deserving or not. There are something like 200 categories in Vermont Medicaid to determine whether you meet that certain category to be deserving of Medicaid. And that's both a function of federal law and of state law determining whether you pick certain options for populations. And all the rhetoric that is around deserving and undeserving poor, it adds to a bloated bureaucracy in the eligibility world. And that bloated bureaucracy blunts our ability to use the tool of public benefits to address societal problems, right? Like if we weren't so concerned in spending a lot of administrative resources to determine if someone is actually disabled or not or actually working or not, think of how much easier it would be to apply and to apply those funds to the people who really need it. I mean, in there, there's still some administration around targeting certain folks who need it most. But for example, in social security, if you're working, your paycheck is dinged against your benefit. And for SSI, it's determined, I think based on the day you get your paycheck, on SSDI, it's based on the day you earn it or something like that. It's so complex to try to intersect with public benefits and become eligible and stay eligible that I think if we work on lessening the divisive rhetoric, we might actually get less bloated bureaucracy. Yeah, I think you had a slide which showed data matches and several categories. One of them is the SNAP program. So I may be, I'm not knowledgeable enough about this, but the SNAP program is food stamps. Yes. So what exactly is being matched? I mean, these are not people, these are people, basically poor people. Food stamps has work requirements now. Oh, okay. And they have disability exemptions for those work requirements. Sorry, I wasn't clear. I'm just visiting on campus today in Popton. But I'm glad I did. I'm what you call a lay minister in the church in Tucson, Arizona. And we helped the ministers out and we're assigned people, it's all confidential. Now, what if I'm thinking to myself, what if I have a woman, let's say it's a woman who maybe qualifies for a lot of these benefits. I don't know anything what the state of Arizona requires. Would it be who made to start investigating so it could work? Because it looks like a lot of work, a lot of time. And I'd like to help someone, but there's gonna be a lot to know, isn't there? You know, I applaud the impulse to help people. I have found helping people find benefits is my favorite thing to do. It's like the big puzzle. I've been doing it since I was 22, just out of college. And the reason I became a lawyer was the closest I could get. This is before Affordable Care Act navigators. There wasn't really a job description for what I was doing. So my advice to you is to check out the state's Medicare advice place. It's either called SHINE or SHIBA. There's some, or SHIP, I think that's the federal term. And what they are, it's a group of volunteers. You get about 40 hours of training from your state's insurance department. It's how I first learned the difference between Medicaid and Medicare. And people call in and ask questions about Medicare. And you can help them navigate the process. For example, getting help with your Medicare premiums. You can get help if you are eligible under some Medicaid programs that are very underutilized. If you don't get Medicare Part B in time, you could be paying a penalty for the rest of your life. So there's some very particular points in Medicare benefits that you can have a positive income effect on some low-income folks. That's where I would encourage you to go. I think. Hi, this is sort of like an opposite of whatever you've been saying. Yeah, sure. What do you do about all the fraud you're seeing around you? For example, I live, we moved just recently to a senior complex. And most of those people look to me really fine. They're going, watching ball games, et cetera. And they're all getting disability.  And these guys are having a great time. So how come all these people qualify? And how come there are lawyers out there who fill out the forms for them? That's a great question. Thank you. And it's a sentiment I hear a lot. I think it's a very common sentiment. Why are people who are getting disability benefits getting that they seem to be fine? They seem to be able-bodied. Why am I paying for their income? And I think this is tough, right? In this environment of divisive language and just kind of looking at someone and thinking that they should be working, there's a lot of people with invisible disabilities, especially in the mental health space. There's a lot of people, for example, who may or may not use a wheelchair some of the time to help them get around and not others. And just because you're not in a wheelchair doesn't mean you're not disabled. And the social security process is so long and so such a high standard. I would ask more questions before assuming that they're not eligible. And I would also think about when we're designing public benefit systems, a lot of times if you become eligible for let's say social security disability, there's a very strong incentive to not go back to work even if you're able because you could lose your benefits. You could become in debt. I had clients who were 40, $70,000 in debt to the Social Security Administration because even though they reported their hours, Social Security didn't write it down right. And they levied it against them years later. So you only have to hear a few of those stories before becoming very cautious about moving from one, if you're thinking about my diagram that I showed for 20 slides, one category to the other because it can be pretty hard to go back. So I would just encourage you not to make assumptions about a person's ability to work just like you can't tell in claims or diagnosis or data matches, you can't necessarily tell by looking at them. Any other question? I'm wondering if the system makes it easier for the employers to not provide health insurance. Does the system make it easier for employers to not provide health insurance because you have a work requirement but it seems like there's assumption that okay, they'll still have the Medicaid even though they're working. So the employer doesn't have to do anything. Is that right? Now you're calling me out on what an employer's requirements are now under the Affordable Care Act. I don't remember if it's still delayed or not. Do you know? I can't help you on your design. So there is a federal requirement that may or may not be in place for employers of a certain number of employees to offer health insurance. There's also requirements in the state of Massachusetts for employers of a certain number of employees to offer health insurance. And I think the research that's been done at least in Massachusetts is that the existence of Medicaid has not dramatically decreased the number of people with employer-sponsored health insurance. Here, I don't think it affects their obligation as an employer. I think in general, when we reduce the robustness of our safety net, it may pull people into more desperate circumstances in terms of work conditions. So thinking about it as a labor issue. Sometimes labor is a little bit not aligned with kind of cash low income benefits. But if you think about it in terms of if there's people who aren't getting benefits because they're not working, so they have to work. That means that employers don't have to offer as rich set of benefit packages because there's more people trying to get into the labor force. So there's some interesting questions to ask there. You described these different categories of people, some people who get determination quickly, others take long time, others bounce back and forth. And so I'm wondering has there been research to try to determine how many people are in each of those groups which would inform, potentially inform the policy? I would love to get funding for such research. Let me know if you know any of the resources. This was, and thank you so much for inviting me to come. This was, I wanted to pick a topic I hadn't known a lot about before to use the fact that I have to stand up in front of a bunch of people and talk about it as an impetus to learn it fast. So thank you for being my first try and talking about so. I think we have a question over here. Yeah, when I signed up for Medicare, it seemed like their website was just unfathomable to a person of average intelligence. And do you think that this is much of an issue for the people that you are talking about for trying to get onto such programs? So Arkansas, and I keep talking Arkansas, I don't mean to pick on them. They're just the only state that's implemented the program so far, work requirements. So their website, it used to be that you had to use the website to record your work requirements. Advocates, this is an advocate, but Kaiser Family Foundation has some great briefs about how hard it is to navigate, the get an account, get on, and report your work requirements. Arkansas is one of the least connected states in the United States. And at one point, I don't know if this is true anymore, but the actual website to report your work requirements was only open during business hours. The website shut down after business hours. So Arkansas also offered, they had to promise to offer reasonable modifications to the application process. So that might be another avenue. If for example, you have a disabled client that even if you can't, one avenue is to say, hey, you need to make this reporting process easier or even reduce the number of hours for me. There are some other obligations, not just wholeheartedly fully exempting people with disabilities, there's some other obligations as well. And I think the website might be a prime target for those obligations. Later they said you could call, but there was issues with calling as well, so. Thank you so much for your wonderful, wonderful presentation. I wanted to know if you think the disparity in the data analysis perspective, do you feel like the problem is simply from a policy standpoint of implementing it or is it also a technological standpoint where if you had better programming or more funding or more sort of the technology aspect of pushing that, would that also help increase the problem? I think I go back to the Social Security Administration who's had to determine whether a person is disabled or not since the 70s and it's still a really long process and really they have thousands and thousands of employees working on this. It's just really intense and I think it's also indicative of the nature of how we experience life, health, our bodies, disability, is different than the black and white nature of public benefits eligibility. So any more questions? I know that class is about to start for the people on class schedules, but we want to give you guys the chance to pick Rachel's brain as thoroughly as possible. So, no, okay. Oh, do I see in the back maybe this corner's a tentative hand? Nope, okay. Going, going, gone, I will say. Let's give Rachel a big round of applause. And thank you guys for coming. Please explore the rest of our digital lunch series as well as there's an event tomorrow looking at vaccines and then as I mentioned the drug pricing event next week that we hope we see all of you guys at. Have a good day.