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This is Laura Diet with the Becker Healthcare

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podcast. I'm thrilled today to be joined by

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Sunny Goya, Senior Vice President and Head of

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diversified businesses at Blue Cross, North Carolina. Sunny

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is pleasure to have you on the podcast

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today?

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Thanks for inviting me here. Really excited to

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speak with you.

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Absolutely. And I'm looking forward to learning more

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about how you're thinking about the future of

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Blue Cross North Carolina and some of the

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cool things that you're doing within the community.

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But before we dive into that discussion, You

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tell me a little bit more about yourself

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in your background?

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Happy too.

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As the head of diversified businesses for Blue

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cross, North Carolina.

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Effectively manage all of our non insurance companies

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and resources that advance the company's strategy to

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improve

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convenient access to quality and affordable care in

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our states.

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And I lead the team that manages

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multi billion dollar portfolio of companies,

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partnerships, joint ventures and minority investment.

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In addition to those duties I serve as

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an advisor on several boards, including Echo Health

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venture, Sure health, All solutions at number of

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others.

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And my background my professional background here is

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that I was in investment banking, venture capital,

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strategic planning,

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and all of that's been driven by my

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interest and innovation. It's a big reason why

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I'm actually in healthcare

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because I think there's a significant need and

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a lot of innovation that's actually happening. That

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could really drive tangible differences in people's lives

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And excited to be here than speak to

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you about it.

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Excellent. Well, let's dive right in. What are

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some of the biggest trends and headwind that

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you're following right now?

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You know, let me let me start off

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with focus on access to care.

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With the current labor shortages driven by the

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great resignation and by the number of clinical

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burnout outs to really looking forward in the

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future to with the next decade of our

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aging population is.

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It's exciting to see a lot of folks

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trying see leverage new services and technologies to

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expand access to care.

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These services are being groomed by a number

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of stakeholders from venture capital,

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funding early stage organizations to all the way

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together Spectrum where to those that are publicly

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traded

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and the breath of services that we're seeing

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that we're tracking,

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range for from pure tele solutions, the hybrid

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tech and services hub and smoke for rural

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communities,

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providing access to quality,

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affordable healthcare

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across the spectrum, it's really, really exciting

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even the number of health systems we see,

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that are today focused on rebuilding their care

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delivery footprints from,

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the big inpatient centers to more ambulatory and

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income models. That focus on access to care

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is a trend that we are tracking close

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way.

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You know, the the second 1 here is

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what I call diversification and collaboration.

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We're seeing a lot of increased investments in

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partnerships. And organizations that are attempting to diversify

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the kind of legacy healthcare model.

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And with so much more and collaboration happening

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in industry in my opinion that leads to

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nothing but good, but we're tracking this closely.

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And those activities are kind of widespread, right?

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Their

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across a number of different types of organizations

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mapping against

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lots of different

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strategies

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some of them are just accessing new profit,

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others to provide a more holistic set of

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services and solutions to their patients and our

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members.

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Others are really just simply aligning the use

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of their capital towards their company's mission and

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purpose and making sure that they're creating greatest

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impact on healthcare possible.

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And then the third trend that I would

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say

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that we're tracking closely here is

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I think we see a lot significant

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investments by almost every stakeholder in healthcare care

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on technological advancement. Generative Ai is probably 1

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of the more exciting ones that everyone's talking

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about

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and it does feel like Ai and some

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of these new pushes and technological advances are

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really driving the entire industry forward versus I

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think historically, you've seen a lot of select

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views that have 1 and you've got from

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losers here.

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And that's because there's 3 areas that it's

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attacking. 1 is reducing administrative burden think about

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automating those back office processes and improving billing

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processes,

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enabling physicians to focus on high quality care

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by managing at a du and mutation activities

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or even assisting in diagnosis and treatment of

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patients.

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And as I mentioned earlier, I think it

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can also help the spam the work a

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person can do right by

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simplifying human interactions in the call centers or

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even at the nurse level,

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suggesting interventions or

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gaps in care that they should be tracking

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towards or monitoring

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remote monitoring data is really kind of an

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interesting 1. So I think that's a really,

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really exciting

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trend that we'll be watching for quite some

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time here. In terms of headwind,

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couple I'd call out here. First 1 is

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just driving cost

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continue

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to be a challenge and look to be

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a challenge in the future.

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We're in an affordability crisis where

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today, healthcare represents about 17 percent of Gdp.

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And there's about 2 20000000000

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dollars in medical debt weighing down 15 percent

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of household across its country. At staggering,

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when you layer on top of that, the

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impact of inflation that's driving up the cost

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of delivery and health systems

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problem is getting worse. And then couple that

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with the price of drugs. We have a

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really tough road ahead of us.

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Prices of existing drugs are increasing dramatically, the

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there's an accelerated pace of new cell and

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gene therapies. They're being improved groups.

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And I think we're anticipating about 55

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by 20 27 that Are got costs so

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under 2000000 dollars on average.

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And Gl,

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I've a friends around Gl and it's driving

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up the cost of care,

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and I think by 2030, we're projecting about

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30000000 Americans we'll be using Gl lps

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and that's a staggering number,

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even within our own datasets sets, we're seeing

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prescription drugs from 20 22 to 20 23

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growing up 5 percent,

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mostly driven by specialty drugs, which was almost

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at 9 percent trees there. But we're seeing

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these the rising costs hitting us everywhere.

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The second headwind provider shortages and labor costs,

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9 I mentioned this is 1 of the

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most critical areas

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is our workforce shortages.

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Today, about hundred million Americans Live in an

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area with a primary care shortage.

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As effectively 30 percent of our population living

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in an area without adequate primary care coverage

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to make that work

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to make that come even more real 166000000

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people live in an area with mental health

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shortages.

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So when you look forward here

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over the next decade,

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we're anticipating and projecting somewhere in about 124000

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position shortage in the U. S. That is

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staggering.

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And there is such a critical need to

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continue to develop and leverage technology and find

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alternative ways to deliver care to start to

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address this headwind, but it is a day

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that's impacting everybody.

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Technology

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So those would be the the 2 headwind

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that I would call out.

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Well, that's fascinating. And, you know, you really

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covered a lot of ground in terms of

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seeing so many different...

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Areas where you really... There's opportunities for growth

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and development continue to

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provide clearance, bridge some of those gaps, and

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it fascinating too to hear about how you're

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thinking on some of the rising costs of

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new drugs, inflation,

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especially some of those innovative,

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solutions and treatments,

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therapies as well that could be really beneficial

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for certain patients, how to navigate that and

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make sure there's access to care when it

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will make a big difference.

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So, you know, I just... Feel like there's

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so many things happening right now as you

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said,

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and so the opportunities to really

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continue to grow and develop. I'm wondering how

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you're thinking about growth for the future. What

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does that look like for...

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Blue Cross of North Carolina?

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Yeah.

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Great question. You know, I'm I'm really bullish

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on the growth for insurers and in transforming

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healthcare. And I think that's the really important

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statement of transforming healthcare. Because I think there

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will be some

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insurance companies who will focus on

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what they have done over the past

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10/20/4080

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years of their existence.

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But I think we need to be transforming

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and meeting the needs of

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what our stakeholders are our members our patients

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are looking for. And so I'm excited about

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maybe 3 categories here of growth for us.

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I see a lot of opportunities for payers

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that seek out new partners

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for every investment we make, there must be

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a measurable

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health outcome for our members

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and those outcomes will vary but they're always

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present. I'll give you some examples here at

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North Carolina.

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We a few years ago partnered,

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and founded a company called All Solutions.

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Did this in partnership with a private equity

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firm.

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The intention was to build

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a company that could support independent primary care

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across our states.

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Today only a few years later, we are

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managing 36 locations across our

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our triangle and Charlotte regions providing high quality

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primary care that has integrated of health psychiatry

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nutrition, chronic care management

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and a number of other services that you

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can see in person and virtually.

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Another partnership we partnered with Mar Group to

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provide Medicaid services in our states

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we now are the largest plan and manage

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just about 600000

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lives across our states ensuring that

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those of the media population have access to

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high quality carriers to improve their lives.

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I think there's a lot of other opportunities

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to partner as we think about the future

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and so those platforms I think are going

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to hit in categories like better member engagement

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to provide our members

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and our consumers, the answers are seeking

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and to be able to help support the

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decisions to improve their health turning.

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Another area that we are exploring here is

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expanding

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clinical data interoperability and decision sports to effectively

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share our data and enable physicians and providers

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to be able to guide their patients to

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make better more informed decisions.

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We think that be really critical.

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And so there's a number of other

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categories

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that we have

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expanded into, like dispatch health getting into income

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care.

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We've been partnering with health systems to think

279
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about new payer and

280
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care management type solutions. So I think partnership

281
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is going to be a big category and

282
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it's a big category of for our success,

283
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but also success as we look forward,

284
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The second category I'd takes talked about is

285
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the health, what we call the front door

286
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healthcare.

287
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We think there is a large

288
00:10:28,121 --> 00:10:30,823
opportunity and helping our patients and our members

289
00:10:30,823 --> 00:10:33,047
navigate the care they need. But there's been

290
00:10:33,047 --> 00:10:34,183
a lot of dollars

291
00:10:34,968 --> 00:10:37,744
spent into navigation and transparency solutions,

292
00:10:38,299 --> 00:10:40,757
range rewards, platforms and many other types of

293
00:10:40,757 --> 00:10:41,257
platforms

294
00:10:42,026 --> 00:10:42,685
and network

295
00:10:43,709 --> 00:10:46,096
The solutions have been successful, but there's so

296
00:10:46,096 --> 00:10:48,641
much more opportunity here. The reality is our

297
00:10:48,641 --> 00:10:50,312
members and our patients they need so much

298
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more from us.

299
00:10:51,920 --> 00:10:53,220
So we are,

300
00:10:53,759 --> 00:10:56,340
really focused on partnering and creating a seamless

301
00:10:56,559 --> 00:10:59,299
high quality care delivery footprint. That will be

302
00:10:59,360 --> 00:11:01,059
more integrated with our services

303
00:11:01,534 --> 00:11:04,095
to create amazing experiences for all North Carolina.

304
00:11:04,735 --> 00:11:06,355
And that front door of healthcare

305
00:11:07,054 --> 00:11:09,475
really shouldn't just consist of tech solutions

306
00:11:10,826 --> 00:11:14,096
should should incorporate human supports, how do we

307
00:11:14,096 --> 00:11:15,633
actually leverage the things. But also

308
00:11:16,011 --> 00:11:18,084
a network across the state of all of

309
00:11:18,084 --> 00:11:20,575
those front door assets of urgent care is

310
00:11:20,575 --> 00:11:23,615
primary care, ambulatory surgery centers, women's health health

311
00:11:23,615 --> 00:11:26,495
telehealth solutions. How can we create that integrated

312
00:11:26,495 --> 00:11:28,686
bridge with all those good people join

313
00:11:29,061 --> 00:11:30,890
sorry, enter into their healthcare journey on very

314
00:11:30,890 --> 00:11:31,526
different spots.

315
00:11:33,434 --> 00:11:35,955
I think back to recent announcements here where

316
00:11:36,233 --> 00:11:38,459
the number of retailers who kind of wanted

317
00:11:38,459 --> 00:11:39,811
into this and brick and mortar was the

318
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O gateway here,

319
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but healthcare is complex.

320
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And what works with people to pick up

321
00:11:46,106 --> 00:11:47,773
a pan, It's not the exact same thing

322
00:11:47,773 --> 00:11:50,155
as to pick up and actually get their

323
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health care needs served.

324
00:11:51,901 --> 00:11:54,381
You really have to think about a synthetic

325
00:11:54,381 --> 00:11:56,795
or a real integration approach to insurance

326
00:11:57,411 --> 00:11:58,469
and the care delivery

327
00:11:58,846 --> 00:12:02,009
actually makes this successful. That's what we believe

328
00:12:02,210 --> 00:12:05,009
the value comes from ip payer and a

329
00:12:05,009 --> 00:12:07,669
provider creating an integrated front door

330
00:12:08,049 --> 00:12:09,970
at collaboration that's going to be really successful.

331
00:12:10,129 --> 00:12:11,490
It's going to drive better value based care.

332
00:12:11,903 --> 00:12:14,838
Better referral management improves member and patient experience,

333
00:12:15,156 --> 00:12:17,773
etcetera. So that's a second. And then the

334
00:12:17,773 --> 00:12:20,326
last 1 is a big area for carolina.

335
00:12:20,485 --> 00:12:22,307
We're really excited about the growth in value

336
00:12:22,307 --> 00:12:24,763
based care and all the models surrounding it.

337
00:12:25,476 --> 00:12:26,823
I think in January,

338
00:12:27,473 --> 00:12:29,941
Be estimated that about 90000000 lives will be

339
00:12:29,941 --> 00:12:32,647
in value based care models and contracts by

340
00:12:32,647 --> 00:12:33,284
20 27,

341
00:12:33,761 --> 00:12:35,527
more than double where we were in 20

342
00:12:35,527 --> 00:12:37,356
22, which is about 43000000

343
00:12:37,356 --> 00:12:37,595
lives.

344
00:12:38,708 --> 00:12:40,219
A lot of this is because value based

345
00:12:40,219 --> 00:12:43,400
care focuses on aligning the incentives between providers,

346
00:12:43,638 --> 00:12:46,284
payers and consumers. And and we see these

347
00:12:46,284 --> 00:12:48,304
value based care models expanding

348
00:12:48,845 --> 00:12:51,184
beyond where they've started in primary care

349
00:12:52,125 --> 00:12:55,192
into hospital care and into specialties like oncology

350
00:12:55,644 --> 00:12:56,541
orthopedic ne,

351
00:12:56,914 --> 00:12:58,184
behavioral health and so many more.

352
00:12:59,454 --> 00:13:00,882
I'm proud of the work that we have

353
00:13:00,882 --> 00:13:03,282
done at North Carolina because we've launched our

354
00:13:03,282 --> 00:13:05,270
own blue premier model which is our value

355
00:13:05,270 --> 00:13:06,008
based care

356
00:13:07,337 --> 00:13:10,858
construct and 20 19. And we've already shared

357
00:13:10,915 --> 00:13:13,567
at and sorry earned about 500000000.0 dollars in

358
00:13:13,567 --> 00:13:13,966
savings,

359
00:13:15,405 --> 00:13:16,364
that's to last year.

360
00:13:16,923 --> 00:13:18,762
And a lot of that shared with the

361
00:13:18,762 --> 00:13:20,520
community with our health systems.

362
00:13:21,491 --> 00:13:23,481
And that's critical. So coming back to I

363
00:13:23,481 --> 00:13:25,255
said earlier right. This is all about aligning

364
00:13:25,312 --> 00:13:27,302
incentives between providers payers and consumers.

365
00:13:27,860 --> 00:13:29,709
To us, this is the best way to

366
00:13:29,709 --> 00:13:31,887
improve access to improve quality and to improve

367
00:13:32,026 --> 00:13:33,784
affordability, which is 1 of the biggest challenges

368
00:13:33,784 --> 00:13:34,343
in our space.

369
00:13:35,862 --> 00:13:37,835
That's amazing to hear. You know, and really

370
00:13:37,955 --> 00:13:40,035
impressive all the different projects you have going

371
00:13:40,035 --> 00:13:42,134
on in the different ways you're using technology

372
00:13:42,274 --> 00:13:45,210
to improve the access to care and allow

373
00:13:45,329 --> 00:13:47,553
for patients and members to connect with you

374
00:13:47,553 --> 00:13:49,539
in a variety of different ways. And your

375
00:13:49,539 --> 00:13:52,001
last, you know, statements on value based Care

376
00:13:52,001 --> 00:13:54,067
too is just, really, it seems like cutting

377
00:13:54,067 --> 00:13:56,073
edge and on the 4 forefront of how

378
00:13:56,073 --> 00:13:58,470
health care is moving where the transformation is

379
00:13:58,470 --> 00:13:58,950
and truly,

380
00:13:59,589 --> 00:14:01,666
can make a big difference in terms of

381
00:14:01,666 --> 00:14:03,836
changing the way that how care. Resources are

382
00:14:03,836 --> 00:14:06,546
used in the community and certainly the outcomes

383
00:14:06,546 --> 00:14:08,538
that come along with them too. Now before

384
00:14:08,538 --> 00:14:10,053
we I wrap up here, I'm wondering, could

385
00:14:10,053 --> 00:14:11,977
you tell me about up project or initiative

386
00:14:11,977 --> 00:14:13,883
from the last year that yielded the best

387
00:14:13,883 --> 00:14:14,201
results?

388
00:14:15,868 --> 00:14:16,663
Yeah. Happy to.

389
00:14:17,536 --> 00:14:19,363
We've been on a mission to expand Behavioral

390
00:14:19,363 --> 00:14:21,289
health across our states. And I know many

391
00:14:21,289 --> 00:14:21,789
other,

392
00:14:22,408 --> 00:14:24,405
but insurance companies as well as Health systems

393
00:14:24,405 --> 00:14:26,164
have been doing this. But I think we've

394
00:14:26,164 --> 00:14:28,182
taken a very different approach. I'm really proud

395
00:14:28,401 --> 00:14:29,440
of what we've accomplished.

396
00:14:30,334 --> 00:14:32,569
As I mentioned earlier, is the lack of

397
00:14:32,569 --> 00:14:35,043
access to these services in a timely fashion

398
00:14:35,043 --> 00:14:37,357
just creates significant concern for us in the

399
00:14:37,357 --> 00:14:38,076
entire industry.

400
00:14:38,729 --> 00:14:39,846
In light of that a few years ago,

401
00:14:40,006 --> 00:14:42,479
we partnered with an organization called Ava care

402
00:14:42,479 --> 00:14:44,633
to catapult that service inside our states.

403
00:14:45,750 --> 00:14:47,836
Last here we grew that partnership by hiring

404
00:14:47,836 --> 00:14:49,746
over 90 therapists and psychiatrists,

405
00:14:50,701 --> 00:14:53,407
integrating them into primary care practices across the

406
00:14:53,407 --> 00:14:56,524
state here and we managed about 90000

407
00:14:56,524 --> 00:14:57,024
visits

408
00:14:57,638 --> 00:14:59,785
inside of those clinics as well as virtually,

409
00:15:00,024 --> 00:15:02,273
which is really exciting for us because

410
00:15:02,664 --> 00:15:03,164
effectively,

411
00:15:03,863 --> 00:15:05,221
that capacity didn't exist,

412
00:15:05,860 --> 00:15:07,858
but we've really been pushing hard to increase

413
00:15:07,858 --> 00:15:08,358
capacity

414
00:15:08,737 --> 00:15:10,015
by enabling this partnership.

415
00:15:10,829 --> 00:15:12,187
It hasn't been an easy hunch.

416
00:15:13,226 --> 00:15:15,004
But the Fortunate part is

417
00:15:15,623 --> 00:15:18,432
there are so many people that just are

418
00:15:18,432 --> 00:15:20,581
demanding and looking for this kind of help,

419
00:15:21,218 --> 00:15:23,049
finding the actual patients to get to the

420
00:15:23,049 --> 00:15:25,438
services isn't the hard part. The harder part

421
00:15:25,438 --> 00:15:27,621
really been about integrating those services

422
00:15:27,994 --> 00:15:30,294
into their care journey into the primary care.

423
00:15:31,087 --> 00:15:33,205
But we've seen some really immediate results

424
00:15:34,043 --> 00:15:35,878
we have expanded access that I mentioned to

425
00:15:35,878 --> 00:15:37,097
90000 visits

426
00:15:37,475 --> 00:15:39,870
last year and that fort our ability to

427
00:15:39,870 --> 00:15:41,546
offer affordable convenient care folks.

428
00:15:42,199 --> 00:15:44,745
The primary care physicians are raving about this.

429
00:15:45,381 --> 00:15:48,405
They love the integration and it helps them

430
00:15:48,405 --> 00:15:50,473
provide more holistic care to their patients.

431
00:15:51,523 --> 00:15:53,593
And we've actually seen significant amount of impact

432
00:15:53,593 --> 00:15:55,822
from those practices in the shared savings piece

433
00:15:55,822 --> 00:15:58,073
where in their value contracts. They've actually earned

434
00:15:58,130 --> 00:15:58,847
significant savings.

435
00:15:59,578 --> 00:16:01,726
So it's paying off for the positions as

436
00:16:01,726 --> 00:16:01,965
well.

437
00:16:02,681 --> 00:16:04,113
So you uganda end up and it's really

438
00:16:04,113 --> 00:16:06,022
this great win win win scenario,

439
00:16:06,499 --> 00:16:08,743
where the members are getting more access, physicians

440
00:16:08,743 --> 00:16:11,694
are getting paid more for higher quality work.

441
00:16:12,492 --> 00:16:14,805
And as a plan, we know that our

442
00:16:14,805 --> 00:16:17,437
members are getting the quality care that they

443
00:16:17,437 --> 00:16:17,596
need.

444
00:16:18,409 --> 00:16:20,484
I'm really excited about that. We have a

445
00:16:20,484 --> 00:16:21,521
lot of work in front of us to

446
00:16:21,521 --> 00:16:22,399
continue to expand this.

447
00:16:23,436 --> 00:16:25,750
We're not done. We need to continue to

448
00:16:25,750 --> 00:16:28,319
so Build upon this footprint and help support

449
00:16:28,319 --> 00:16:29,676
more and more of our members across the

450
00:16:29,676 --> 00:16:29,835
states.

451
00:16:31,352 --> 00:16:33,666
That's amazing here. You know, and really impressive

452
00:16:33,666 --> 00:16:36,797
to think about all the different opportunities that

453
00:16:36,797 --> 00:16:38,474
you can continue to work on and I...

454
00:16:38,714 --> 00:16:39,294
I'm sure

455
00:16:39,832 --> 00:16:41,830
people that... This will affect in the future.

456
00:16:42,243 --> 00:16:43,591
Sunny, thank you so much for joining us

457
00:16:43,591 --> 00:16:45,098
on the podcast today. This has been a

458
00:16:45,098 --> 00:16:46,922
really fun and interesting discussion, and I look

459
00:16:46,922 --> 00:16:48,270
forward to connecting with you again soon.

460
00:16:49,157 --> 00:16:50,591
Yes, thank you for having me. It's a

461
00:16:50,591 --> 00:16:51,945
pleasure. Look forward to seeing you.