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Imagine this. You're at the Swiss Hotel in

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Chicago surrounded by top executives from leading insurance

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companies and health systems.

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Welcome to Becker's Fall Pair Issues Roundtable, November

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4th through 6, 2024.

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Picture the excitement as you gather business cards

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from over 500 executive level attendees,

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building invaluable connections.

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Feel the energy as you participate in over

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26 educational sessions led by 90 elite speakers.

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Envision yourself engaging in lively discussions about new

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health plans, hospital at home models, behavioral health,

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and price transparency.

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Now imagine being inspired by keynotes from boxing

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legend, Sugar Ray Leonard, and 4 time NBA

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you motivated and ready to innovate.

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Don't miss out on this unique opportunity. Get

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registered today. Visit beckershospital

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hospitalreview.com

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and click on the events page to find

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the conference website. That's the beckers hospital review.com

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events page. See you in Chicago.

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Welcome everyone to the Becker's Healthcare podcast series.

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I'm Mariah Mohammed, writer and moderator of Becker's

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Healthcare, and I'm thrilled to have with me

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today Jo Glinka, director of PA Health Choices

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at Highmark Whole Care. Jo, welcome to the

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podcast. We're very excited to have you join

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us today. To get us started, would you

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mind please introducing yourself and telling us a

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bit about your background?

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Sure. It's great to be here, Mariah. Appreciate

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the opportunity.

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I again, director of health choices at Highmark

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WholeCare. Highmark WholeCare is part of the Highmark

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family of companies

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and the largest, Medicaid managed care organization within

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Highmark's Medicaid segment.

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We have the privilege and responsibility of serving

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approximately

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340,000

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Pennsylvanians in need at the current time.

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The HealthChoices program in Pennsylvania is really the

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Commonwealth's,

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Medicaid Managed Care Program.

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And there are 3 domains within that program

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because Pennsylvania is not an integrated state when

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it comes to Medicaid service delivery.

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The Health Choices program exists for, 1, physical

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health, which is where

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our purview is, where where we operate within.

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But there's also a behavioral health health choices

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and a health choices program for to manage

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long term services and supports delivery.

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I'm Pittsburgh born and bred and graduated at

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Carnegie Mellon University

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and, started my career,

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quite a few years ago back at a

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company called US HealthCare.

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And, over my 35 years in managed care,

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I've had the privilege of serving in a

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number of different capacities, which would encompass,

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both the commercial and the government plan space.

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And then as far as actual,

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career steps,

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I've been in marketing

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and sales. I've served in business development efforts,

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enrollment,

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the government affairs and government relations as well,

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and now plan administration,

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for Highmark Whole Care.

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Wonderful. Wonderful. Thank you so much for giving

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us that background on Highmark and your professional

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experience.

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And with the years of experience you have

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in this field, I'm sure you've seen a

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lot of things come and go, problems and

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solutions.

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For you, what are some of the big

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trends and headwinds you're following right now in

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the news?

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Well,

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there's a lot of thing and it's not

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necessarily in the news. It's things that we're

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encountering every day.

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And and we've just,

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at least in Pennsylvania,

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we have find come through the public health

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emergency unwinding process. Some states are still going

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through it.

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But during the

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epidemic, Medicaid programs throughout the country

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maintained continuous enrollment

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in order to bolster and keep the safety

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net available for those who are

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many millions of people who were losing their

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jobs and so forth.

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And, in Pennsylvania, we saw an escalation in

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the role of the Medicaid enrollment

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to the tune of about 500000 or 600000

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people,

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above and beyond what it typically

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is.

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We have, you know, beginning in April of

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last year,

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the unwinding of that continuous enrollment was commenced.

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And, now what we're seeing,

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after losing

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quite a few people off our roles, we're

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not the only managed care organizations that has

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experienced that. But the overall acuity,

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the,

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of our population that remains

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on the enrollment has increased dramatically,

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costing us more on a per member per

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month basis. And that's simply because

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when you look at how Pennsylvania Medicaid enrollment

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grew,

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60 to 65%

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of that growth was within the Medicaid expansion

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population

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that that would, you know, that Pennsylvania embarked

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upon per the Affordable Care

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Act. So, you know, that population itself,

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is a population of 19 to 64s,

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typically single adults.

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But when it comes to

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risk, they are of a lower risk profile

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than what you'll find in your more traditional

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categories of aid. It would include TANF and

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ABD and SSI and so forth.

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So you have a basically,

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a healthier risk that's diluting,

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the more severe risk when you have all

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the continuous enrollment going on. And now with

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that lower risk, if you will, vacating the

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plan through unwinding,

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you you you're left with the stairs

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who need services, but you don't have the

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revenue you had before in order to,

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care for those individuals. So the the acuity

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has gone up and it's and it's got

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our attention as well as other managed care

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organizations that we do compete against.

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One of the other things we're also looking

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at is the escalation continued escalation and the

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use of GLP-1s.

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These are the weight management medications. Many of

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us have seen plenty of advertisements on TV

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for medications such as Ozempic, Wegovy,

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Victoza,

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Saxenda and a number of others.

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These drugs are very, very expensive

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and they are being prescribed quite a bit.

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They're being driven by

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consumer requests coming into the office and they're

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used in the treatment of diabetes

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and and weight management.

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To give you an idea of, what we're

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experiencing right now on that escalation since January,

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although our enrollment has gone down for the

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unwinding,

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our utilization per for 1,000 members has escalated

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36%

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since January just with this one class of

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medications.

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And the overall cost per member per month

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basis has escalated some 33%

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since January of this year alone.

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It really has our concern. It's driving,

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our overall cost trend

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and it's making things very, very difficult to

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manage within the means that we have. You

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know, we're funded by taxpayers, and we need

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to be great fiscal stewards of the of

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the people's money,

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but it's it's escalations like this which are

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particularly challenging.

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One of the other things we're looking at

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is the, you know, the elevated attention to

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health related social needs. You

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know, it seems to be the new nomenclature

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in place of social determinants of health.

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Imer ColdCare and its roots,

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we've been paying attention to social determinants of

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health or socioeconomic

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impact to health for some 25 years.

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And, you know, as analytical tools become more

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sophisticated,

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you know, we are striving to know everything

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we can as far as what the socioeconomic

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impact is to our members.

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There's been plenty of studies done where,

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when it comes to a person's overall health

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status, 20% of a person's overall health status

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is clinical,

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which may be counterintuitive to what most people

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would think. You have a component there of

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heredity,

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but then that remaining space around 60% or

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so,

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is

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that determines a person's health status will be

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things like

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the level of education they have,

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the mode of transportation they have available,

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where they live,

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the quality of their water, their proximity,

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to a provide their provider do they go

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see, proximity to a reliable food source if

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they're in a food desert

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and so forth.

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And,

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so,

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this area continues to get

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more and more focus

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because of the huge impact it has. And

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and now, you know, you've mentioned before, I've

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been in the industry for a long time,

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you know, we've gone from people calling in

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to, to get a new card, to change

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their doctor, to ask if the medication's on.

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And so and we still get those calls.

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But now we're getting calls like, can you

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help me get a GED so I can

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get a job?

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Can you help me find,

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resources that I can have broadband access in

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my area? Can you help me find a

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childcare center so I can go get a

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job? Can you provide me transportation to a

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food bank? I mean, these are very, very

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compelling

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things,

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that add up to an overall socioeconomic

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impact

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that can be

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significant at the individual level.

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And then, the last thing that I wanted

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to mention was

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the application of artificial intelligence

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and decision making. We,

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here at the plan, we've incorporated

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a number of machine learning disciplines in how

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we look at our membership,

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you know, so that we can begin to

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understand,

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you know, what,

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what

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possibility there is for

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one of our members to

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present in the emergency room and for what

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condition,

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if we know what they're gonna present for

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and we know what the precursors to that

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condition may be,

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we wanna be able to work upstream

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to meet a person earlier in that journey

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so we can bend the cost curve earlier

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and achieve a desired health outcome without being

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as costly had that individual gotten to point

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x.

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And so what we're finding is, you know,

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through that as the machine continues to design

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on itself, you have artificial intelligence. And where

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we see AI going is

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it will provide

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an incredible opportunity

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for more precision in imaging

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and diagnosing

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and mining electronic health records.

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And one of the things that we are

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also seeing is that the human element is

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still going to have to be involved with

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that,

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because we want to make sure that as

278
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conclusions are reached that those conclusions

279
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can be reached in an equitable manner. And

280
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so that we we wanna make every effort

281
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to reduce health inequities, which are,

282
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considerable in this day and age.

283
00:10:30,279 --> 00:10:32,519
Yeah. Yeah. Absolutely. Thank you so much for

284
00:10:32,519 --> 00:10:34,360
giving us all that insight. You know, the

285
00:10:34,360 --> 00:10:36,840
the weight loss meds are definitely a trending

286
00:10:36,840 --> 00:10:38,574
topic right now. And I know at some

287
00:10:38,574 --> 00:10:40,894
of our conferences later this year, we have

288
00:10:40,894 --> 00:10:43,454
several panels on it. I'm very interested to

289
00:10:43,454 --> 00:10:45,214
see what other execs in your field are,

290
00:10:45,214 --> 00:10:47,394
you know, kinda handling this this wave.

291
00:10:48,014 --> 00:10:50,174
In your opinion, how are you thinking about

292
00:10:50,174 --> 00:10:52,429
growth for the future, whether it's focused on

293
00:10:52,429 --> 00:10:54,690
insurance, you know, the weight loss medications,

294
00:10:55,070 --> 00:10:56,929
workforce, or anything else?

295
00:10:58,830 --> 00:10:59,809
In terms of

296
00:11:00,509 --> 00:11:03,089
we as a matter of fact, I personally

297
00:11:03,230 --> 00:11:06,934
involved within Pennsylvania Pennsylvania has what's known as

298
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a medical assistance advisory committee.

299
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It's, it's a a stakeholder body

300
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to

301
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advise the Department of Human Services on ways

302
00:11:16,355 --> 00:11:18,615
to improve access and quality of care.

303
00:11:18,920 --> 00:11:20,519
And one of the things that the the

304
00:11:20,519 --> 00:11:22,759
managed care subcommittee that I chair is working

305
00:11:22,759 --> 00:11:23,580
on right now

306
00:11:23,960 --> 00:11:25,660
are are we're trying to research

307
00:11:26,200 --> 00:11:28,620
what opportunities there would be to improve,

308
00:11:29,480 --> 00:11:30,779
accessibility to providers,

309
00:11:31,559 --> 00:11:34,034
in in in the primary care space, the

310
00:11:34,034 --> 00:11:36,355
dental space, and behavioral health space. And we're

311
00:11:36,514 --> 00:11:38,514
you know, because there are workforce issues in

312
00:11:38,514 --> 00:11:39,575
all of those areas,

313
00:11:40,195 --> 00:11:41,875
so we're trying to to tackle that at

314
00:11:41,875 --> 00:11:42,855
the state level.

315
00:11:43,554 --> 00:11:46,434
In terms of other growth items on our

316
00:11:46,434 --> 00:11:48,500
enterprise lines, we're always going to be looking

317
00:11:48,500 --> 00:11:50,440
at new markets to be able to take

318
00:11:50,579 --> 00:11:51,240
our mission

319
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and capability into other markets to be a

320
00:11:53,699 --> 00:11:54,199
catalyst

321
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for

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improvement in the overall model.

323
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Not that we're the silver bullet, but we

324
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believe that we can bring that to a

325
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market.

326
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So we will be carefully looking at various

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00:12:07,154 --> 00:12:07,654
opportunities

328
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to do that. And then in terms of

329
00:12:09,795 --> 00:12:11,394
growth, we want to be able to continue

330
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to grow in our relationship

331
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and relating to our members,

332
00:12:15,370 --> 00:12:17,870
relating to the providers that we're partnered with

333
00:12:18,169 --> 00:12:20,649
that actually deliver the care, partnering, you know,

334
00:12:20,649 --> 00:12:22,970
in growing in our relationships with community based

335
00:12:22,970 --> 00:12:26,009
partners that run the food banks and the

336
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workforce development,

337
00:12:27,529 --> 00:12:29,529
entities to help people get jobs and so

338
00:12:29,529 --> 00:12:30,589
forth. So

339
00:12:31,024 --> 00:12:32,785
the growth is, you know, in terms of

340
00:12:32,785 --> 00:12:34,245
that competency and connection

341
00:12:34,785 --> 00:12:37,504
as well as geographic and trying to take,

342
00:12:37,504 --> 00:12:39,924
you know, take our track record abroad.

343
00:12:41,424 --> 00:12:43,024
Yeah. Thank you so much for giving us

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00:12:43,024 --> 00:12:45,320
that insight on that. And and, Joe, before

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00:12:45,320 --> 00:12:47,480
I I, let you go and, you know,

346
00:12:47,480 --> 00:12:49,259
have you enjoy the rest of your day,

347
00:12:49,560 --> 00:12:51,480
can you tell me more about a project

348
00:12:51,480 --> 00:12:54,200
or initiative from the the last year that

349
00:12:54,200 --> 00:12:56,220
yielded the best results for you?

350
00:12:57,174 --> 00:12:59,975
Yeah. Thank you for asking that question. During

351
00:12:59,975 --> 00:13:04,235
the public health on, emergent well, during continuous

352
00:13:04,294 --> 00:13:04,794
enrollment,

353
00:13:05,495 --> 00:13:07,754
and then, of course, the following unwinding,

354
00:13:08,860 --> 00:13:10,300
we're, you know, we're looking at a period

355
00:13:10,300 --> 00:13:12,639
of time of some 3 years where people

356
00:13:12,700 --> 00:13:13,200
were

357
00:13:13,660 --> 00:13:14,240
were not

358
00:13:14,779 --> 00:13:15,279
required

359
00:13:15,899 --> 00:13:18,300
to submit information because they were gonna they

360
00:13:18,460 --> 00:13:20,139
once they were eligible for Medicaid, they were

361
00:13:20,139 --> 00:13:22,274
gonna be maintained. And so after a 3

362
00:13:22,274 --> 00:13:23,414
year period of time,

363
00:13:23,794 --> 00:13:25,735
you know, you have individuals who

364
00:13:26,115 --> 00:13:29,394
may not remember that they have to begin,

365
00:13:29,394 --> 00:13:31,815
you know, submitting their information to be redetermined.

366
00:13:32,034 --> 00:13:32,695
You have

367
00:13:33,475 --> 00:13:35,975
individuals who may have came on during the

368
00:13:36,879 --> 00:13:38,799
epidemic and didn't know that you had to

369
00:13:38,799 --> 00:13:39,539
be redetermined,

370
00:13:40,080 --> 00:13:42,480
and then you have individuals who had an

371
00:13:42,480 --> 00:13:44,419
idea that they probably weren't gonna qualify

372
00:13:44,879 --> 00:13:47,039
and no and had no idea to to

373
00:13:47,039 --> 00:13:47,539
turn.

374
00:13:48,159 --> 00:13:48,659
So

375
00:13:49,264 --> 00:13:50,884
through that process, we were trying

376
00:13:51,424 --> 00:13:52,164
to ascertain,

377
00:13:53,424 --> 00:13:54,884
any way that we could

378
00:13:55,585 --> 00:13:57,205
engage at least our membership

379
00:13:58,304 --> 00:14:00,384
to connect with them, to be able to

380
00:14:00,384 --> 00:14:02,565
provide needed assistance to them,

381
00:14:03,570 --> 00:14:05,110
with their eligibility determination

382
00:14:05,889 --> 00:14:08,210
and and shepherd them to other insurance domains

383
00:14:08,210 --> 00:14:10,050
to the within the parameters we have to

384
00:14:10,050 --> 00:14:10,790
work within.

385
00:14:11,170 --> 00:14:13,430
So one of the things that we developed,

386
00:14:13,970 --> 00:14:16,370
very proud to talk about is our title

387
00:14:16,370 --> 00:14:17,590
1 school initiative,

388
00:14:18,455 --> 00:14:20,934
which, Title 1 Schools are those individuals who

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00:14:20,934 --> 00:14:21,835
really have

390
00:14:22,855 --> 00:14:25,815
a considerable proportion of their students that are

391
00:14:25,815 --> 00:14:27,595
in need. They are low income

392
00:14:28,175 --> 00:14:28,675
and,

393
00:14:29,575 --> 00:14:31,495
what we wanted to do was we wanted

394
00:14:31,495 --> 00:14:32,794
to make ourselves

395
00:14:33,095 --> 00:14:33,595
available

396
00:14:34,720 --> 00:14:37,120
to the parents of such individuals who may

397
00:14:37,120 --> 00:14:38,340
qualify for Medicaid,

398
00:14:38,960 --> 00:14:41,440
so that we could actually help them, with

399
00:14:41,440 --> 00:14:44,879
their digital submissions of their eligibility information in

400
00:14:44,879 --> 00:14:47,460
Pennsylvania. Pennsylvania system is called Compass.

401
00:14:48,044 --> 00:14:49,345
We have dozens

402
00:14:49,964 --> 00:14:52,445
of our employees who are registered as Compass

403
00:14:52,445 --> 00:14:53,345
Community Partners

404
00:14:53,884 --> 00:14:57,985
and they're engaged in helping our members apply,

405
00:14:58,125 --> 00:15:00,065
reapply from an eligibility standpoint

406
00:15:00,659 --> 00:15:03,320
in order to maintain coverage and to maintain

407
00:15:03,620 --> 00:15:04,919
a continuity of care.

408
00:15:05,299 --> 00:15:07,779
So what we're finding now in working with

409
00:15:07,779 --> 00:15:09,079
the literally

410
00:15:09,379 --> 00:15:09,879
dozens

411
00:15:10,500 --> 00:15:12,820
dozens and dozens of school districts that fall

412
00:15:12,820 --> 00:15:15,399
into this category and throughout our service area,

413
00:15:16,554 --> 00:15:17,294
the schools

414
00:15:17,674 --> 00:15:18,815
value what we bring,

415
00:15:19,355 --> 00:15:21,115
to them. Not just in terms of the

416
00:15:21,115 --> 00:15:23,115
Compass navigation, but now we're being able to

417
00:15:23,195 --> 00:15:26,254
we're bringing additional services in, health fairs.

418
00:15:26,794 --> 00:15:28,154
And one of the other things we're being

419
00:15:28,154 --> 00:15:29,834
able to do is bring a mobile farmers

420
00:15:29,834 --> 00:15:32,710
markets into these school districts and various schools

421
00:15:32,710 --> 00:15:34,009
on a repeated basis.

422
00:15:34,470 --> 00:15:36,710
I'm very proud to to share that to

423
00:15:36,710 --> 00:15:39,769
date here in 2024 alone, we have distributed

424
00:15:39,830 --> 00:15:41,370
over 27 tons

425
00:15:41,910 --> 00:15:45,129
of food, fresh produce, meat, poultry, and fish

426
00:15:45,595 --> 00:15:47,674
to families in need. And we're on track

427
00:15:47,674 --> 00:15:49,294
for exceeding the 30 ton

428
00:15:49,674 --> 00:15:51,995
mark, by the end of this year, just

429
00:15:51,995 --> 00:15:54,235
in the Highmark Whole Care, a regional Medicaid

430
00:15:54,235 --> 00:15:55,294
managed care organization.

431
00:15:55,754 --> 00:15:57,294
Why? Because food is medicine.

432
00:15:58,340 --> 00:16:00,440
And, the healthier we can help people,

433
00:16:00,980 --> 00:16:01,480
eat,

434
00:16:02,019 --> 00:16:04,279
we think that's that's a certainly

435
00:16:04,660 --> 00:16:05,160
helpful

436
00:16:05,540 --> 00:16:08,820
in managing overall health conditions. So schools are

437
00:16:08,820 --> 00:16:11,475
inviting us back on a repeated basis. Schools

438
00:16:11,475 --> 00:16:13,154
tend to be the centerpiece of a lot

439
00:16:13,154 --> 00:16:14,294
of, a lot of communities,

440
00:16:14,995 --> 00:16:17,074
and, we just continue to see the growth

441
00:16:17,074 --> 00:16:19,475
and the proliferation of that program. And we're

442
00:16:19,475 --> 00:16:21,315
very excited about what that may morph into

443
00:16:21,315 --> 00:16:22,855
down the road in terms of additional,

444
00:16:23,954 --> 00:16:24,454
resources

445
00:16:24,754 --> 00:16:26,514
and services we can bring to bear in

446
00:16:26,514 --> 00:16:27,389
that type of setting.

447
00:16:28,910 --> 00:16:31,549
Yeah. Wow. That is an amazing accomplishment, and

448
00:16:31,549 --> 00:16:33,170
I just love hearing about organizations

449
00:16:33,549 --> 00:16:36,269
really helping the community they're servicing. So thank

450
00:16:36,269 --> 00:16:38,370
you so much for sharing that that statistic.

451
00:16:38,830 --> 00:16:40,269
And thank you so much for those final

452
00:16:40,269 --> 00:16:42,884
thoughts. This has definitely been informative discussion. So,

453
00:16:43,125 --> 00:16:44,325
again, I wanna thank you so much for

454
00:16:44,325 --> 00:16:46,485
coming on Becker's HealthCare, especially for the first

455
00:16:46,485 --> 00:16:48,404
time. And I look forward to connecting with

456
00:16:48,404 --> 00:16:50,565
you again soon, Joe. Yeah. Thank you very

457
00:16:50,565 --> 00:16:52,105
much for the opportunity, and,

458
00:16:52,485 --> 00:16:54,165
look forward to the next time when and

459
00:16:54,165 --> 00:16:55,705
if that when that comes.