WEBVTT 1 00:00:02.000 --> 00:00:04.719 - The strategic agenda facing hospital and health system 2 00:00:04.719 --> 00:00:06.819 - leaders right now is not a short list. 3 00:00:07.200 --> 00:00:09.839 - Growth in a consolidating market, sustainable margins in 4 00:00:09.839 --> 00:00:12.080 - a reimbursement environment that rarely moves in your 5 00:00:12.080 --> 00:00:12.464 - favor, 6 00:00:12.945 --> 00:00:15.445 - a tech investment cycle that demands both urgency 7 00:00:15.585 --> 00:00:16.404 - and discipline, 8 00:00:16.945 --> 00:00:19.344 - and a workforce story that is still being 9 00:00:19.344 --> 00:00:19.844 - written. 10 00:00:20.464 --> 00:00:23.904 - Eker's fourteenth annual CEO CFO roundtable brings together 11 00:00:23.904 --> 00:00:27.265 - more than 1,500 executive level attendees and nearly 12 00:00:27.265 --> 00:00:30.010 - 400 speakers across four days of sessions that 13 00:00:30.010 --> 00:00:32.350 - are designed to help c suite leaders benchmark, 14 00:00:32.570 --> 00:00:34.510 - pressure test, and sharpen their priorities. 15 00:00:35.049 --> 00:00:37.049 - Not in the abstract, but against the real 16 00:00:37.049 --> 00:00:39.310 - decisions they'll face heading into the next year. 17 00:00:39.530 --> 00:00:40.969 - It's the kind of event you leave with 18 00:00:40.969 --> 00:00:42.810 - a clear sense of where you stand and 19 00:00:42.810 --> 00:00:43.789 - what comes next. 20 00:00:44.295 --> 00:00:46.454 - So join us November second through the fifth 21 00:00:46.454 --> 00:00:48.234 - at the Hyatt Regency in Chicago, 22 00:00:48.534 --> 00:00:50.314 - and come ready to do the hard thinking. 23 00:00:50.695 --> 00:00:54.534 - Register on our events page at beckershospitalreview.com 24 00:00:54.534 --> 00:00:56.295 - by clicking on the events tab in the 25 00:00:56.295 --> 00:00:57.114 - upper right. 26 00:00:58.079 --> 00:01:00.159 - This is Laura Dirda with the Becker's Healthcare 27 00:01:00.159 --> 00:01:00.659 - podcast. 28 00:01:01.039 --> 00:01:02.640 - I'm thrilled today to be joined by doctor 29 00:01:02.640 --> 00:01:06.159 - Surendra Kara, president of the Cleveland Clinic Florida 30 00:01:06.159 --> 00:01:08.640 - Accountable Care Organization and vice chief for the 31 00:01:08.640 --> 00:01:10.799 - Primary Care Institute for the Florida Market of 32 00:01:10.799 --> 00:01:13.025 - Cleveland Clinic. Doctor Cara, it's a pleasure to 33 00:01:13.025 --> 00:01:14.405 - have you on the podcast today. 34 00:01:14.704 --> 00:01:16.625 - Hi, Laura. Nice to be here. Thanks for 35 00:01:16.625 --> 00:01:17.365 - having me. 36 00:01:17.905 --> 00:01:20.784 - Absolutely. Now I'm excited for our conversation. I 37 00:01:20.784 --> 00:01:21.765 - think it'll be, 38 00:01:22.064 --> 00:01:24.225 - a lot of fun just to learn about 39 00:01:24.225 --> 00:01:26.609 - what you're doing at Cleveland Clinic Florida and 40 00:01:26.770 --> 00:01:28.530 - how you're thinking about the future. But before 41 00:01:28.530 --> 00:01:30.209 - we dive in, can you tell us just 42 00:01:30.209 --> 00:01:32.230 - a little bit about yourself and your background? 43 00:01:32.930 --> 00:01:34.849 - Sure. Sure. So a lot of my background, 44 00:01:34.849 --> 00:01:35.349 - I, 45 00:01:36.049 --> 00:01:36.689 - in short, 46 00:01:37.650 --> 00:01:40.129 - trained in in India in med school, did 47 00:01:40.129 --> 00:01:42.584 - my postgraduate training in England, and then 48 00:01:43.064 --> 00:01:44.844 - in in The US was predominantly, 49 00:01:45.465 --> 00:01:47.325 - in the first half of my career, 50 00:01:47.784 --> 00:01:50.924 - on the inpatient side, immersed in inpatient 51 00:01:51.784 --> 00:01:54.984 - quality, safety, chief quality officer. And then in 52 00:01:54.984 --> 00:01:55.644 - the second, 53 00:01:56.700 --> 00:01:57.200 - migrated 54 00:01:57.819 --> 00:02:00.939 - slowly towards population health, value based care, and 55 00:02:00.939 --> 00:02:01.760 - primary care. 56 00:02:02.620 --> 00:02:05.659 - And so I've been with Cleveland Clinic, Cleveland 57 00:02:05.659 --> 00:02:07.760 - Clinic Florida for the last four years, 58 00:02:08.219 --> 00:02:08.719 - overseeing 59 00:02:09.875 --> 00:02:13.174 - their primary care institute in Florida and also 60 00:02:13.234 --> 00:02:14.854 - overseeing the ACO, 61 00:02:16.435 --> 00:02:17.414 - the treatment clinic, 62 00:02:18.914 --> 00:02:21.174 - what we call the treatment of Florida integrated 63 00:02:21.234 --> 00:02:22.354 - health care ACO. 64 00:02:22.914 --> 00:02:24.854 - I so I'm the president of that ACO. 65 00:02:25.849 --> 00:02:28.909 - So my role is work overseeing the institute 66 00:02:29.449 --> 00:02:31.069 - on the people, operations, 67 00:02:31.449 --> 00:02:33.469 - processes point of view. And then 68 00:02:34.090 --> 00:02:36.330 - as president of the ACU, I oversee the, 69 00:02:36.729 --> 00:02:38.030 - the value based care 70 00:02:38.625 --> 00:02:42.625 - and the care delivery structures and innovations that 71 00:02:42.625 --> 00:02:43.125 - supports, 72 00:02:44.224 --> 00:02:45.125 - supports that. 73 00:02:45.905 --> 00:02:47.504 - That's great to hear. And, you know, it's 74 00:02:47.504 --> 00:02:48.324 - such an important 75 00:02:48.864 --> 00:02:50.224 - aspect of the, 76 00:02:50.944 --> 00:02:53.185 - whole organization to oversee and look because I 77 00:02:53.185 --> 00:02:54.590 - know, you know, ACO 78 00:02:54.969 --> 00:02:57.210 - is so important and touches a variety of 79 00:02:57.210 --> 00:03:00.250 - different aspects of the whole enterprise and then 80 00:03:00.250 --> 00:03:03.289 - looking at, everything else that funnels into being 81 00:03:03.289 --> 00:03:04.909 - able to provide care is so critical. 82 00:03:05.210 --> 00:03:06.555 - Now could you give us just a a 83 00:03:06.555 --> 00:03:08.314 - quick state of the union? What's going well 84 00:03:08.314 --> 00:03:09.514 - this year, and what are you focused on 85 00:03:09.514 --> 00:03:11.215 - for the rest of 2026? 86 00:03:11.995 --> 00:03:14.495 - Yeah. No. Beautiful. So I think my 87 00:03:15.675 --> 00:03:16.974 - my journey into 88 00:03:17.435 --> 00:03:20.974 - primary care started with managing the complex patients 89 00:03:21.790 --> 00:03:24.050 - and in trying to work my way through 90 00:03:24.110 --> 00:03:24.610 - readmissions. 91 00:03:26.270 --> 00:03:28.050 - And one of the things I realized 92 00:03:28.510 --> 00:03:30.050 - during that time was 93 00:03:31.230 --> 00:03:33.870 - the the difficulty and challenges that primary care 94 00:03:33.870 --> 00:03:35.010 - faces with access. 95 00:03:36.284 --> 00:03:39.405 - So pretty much the last four years and 96 00:03:39.405 --> 00:03:40.144 - more so, 97 00:03:40.844 --> 00:03:43.324 - almost the completion of that happened this year 98 00:03:43.324 --> 00:03:45.245 - is the work that we have done on 99 00:03:45.245 --> 00:03:47.344 - access redesign in primary care. 100 00:03:48.500 --> 00:03:50.680 - And then we divided that that work, 101 00:03:51.300 --> 00:03:52.360 - Lauren, into 102 00:03:53.620 --> 00:03:56.340 - the just hiring of clinicians and expansion of 103 00:03:56.340 --> 00:03:58.599 - primary care, across Florida. 104 00:03:59.379 --> 00:04:02.120 - And, for example, we've now in my third 105 00:04:02.864 --> 00:04:03.604 - third year 106 00:04:04.144 --> 00:04:07.025 - sorry. Fourth year, we've now recruited over over 107 00:04:07.025 --> 00:04:07.604 - a 100 108 00:04:08.384 --> 00:04:11.685 - clinicians into the Prameka Institute across the region. 109 00:04:12.864 --> 00:04:15.584 - That has led to an absolute opening of 110 00:04:15.584 --> 00:04:16.084 - access, 111 00:04:17.310 --> 00:04:18.909 - But then we've done a lot of work 112 00:04:18.909 --> 00:04:19.970 - on access innovations. 113 00:04:20.589 --> 00:04:22.669 - We for example, we have a team called 114 00:04:22.669 --> 00:04:25.389 - the clinical access team that has now seen 115 00:04:25.389 --> 00:04:27.810 - over 20,000 visits, and this team 116 00:04:28.589 --> 00:04:31.754 - essentially manages same day access for patients when 117 00:04:31.754 --> 00:04:33.995 - they need it, complex patients when they leave 118 00:04:33.995 --> 00:04:34.654 - the hospital. 119 00:04:35.435 --> 00:04:38.074 - They also see patients when physicians, primary care 120 00:04:38.074 --> 00:04:40.735 - physicians, or or FMLA or leave, 121 00:04:42.314 --> 00:04:44.475 - and then then they manage their patients during 122 00:04:44.475 --> 00:04:46.415 - that time. So that team alone 123 00:04:47.250 --> 00:04:50.870 - has, has significantly improved our access in addition 124 00:04:51.490 --> 00:04:53.810 - to the recruitment and expansion of primary care 125 00:04:53.810 --> 00:04:55.349 - that Cleveland Clinic has supported. 126 00:04:56.289 --> 00:04:58.769 - We've continued to do innovations of primary care. 127 00:04:58.769 --> 00:05:00.610 - In a couple of weeks, we will launch 128 00:05:00.610 --> 00:05:01.430 - our first, 129 00:05:01.944 --> 00:05:02.904 - what we call, 130 00:05:03.305 --> 00:05:05.865 - primary care integrated model for care in the 131 00:05:05.865 --> 00:05:08.444 - evening and weekends. So we'll have our first 132 00:05:09.064 --> 00:05:11.944 - four primary care physicians who will work in 133 00:05:11.944 --> 00:05:14.504 - the evening, and they will be like any 134 00:05:14.504 --> 00:05:16.345 - other primary care physicians. They will have a 135 00:05:16.345 --> 00:05:17.404 - panel of patients, 136 00:05:17.889 --> 00:05:20.290 - but they will open access to our patients 137 00:05:20.290 --> 00:05:21.750 - in the evening and on weekends. 138 00:05:22.529 --> 00:05:24.850 - And they'll work in partnership with the data 139 00:05:24.850 --> 00:05:26.069 - in primary care physicians. 140 00:05:27.009 --> 00:05:27.910 - So it's innovations 141 00:05:28.770 --> 00:05:31.589 - in access like that. We redesigned our templates. 142 00:05:31.730 --> 00:05:32.389 - We've introduced 143 00:05:33.274 --> 00:05:34.974 - for for clinician retention. 144 00:05:35.675 --> 00:05:38.074 - We now have thirty minute templates that we 145 00:05:38.074 --> 00:05:39.615 - offer to primary care physicians. 146 00:05:40.394 --> 00:05:42.634 - As you know, primary care patients are very 147 00:05:42.634 --> 00:05:43.134 - complex. 148 00:05:43.435 --> 00:05:45.294 - So fifteen minute, twenty minutes 149 00:05:45.675 --> 00:05:47.834 - doesn't do justice to them. So we now 150 00:05:47.834 --> 00:05:51.439 - have well over 75 clinicians on the thirty 151 00:05:51.439 --> 00:05:52.900 - minute template, and 152 00:05:53.680 --> 00:05:56.160 - that has been a huge improvement, not just 153 00:05:56.160 --> 00:05:58.960 - in in clinician well-being, but the time that 154 00:05:58.960 --> 00:06:00.160 - they get to spend with the, 155 00:06:01.414 --> 00:06:02.235 - with the patient. 156 00:06:02.774 --> 00:06:04.375 - So if you if you add all of 157 00:06:04.375 --> 00:06:05.115 - this up, 158 00:06:05.495 --> 00:06:07.974 - I'll say the the big team for the 159 00:06:07.974 --> 00:06:08.954 - last four years, 160 00:06:09.334 --> 00:06:10.794 - which has almost reached 161 00:06:11.175 --> 00:06:14.079 - its perfection this year, but not still a 162 00:06:14.079 --> 00:06:15.600 - lot of work to do is is the 163 00:06:15.600 --> 00:06:16.660 - work around access. 164 00:06:17.360 --> 00:06:19.759 - So the net result is we've dropped new 165 00:06:19.759 --> 00:06:22.419 - patient wait days by almost 75%. 166 00:06:23.360 --> 00:06:26.019 - Two years ago, our patients were waiting months 167 00:06:26.404 --> 00:06:28.324 - to find a primary care physician, and now 168 00:06:28.324 --> 00:06:30.805 - that has dropped to under under, like, few 169 00:06:30.805 --> 00:06:32.805 - days. You can find a primary care physician 170 00:06:32.805 --> 00:06:34.345 - in some parts of the market. 171 00:06:35.845 --> 00:06:36.564 - We have, 172 00:06:37.125 --> 00:06:38.025 - you know, the 173 00:06:38.564 --> 00:06:40.564 - the number of visits that you get with 174 00:06:40.564 --> 00:06:41.944 - a primary care physician, 175 00:06:43.259 --> 00:06:45.099 - from three years ago to now, that has 176 00:06:45.099 --> 00:06:48.379 - doubled. So an average patient now gets double 177 00:06:48.379 --> 00:06:50.560 - the number of visits that they would get 178 00:06:50.939 --> 00:06:53.360 - three years ago with their primary care physician. 179 00:06:54.139 --> 00:06:56.985 - We've completed over seventy five percent of of 180 00:06:56.985 --> 00:06:58.285 - our patients who are eligible 181 00:06:58.904 --> 00:07:01.625 - at the annual wellness visits completed now. That 182 00:07:01.625 --> 00:07:03.644 - number was half a few years ago. 183 00:07:04.665 --> 00:07:07.064 - The net result is not just better patient 184 00:07:07.064 --> 00:07:09.810 - care, better access, but the second year in 185 00:07:09.810 --> 00:07:11.670 - a row, our ACO has had 186 00:07:12.050 --> 00:07:15.009 - a positive shared savings. So we are we 187 00:07:15.009 --> 00:07:17.750 - are seeing the numbers improve in in metrics 188 00:07:17.810 --> 00:07:20.470 - like appointments spent when, you know, when wanted. 189 00:07:20.850 --> 00:07:23.170 - Our turnover rate for clinicians, which was in 190 00:07:23.170 --> 00:07:24.470 - double digit, is now 191 00:07:24.805 --> 00:07:27.604 - in the low, you know, under 5%. So 192 00:07:27.604 --> 00:07:29.845 - we've we've and for the first time, as 193 00:07:29.845 --> 00:07:32.004 - an example, with two of our submarkets, we 194 00:07:32.004 --> 00:07:33.925 - have no openings in primary care, which we 195 00:07:33.925 --> 00:07:35.464 - never thought we would see today. 196 00:07:36.154 --> 00:07:37.144 - So we've recruited 197 00:07:37.589 --> 00:07:40.389 - successfully. Our turnover has dropped. We've done access 198 00:07:40.389 --> 00:07:40.889 - innovations. 199 00:07:42.149 --> 00:07:44.410 - All of that has resulted in in 200 00:07:45.110 --> 00:07:48.009 - in addressing those challenges of a very complex 201 00:07:48.230 --> 00:07:51.209 - patient population in Florida. You know, they're older. 202 00:07:51.935 --> 00:07:54.894 - About seven some markets, almost 72% 203 00:07:54.894 --> 00:07:56.834 - of them are on Medicare and managed Medicare. 204 00:07:58.254 --> 00:07:59.935 - So I think the 205 00:08:00.414 --> 00:08:02.254 - extremely proud of the work that we have 206 00:08:02.254 --> 00:08:03.555 - done around that, Laura. 207 00:08:04.060 --> 00:08:06.240 - That's amazing to hear and and very impressive. 208 00:08:06.699 --> 00:08:08.860 - And and, you know, love to to kind 209 00:08:08.860 --> 00:08:10.540 - of hear how you're thinking about that as 210 00:08:10.540 --> 00:08:11.040 - well. 211 00:08:11.660 --> 00:08:13.500 - Yeah. No. And I I'll tell you, we 212 00:08:13.500 --> 00:08:16.654 - we declared access not a scheduling issue. 213 00:08:17.115 --> 00:08:18.954 - Access is a safety issue. You know, I 214 00:08:18.954 --> 00:08:21.534 - came from the quality safety world. 215 00:08:22.394 --> 00:08:24.954 - Lack of access is almost a I consider 216 00:08:24.954 --> 00:08:26.175 - it a safety event. 217 00:08:26.634 --> 00:08:29.115 - So we say access is no longer a 218 00:08:29.115 --> 00:08:31.759 - scheduling problem. It's a health outcome strategy, 219 00:08:32.700 --> 00:08:35.100 - and that is deeply tied to our value 220 00:08:35.100 --> 00:08:38.379 - based agenda and our our the care that 221 00:08:38.379 --> 00:08:39.679 - we provide to our patients. 222 00:08:40.460 --> 00:08:42.080 - It's very proud of that workload. 223 00:08:43.179 --> 00:08:45.634 - Absolutely. And that's amazing to hear. And, you 224 00:08:45.634 --> 00:08:47.975 - know, when you think about that mindset shift 225 00:08:48.355 --> 00:08:48.855 - of, 226 00:08:49.394 --> 00:08:49.894 - having 227 00:08:50.434 --> 00:08:52.674 - access be a health outcome strategy tied to 228 00:08:52.674 --> 00:08:55.075 - quality, tied to everything else that you're looking 229 00:08:55.075 --> 00:08:56.995 - at for the patients, you know, it seems 230 00:08:56.995 --> 00:08:59.070 - like the team has been very innovative in 231 00:08:59.389 --> 00:09:02.509 - improving that access and finding ways that, they 232 00:09:02.509 --> 00:09:04.529 - can continue to, you know, 233 00:09:04.910 --> 00:09:05.410 - be, 234 00:09:05.950 --> 00:09:07.090 - innovative in, 235 00:09:08.269 --> 00:09:10.929 - redesigning care delivery and that whole process. 236 00:09:11.965 --> 00:09:13.965 - And I'm curious when you look at everything 237 00:09:13.965 --> 00:09:15.404 - that's going on, what are some of the 238 00:09:15.404 --> 00:09:16.785 - big headwinds that, 239 00:09:17.165 --> 00:09:19.004 - you're seeing right now or or that you're 240 00:09:19.004 --> 00:09:20.045 - facing as you're, 241 00:09:20.365 --> 00:09:22.304 - redesigning care and having the success? 242 00:09:22.764 --> 00:09:24.605 - How are you thinking about those headwinds in 243 00:09:24.605 --> 00:09:26.225 - preparing for them going forward? 244 00:09:27.089 --> 00:09:28.789 - Yeah. Oh, beautiful. So 245 00:09:29.330 --> 00:09:30.289 - I can tell you, 246 00:09:31.009 --> 00:09:33.409 - one of our biggest challenges is is a 247 00:09:33.409 --> 00:09:35.250 - national challenge, and then some of it is 248 00:09:35.250 --> 00:09:36.629 - very local to Florida. 249 00:09:37.570 --> 00:09:39.490 - The national challenge, I mean, if you saw 250 00:09:39.490 --> 00:09:42.345 - the study, for example, in JAMA a few 251 00:09:42.504 --> 00:09:44.924 - few weeks ago on the number of messages 252 00:09:44.985 --> 00:09:47.004 - that come to our primary care physicians. 253 00:09:47.704 --> 00:09:49.725 - So in the last five years, 254 00:09:50.184 --> 00:09:52.345 - the number of messages that come to primary 255 00:09:52.345 --> 00:09:56.105 - care physicians through portals, like MyChart messages and 256 00:09:56.105 --> 00:09:57.164 - and patient portals 257 00:09:57.559 --> 00:09:59.899 - has gone up by a 153%. 258 00:10:02.120 --> 00:10:04.360 - So that is if you see a primary 259 00:10:04.360 --> 00:10:06.919 - care clinic, you see a physical clinic. You 260 00:10:06.919 --> 00:10:08.220 - see primary care physicians. 261 00:10:09.000 --> 00:10:11.715 - What what no one sees is what what 262 00:10:11.715 --> 00:10:14.595 - I increasingly call the digital clinic. So running 263 00:10:14.595 --> 00:10:16.535 - in parallel to the physical clinic 264 00:10:17.075 --> 00:10:19.475 - is the digital messages that our patient has 265 00:10:19.634 --> 00:10:21.475 - are sending us, and that has gone up 266 00:10:21.475 --> 00:10:23.394 - by by a 153%. 267 00:10:23.394 --> 00:10:25.720 - Five years ago, they used to send about 268 00:10:25.720 --> 00:10:28.200 - point nine nine message or about one message 269 00:10:28.200 --> 00:10:30.039 - per patient, and now it's about two and 270 00:10:30.039 --> 00:10:31.659 - a half messages per patient. 271 00:10:33.000 --> 00:10:35.419 - We have not accounted for that. So, 272 00:10:35.799 --> 00:10:36.299 - nowhere, 273 00:10:36.839 --> 00:10:39.714 - I mean, we have inbox ologists. Increasingly, Cleveland 274 00:10:39.714 --> 00:10:42.914 - Clinic has ATPs who function as inboxologists in 275 00:10:42.914 --> 00:10:44.054 - managing these messages, 276 00:10:44.674 --> 00:10:45.894 - but we have not, 277 00:10:46.674 --> 00:10:47.174 - collectively, 278 00:10:47.634 --> 00:10:48.134 - strategically, 279 00:10:48.995 --> 00:10:50.134 - by way of policy, 280 00:10:50.789 --> 00:10:52.009 - payments, and measurements, 281 00:10:52.709 --> 00:10:55.209 - looked at what's happening in this digital 282 00:10:55.669 --> 00:10:58.330 - workload that has that has come out. 283 00:10:58.709 --> 00:11:00.889 - So the net result, for example, in 284 00:11:01.350 --> 00:11:03.450 - Cleveland Clinic primary care in Florida, 285 00:11:04.074 --> 00:11:06.254 - for every hour that a primary care physician 286 00:11:06.315 --> 00:11:09.034 - sees patients, they generate fifteen minutes of what 287 00:11:09.034 --> 00:11:11.834 - we call work outside of work. So that's 288 00:11:11.834 --> 00:11:12.894 - their task time, 289 00:11:13.195 --> 00:11:15.134 - time outside of scheduled hours. 290 00:11:15.674 --> 00:11:17.514 - So for every hour that they work, they 291 00:11:17.514 --> 00:11:19.879 - take fifteen minutes of work home. So if 292 00:11:19.879 --> 00:11:21.559 - you work a eight hour day, you've taken 293 00:11:21.559 --> 00:11:23.080 - about an hour and a half, two hours 294 00:11:23.080 --> 00:11:23.980 - of work home. 295 00:11:25.159 --> 00:11:27.799 - That is unaccounted for work. That is work 296 00:11:27.799 --> 00:11:29.799 - that primary care docs are doing on their 297 00:11:29.799 --> 00:11:31.340 - own time, on a weekends. 298 00:11:32.200 --> 00:11:34.519 - And if we don't find a solution to 299 00:11:34.519 --> 00:11:35.019 - that, 300 00:11:35.414 --> 00:11:37.735 - I think the the issues that primary care 301 00:11:37.735 --> 00:11:40.134 - faces with this they just continue to get 302 00:11:40.134 --> 00:11:42.214 - worse. I mean, we are projecting about an 303 00:11:42.214 --> 00:11:43.674 - 87, 90,000 304 00:11:43.894 --> 00:11:46.394 - primary care physician by 2037. 305 00:11:46.934 --> 00:11:48.455 - A lot of that is coming from the 306 00:11:48.455 --> 00:11:50.490 - burnout that they face, not just from the 307 00:11:50.490 --> 00:11:52.970 - physical work that they do, but the work 308 00:11:52.970 --> 00:11:54.889 - outside of work that they have to handle, 309 00:11:54.889 --> 00:11:56.029 - what we call the digital 310 00:11:56.410 --> 00:11:58.970 - work. So that is a real challenge, and 311 00:11:58.970 --> 00:12:01.309 - and different ways to solve that including, 312 00:12:01.929 --> 00:12:03.710 - treatment. So we have an inboxology 313 00:12:04.090 --> 00:12:05.470 - structure that is someone 314 00:12:05.985 --> 00:12:08.384 - sits and manages these in baskets for the 315 00:12:08.384 --> 00:12:09.764 - for the primary care physicians. 316 00:12:10.625 --> 00:12:12.705 - When they go on vacation, they come back 317 00:12:12.705 --> 00:12:15.445 - to about 65, 70% of the in basket 318 00:12:15.504 --> 00:12:17.924 - work done for them. So they're not sitting 319 00:12:18.225 --> 00:12:20.384 - after their vacation and going through hundreds of 320 00:12:20.384 --> 00:12:20.884 - messages. 321 00:12:21.679 --> 00:12:23.519 - But that is not all. I think there's 322 00:12:23.519 --> 00:12:26.000 - something I I I personally call a digital 323 00:12:26.000 --> 00:12:28.579 - corridor. I feel we need to design something 324 00:12:29.120 --> 00:12:30.659 - that runs in parallel 325 00:12:31.120 --> 00:12:33.299 - and in real time to primary care practices, 326 00:12:34.125 --> 00:12:36.205 - which I I I I just call it 327 00:12:36.205 --> 00:12:38.785 - a digital corridor. And in that, there are 328 00:12:38.924 --> 00:12:39.424 - inboxologists. 329 00:12:40.125 --> 00:12:42.524 - There are nurses. There are APPs who do 330 00:12:42.524 --> 00:12:43.184 - the work. 331 00:12:43.565 --> 00:12:46.044 - There are APPs and maybe even physicians who 332 00:12:46.044 --> 00:12:48.524 - do virtual visits so that the general sense 333 00:12:48.524 --> 00:12:49.105 - of pressure 334 00:12:49.580 --> 00:12:51.919 - that the clinics feel is shifted 335 00:12:52.299 --> 00:12:53.759 - into this this corridor. 336 00:12:54.620 --> 00:12:56.940 - So for example, in in our clinical access 337 00:12:56.940 --> 00:12:58.080 - team that we have, 338 00:12:58.860 --> 00:12:59.600 - which is 339 00:13:00.059 --> 00:13:02.059 - which I had mentioned earlier is an access 340 00:13:02.059 --> 00:13:02.559 - innovation. 341 00:13:03.254 --> 00:13:05.975 - One of the APPs there is is always 342 00:13:05.975 --> 00:13:08.075 - functioning as an in bask inboxologists, 343 00:13:08.535 --> 00:13:10.695 - and they're managing the in basket work that 344 00:13:10.695 --> 00:13:13.115 - comes out of the primary care practices. 345 00:13:13.654 --> 00:13:15.415 - I feel you need to you need to 346 00:13:15.415 --> 00:13:17.754 - expand that. I think we really need to 347 00:13:18.289 --> 00:13:21.329 - address this problem seriously, and not just in 348 00:13:21.329 --> 00:13:24.370 - care delivery redesigns, but also in policy. And 349 00:13:24.370 --> 00:13:25.889 - how do we account for this? You know, 350 00:13:25.889 --> 00:13:28.769 - we measure visits. We reimburse for visits. We 351 00:13:28.769 --> 00:13:31.269 - measure our views. We reimburse for our views. 352 00:13:31.535 --> 00:13:33.695 - But we we don't measure and we don't 353 00:13:33.695 --> 00:13:36.254 - count the digital workflow. So I think that 354 00:13:36.254 --> 00:13:38.815 - the policy changes need to be made and 355 00:13:38.815 --> 00:13:40.654 - payment changes need to be made and how 356 00:13:40.654 --> 00:13:41.475 - we do that. 357 00:13:42.335 --> 00:13:44.815 - And whether that is shifting some to the 358 00:13:44.815 --> 00:13:47.330 - patients or whether it is by the by 359 00:13:47.330 --> 00:13:48.070 - the peer 360 00:13:48.370 --> 00:13:50.450 - that needs to be determined. But but either 361 00:13:50.450 --> 00:13:52.610 - way, the digital aspect of our work needs 362 00:13:52.610 --> 00:13:53.910 - to be looked at seriously. 363 00:13:54.690 --> 00:13:56.930 - The other thing in Florida, I think, is 364 00:13:56.930 --> 00:13:58.389 - is this changing demographics. 365 00:13:59.009 --> 00:13:59.570 - I think, 366 00:14:00.215 --> 00:14:02.475 - we always knew Florida, I mean, was was 367 00:14:03.014 --> 00:14:04.794 - was the place for people to retire. 368 00:14:05.254 --> 00:14:06.794 - And now we anticipate 369 00:14:07.335 --> 00:14:10.315 - by, for example, by 2037, 370 00:14:10.535 --> 00:14:11.174 - the '20, 371 00:14:11.654 --> 00:14:14.134 - the CBO estimates that by 2034, 372 00:14:14.134 --> 00:14:14.634 - almost 373 00:14:15.069 --> 00:14:17.709 - sixty three, sixty four percent of our Medicare 374 00:14:17.709 --> 00:14:19.409 - patients would be on managed Medicare. 375 00:14:20.429 --> 00:14:22.269 - So the combination of the pressure that a 376 00:14:22.269 --> 00:14:24.049 - state like Florida fee feels, 377 00:14:24.909 --> 00:14:27.970 - managed Medicare and and Medicare patients 378 00:14:28.429 --> 00:14:29.889 - is a lot. So 379 00:14:30.955 --> 00:14:33.215 - category redesigns that supports, 380 00:14:34.634 --> 00:14:36.014 - these complex patients, 381 00:14:36.955 --> 00:14:38.475 - needs to be made. And I think I 382 00:14:38.475 --> 00:14:40.894 - don't think we have made enough practice optimization, 383 00:14:41.674 --> 00:14:43.995 - and support structure has not really changed a 384 00:14:43.995 --> 00:14:45.375 - whole lot in that direction. 385 00:14:45.920 --> 00:14:47.620 - A lot of that needs to happen. 386 00:14:48.160 --> 00:14:50.399 - We still function as a traditional primary care 387 00:14:50.399 --> 00:14:52.660 - assuming a very different tier mix 388 00:14:53.279 --> 00:14:55.139 - than a rising complexity 389 00:14:55.759 --> 00:14:56.660 - aging populations, 390 00:14:57.120 --> 00:14:59.475 - but I think we we need to very 391 00:14:59.475 --> 00:15:02.375 - intentionally need to make investment in that direction. 392 00:15:03.315 --> 00:15:04.754 - Those will be the two big that I 393 00:15:04.754 --> 00:15:05.254 - see, 394 00:15:06.115 --> 00:15:08.274 - you know, from the burnout prevention and then 395 00:15:08.274 --> 00:15:10.455 - then care we redesign that supports 396 00:15:10.995 --> 00:15:13.634 - the rising complexity and the demographic shifts in 397 00:15:13.634 --> 00:15:14.294 - our patients. 398 00:15:15.500 --> 00:15:16.940 - Absolutely. I think that makes a lot of 399 00:15:16.940 --> 00:15:18.620 - sense, and I appreciate you laying that out 400 00:15:18.620 --> 00:15:21.019 - so clearly for us because there's, you know, 401 00:15:21.019 --> 00:15:23.899 - so much, that it it relies on primary 402 00:15:23.899 --> 00:15:25.899 - care physicians being able to do what they 403 00:15:25.899 --> 00:15:27.980 - do in a critical role within the health 404 00:15:27.980 --> 00:15:30.735 - health care ecosystem. So to build that support 405 00:15:30.735 --> 00:15:32.674 - system around that digital work they're doing, 406 00:15:33.694 --> 00:15:36.095 - it's been great to see the start of 407 00:15:36.095 --> 00:15:37.774 - that. And then to your point, you know, 408 00:15:37.774 --> 00:15:40.574 - continuing to expand that and grow how you're 409 00:15:40.574 --> 00:15:42.179 - supporting their work as well. 410 00:15:42.740 --> 00:15:44.100 - And and as you've been going through this 411 00:15:44.100 --> 00:15:44.600 - transformation, 412 00:15:45.059 --> 00:15:45.799 - I'm curious 413 00:15:46.179 --> 00:15:46.659 - how, 414 00:15:47.460 --> 00:15:49.700 - easy or hard has it been to, you 415 00:15:49.700 --> 00:15:52.039 - know, put put people into these new positions 416 00:15:52.259 --> 00:15:52.919 - and roles, 417 00:15:53.539 --> 00:15:56.200 - as the digital workload has been increasing? Has 418 00:15:56.684 --> 00:15:58.845 - there it been well received, or or has 419 00:15:58.845 --> 00:16:01.085 - it taken some time to get people, 420 00:16:02.605 --> 00:16:04.845 - understanding how important this is and and what 421 00:16:04.845 --> 00:16:06.924 - they need to do in order to, make 422 00:16:06.924 --> 00:16:08.705 - sure the entire ecosystem works? 423 00:16:10.039 --> 00:16:12.759 - Beautiful question. So both. In a way, it 424 00:16:12.759 --> 00:16:13.899 - is it's 425 00:16:14.519 --> 00:16:16.120 - it was quite heartening to see that there 426 00:16:16.120 --> 00:16:17.899 - are people who want to do that work, 427 00:16:18.440 --> 00:16:19.419 - that there were, 428 00:16:19.879 --> 00:16:20.679 - there are, 429 00:16:21.159 --> 00:16:22.860 - clinicians who are willing to 430 00:16:23.475 --> 00:16:26.754 - be digital clinicians and managing basket and digital 431 00:16:26.754 --> 00:16:29.315 - visits and and support the practices in that 432 00:16:29.315 --> 00:16:30.855 - way. But on the other hand, 433 00:16:31.714 --> 00:16:33.014 - that space is, 434 00:16:33.394 --> 00:16:35.315 - as I said, the the structure there is 435 00:16:35.315 --> 00:16:38.034 - not well designed. The return on investments there 436 00:16:38.034 --> 00:16:39.014 - are not clear. 437 00:16:40.190 --> 00:16:42.590 - So so if if if if they are 438 00:16:42.590 --> 00:16:44.450 - doing work that has no tangible 439 00:16:45.389 --> 00:16:47.170 - business model tied to it 440 00:16:47.629 --> 00:16:49.009 - other than, you know, 441 00:16:49.470 --> 00:16:52.450 - offloading the clinicians in the physical space 442 00:16:53.174 --> 00:16:54.475 - and and retention, 443 00:16:54.855 --> 00:16:56.695 - then I think it just makes it harder 444 00:16:56.695 --> 00:16:58.534 - for them to understand the work and for 445 00:16:58.534 --> 00:17:00.215 - us to expand that work from the from 446 00:17:00.215 --> 00:17:01.514 - the business point of view. 447 00:17:02.294 --> 00:17:03.735 - I think if anything has come in the 448 00:17:03.735 --> 00:17:06.579 - way, of of of adoption of that, it 449 00:17:06.579 --> 00:17:09.299 - is that that lack of clarity or or 450 00:17:09.299 --> 00:17:11.859 - ambiguity that surrounds that space. But I think 451 00:17:11.859 --> 00:17:13.640 - from the adoption point of view, 452 00:17:14.179 --> 00:17:16.740 - I myself are quite pleasantly surprised on the 453 00:17:16.740 --> 00:17:18.200 - number of people who are 454 00:17:19.015 --> 00:17:21.335 - willing to embrace these kind of innovations in 455 00:17:21.335 --> 00:17:23.414 - primary care. So whether it is being a 456 00:17:23.414 --> 00:17:23.914 - digital, 457 00:17:24.775 --> 00:17:26.075 - primary care clinician 458 00:17:26.454 --> 00:17:29.335 - or a clinical access team member where you 459 00:17:29.335 --> 00:17:32.315 - provide access without being a primary care physician 460 00:17:33.200 --> 00:17:33.859 - or recruiting 461 00:17:34.160 --> 00:17:36.240 - the evening primary care physicians, which I thought 462 00:17:36.240 --> 00:17:37.759 - would be very hard, but we will manage 463 00:17:37.759 --> 00:17:40.180 - to we manage to recruit all of them 464 00:17:40.480 --> 00:17:42.160 - for the pilot to go live in two 465 00:17:42.160 --> 00:17:45.119 - weeks' time. I'm quite impressed really on the 466 00:17:45.119 --> 00:17:47.359 - willingness of the workforce and the people to 467 00:17:47.359 --> 00:17:47.859 - embrace 468 00:17:48.785 --> 00:17:50.164 - these schedule redesigns 469 00:17:50.625 --> 00:17:52.544 - and their willingness to jump in and do 470 00:17:52.544 --> 00:17:54.565 - it. So I'm very impressed there 471 00:17:54.944 --> 00:17:57.984 - and quite satisfying. I think they having worked 472 00:17:57.984 --> 00:17:58.944 - at the other side, 473 00:17:59.265 --> 00:18:01.904 - these clinicians find it very satisfying to do 474 00:18:01.904 --> 00:18:04.549 - the work that they know are helping their 475 00:18:04.549 --> 00:18:07.109 - colleagues in the physical space. For example, an 476 00:18:07.109 --> 00:18:07.769 - in basket, 477 00:18:08.950 --> 00:18:09.450 - clinician 478 00:18:09.750 --> 00:18:10.730 - or an APP 479 00:18:11.109 --> 00:18:13.829 - feels extremely satisfied. You know, that seventy, seventy 480 00:18:13.829 --> 00:18:15.049 - five percent of the work 481 00:18:15.430 --> 00:18:17.430 - could be done when someone is on vacation 482 00:18:17.430 --> 00:18:19.484 - and the primary care docs are coming back 483 00:18:19.884 --> 00:18:22.045 - to a much lighter workload than they used 484 00:18:22.045 --> 00:18:22.545 - to. 485 00:18:23.325 --> 00:18:25.585 - So I think it's a combination of of 486 00:18:25.964 --> 00:18:28.224 - very well embraced by 487 00:18:28.605 --> 00:18:30.384 - the clinicians who are doing it, 488 00:18:30.845 --> 00:18:32.304 - some ambiguity around 489 00:18:32.769 --> 00:18:34.769 - the the business modeling of that and the 490 00:18:34.769 --> 00:18:36.150 - expansion of that, and 491 00:18:36.609 --> 00:18:37.990 - then and then some gratification 492 00:18:39.089 --> 00:18:40.609 - in the work that they do in in 493 00:18:40.609 --> 00:18:44.130 - eventually preventing burnout and re and improving retention 494 00:18:44.130 --> 00:18:45.190 - in primary care. 495 00:18:45.650 --> 00:18:46.710 - Does that make sense? 496 00:18:47.305 --> 00:18:49.785 - Oh, absolutely. Yes. Thank you so much for 497 00:18:49.785 --> 00:18:51.224 - digging a bit deeper in there. And I 498 00:18:51.224 --> 00:18:52.664 - think, you know, that that's, 499 00:18:53.065 --> 00:18:54.265 - it can be such a big, 500 00:18:54.664 --> 00:18:56.744 - focus for a lot of the executive leadership 501 00:18:56.744 --> 00:18:58.505 - teams in terms of just making sure they 502 00:18:58.505 --> 00:19:00.265 - have everything set up in the right way 503 00:19:00.265 --> 00:19:02.529 - and are delivering the right messages that are 504 00:19:02.529 --> 00:19:04.070 - motivating the team and helping, 505 00:19:04.769 --> 00:19:07.350 - everyone grow and transform in the same way. 506 00:19:07.410 --> 00:19:09.490 - Now I'm curious. What is the next step 507 00:19:09.490 --> 00:19:10.850 - for you over the next two or three 508 00:19:10.850 --> 00:19:12.529 - years? Where do you see growth coming from, 509 00:19:12.529 --> 00:19:14.150 - and and what comes next? 510 00:19:15.494 --> 00:19:17.414 - Yeah. Beautiful. So I think the work on 511 00:19:17.414 --> 00:19:20.474 - access will just continue, Laura. That work is 512 00:19:20.775 --> 00:19:23.174 - our foundational work, but it is also the 513 00:19:23.174 --> 00:19:24.714 - future. So the future growth 514 00:19:25.414 --> 00:19:27.674 - will come from continuing to 515 00:19:28.589 --> 00:19:29.730 - sharpen access 516 00:19:30.109 --> 00:19:32.829 - both in the absolute sense of recruitment and 517 00:19:32.829 --> 00:19:33.329 - expansion, 518 00:19:34.429 --> 00:19:36.369 - but also innovations and access, 519 00:19:36.750 --> 00:19:37.730 - digital access, 520 00:19:38.750 --> 00:19:41.250 - and continuing to explore ways by which 521 00:19:41.575 --> 00:19:42.875 - the patients are seen 522 00:19:43.174 --> 00:19:45.015 - where they want to be seen and when 523 00:19:45.015 --> 00:19:46.455 - they want to be seen. And they are 524 00:19:46.455 --> 00:19:48.934 - not limited by the traditional designs of the 525 00:19:48.934 --> 00:19:52.215 - 8AM to 4PM primary care or 5PM primary 526 00:19:52.215 --> 00:19:52.715 - care. 527 00:19:53.095 --> 00:19:55.335 - So I think that work around access, access 528 00:19:55.335 --> 00:19:57.035 - innovation, digital access 529 00:19:57.660 --> 00:19:59.420 - is a huge team. And then try to 530 00:19:59.420 --> 00:20:00.080 - do that. 531 00:20:00.460 --> 00:20:02.000 - I feel very excited about 532 00:20:02.299 --> 00:20:04.619 - the prospect of AI and what that will 533 00:20:04.619 --> 00:20:06.559 - do for primary care and 534 00:20:06.940 --> 00:20:08.799 - whether it be in the space of 535 00:20:09.100 --> 00:20:11.445 - ambient Scribes, which we are now using, you 536 00:20:11.445 --> 00:20:13.605 - know, 90% of our primary care physicians are 537 00:20:13.605 --> 00:20:16.565 - now using Ambient Scribe. It's been life changing. 538 00:20:16.565 --> 00:20:18.565 - You know? We used to spend hours doing 539 00:20:18.565 --> 00:20:20.484 - our notes, and now we have a tool 540 00:20:20.484 --> 00:20:21.384 - that does that. 541 00:20:21.859 --> 00:20:22.519 - But, also, 542 00:20:22.820 --> 00:20:24.500 - what will be the next step in that 543 00:20:24.500 --> 00:20:25.000 - tool? 544 00:20:25.299 --> 00:20:27.799 - How will that aid us in our clinical 545 00:20:27.859 --> 00:20:28.359 - documentation, 546 00:20:28.740 --> 00:20:29.640 - in our billing, 547 00:20:30.259 --> 00:20:31.160 - in subsegmenting 548 00:20:31.619 --> 00:20:34.340 - our patients' risks? So we redesign the future 549 00:20:34.340 --> 00:20:35.880 - care delivery. It could be redesigned 550 00:20:36.340 --> 00:20:37.755 - around the complexity of the 551 00:20:38.474 --> 00:20:40.654 - patient. So I run a complex care clinic. 552 00:20:41.275 --> 00:20:42.015 - Could future 553 00:20:42.474 --> 00:20:46.075 - AI delivery tools segment the population? So based 554 00:20:46.075 --> 00:20:47.535 - on the design of the clinic, 555 00:20:48.154 --> 00:20:50.714 - those patients, will be seen. So feel very 556 00:20:50.714 --> 00:20:51.694 - excited about 557 00:20:52.019 --> 00:20:54.180 - the work in AI, the so the predictive 558 00:20:54.180 --> 00:20:55.960 - risk modelings of AI. Also, 559 00:20:56.420 --> 00:20:59.380 - the ability of AI to to help primary 560 00:20:59.380 --> 00:21:02.039 - care physicians just like the the scribe, 561 00:21:02.580 --> 00:21:04.500 - and we inscribe the work that they can 562 00:21:04.500 --> 00:21:06.794 - do in managing it in baskets. So there's 563 00:21:06.794 --> 00:21:09.375 - a pilot in Cleveland Clinic right now on 564 00:21:09.595 --> 00:21:10.815 - in basket responses, 565 00:21:11.434 --> 00:21:14.875 - using AI. So feel very, very excited about 566 00:21:14.875 --> 00:21:15.615 - how that'll 567 00:21:16.394 --> 00:21:18.095 - almost like AI could redesign 568 00:21:18.474 --> 00:21:20.554 - the entire flow of primary care and the 569 00:21:20.554 --> 00:21:23.170 - future of primary care. You The role that 570 00:21:23.170 --> 00:21:25.970 - that would take in our screenings, our annual 571 00:21:25.970 --> 00:21:26.869 - wellness exams, 572 00:21:27.170 --> 00:21:27.910 - our physicals, 573 00:21:28.850 --> 00:21:31.029 - questionnaires that we send out. So, 574 00:21:32.210 --> 00:21:34.470 - lots of spaces and areas where 575 00:21:34.855 --> 00:21:37.494 - both Cleveland Clinic and nationally, there there's room 576 00:21:37.494 --> 00:21:38.315 - for changes. 577 00:21:39.095 --> 00:21:40.774 - So I think the future will be I 578 00:21:40.774 --> 00:21:43.194 - feel very excited about the work on access, 579 00:21:43.335 --> 00:21:46.075 - the work on digital access, the work on 580 00:21:46.214 --> 00:21:48.875 - supporting primary care and making primary care, 581 00:21:49.650 --> 00:21:52.049 - not just something you know, traditionally, there's a 582 00:21:52.049 --> 00:21:54.369 - crisis in primary care, people leaving, but but 583 00:21:54.369 --> 00:21:56.690 - to switch it back into where people feel 584 00:21:56.690 --> 00:21:57.190 - engaged 585 00:21:57.730 --> 00:21:59.809 - in in the work that they they feel 586 00:21:59.970 --> 00:22:02.130 - traditionally, they feel very drawn to being primary 587 00:22:02.130 --> 00:22:02.869 - care physicians. 588 00:22:03.535 --> 00:22:05.454 - And I think a big portion of that 589 00:22:05.454 --> 00:22:07.694 - will be the work and access and and 590 00:22:07.694 --> 00:22:08.994 - then the role of AI. 591 00:22:10.494 --> 00:22:12.815 - That's amazing to hear. And, you know, it's 592 00:22:12.815 --> 00:22:14.734 - so incredible to think about what, 593 00:22:15.214 --> 00:22:16.740 - technology and AI has 594 00:22:17.140 --> 00:22:18.980 - allowed us to do in the health care 595 00:22:18.980 --> 00:22:19.480 - industry, 596 00:22:19.940 --> 00:22:21.700 - that wouldn't have even been imaginable a few 597 00:22:21.700 --> 00:22:24.200 - years ago. So it's, cool to have that 598 00:22:24.339 --> 00:22:27.220 - opportunity and then find those smart ways where, 599 00:22:27.380 --> 00:22:30.500 - clinicians are leveraging the technology to superpower them 600 00:22:30.500 --> 00:22:32.039 - and what they're doing for patients. 601 00:22:32.515 --> 00:22:34.994 - Before we wrap up here, I'm curious, who 602 00:22:34.994 --> 00:22:36.835 - do you admire as a leader, really, from 603 00:22:36.835 --> 00:22:38.214 - any industry and why? 604 00:22:39.394 --> 00:22:41.234 - Well, there are lots of people in the 605 00:22:41.234 --> 00:22:42.694 - industry I admire, 606 00:22:43.394 --> 00:22:45.734 - you know, and my my quality safety days, 607 00:22:46.159 --> 00:22:48.640 - Don Berwick. I was I absolutely love doctor 608 00:22:48.640 --> 00:22:51.119 - Berwick and the work and the the the 609 00:22:51.119 --> 00:22:53.759 - simplicity with which she delivered the message on 610 00:22:53.759 --> 00:22:54.819 - quality and safety. 611 00:22:55.519 --> 00:22:57.919 - But as as a leader, since my high 612 00:22:57.919 --> 00:23:00.159 - school days, Laura, I'm I'm a a big, 613 00:23:00.159 --> 00:23:02.715 - big fan of of Gandhi, Mahatma Gandhi. 614 00:23:03.095 --> 00:23:05.894 - And and coming from India, that's that's so 615 00:23:05.975 --> 00:23:08.375 - and then I can safely say the more 616 00:23:08.375 --> 00:23:09.994 - I read about Gandhi, 617 00:23:10.775 --> 00:23:13.195 - the more I'm convinced is is 618 00:23:13.654 --> 00:23:15.390 - if there's a leader in health care today 619 00:23:15.390 --> 00:23:17.230 - that that someone needs to look at it, 620 00:23:17.230 --> 00:23:18.289 - it is his teachings. 621 00:23:19.309 --> 00:23:19.809 - And 622 00:23:20.349 --> 00:23:22.130 - I think his idea of of 623 00:23:23.869 --> 00:23:27.230 - of equity, his idea of finding solutions that 624 00:23:27.230 --> 00:23:29.730 - works for everyone, not just for some, 625 00:23:30.445 --> 00:23:31.724 - His idea of, 626 00:23:32.205 --> 00:23:32.705 - of 627 00:23:33.244 --> 00:23:35.404 - he had a phrase that he said commerce 628 00:23:35.404 --> 00:23:37.565 - without conscience is a sin. I don't like 629 00:23:37.565 --> 00:23:39.244 - to use the word sin, but he used 630 00:23:39.244 --> 00:23:42.445 - it. He defined seven social sins, one of 631 00:23:42.445 --> 00:23:44.384 - which was commerce without a conscience. 632 00:23:45.419 --> 00:23:47.359 - Now we've seen a thousand percent increase 633 00:23:47.899 --> 00:23:49.759 - in equity money flow into 634 00:23:50.220 --> 00:23:52.000 - health care and primary care. 635 00:23:52.619 --> 00:23:53.759 - What does this mean, 636 00:23:55.339 --> 00:23:57.019 - for us? What does it mean for our 637 00:23:57.019 --> 00:23:58.139 - patients? You know, I 638 00:23:59.115 --> 00:24:01.355 - he said something very beautiful, Laura. He said 639 00:24:01.355 --> 00:24:03.755 - there's there's enough in the world for all 640 00:24:03.755 --> 00:24:05.454 - of us for what we need, 641 00:24:05.835 --> 00:24:08.015 - but there'll never be enough for our greed. 642 00:24:08.714 --> 00:24:11.595 - So so I I feel very drawn to 643 00:24:11.595 --> 00:24:12.815 - the teachings of 644 00:24:13.599 --> 00:24:16.319 - of of my middle school, high school learnings 645 00:24:16.319 --> 00:24:18.159 - of Gandhi, and now I keep reading it. 646 00:24:18.159 --> 00:24:18.659 - So 647 00:24:19.279 --> 00:24:20.880 - health care, I have a lot of heroes, 648 00:24:20.880 --> 00:24:22.960 - but but over time, I found the the 649 00:24:22.960 --> 00:24:23.940 - teachings of 650 00:24:24.240 --> 00:24:25.700 - of Gandhi very meaningful. 651 00:24:26.000 --> 00:24:26.500 - This 652 00:24:26.880 --> 00:24:28.259 - this call for tolerance, 653 00:24:29.115 --> 00:24:29.615 - nonviolence, 654 00:24:30.075 --> 00:24:31.535 - we need it more than ever. 655 00:24:32.555 --> 00:24:33.694 - He remains my hero. 656 00:24:34.795 --> 00:24:36.575 - Absolutely. What an inspiring 657 00:24:36.875 --> 00:24:38.894 - person to look to and and truly, 658 00:24:39.914 --> 00:24:41.434 - embody the things that, 659 00:24:41.994 --> 00:24:42.974 - Mahatma Gandhi 660 00:24:43.460 --> 00:24:46.599 - taught and lived out, during this time and, 661 00:24:46.820 --> 00:24:49.779 - you know, incredible inspiration for health care and 662 00:24:49.779 --> 00:24:52.259 - any industry in general. Thank you so much 663 00:24:52.259 --> 00:24:53.940 - for joining us on the podcast today. This 664 00:24:53.940 --> 00:24:54.980 - has been such a, 665 00:24:55.299 --> 00:24:57.700 - great conversation, doctor Kiera, and I'm looking forward 666 00:24:57.700 --> 00:24:59.565 - to speaking with you as well and seeing 667 00:24:59.565 --> 00:25:00.865 - you in person at our, 668 00:25:01.484 --> 00:25:04.045 - in November CEO, CFO roundtable. I think it's 669 00:25:04.045 --> 00:25:07.244 - gonna be, an incredible opportunity for us to 670 00:25:07.244 --> 00:25:08.924 - connect and and dig deeper into many of 671 00:25:08.924 --> 00:25:10.845 - the themes you talked about, and we'll just 672 00:25:10.845 --> 00:25:12.384 - look forward to seeing you there. 673 00:25:12.877 --> 00:25:15.037 - Beautiful. I'm very excited for that. Thank you 674 00:25:15.037 --> 00:25:17.277 - for this opportunity. Thank you for the November 675 00:25:17.277 --> 00:25:19.217 - opportunity, and hope to see you there.