1 00:00:00,240 --> 00:00:02,720 Imagine this. You're at the Swiss Hotel in 2 00:00:02,720 --> 00:00:06,399 Chicago surrounded by top executives from leading insurance 3 00:00:06,399 --> 00:00:08,099 companies and health systems. 4 00:00:08,480 --> 00:00:12,160 Welcome to Becker's Fall Pair Issues Roundtable, November 5 00:00:12,160 --> 00:00:13,859 4th through 6, 2024. 6 00:00:14,625 --> 00:00:17,345 Picture the excitement as you gather business cards 7 00:00:17,345 --> 00:00:20,005 from over 500 executive level attendees, 8 00:00:20,545 --> 00:00:22,164 building invaluable connections. 9 00:00:22,704 --> 00:00:25,345 Feel the energy as you participate in over 10 00:00:25,345 --> 00:00:29,285 26 educational sessions led by 90 elite speakers. 11 00:00:29,769 --> 00:00:32,969 Envision yourself engaging in lively discussions about new 12 00:00:32,969 --> 00:00:36,409 health plans, hospital at home models, behavioral health, 13 00:00:36,409 --> 00:00:37,549 and price transparency. 14 00:00:38,170 --> 00:00:41,690 Now imagine being inspired by keynotes from boxing 15 00:00:41,690 --> 00:00:45,045 legend, Sugar Ray Leonard, and 4 time NBA 16 00:00:45,184 --> 00:00:47,744 All Star, Chris Webber. Their stories will leave 17 00:00:47,744 --> 00:00:50,004 you motivated and ready to innovate. 18 00:00:50,384 --> 00:00:53,024 Don't miss out on this unique opportunity. Get 19 00:00:53,024 --> 00:00:55,204 registered today. Visit beckershospital 20 00:00:55,600 --> 00:00:56,100 hospitalreview.com 21 00:00:57,199 --> 00:00:59,039 and click on the events page to find 22 00:00:59,039 --> 00:01:02,820 the conference website. That's the beckers hospital review.com 23 00:01:03,600 --> 00:01:05,700 events page. See you in Chicago. 24 00:01:06,560 --> 00:01:09,314 Welcome everyone to the Becker's Healthcare podcast series. 25 00:01:09,314 --> 00:01:11,795 I'm Mariah Muhammad, writer and moderator with Becker's 26 00:01:11,795 --> 00:01:13,555 Healthcare, and I'm thrilled to have with me 27 00:01:13,555 --> 00:01:14,775 today Chris Palmore, 28 00:01:15,155 --> 00:01:17,015 president and CEO of Commonwealth 29 00:01:17,314 --> 00:01:19,954 Care Alliance. Chris, welcome back to the podcast. 30 00:01:19,954 --> 00:01:21,395 We're very excited to have you join us 31 00:01:21,395 --> 00:01:22,979 today. To get us started, would you mind 32 00:01:22,979 --> 00:01:24,739 please introducing yourself and telling us a bit 33 00:01:24,739 --> 00:01:25,560 about your background? 34 00:01:27,060 --> 00:01:29,719 Yeah. Sure. So so, again, I'm Chris Palmeri. 35 00:01:30,099 --> 00:01:32,340 I have been in health care for 30 36 00:01:32,340 --> 00:01:34,659 years, and I've been fortunate to be CEO 37 00:01:34,659 --> 00:01:37,159 of 6 different companies over the past 23 38 00:01:37,219 --> 00:01:39,614 years. And as you indicated, I am currently 39 00:01:39,614 --> 00:01:41,854 the CEO of Commonwealth Care Alliance, and I've 40 00:01:41,854 --> 00:01:42,515 done that 41 00:01:42,894 --> 00:01:44,575 for, 9 years. And, 42 00:01:45,215 --> 00:01:47,555 I've been involved in both for profit, 43 00:01:48,174 --> 00:01:49,555 and nonprofit organizations. 44 00:01:50,334 --> 00:01:52,354 Most of my career has actually been spent 45 00:01:52,670 --> 00:01:54,590 on the nonprofit side, and, 46 00:01:55,069 --> 00:01:57,649 CCA is a nonprofit organization that, 47 00:01:58,109 --> 00:02:00,989 serves over a 100000 people across 4 states. 48 00:02:01,229 --> 00:02:03,549 We are both a payer as a Medicare 49 00:02:03,549 --> 00:02:05,489 Advantage Plan as well as an integrated 50 00:02:05,954 --> 00:02:08,115 health plan for dual eligibles or people with 51 00:02:08,115 --> 00:02:09,094 Medicare and Medicaid, 52 00:02:09,395 --> 00:02:11,235 and we are a provider. We own and 53 00:02:11,235 --> 00:02:11,715 operate, 54 00:02:12,034 --> 00:02:15,094 primary care sites and a variety of services 55 00:02:15,715 --> 00:02:18,615 that impact individuals with chronic illness. 56 00:02:19,460 --> 00:02:21,400 I also founded, in 2016, 57 00:02:22,020 --> 00:02:24,199 Winter Street Ventures, which is CCA's, 58 00:02:25,540 --> 00:02:26,520 start up accelerator 59 00:02:26,819 --> 00:02:27,480 and venture 60 00:02:27,939 --> 00:02:29,159 investment subsidiary, 61 00:02:29,860 --> 00:02:32,655 and, we look to invest in disruptive and 62 00:02:32,655 --> 00:02:34,675 innovative companies that align our mission, 63 00:02:35,215 --> 00:02:36,995 which serves people with significant 64 00:02:37,455 --> 00:02:38,435 health care needs, 65 00:02:39,135 --> 00:02:41,135 with companies that are looking to address a 66 00:02:41,135 --> 00:02:42,915 variety of issues that we encounter 67 00:02:43,295 --> 00:02:45,075 trying to meet the needs of our consumers. 68 00:02:46,299 --> 00:02:47,979 Wonderful. Thank you so much for giving me 69 00:02:47,979 --> 00:02:49,280 that, that explanation. 70 00:02:50,060 --> 00:02:51,419 The first thing that I really want to 71 00:02:51,419 --> 00:02:53,659 discuss with you, Chris, if people don't know 72 00:02:53,659 --> 00:02:55,759 about the Steward Health System Crisis, 73 00:02:56,060 --> 00:02:58,060 it was reported earlier this year that there 74 00:02:58,060 --> 00:02:58,799 was a financial, 75 00:02:59,180 --> 00:03:00,639 collapse of the health system, 76 00:03:01,205 --> 00:03:03,284 which which led to a lack of adequate 77 00:03:03,284 --> 00:03:05,465 staffing and supplies, media reports. 78 00:03:06,084 --> 00:03:08,084 What can the health care industry learn from 79 00:03:08,084 --> 00:03:09,544 this crisis, do you think? 80 00:03:10,164 --> 00:03:12,485 Well, I mean, first of all, there's probably 81 00:03:12,485 --> 00:03:14,485 not many people in health care that haven't 82 00:03:14,485 --> 00:03:16,199 heard of the Stewart crisis. As you said, 83 00:03:16,199 --> 00:03:18,759 it's been it's been fanfare in the media 84 00:03:18,759 --> 00:03:19,259 for, 85 00:03:19,879 --> 00:03:21,259 quite some time, and, 86 00:03:22,040 --> 00:03:24,599 the entire relationship with Steward and, 87 00:03:24,919 --> 00:03:25,900 its First Capital 88 00:03:26,439 --> 00:03:26,919 partner, 89 00:03:27,240 --> 00:03:28,300 really goes back, 90 00:03:28,655 --> 00:03:29,955 over 14 years. 91 00:03:30,335 --> 00:03:30,814 And, 92 00:03:31,455 --> 00:03:33,855 I think in terms of the construct of 93 00:03:33,855 --> 00:03:34,594 that relationship, 94 00:03:35,055 --> 00:03:36,675 it was designed to actually, 95 00:03:37,615 --> 00:03:39,875 create some critical mass and efficiencies, 96 00:03:42,289 --> 00:03:44,829 in operations of hospitals across several states. 97 00:03:45,370 --> 00:03:47,789 And, as we've we've read now, 98 00:03:48,090 --> 00:03:50,650 it looks like that did not go, certainly 99 00:03:50,650 --> 00:03:51,389 as planned. 100 00:03:52,090 --> 00:03:54,169 I think one of the learnings is just 101 00:03:54,169 --> 00:03:55,549 really, frankly, understanding 102 00:03:56,344 --> 00:03:58,824 is there an alignment with the organization's mission, 103 00:03:58,824 --> 00:04:01,004 in this case, to operate community based 104 00:04:01,465 --> 00:04:03,465 hospitals in multiple markets and serve, 105 00:04:04,584 --> 00:04:06,985 you know, medically fragile people? Is there an 106 00:04:06,985 --> 00:04:09,465 alignment with the mission of that organization, its 107 00:04:09,465 --> 00:04:10,365 needs for 108 00:04:10,770 --> 00:04:12,310 financing, and capital, 109 00:04:13,009 --> 00:04:15,169 with the with the outside capital source, in 110 00:04:15,169 --> 00:04:17,089 this case, private equity? I think we all 111 00:04:17,089 --> 00:04:17,990 realize that, 112 00:04:18,689 --> 00:04:20,870 the the nature of private equity, while, 113 00:04:21,410 --> 00:04:23,569 its interest in doing good in the businesses 114 00:04:23,569 --> 00:04:26,044 it invests in, including health care, there is 115 00:04:26,044 --> 00:04:27,564 also an obligation for, 116 00:04:27,884 --> 00:04:30,365 that capital partner to make a return on 117 00:04:30,365 --> 00:04:31,024 its investment. 118 00:04:31,404 --> 00:04:33,824 And understanding what the horizon for that, 119 00:04:34,365 --> 00:04:36,285 return would be, how much that return would 120 00:04:36,285 --> 00:04:37,745 be, and what sources 121 00:04:38,160 --> 00:04:41,379 or potential profit pools would fund those returns, 122 00:04:41,519 --> 00:04:43,680 I think, are are really critical. And it 123 00:04:43,680 --> 00:04:44,899 seems like just through, 124 00:04:45,519 --> 00:04:46,319 the the, 125 00:04:46,720 --> 00:04:48,720 sequence of events, and there's many and it's 126 00:04:48,720 --> 00:04:49,540 very complicated, 127 00:04:50,000 --> 00:04:52,180 of what happened in this particular Steward 128 00:04:52,694 --> 00:04:55,175 situation, it it seems that there potentially was 129 00:04:55,175 --> 00:04:56,875 a misalignment along the way. 130 00:04:57,735 --> 00:04:59,735 Yeah. Yeah. That definitely makes a a lot 131 00:04:59,735 --> 00:05:01,334 of sense. Thank you for giving us that 132 00:05:01,334 --> 00:05:01,834 insight. 133 00:05:02,294 --> 00:05:04,774 And kinda what you were talking about, there 134 00:05:04,774 --> 00:05:06,615 are a lot of moving parts right now 135 00:05:06,615 --> 00:05:09,319 in health care. Everyone has their attention focused 136 00:05:09,319 --> 00:05:11,339 on several, you know, different aspects, 137 00:05:11,720 --> 00:05:12,860 in what they're doing. 138 00:05:13,240 --> 00:05:14,680 For you, where in the industry do you 139 00:05:14,680 --> 00:05:16,379 think is the most right for innovation? 140 00:05:17,399 --> 00:05:19,240 Well, I think there's a variety of of 141 00:05:19,240 --> 00:05:22,199 areas. So, you know, first of all, really 142 00:05:22,199 --> 00:05:24,335 across the country, but particularly in the northeast, 143 00:05:24,335 --> 00:05:26,975 we are seeing an uptick, in utilization of 144 00:05:26,975 --> 00:05:27,875 health care services 145 00:05:28,415 --> 00:05:31,154 by all populations, both those with financial resources 146 00:05:31,295 --> 00:05:32,754 as well as those that are indigent, 147 00:05:33,295 --> 00:05:35,775 and, that has really raised the awareness, I 148 00:05:35,775 --> 00:05:37,600 think, of of everyone in terms of what 149 00:05:37,600 --> 00:05:39,220 the what the costs are, 150 00:05:39,680 --> 00:05:41,600 to actually meet the needs of these consumers 151 00:05:41,600 --> 00:05:44,800 and whether those costs are actually funded right 152 00:05:44,800 --> 00:05:46,660 now by insurance premiums, 153 00:05:47,520 --> 00:05:50,480 states, the federal government through Medicare fee for 154 00:05:50,480 --> 00:05:51,860 service and Medicare Advantage. 155 00:05:52,855 --> 00:05:54,535 All of this sort of goes back to 156 00:05:54,535 --> 00:05:56,875 how are we meeting the needs of consumers, 157 00:05:57,254 --> 00:05:59,095 and we think that one of the right 158 00:05:59,095 --> 00:06:01,995 areas continues to be leveraging technology, 159 00:06:02,694 --> 00:06:04,295 to innovate care for, 160 00:06:04,694 --> 00:06:05,915 members and patients. 161 00:06:06,990 --> 00:06:09,149 And we think that this can make sure 162 00:06:09,149 --> 00:06:11,389 that consumers have the right services at the 163 00:06:11,389 --> 00:06:12,129 right time, 164 00:06:12,589 --> 00:06:14,669 making sure that the site of service is 165 00:06:14,669 --> 00:06:16,610 exactly where they need it, and it's oftentimes 166 00:06:16,750 --> 00:06:19,470 not, in the emergency department of an acute 167 00:06:19,470 --> 00:06:21,169 care hospital. It could be at home. 168 00:06:21,634 --> 00:06:23,334 Making sure that consumers have 169 00:06:23,875 --> 00:06:25,975 great access to primary care, 170 00:06:26,514 --> 00:06:28,855 and care navigation that can help somebody, 171 00:06:29,314 --> 00:06:31,955 really, sort of wade through a very complicated 172 00:06:31,955 --> 00:06:34,194 health care system. And and our belief is 173 00:06:34,194 --> 00:06:34,694 that, 174 00:06:35,329 --> 00:06:37,410 when that is all done right, you can 175 00:06:37,410 --> 00:06:39,970 you can reduce the friction that consumers often 176 00:06:39,970 --> 00:06:42,149 feel by trying to access health care services, 177 00:06:42,449 --> 00:06:43,509 and you can also 178 00:06:43,889 --> 00:06:45,509 greatly reduce costs 179 00:06:45,810 --> 00:06:47,889 to get those consumers the services that they 180 00:06:47,889 --> 00:06:48,389 need. 181 00:06:49,144 --> 00:06:51,305 Yeah. I appreciate you giving us that that 182 00:06:51,305 --> 00:06:53,485 insight right there. In your opinion, 183 00:06:53,785 --> 00:06:55,964 what would you say are the key components, 184 00:06:56,664 --> 00:06:59,865 to a successful collaboration between nonprofit organizations and 185 00:06:59,865 --> 00:07:00,764 private capital? 186 00:07:01,399 --> 00:07:02,800 Well, it's sort of what I said earlier. 187 00:07:02,800 --> 00:07:04,120 I think, first of all, there has to 188 00:07:04,120 --> 00:07:04,860 be an alignment 189 00:07:05,399 --> 00:07:07,560 of of interest. So I think the the 190 00:07:07,560 --> 00:07:10,279 the nonprofits in particular, they're they're usually community 191 00:07:10,279 --> 00:07:13,480 based, mission driven organizations. They were created for 192 00:07:13,480 --> 00:07:14,779 a purpose and a reason. 193 00:07:15,394 --> 00:07:18,834 And, and, again, outside capital, also has a 194 00:07:18,834 --> 00:07:20,754 purpose and a reason and for both parties 195 00:07:20,754 --> 00:07:23,634 to understand what those what those purposes are 196 00:07:23,634 --> 00:07:25,875 and how they are gonna come together. So 197 00:07:25,875 --> 00:07:28,694 in this case, with a nonprofit, it's potentially 198 00:07:28,754 --> 00:07:29,254 advancing, 199 00:07:29,954 --> 00:07:30,694 its mission, 200 00:07:31,370 --> 00:07:34,169 to serve people in whatever way it desires 201 00:07:34,169 --> 00:07:37,069 to do so. And by leveraging outside capital, 202 00:07:37,689 --> 00:07:40,750 understanding what that capital will be used for, 203 00:07:41,290 --> 00:07:43,769 whether that will create, an opportunity to serve 204 00:07:43,769 --> 00:07:46,535 more people and potentially develop scale economies, 205 00:07:47,394 --> 00:07:48,375 or something else, 206 00:07:49,074 --> 00:07:51,475 an acquisition perhaps, which also would be a 207 00:07:51,475 --> 00:07:52,375 way to scale. 208 00:07:53,074 --> 00:07:53,714 I think, 209 00:07:54,035 --> 00:07:56,514 then looking at a long term financial plan, 210 00:07:56,514 --> 00:07:59,235 which would indicate whether if that plan was 211 00:07:59,235 --> 00:08:00,294 executed appropriately, 212 00:08:00,810 --> 00:08:02,669 there would be the synergies that, 213 00:08:02,970 --> 00:08:05,550 would come to play in either, more profitability 214 00:08:05,930 --> 00:08:08,889 or efficiency in operating costs. And hopefully, those 215 00:08:08,889 --> 00:08:11,370 synergies would then be able to repay the 216 00:08:11,370 --> 00:08:13,610 use of the private capital, which is exactly 217 00:08:13,610 --> 00:08:16,214 what the private capital's objective is, is to 218 00:08:16,214 --> 00:08:17,274 make an investment, 219 00:08:17,975 --> 00:08:19,814 and then ultimately make a return on that 220 00:08:19,814 --> 00:08:20,314 investment, 221 00:08:20,774 --> 00:08:22,954 to their, limited partners or shareholders. 222 00:08:23,414 --> 00:08:26,154 So I think it's having that conversation upfront, 223 00:08:26,454 --> 00:08:28,394 number 1. Number 2, understanding 224 00:08:29,290 --> 00:08:30,910 what the time horizon is. 225 00:08:31,850 --> 00:08:34,350 3rd, really understanding what are the key performance 226 00:08:34,410 --> 00:08:34,910 indicators. 227 00:08:35,850 --> 00:08:38,169 4th, having a plan if things don't go 228 00:08:38,169 --> 00:08:38,910 as planned, 229 00:08:39,289 --> 00:08:41,450 meaning that there are contingencies in the event 230 00:08:41,450 --> 00:08:41,950 that 231 00:08:42,514 --> 00:08:45,475 unforeseen headwinds were were hit and understanding what 232 00:08:45,475 --> 00:08:47,315 would happen at that point in time, whether 233 00:08:47,315 --> 00:08:49,475 it means that the the time horizon has 234 00:08:49,475 --> 00:08:51,975 to be extended, additional capital has to be, 235 00:08:52,274 --> 00:08:55,259 brought in, potentially a change of direction. And, 236 00:08:55,259 --> 00:08:57,580 again, this is these are circumstances that when 237 00:08:57,580 --> 00:08:59,920 everything is going well and according to plan, 238 00:09:00,220 --> 00:09:01,820 there are no problems and there are no 239 00:09:01,820 --> 00:09:06,000 complaints. Usually, the challenges arise when something unexpected 240 00:09:06,300 --> 00:09:09,215 occurs and that alters the plan. And I 241 00:09:09,215 --> 00:09:11,795 think it's really understanding between the two parties 242 00:09:12,175 --> 00:09:15,075 what happens in those times of unforeseen circumstance 243 00:09:15,774 --> 00:09:17,795 and how will situations be remediated. 244 00:09:18,975 --> 00:09:21,535 Yeah. I appreciate all the the great advice 245 00:09:21,535 --> 00:09:23,695 and insights you've given so far in this 246 00:09:23,695 --> 00:09:24,195 podcast. 247 00:09:25,480 --> 00:09:27,399 One last thing, Chris, before we wrap up 248 00:09:27,399 --> 00:09:29,720 today, can you share any predictions for what 249 00:09:29,720 --> 00:09:31,480 health care will look like in the next 250 00:09:31,480 --> 00:09:32,539 2 to 3 years? 251 00:09:33,399 --> 00:09:36,220 That's an interesting question. We have a presidential 252 00:09:36,440 --> 00:09:36,940 election, 253 00:09:37,319 --> 00:09:38,839 upcoming, and we're going to have a new 254 00:09:38,839 --> 00:09:41,154 president. Whether we change parties or not is 255 00:09:41,154 --> 00:09:42,375 is yet to be seen. 256 00:09:43,154 --> 00:09:45,235 And without making this political, I think that, 257 00:09:45,235 --> 00:09:46,695 you know, we have some factors 258 00:09:47,154 --> 00:09:49,235 right now in the health care system. So 259 00:09:49,235 --> 00:09:50,774 we do have rising utilization. 260 00:09:51,549 --> 00:09:53,950 We have rising costs of labor. We have, 261 00:09:54,350 --> 00:09:56,269 people that work in health care at the 262 00:09:56,269 --> 00:09:57,009 front lines, 263 00:09:57,389 --> 00:09:59,389 are not as desirous potentially to do those 264 00:09:59,389 --> 00:10:00,769 jobs as they once were. 265 00:10:01,230 --> 00:10:03,710 We have changes potentially happening in the way 266 00:10:03,710 --> 00:10:05,090 the federal government funds, 267 00:10:05,725 --> 00:10:08,445 Medicare Advantage, where there's, today, 51% of all 268 00:10:08,445 --> 00:10:11,165 Americans are covered, and there's potentially a desire 269 00:10:11,165 --> 00:10:11,825 to have, 270 00:10:12,285 --> 00:10:14,924 the the folks re retreat back to fee 271 00:10:14,924 --> 00:10:17,245 for service, and that potentially could be done 272 00:10:17,245 --> 00:10:18,865 through, additional regulation 273 00:10:19,299 --> 00:10:20,600 or changes in funding. 274 00:10:20,980 --> 00:10:22,660 So you have a lot of things that 275 00:10:22,660 --> 00:10:23,639 are going on, 276 00:10:24,100 --> 00:10:25,700 right now, and I think the call to 277 00:10:25,700 --> 00:10:29,320 action from the insurance carriers, the provider communities 278 00:10:29,620 --> 00:10:31,700 that I would suggest is, you know, understand 279 00:10:31,700 --> 00:10:32,440 these headwinds. 280 00:10:33,004 --> 00:10:34,845 These are these are not just, I believe, 281 00:10:34,845 --> 00:10:37,164 blips. These are going to be some some, 282 00:10:37,404 --> 00:10:39,404 things that we're seeing that will ultimately become 283 00:10:39,404 --> 00:10:41,585 longer term trends, in the organization. 284 00:10:41,965 --> 00:10:42,845 We still have, 285 00:10:43,725 --> 00:10:45,825 people in this country that need access 286 00:10:46,230 --> 00:10:46,970 to good 287 00:10:47,429 --> 00:10:50,570 quality health care and really making sure that, 288 00:10:50,789 --> 00:10:52,470 again, all of the needs are met and 289 00:10:52,470 --> 00:10:55,129 understanding what those costs are going to be 290 00:10:55,429 --> 00:10:57,769 to meet those consumer needs. I think that's 291 00:10:57,990 --> 00:10:59,669 sort of where we're gonna be over the 292 00:10:59,669 --> 00:11:00,889 next couple of years. 293 00:11:01,245 --> 00:11:02,945 It's amazing to think that, 294 00:11:03,325 --> 00:11:05,245 some of the utilization that we're seeing could 295 00:11:05,245 --> 00:11:05,745 be, 296 00:11:06,365 --> 00:11:07,904 pent up demand from COVID 297 00:11:08,285 --> 00:11:10,865 despite that pandemic being over for several years. 298 00:11:11,245 --> 00:11:13,245 It seems like now things are getting back 299 00:11:13,245 --> 00:11:13,710 to 300 00:11:14,750 --> 00:11:15,250 more 301 00:11:15,550 --> 00:11:16,050 normalized, 302 00:11:16,830 --> 00:11:19,970 patterns, and, with normalization, the costs have certainly 303 00:11:20,350 --> 00:11:21,250 gone up. 304 00:11:21,629 --> 00:11:24,110 We're seeing, you know, consumers now really engage 305 00:11:24,110 --> 00:11:26,350 in the use of of new therapies like 306 00:11:26,350 --> 00:11:28,529 GLP ones, which is, you know, 307 00:11:29,184 --> 00:11:30,945 created now and being used to help people 308 00:11:30,945 --> 00:11:33,585 that are, struggling with obesity. And the whole 309 00:11:33,585 --> 00:11:35,745 sort of thought of that is that there 310 00:11:35,745 --> 00:11:36,644 will be downstream, 311 00:11:37,184 --> 00:11:39,425 cost reduction in the health care system. We 312 00:11:39,425 --> 00:11:41,425 haven't seen that yet. We're just seeing really 313 00:11:41,425 --> 00:11:43,745 the cost on the pharmaceutical side, so it's 314 00:11:43,745 --> 00:11:45,929 gonna take some time for some of that 315 00:11:45,929 --> 00:11:48,169 promise to work through. And I think we 316 00:11:48,169 --> 00:11:49,929 we have to be patient. It's hard to 317 00:11:49,929 --> 00:11:52,350 be patient when you have costs rising, reimbursement, 318 00:11:53,289 --> 00:11:53,789 reducing, 319 00:11:54,329 --> 00:11:56,329 but we have to really understand what these 320 00:11:56,329 --> 00:11:58,509 trends are so that we potentially can reset 321 00:11:58,970 --> 00:12:00,750 the industry so that, again, 322 00:12:01,154 --> 00:12:03,875 the insurance carriers are funded appropriately to to 323 00:12:03,875 --> 00:12:07,394 cover the populations they're entrusted to. The provider 324 00:12:07,394 --> 00:12:09,815 community is getting appropriate reimbursement 325 00:12:10,355 --> 00:12:12,595 to cover its costs and cover potentially the 326 00:12:12,595 --> 00:12:14,454 new wage index that's gonna be, 327 00:12:14,754 --> 00:12:17,169 associated with getting people to wanna do the 328 00:12:17,169 --> 00:12:19,570 jobs that are necessary to operate the care 329 00:12:19,570 --> 00:12:22,049 delivery side. And then we, of course, have, 330 00:12:22,610 --> 00:12:24,769 both the consumer that is not only a 331 00:12:24,769 --> 00:12:27,090 a consumer of the services but potentially also 332 00:12:27,090 --> 00:12:29,774 a payer of their insurance premiums. And then 333 00:12:29,774 --> 00:12:31,534 we have the state and federal governments, which 334 00:12:31,534 --> 00:12:32,195 are also, 335 00:12:32,894 --> 00:12:35,054 big sponsors in the cost of of health 336 00:12:35,054 --> 00:12:37,534 care and funding premiums, either through the Medicare 337 00:12:37,534 --> 00:12:39,554 program or through private insurance companies. 338 00:12:39,950 --> 00:12:41,870 All of these things are sort of colliding 339 00:12:41,870 --> 00:12:43,789 right now. And I think over the next 340 00:12:43,789 --> 00:12:46,190 2 or 3 years, again, once we get 341 00:12:46,190 --> 00:12:47,950 a sense of what the if there's a 342 00:12:47,950 --> 00:12:51,169 new normal of cost trend, utilization of services, 343 00:12:51,629 --> 00:12:54,450 labor, etcetera, we're gonna have to reset this 344 00:12:54,674 --> 00:12:56,355 so that people can continue to get the 345 00:12:56,355 --> 00:12:58,355 care and services that they need and that 346 00:12:58,355 --> 00:12:59,875 you have insurance companies that are in a 347 00:12:59,875 --> 00:13:01,554 position to be able to do it. We 348 00:13:01,554 --> 00:13:03,735 have a a Medicare program that can continue, 349 00:13:04,195 --> 00:13:06,115 either through fee for service or through private 350 00:13:06,115 --> 00:13:08,054 insurance to ensure the 70,000,000 351 00:13:08,929 --> 00:13:11,750 Americans that it's entrusted with, and then continuing 352 00:13:11,809 --> 00:13:14,070 to have appropriate funding at the state level 353 00:13:14,289 --> 00:13:16,629 for its, for its Medicaid programs. 354 00:13:17,730 --> 00:13:19,730 Wonderful. Wonderful. Thank you so much for those 355 00:13:19,730 --> 00:13:21,889 final thoughts. I think you spoke on a 356 00:13:21,889 --> 00:13:24,105 lot of hot topics that other are also 357 00:13:24,105 --> 00:13:26,585 talking about, Chris. So thank you so much 358 00:13:26,585 --> 00:13:27,565 for, you know, 359 00:13:28,105 --> 00:13:30,424 coming on the podcast. This is a very 360 00:13:30,424 --> 00:13:31,485 informative discussion, 361 00:13:31,945 --> 00:13:33,384 and I look forward to connecting with you 362 00:13:33,384 --> 00:13:34,125 again soon. 363 00:13:34,759 --> 00:13:36,759 It was really my pleasure. Thanks for having 364 00:13:36,759 --> 00:13:37,799 me today, and, 365 00:13:38,439 --> 00:13:40,059 have a have a wonderful day.