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Hello, everyone. This is Jacob Emerson with the

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Becker's Payer Issues podcast.

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Thrilled today to be joined by a special

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guest. Doctor Lisa Sall is UnitedHealthcare's

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National Medical Director of Maternal Child Health. Doctor

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Sall, thanks so much for taking the time

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to be with us on the podcast today.

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Thanks for having me, Jacob.

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Happy to be here.

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So, Lisa, the philanthropic arm of UnitedHealth Group,

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the UnitedHealth

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Foundation,

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has just released a report within the last

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few weeks called America's Health Rankings 2024

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Maternal and Infant Health Data Brief. This is

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obviously such an important issue for our country

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and within our health care system.

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So can you talk to us a little

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bit about what this report is showing and

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what the need is for such a report?

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Well, to start with why there's such a

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need for the report is that healthy women

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and children are the foundation

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of our communities across the country.

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And it's really important to understand

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the disparities that they face. And so the

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America's Health Rankings 2024

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Maternal and Infant Health Disparities Data Brief

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is really hoping to shed a light on

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the breadth,

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depth, and persistence of disparities and outcomes

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and the drivers of health for

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the approximately 61,000,000

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women of reproductive age

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and 4,000,000 infants in the United States.

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So what we typically

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have seen in

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our America's Health Rankings report is a is

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a broader view on maternal and infant health.

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And, the way that we're looking at this

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new analysis, it builds on last year's America's

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Health Rankings of Women and Children

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report by looking at 5 years of data

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and aggregating that data to offer more detailed

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understanding of disparities by race,

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ethnicity,

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education, and income at both the national and

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state levels across 14 measures of of health.

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And, ideally,

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what we wanna do is align these measurements,

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related to public health goals and benchmarks like

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healthy people 2030.

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So this report, Lisa, it sounds like is

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is taking a very wide look at maternal,

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and infant health outcomes all over the country

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across a wide variety of metrics.

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In knowing that, what would you say are

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some of the key highlights of the brief

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from from this year's report?

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There are 4 key highlights

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that I would like to call out from

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the report. The first is that in 2020,

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severe maternal morbidity

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was 2 times higher among black women

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than white women and

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about 1 and a half times higher among

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Black than Hispanic

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birthing people.

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The second

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is that infant mortality was 2.9

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times higher among infants born to black than

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Asian mothers,

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2.4

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times higher than white, and 2.2

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times higher than Hispanic mothers in the 2018

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to 2021

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time frame.

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The next key takeaway

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is as as we look at females

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that are in the childbearing age defined as

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18 to 44,

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if we look at the comparison between 2010

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and 2014

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high school education than college graduates. And then

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the 4th item

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that I want to note is that the

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low birth

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weight differed by race and ethnicity with low

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birth weight infants born to Black mothers

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2 times higher compared to infants born to

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white mothers. So these disparities

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are are are clear.

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They are persistent,

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and it's a key reason why a report

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like this is is really important to to

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highlight some of these differences so that we

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can think about how we as communities can

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address them.

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Absolutely, and some really sobering statistics that you

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just shared, especially when it comes to how

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these outcomes break down across racial

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and uninsured

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individuals,

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demographics.

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Obviously, Lisa, as you know, maternal mortality

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rates, it's such a

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pervasive issue in this country for,

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in for the healthcare system, especially.

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Is there anything you want to expand upon

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on that issue in terms of what the

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brief found

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and, what it might be recommending?

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Certainly. Well, I've been practicing medicine for the

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last 20 years, and the

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maternal mortality rate in the United States has

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only been steadily increasing

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over that period of time.

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It is the highest among high income countries.

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And as we've highlighted in the 2023

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Health of Women and Children report,

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in 2017

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to 2021

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time frame, there were 22.4

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deaths per 100,000

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live births, which is higher than the Healthy

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People 2030 target of 15.7

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deaths per 100

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live births.

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In this time period of

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2017 to

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2021, 6 states had maternal mortality rates below

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the Healthy People 20 20 2030 target rather.

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And I happen to live in one of

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those states, Minnesota, but the others include California,

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Massachusetts,

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Pennsylvania,

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Utah, and Wisconsin.

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And as we break it down

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by race

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and education,

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American Indian and Alaska Native, Black, and Hawaiian

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Pacific Islander women had rates of maternal mortality

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that were 2 and a half to 4

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and a half times higher than other groups.

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And by education, the maternal mortality rate was

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nearly 3 times higher

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among high school graduates than college graduates.

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Wow. I mean, just listening to you talk

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about some of these numbers and examples, it's

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it's,

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it's very,

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it's such a challenge for our health care

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system,

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to to

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fix clearly.

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Can you also discuss, Lisa, about what the

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brief is showing related to infant mortality rates

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and what your experience has been throughout your

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career in terms of,

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this this trend and how it's evolved over

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over the years?

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Well, there is some good news here with

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infant mortality rates. Unlike maternal

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mortality, the infant mortality rate has improved

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over the past decade by about 13%,

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decreasing from 6.3 to 5.5 per 1000 live

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births,

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and it's moving closer

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to the Healthy People 2030 target of 5

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per 1000 live births.

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However,

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infant mortality does remain consistently higher in the

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United States,

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than in any other,

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developed

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countries.

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And as a health health outcome measure in

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Healthy People 2030

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leading health indicator,

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infant mortality is the number of infant deaths

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before age 1 per 1,000

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live births.

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So as we look at our as we

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look at the breakdown by racial and ethnic

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groups,

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there are some positive statistics to report.

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As we compare 28

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20,008

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to 2,011

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and 2,018

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to 2021,

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the rate decreased

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by 15%

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for infants born to white mothers,

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decreased by 12% for infants born to black

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mothers,

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and decreased by 9% for infants born to

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Hispanic mothers.

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But despite these improvements, the disparities by race

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and ethnicity still do persist.

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Infants born to Black American

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Indian and Alaska Native and Hawaiian Pacific Islander

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mothers

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experienced disparities in infant mortality

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relative to Asian, Hispanic, multiracial,

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and white mothers.

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So if we wanna break that down into

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more specifics,

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for black women,

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the mortality rate was 2.9

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times higher

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than Asian women,

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2.4

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times higher than White, and 2.2 times higher

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than Hispanic mothers.

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And it's 2.2 times higher among infants born

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to American Indian and Alaska Native than Asian

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mothers.

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So again, while the news overall is good

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that we're seeing an overall trend

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towards

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decreases

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in infant mortality,

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we still need to think about how these

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disparities,

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play a role

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and and how we can look at different,

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ethnic groups, education levels, and socioeconomic

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groups to determine how to close these close

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these disparity gaps once and for all.

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Understood. So this is clearly a very nuanced

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issue in terms of the overall trend is

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improving within the country, but there are clearly

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racial groups that are not seeing,

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the same amount of

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increasing health outcomes in this space. It's very

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interesting to hear about this.

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So then Lisa, what do you recommend that

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the clinical community and the public health community

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do about these disparities

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that you're talking about, both on the maternal

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and infant

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fronts? The only way that we will tackle

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this issue and make any significant strides in

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terms of maternal

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and infant health regarding morbidity and mortality

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is for it to be a collaborative

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effort with our clinical community,

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our public health community.

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And as we as I am representing the

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payer community,

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these communities do need to come together.

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And what this report is intended to do

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and what we hope that it accomplishes is

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that it encourages stakeholders in these communities

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to use this information to spark action

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about how they can have an impact on

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maternal and infant health disparities.

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So we're calling upon our leaders,

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providers,

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and public health

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workers

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to engage in this space

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to have data driven discussions about solutions

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to challenges documented

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here in this brief.

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We're looking for providers to familiarize themselves with

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the findings and the trends and advocate for

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their patients.

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And also to think about how we can

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review the state profiles

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provided within the brief

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to help public health officials guide actions within

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their own communities

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based on what they see that specifically

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pertains to

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the information that is found within their state

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to drive significant change.

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Absolutely. And to follow-up with you on how

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this has to be a collaborative

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effort within the healthcare community to address these

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challenges.

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As one of the country's leading healthcare organizations,

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Lisa, what would you say UnitedHealth Group specifically

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is doing to address these disparities among,

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maternal and and infant

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populations?

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Well, UnitedHealth Group is doing a really

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wonderful job at

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engaging

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within

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communities

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as well as engaging

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with

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members

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to think about how we can be part

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of the the wheel of of collaborative change

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that I described.

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And for example, we have programs that are

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aimed at improving birth outcomes, including

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multiple investments to expand the availability of doulas

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throughout our states where we provide

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Medicaid

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plans. Doulas have been shown to

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not only decrease

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c section rates, but improve the experience of

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birthing people,

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improve breastfeeding rates,

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both of which are shown to have a

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positive impact not only on maternal morbidity

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but also,

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infant morbidity and infant mortality

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as well as, the prolongation of of pregnancy

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and gestation.

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We are also

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working on,

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value based relationships with providers

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through our UnitedHealthcare network,

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and that

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in that way, we are aligning incentives for

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improved birth outcomes.

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We have pharmacy outreach programs in our OptumRx

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to support expected people.

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We're looking at how we can continue

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to grow our member incentive

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models

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that improve prenatal and postpartum visit rates

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and then community engagement models like one that

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we have in Kansas City called the UnitedHealthcare

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Catalyst Program.

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And through that program,

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we've seen a 52%

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increase in postpartum care engagement

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and a 66%

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reduction in low birth weight prevalence.

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Those are huge impacts and

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and really important as we think about,

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the continuum of care, the continuum of care

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from the maternity time period into the postpartum

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time period and how important those engagements

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are

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in,

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the long term health

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of birthing people as they go on to

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care for their babies.

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And then lastly,

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I would mention that in New York, to

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to address maternal health disparities,

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the United Health Foundation and a Brooklyn based

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nonprofit named CAMBA

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announced a 3 year,

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$3,000,000 grant partnership a few years ago

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to increase access to prenatal care for underserved

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and homeless individuals

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in Brooklyn.

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So those are just some examples

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of how UnitedHealth

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Group

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is engaging with communities and members and trying

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to get

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to where care is delivered,

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by partnering with both members, agencies,

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and and government public health programs

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to promote that effort.

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Wonderful. Clearly, a lot of impactful work going

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on across the UnitedHealth enterprise. So appreciate you

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sharing a few of those examples with us,

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Lisa.

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Before we go, any other final thoughts you'd

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like to share while you have the ears

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of a lot of health plan leaders from

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all over the country?

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Well, I think that this is such an

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important issue and one that's near and dear

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to my heart, as a perinatologist

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and one that's practiced for 20 years. My

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life's work has been

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caring for

402
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pregnant

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people

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and,

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promoting

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the best possible

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birth outcome both for the birthing person as

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well as for their infant or infants. And

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I think that

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this information that we see in our report

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and our in our brief

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is just highlighting what we've known

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for decades, and we're not seeing things necessarily

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improving at the rate that we'd like to.

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And I think just to emphasize the fact

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that without the collective efforts of all individuals

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and all agencies and all health care systems

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and providers

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that touch birthing people,

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we really will not be able to move

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the needle in any meaningful way. And so

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my plea

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is to read the report,

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to digest

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what what it's saying and where it applies

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to you locally,

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and to make those efforts and outreach to

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collaborate with whomever you can,

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to

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help us make meaningful change in this space.

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Fantastic. Well, doctor Sall, thank you so much

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for taking the time to be with us

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and for sharing your insights with our listeners.

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We truly appreciate it.

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00:17:26,559 --> 00:17:28,320
Thank you, Jacob. It was a pleasure to

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00:17:28,320 --> 00:17:29,059
be here.

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00:17:29,626 --> 00:17:31,226
And if you'd like to listen to more

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00:17:31,226 --> 00:17:33,546
podcasts from Becker's Health Care, you can visit

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00:17:33,546 --> 00:17:34,046
beckershospitalreview.com.