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Welcome everyone to the Becker's Healthcare podcast series.

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I'm Mariah Muhammad, writer and moderator with Becker's

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Healthcare. And I'm thrilled to have with me

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today, Brian Jansen, chief information officer for Medicare

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at WPS

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Health Insurance.

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Ryan, welcome to the podcast. We're very excited

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to have you join us today. To get

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us started, would you mind please introducing yourself

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and telling us a bit about your background?

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Sure. Thank you very much for having me

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today. I really enjoy the Becker's,

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daily updates and these podcasts.

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So my name is Brian Jansen, as you

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mentioned, and I've been with just the health

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insurance industry for the last twenty years, you

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know, starting with EMR implementations

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at hospitals and clinics with Epic systems

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before going from the provider side to the

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the payer side,

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working both at a regional HMO

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here in Southern Wisconsin

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before moving to a PPO commercial

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product,

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spending time with technology

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and operations here at Wisconsin's Physicians Insurance,

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and now CIO of our Medicare

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division,

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currently overseeing six states across two,

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CMS contracts, a

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little over a hundred million claims a year

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for 7,000,000

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beneficiaries.

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Wonderful. Thank you so much for giving us

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that information.

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So what are some of the biggest issues

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you're following in health care,

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whether on the provider side, insurance side, for

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for 2025?

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Yeah. I think 2025

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is gonna be an exciting year.

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When it comes to just the pace of

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change, I don't know who whether your payer

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or provider right now isn't really focused on

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government policy

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with a new administration,

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better understanding

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where

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the entire market's gonna go when it comes

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to Medicare Advantage,

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reimbursement

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rates.

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Clearly, DOGE is now going to get more

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involved with fraud, waste, and abuse as well

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as likely some operational,

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items at the government level.

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I I think

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government policy

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is really gonna dictate where the industry is

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going in the next few years, especially under

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new CMS leadership,

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and will really help guide both commercial

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providers,

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commercial payers,

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and government entities readjust their their own strategies.

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It's in addition to

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government policy.

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I think in the last two years,

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we've had

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speed

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of technology

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development

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and implementation

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that I think the entire industry

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right now is really focusing on how to

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best leverage,

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you know, whether it's

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changes in how we're able to use data

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to better understand our customers,

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or I I don't even think we can

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answer

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or have a response that doesn't include some

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sort of mention of AI these days.

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And

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how is

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AI within health care gonna be

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used and used responsibly

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in order to get better patient outcomes

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and reduce our overall

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cost

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structure in

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in the nation.

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And we've got such a heart such a

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large percentage of our GDP

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focused on health care, and, hopefully, changes in

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technology

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can start to

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bring health care outcomes

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more in alignment with our overall expenditures.

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So I think 2025

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is gonna be pivotal

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when it comes to

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both government policy setting a direction

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And how are some of these new technologies

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going to help everyone achieve positive

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outcomes,

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for both our providers

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and our patients?

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Yeah. Definitely. Thank you so much for giving

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us that that insight into kinda what you're

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thinking about for this year. Is there anything

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that's making you

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the most excited or a little bit nervous,

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and pertaining to,

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the trends of 2025,

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the news of 2025,

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anything you're specifically doing at your organization?

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Yeah. I would say

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the things that make me excited

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always have a flip side of the coin

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and also make us nervous.

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You know, one of the things when we

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talk about the changing pace of technology,

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I think 2025

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in some respects,

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our technological

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capabilities have also,

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in some ways, out paced

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our ability to implement

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policy

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and

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safeguards in the health care sector.

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So I think

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not only am I excited about our new

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capabilities,

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I'm a little bit nervous about

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our ability as an industry

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to

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understand and stay stay ahead of those changes.

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It's certainly gonna reshape organizational

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budgets.

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How do we

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view insourcing versus outsourcing?

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It's gonna dynamically change how we're able to

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interact with our customers.

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And the question is gonna be, are we

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using it

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in a responsible

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way for positive outcomes,

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or are we gonna kinda get behind

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behind the eight ball on this?

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That's a conscious effort, I think, at most

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organizations,

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ours included.

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Another thing that makes me excited this year,

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really

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coming off of 2024,

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I think we've got a an opportunity

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really to focus more on health care literacy.

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I think some of the tragic events of

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2024

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really showed us

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areas that we can better educate

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our customers,

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better educate

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the population

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on

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who are the actors, who are the responsible

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parties

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when it comes to the administration of health

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care

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from your providers to your PBMs

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to

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your your payers.

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I think there's a real opportunity

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that we can all come together in the

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industry to help

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educate

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and

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inform,

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ultimately, the consumers of of health care. I

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think I'm a little nervous if we don't

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take this opportunity

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to really advance the industry and help inform

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our our consumers.

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I think probably the last thing that really

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makes me nervous

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is I think the fragility of the health

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care environment has really kinda started to pop

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up more and more in 2024.

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We're starting to understand

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impacts if, say, a clearinghouse goes down

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or we have issues at a PBM.

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When

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the health care sector becomes more and more

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concentrated

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with fewer players,

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I think we need to better understand

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how that can impact the stability of of

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the health care system as a whole. I

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know it's something that

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we're certainly

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taking into consideration over the next year and

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just to better understand where

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where some of those, like, opportunities

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or fail safes exist.

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Yeah. That completely makes a lot of sense.

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I definitely agree with you on a lot

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of things that you said.

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In your your opinion and, you know, you

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touched a little bit on this about, having

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the responsibility,

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to kinda teach others, but what would the

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most effective health care leaders need in order

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to be successful in the next two to

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three years do you think?

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Yeah. I think this is gonna be a

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challenging time for health care leaders.

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When we have such rapid

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changes in a sector,

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you know,

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the ability to really

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pivot on strategic plans

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is going to be

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necessary for any health care leader. I remember

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years ago, we used to talk about three

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year and five year plans.

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I I I think most organizations

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have certainly

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shrunk those time frames

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just given the rapid pace of health care

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change, and successful leaders are gonna have to

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really have a plan a and a plan

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b

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with strategic goals and outcomes

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based on changes that could

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really happen with

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federal,

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policy changes,

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when it comes to

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reimbursement rates, when it comes to

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technological changes that

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really shift

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where work happens.

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You know, the ability to

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understand

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where a market is going

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and

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pivot accordingly

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to

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really leverage that and turn headwinds into tailwinds,

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I think is gonna be critical for health

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care leaders,

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both

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from the financial

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aspects of their organizations

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as well as

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the health outcomes of

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patients or or plan members.

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You know, I I look at those two

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things as

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not mutually exclusive.

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I think that's gonna be

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key and better understanding

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what the customers are looking for and how

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you can profitably

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deliver great customer expectations,

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experience,

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and positive health outcomes.

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Yeah. Yeah. Definitely. Thank you so much for

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those final thoughts. It's definitely been,

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a formative discussion. So, again, I wanna thank

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you so much for coming on at Becker's

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Healthcare,

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especially for the first time.

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And I look forward to connecting with you

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again soon.

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Yeah. Thank you very much for the opportunity.

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It was great speaking with you. You as

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well.