What If the Best Healthcare Decision Wasn't Surgery at All?

Speaker A: Foreign. This is the Disrupt Healthcare Podcast.

Speaker B: Welcome back to another episode of the Disrupt Healthcare Podcast. And, um, I forget who I was in college and they had a place called Bagel Bagel. And they said it was so good we had to use the name twice. This speaker, this guest was so good we had to have him on again. Uh, Doc, for anybody that missed our first, uh, set of interviews, uh, and has never met you or your great company, give us an introduction.

Speaker A: You know, I like to name it twice. Like New York. New York. Right, right. I'm a New Yorker. Yeah, no, I'm Steve Schultzer. I'm an orthopedic surgeon practicing in the insurance capital of the world, which, a trivia question. Hartford, Connecticut. I didn't know that my subspecialty, Lester, has been, uh, joint replacement, uh, otherwise known as a sterile carpenter. Just replaced hips and knees, stopped operating a few years ago to come full time. As, uh, co founder, chief medical officer of Upswing, I've been involved and interested in true value based healthcare. And I know people say, what do you mean by that? And I can define it. But probably since 20 years when we started launching brick and mortar centers of excellence for orthopedics, got involved in the Harvard Business School and really, really enjoyed looking at a better way of delivering orthopedic surgery. Uh, again, thinking of the surgical, uh, realm of orthopedics. But fortunately, as we said the other day, most of orthopedics is not in the operating room. Fortunately. So, uh, that's a little bit about me. I'm from the Bronx, New York. Don't hold that against me. Um, I moved from a Yankee to a Met fan. I don't know why I did that, but I don't know. I'm m paying the price now.

Speaker B: So, Doc, uh, when we talk about Upswing, tell us what the value prop is for, uh, Upswing.

Speaker A: Yeah, this is really important, Lester. So my co founder, Jay Kimmel is also an orthopedic surgeon and we work together building these brick and mortar orthopedic centers of excellence. Really important. But we both came to the conclusion that who you see when you have an orthopedic event, and as you know, half of us have an orthopedic incident every year, so it's ubiquitous in our country. Who you see for that very first visit dictates the clinical outcome as well as the cost of that journey. Right. And you know the health system far better than I do. The incentives are misaligned. Right. And, uh, what I'm about to say or say during our conversation is not meant to disparage any of my colleagues because it's just a system problem. But let's say, you know, you roll your ankle playing soccer with your kids, it gets a little puffy and, you know, you don't know what to do about it. It hurts a little bit. Oh, yeah. I better go to the ER, get some X rays. Well, then that ER visits can be 2,500 bucks. And your ankle's not broken because you finished playing soccer on it.

Speaker B: Right?

Speaker A: So what most people need, because most people experience low and medium acuity orthopedic events, what they want is advice. Right? As an orthopedic surgeon, not unique to me or to Jay. We've got hundreds of friends and colleagues and neighbors who knock on our door, text and email, hey, my son just did this. My back hurts. They just want guidance and advice. Lester. So we built this company, we use the term the ouch moment. If you're in Puerto Rico or Hartford, no matter where you are, when you have an ouch moment, you want an answer. Two questions. Where? What is it? And what do I need to do about it? And if you can do that without going to the ER or your primary care Doc, that's what people want. Life is complicated. So that's what. We built a company around that ouch moment. To give people the advice they want right from the beginning so they get on the right path. The most efficient course on that health care journey.

Speaker B: So, doc, uh, let's. Let's play that scenario, right? So, uh, I'm not a soccer guy, so I'm going to change it to, uh, baseball. I'm rounding second. I step on the bag. It's weird. I, uh, ouch moment. Get done. I have a phone number I can call. Who's on the other end? Walk me through from that ouch moment. I was actually listening during open enrollment. I know I have this benefit. Who am I calling? What are they talking me through? Walk me through that.

Speaker A: Yeah. So if you know you've got the benefit, that means that my company, Upswing, has a relationship with your employer. It almost always we work off of a file transfer, SFTP file electronic transfer. It's refreshed once a week, every other week. What you would do is go to signup office upswinghealth.com. you come on to our site pretty quickly. You put in your name and your email address. You get an authentication factor because we're SOC2. And then within minutes, you're on our platform. Lester, once you're on our Platform, we ask you two questions. Do you want to learn about your condition or do you want to talk to somebody? We give them that choice. Most people want to talk to somebody when they're in pain, but some, it's more subacute, not like yourself. And they'll say, let me learn about it. So let's say we went down that pathway. They click on that button and they would be brought into our diagnostic tool. We call it a symptom assessment tool. And we built these algorithms with 10 very smart orthopedic subspecialists. We cover everything from head to toe, 160 different orthopedic conditions. And we built these algorithms as if you were sitting in front of me with your sore ankle. How did it happen? Where does it hurt? Did you ever have it before all these questions? So it duplicates the doctor patient experience. And as we learn in medical school, 80% of a diagnosis is a history. Right after doing this for three decades or more, I know what your situation is. Just right through you tell me, I know what your problem is. So these algorithms think and they give you a differential list of conditions. And then you go, oh, you click on another button and you can read about that condition. Very thorough PDF, easy 8th grade language. So if you roll your ankle, you're not going to die of bone cancer. It's very curated. And at the end of that you can say, I'm good, thank you. I know it's not broken because I'm jumping up and down on it. Or you know what, I actually want to talk to somebody now. So they click on another button and, and they would then come into our scheduling platform. At that point, Lester, you would have two choices. Talk to somebody immediately, within 15 minutes, and that individual will be a licensed athletic trainer. Licensed in the state that you're sitting in. The software, um, does the matching and then you would have a 30 minute telehealth visit with our athletic trainer. Or, Lester, you may say, you know what, I actually want to talk to a doc. I want to skip the athletic trainer. You would get into our scheduling and again, you will be matched with an orthopedic specialist wherever you're sitting. And that's within 24 hours. Most people in pain want to talk to somebody now. And they'll start with an athletic trainer. A little secret, Lester. Maybe it's not a secret as much anymore, but athletic trainers are the most underappreciated stakeholder in orthopedics. Um, they're very smart. They've had years in the locker room Working with athletes. They're fabulous at secondary triage, knowing what they can manage without escalating to a doctor. That's what they do. That's what they're trained to do. They have masters in exercise physiology and kinesiology, so we have a national network of ats, and they're worth their weight in gold. What they would do with you, Lester, with your ankle? Uh, use case. They would ask you the Ottawa ankle rules. Have you ever heard of the Ottawa ankle rules?

Speaker B: I have not.

Speaker A: You're not from Ottawa, but I was in Ottawa on a motorcycle trip. My buddy rolled his ankle. We went to get an X ray in Ottawa and the ER doc asked us seven questions. I said, just get an X ray. I'm an orthopedic surgeon. And the ER doc said, I can't. Uh, you've got to answer these seven questions. And if you get five of them right, you get an X ray. If not, you don't. So, and that's been. That's a validated tool because there are millions of waist and ankle X rays that you know are going to be normal. So we would, the athletic trainer would ask you these list of questions, and if there was any concern about an ankle fracture, she would jump on it and escalate immediately to one of our orthopedic docs. So that's kind of how it works, um, to go a little bit further beyond the acute ankle injury, which, by the way, is the most common orthopedic injury on the planet. You know, the, the docs that get on with you, let's say, was something not acute ankle, but your knee sprained or something. We then have our imaging vendors, we do some E prescribing, our athletic trainers do, um, injury rehabilitation and so on. We manage the whole episode.

Speaker B: So in that scenario, right. If I didn't have this benefit, let's go back to. I agree with you that everyone's going to want to get some care, right. So, you know, if it's a kid, mom's taking me to the urgent care or the er, I'm probably a little stubborn and I'm going to wait it out because I don't want to sit in the er, the emergency or the urgent care. But a lot of times people are going to go get that. So from a cost standpoint, a wasted effort standpoint, I mean, we can go as deep as. That X ray wasn't necessary. And we expose people to X ray. Yeah, like all sorts of different things. Uh, but the thing that I think is really interesting in this is how much better the patient experience was, right? Because you took this, this time of, um, you know, high emotion and you gave somebody some peace of mind to make a clear, sound decision where, absent of that, I think people are always thinking the worst, right? They're always thinking, oh, my God, what if it is broken? I need to go get in there and see it. Uh, and then on the other end, as the practitioner becomes an interesting thing, because nobody wants to wait in that waiting room, pay what they're going to pay. For them to be like, yeah, put some ice on it and go home. You're like, I should have just went home in the first place. So, like, this is such a good balance between the clinical psychology and, uh, economic, uh, you know, spectrum, all three of them.

Speaker A: Yeah. No, listen, you use an important word there, Lester. Peace of mind. That's what people want. They just want advice and peace of mind. They're busy lives. They don't want the CO pays and the coinsurance. All they run into the er. I'll tell you an, uh, interesting fact. We looked at some data from one of our clients. As a state health plan spends $2 million a year on ankle sprains, I repeat, not fractures. These are people that walked out with a set of crutches that we could have done for a minuscule case rate, not to mention six hours in the ER and all that sort of stuff. I'll, uh, give you a great use case here that's a little more robust than just an ankle sprain. We had a patient not too long ago that was moving some furniture, felt a shotgun go off in her buttock and into her leg, um, was in a lot of pain, it was a Friday night. She knew about this benefit called Upswing Health. Waited till the morning, created an account, met with our athletic trainer as initial screen who said, yeah, this sounds like an evolving lumbar disc. Got one of the docs on almost immediately to meet with this lady. She had purely a sensory disc and there was no drop foot or anything like that. And we asked her, could she hold on a little bit longer and let us try to manage this virtually. Otherwise, you know, had she called her PCP on Friday night, he or she would have said, go to the er, Right, Go to the er, get some opioids, get some X rays, follow up with a neurosurgeon and you know how that goes. Right, Leslie? You know how that goes. So anyway, we managed her Medrol dose packs and gabapentin and muscle relaxers and rehab, and within two Weeks, her problem resolved all, virtually all from home. And she was just, she was in tears because her pain went away. But also just the savings of all that grief and ER and go see this and go see that and lost time from work. So that's what we do. Listen M. We can't solve everything virtually. We know that. But for that initial front door for most things in orthopedics, it can be done virtually.

Speaker B: So let's take that word, uh, that you said earlier and you talked about value based care. Um, and it's an interesting. I do a lot of work with hospitals and we're always talking about value based care, but it's rarely applied or it can't be applied as of now to a self funded employer, uh, which theoretically and typically is. Our clientele and audience here is all about stuff when I think about this. This is a strategy to align everybody's incentives. The member is incentivized to be a better health care consumer through lower out of pocket. You could run to the ER or you could do this benefit and notwithstanding an hsa. But this one has a lot of money, this one's free. The employer gets to offer a better benefit while also saving money. And from a practitioner standpoint, again taking away the desire of making as much economics as possible, this just is a smart way of the triage that last time I checked, no emergency room isn't full and not having a bunch of people coming in to the emergency room that never necessarily needed to. So when we think about that value based care you were, that you were talking about before, that's an insurance conversation in a relationship between provider and insurance companies saying, hey, let's manage this claim together. This is the self funded version of value based care where we're really looking at applying the best practices of cost mitigation managed against care like providing care.

Speaker A: Uh,

Speaker B: when you talk to like that state health plan, do they view this as a cost savings or do they view this as an employee benefit?

Speaker A: Wow, you asked some great questions, Lester. I can tease that to six different ways, but I'm uh, very passionate about the word value based health care. Really I get a little emotional about it because it really angers me that there's only one value that matters, Lester, that's to the darn patient.

Speaker B: Period.

Speaker A: Right? If we all agree that the value has to accrue to the patient. Employers call it employee or a member. I call them a patient because I'm a physician. That's the only word that matters. And it's easily measured, Lester. It's outcomes over cost, period. Not the outcomes to me, but the outcomes to you for your ankle sprain over the true cost of delivering the management of that to get that outcome. That's it. If we all agreed that that's the value equation, we wouldn't have these misalignments. We focus on the patient. Right? So I just want to make that point to your listeners that when I talk to some folks throughout the industry, they could say, value to who? Uh, I mean, are you kidding me? It's value to the patient. Let's focus on the patient. Right. The other point you made, um, about the cost to the member. It's really skyrocketing. We know that. And it's forcing people to change behavior. Look for innovation. As I said, we can't solve everything, uh, virtually. I'm a surgeon, made a great career doing surgery, but 30% of what we do is waste. And if you think about, you know, think about the. Let's start with the MRI scan, which is a great machine, but some days I wish it was never created. It's not just a difference that I can get your MRI for 400 bucks, as opposed to 2,500 bucks at our neighboring hospital. That's a delta. The problem is that if you're over 40, 45, and I MRI any part of your body, it ain't going to be normal. And the older you get, I can assure you it's not gonna be normal. But those abnormal MRI scans generate surgical referrals, and then oftentimes, with good intent, procedures that probably wouldn't have been necessary. So it comes back to catching that member, uh, as far upstream as you can. Cause people. I, uh, used to use the word peace of mind. People wanna know they're getting a fair deal, they're getting good quality so that they can take care of their families.

Speaker B: So I want to dig into this because I love this conversation. And given your background, it's an intriguing one, when we think about that. Uh, back to the value, back to the patient, um, as you've seen each side of it, it's an interesting thing. And for 15 years, the first 15 years of my career at, uh, one of the largest advisory firms, I would have never told you. I can not even tell you. I know for a fact I didn't talk about quality and cost. It just wasn't a thing. Like, it wasn't talked about in the marketplace. And it was like, you never get, you know, what's the expression? You never know. Nobody ever got fired for hiring IBM, right? Nobody Gets fired for, you know, uh, hiring Blue Cross or, you know, whatever it might be. And so in those conversations we talk about size. We have the biggest network, that's the biggest hospital, that's the, you know, where you size. I guess from your experience, sitting on, on both sides of the table. Talk to me about that quality and cost conversation because, you know, I buy a house, I buy a nicer house, I'm going to spend more money on it. I buy a nicer car, I want to spend more money on it. Until I saw health care data and claims data, uh, on the same graph as quality metrics, I would have never believed that higher quality actually results in lower costs. Talk to me about that. Quality versus cost, uh, you know, curve and how. What's the real application of that from, from somebody who's taken a scalpel to somebody's body part?

Speaker A: Yeah, um. You're poking a skunk here again because it's a really tough. I just told you what I think. Well, I know and listen, I cut my teeth through Professor Porter, Professor Kaplan at the Harvard Business School. Unfortunately, Professor Porter has passed on, but they are the architects of the value agenda. And it goes back over 20 years. Lester. The first book was called Redefining Healthcare. And that's when. So Porter is the outcome. Porter. Professor Porter is the numerator. Professor Kaplan is the denominator. Um, the denominator being time driven activity based costing. We should know the cost of delivery of every healthcare service every other industry does, right? We're just, you know, I'm a joint replacement guy. We had a focused factory where I would do eight a day. I knew the cost of my employees, the implants, the gauze pads. I knew that as a leader. But most people don't understand the true cost. But here's the problem. Here's a problem I think you're referring to. Because the numerator, the quality is a right brain function. Because people say, you know, quality, smallity, uh, everybody's got quality. I want to focus on cost because it's a left brain, it's tangible, it's a number. I talk about physician quality, especially 10, 15 years ago, because I tell you, Lester, it is getting better. And I think ultimately every physician will have their own value quotient with the artificial intelligence. And looking at our practice patterns, it is getting pretty darn smart. But, uh, I'll call your attention to Ruth Coleman. Do you remember that name from Health Design Plus?

Speaker B: No.

Speaker A: Um, one of the grandams of value based healthcare, she. Her company was called Health Design plus she sold to Contigo. But she did the original Walmart studies, one of the early centers of excellence. She wrote three papers with Jonathan Slotkin in the Harvard Business Review. And in that some great data came out. First piece of data was that 50% of spine surgeries are unnecessary. They went back to their own, never had an operation on 50% of them. So I said, okay, well spine is kind of gray. I admire my spine colleagues. I'm a joint guy. Either you need a joint or you don't. Right? Basically. But 22% of the patients that were referred to the center of Excellence schedule for a joint replacement never had a joint replacement done. I said, wow. But the biggest takeaway from Ruth Coleman in her data was for every dollar that Walmart saved by using a Center of Excellence, 2/3 was in quality and 1/3 was in cost. We argue about cost, case rates, whatever you bundles, we argue about every nickel and dime and ignore the quality piece. Right Now I would agree with you that physician quality and I do a little advising work to Caram Health and National CO to be fully transparent. And when I look at quality, I look at the surgeon, but I look at the facility that they're performing their skills in because I'm a far better surgeon in the center of excellence that we built than in my original 20 years. So. But it is hard. But I'll go one step further and I'll stop on this because I can talk about this forever. If you look at quality, it's really, the word is appropriateness. Right. And Dr. Makary started talking about this years ago. Uh, Embold Health was one of the first physician credentialing clinician that looked at patterns, physician practice patterns. So let's say I see 30 patients, 715.16. Which is um, osteoarthritis of the knee. Those 30 patients, 2/3 of them show up on my OR table like two weeks later for knee replacement. Well, the technology is getting so good at saying, wait a minute, Dr. Steve didn't do a cortisone injection, didn't have any physical therapy, didn't talk about weight loss, smoking cessation. So they can pick up. This is why I say, Lester, we're getting better and better and better at really nailing this physician quality piece. Right. So long winded answer, um, to your question. But I understand the problem with quality because it is a little bit wifty, it's a little soft, it's not as tangible as the cost. But I think overall it's even more Important than the cost. And then you talked about size. Well, to me, size means volume. I can tell you that volume is not a good proxy for quality because especially today in my field of robotic joint replacement. Lester, you're a smart guy. You probably know more about computers than I do. I can teach you how to do a robotic hip or knee replacement. You won't know who needs one or not, but you would get pretty good technically at doing them. It really is that appropriateness to piece that's most important, right?

Speaker B: Uh, so when we think about it like that, right, and you know, I guess I'm leading the witness, right, to an observation piece, right? Because, um, we're at a tipping point, in my opinion, as an industry, as a nation, really, with, like, what are we going to do? Because this, I mean, we're, you know, the cost of a family coverage is what my parents would have paid for a brand new car when I was a child, right? I mean, getting second, third largest expense for employers, the number one reason people file bankruptcy, over 50% of the people are delaying care because they can't afford it, et cetera, et cetera, et cetera. So we're at this tipping point. And, you know, I look at this, and one of the reasons we started this podcast was to expose people to the education and information in case it's being choked off, you know, in other places, whether they don't want to go look for it, uh, their advisor might not be the right source for it. Uh, they are brainwashed with commercials on tv, whatever it might be. So I look at this and I'm like, okay, there is a notion that says, I, um, give premium to somebody who calls that revenue. They. Which is the insurance carrier model, right? What. What I call premium across. Aetna Cigna calls that revenue. And last time I checked, nobody wakes up in the morning wanting to lower their revenues. So you've got that misalignment. You have the notion of. When my reps used to sit in front of me, they would say, hey, the reason you want to work with us is that we've got the biggest network and we've got the biggest discount. And knowing what I know now, Michael, big doesn't mean better. And discount off of what, uh, is the question I should have asked versus. You've got over here, right? The models that say, hey, we've got these niche things that we're going to build in here that, yeah, maybe it's a more complicated structure to put together, but with the intent of making the patient think a little Bit differently about accessing care. As somebody who saw patients and now sees a service that is asking people to change behavior, uh, how much of this whole structure and the way we even navigate is changing patient behavior through changing the way we construct it. So it's almost like making it easy. And not having people think about something has gotten us into this mess. And so making it easy, however making them think about it is a thought of the solution. Where do you put your crystal ball and say in order for us to change health care and stop being a gazillion trillion dollar business, 20% of our GDP, how do we, how do we slow that, that, that expense?

Speaker A: That's a tough one. You know, I gave a talk recently, um, on the sort of the history of how we got to where we are and you know, that term health care is not sustainable. I actually googled it and said, who said that? The first time I heard it in 2010 when with my brick and mortar center of Excellence we launched a bundled payment program and I met with some employers and they said healthcare is not sustainable. I actually googled it. It was the CEO of Pacific Business Group on Health in 2002. I think his name is Dave Lansky. It was the first time where the growth in healthcare expenses exceeded the growth in wages. He said if this continues, that was 24 years ago.

Speaker B: Right.

Speaker A: Wow. But I do think we're at a tipping point. We just can't go on. And I don't. It's a little bit depressing, but there are bright spots. We can talk about that another day. But I think that the, and my company is in the employer sponsored, self funded employer space. You know, it's interesting, a company like uh, ours, like Upswing, has so much proven value. It's incredibly frustrating to be at this for six years and still wondering why aren't people. And when folks ask us, Lester, who's Upswing's biggest competitor, you know what I say? It's muscle memory. It's a status quo. It's not my competitors. It's changing that behavior. So how did Walmart change the behavior? I think it was probably 15 years ago. They said, look guys, either you're in this plan or you're on your own. You're on your out of pocket. Well, you know, they were able to do that so that their utilization rate for their plan is like 88%. Because most people, you can't go out on their own. Fifteen years ago, if you mentioned that to the average employer, they say, I can't tell my patients what to do. But things have changed. And one thing is clear. If a solution like Upswing is a benefit that has no incentives and no one knows about, no one's going to use it. It's as simple as that. The employer doesn't get the benefit, the member doesn't get better. We can't stay in business.

Speaker B: Right.

Speaker A: We are seeing employers can have two choices. Either going to three choices. Lay off people, go with AI and automate. Last I know that bots don't require health insurance or they're going to start investing in these types of solutions. And I think the labor market's not all that great either right now, folks. I think they'd be a little more amenable to saying, hey, you know what? I've got to go with this network where there's no cost and so forth. So I wouldn't call it the full Walmart approach, but I know that Taft Hartley organizations that you've run into more employers are starting to put teeth into their plan as an incentive. They may not be all in or all out, but they're turning up the heat. Because if you want to stay in the plan, for example, what do you do with GLP1s? Should everybody want a GLP1 get one or it's got some guidelines around it or no one get it? So I'm hoping it goes that way. Hoping it's not layoffs and I'm hoping it's not. We're done with your health insurance. Go on. In exchange, I'm hoping that because there are innovative solutions, we've talked about them before. Direct primary care is a great place to start DPC with these wraparound solutions like for msk, Behavioral Health, Cardiometabolic, and again, ironically, Lester, this is what professor porter wrote about 20 years ago. He called it not a center of excellence, but an integrated practice unit. So for example, people with obesity and as a lower extremity surgeon, a lot of my patients suffer with that condition. Patients with obesity have all sorts of health problems around that condition. We need to start to create with primary care at the center of the universe. It can be done. I'm inspired, uh, in that way. The other alternatives I don't think are as good.

Speaker B: Agreed. And you know the crazy part, and we'll end it here. The net promoter score of all of these things that we would call teeth or the Walmart plan or whatever are 10 times higher than the net promoter scores of the normal. Right. Uh, which is one of the most crazy phenomenons is patients, employees, members. They really do want to be told what to do. They want to be guided, they want to be provided something and the way they purchase their cell phone, their car and all of that stuff. They want to be given an option to be a better consumer and they've proven that out in every other consumer based product they've ever purchased. We have just never allowed them to do it in healthcare until the more recent years. So I am also hopeful. Obviously I built a business around it so I'm really hopeful uh, with my heart and my pocketbook. But Doc, I think people are going to listen to this and want to know more. Where can somebody learn more about you upswing listen to things that you maybe have said that were super smart back in the past.

Speaker A: Yeah, thank you very much. And as you can tell I share your passion for seven days a week for the last 20 years trying to fix this. And I have to live in the bright spot world otherwise I get depressed and have to go to some therapy and stuff like that. But I don't want to do. I just feel work. But there are a lot of bright spots and I do see these bright spots starting to coalesce and become a more powerful movement. I don't think it's going to be solved by the federal government. I believe in people and I believe in employers. To reach out to me is SSC H U T Z E R S Shutser Upswing health dot com. My company is Upswing health dot com. It's easy. Um, happy to talk to anybody about anything in healthcare. Love it all.

Speaker B: Awesome. Awesome. Well Doc, thanks for the guidance. Thanks for your passion and being somebody who's on the front line. Um, you know to our audience members this is just another example of small steps you can make that are driving significant value. And so I'll leave everybody with a thought that doing nothing is part of the problem. Right. Like the, the status quo. And again it's not a rip the band aid jump in the middle of the pool cannonball style. You don't have to do that. But the thought process of continuing to do nothing is becoming more and more absurd because of solutions like this that are so low in friction. Create guaranteed you know, ROI and ah it's just a good thing to do. So if there's anything I could leave everybody with, it's do something. So thank you so much. If you enjoyed this episode. Give it a like, give it a share, make some comments and if there's other subjects that anybody wants to hear about, please uh, please leave a comment because we can go find somebody super smart to have on. So, Doc, thanks again, audience members. Thank you. And we'll see you on the next episode of the Disrupt Healthcare podcast.

Speaker A: This is the disrupt healthcare podcast.