1 00:00:00,080 --> 00:00:02,000 Hello, everyone. This is Jacob Emerson with the 2 00:00:02,000 --> 00:00:03,699 Becker's Payer Issues podcast. 3 00:00:04,000 --> 00:00:06,160 Thrilled today to be joined by two special 4 00:00:06,160 --> 00:00:07,299 guests from NCD. 5 00:00:07,679 --> 00:00:10,800 Sam Melamed is the CEO of NCD, and 6 00:00:10,800 --> 00:00:13,359 Brett Voigt is chief strategy officer at the 7 00:00:13,359 --> 00:00:15,664 company. Sam, Brett, thanks so much for taking 8 00:00:15,664 --> 00:00:16,785 the time to be with me on the 9 00:00:16,785 --> 00:00:17,684 podcast today. 10 00:00:18,224 --> 00:00:19,925 Thanks for having us. We're excited. 11 00:00:20,945 --> 00:00:22,625 Awesome. Well, before we dive into everything, we 12 00:00:22,625 --> 00:00:24,945 wanna talk with you about everything that's going 13 00:00:24,945 --> 00:00:27,445 on in Washington affecting health plans. 14 00:00:27,750 --> 00:00:29,429 Can you both tell us a little bit 15 00:00:29,429 --> 00:00:32,310 more about yourselves, your background in health care, 16 00:00:32,310 --> 00:00:33,990 and what it is that you're doing today 17 00:00:33,990 --> 00:00:36,329 at NCD? Brett, I'll come to you first. 18 00:00:37,030 --> 00:00:37,530 Great. 19 00:00:37,829 --> 00:00:40,149 So as you mentioned, my name is Brett 20 00:00:40,149 --> 00:00:42,649 Voigt. I'm chief strategy officer at NCD. 21 00:00:43,265 --> 00:00:45,844 I actually started my career as an investor 22 00:00:46,145 --> 00:00:48,065 where I spent a meaningful amount of time 23 00:00:48,065 --> 00:00:49,844 investing in health care services 24 00:00:50,225 --> 00:00:52,405 and other highly regulated industries. 25 00:00:53,505 --> 00:00:54,565 In 2013, 26 00:00:55,120 --> 00:00:58,479 I saw an interesting dynamic emerging regarding some 27 00:00:58,479 --> 00:00:58,979 changes 28 00:00:59,520 --> 00:01:02,260 in the financial flows and division of responsibilities 29 00:01:02,800 --> 00:01:04,180 between payers and providers, 30 00:01:05,439 --> 00:01:07,280 which which really was some of the early 31 00:01:07,280 --> 00:01:09,325 days of what now today has become 32 00:01:09,704 --> 00:01:11,865 more broadly known as value based care or 33 00:01:11,865 --> 00:01:12,844 accountable care. 34 00:01:13,704 --> 00:01:14,685 And at that point, 35 00:01:15,225 --> 00:01:17,564 I made the decision to chase that intersection 36 00:01:17,704 --> 00:01:19,484 of payer and provider as an operator. 37 00:01:20,280 --> 00:01:21,659 I've spent the last eleven 38 00:01:22,040 --> 00:01:25,500 years operating in high growth risk bearing entities, 39 00:01:26,200 --> 00:01:28,760 including Stops as an early employee at Bright 40 00:01:28,760 --> 00:01:29,260 Health, 41 00:01:30,120 --> 00:01:32,884 where I helped that business grow from $0 42 00:01:32,884 --> 00:01:35,284 in revenue and 20 employees to 4 and 43 00:01:35,284 --> 00:01:37,524 a half billion in in revenue and about 44 00:01:37,524 --> 00:01:38,584 2,000 people, 45 00:01:38,965 --> 00:01:41,284 as well as started my own carrier, Tenure 46 00:01:41,284 --> 00:01:44,024 Health, before joining NCD via acquisition 47 00:01:44,644 --> 00:01:46,185 third quarter of last year. 48 00:01:46,659 --> 00:01:49,459 As chief strategy officer, I partner with Sam 49 00:01:49,459 --> 00:01:51,560 and the rest of our leadership team to 50 00:01:51,939 --> 00:01:54,840 to really define the future for for NCD 51 00:01:54,900 --> 00:01:56,040 and where we're going. 52 00:01:56,659 --> 00:01:58,280 Fantastic. How about you, Sam? 53 00:01:58,784 --> 00:02:01,265 Yeah. So I call myself the chief insurance 54 00:02:01,265 --> 00:02:04,305 nerd here at NCD, and, I started my 55 00:02:04,305 --> 00:02:07,024 career really as a failed insurance agent. I 56 00:02:07,024 --> 00:02:09,344 was trying to sell insurance to feed my 57 00:02:09,344 --> 00:02:12,004 family and just really struggling to succeed. 58 00:02:12,849 --> 00:02:14,849 And, so at that time, I started a 59 00:02:14,849 --> 00:02:17,810 website called insurance forums. That's now the largest 60 00:02:17,810 --> 00:02:18,949 insurance agent, 61 00:02:19,810 --> 00:02:22,849 website in the country. Gets about 80,000 unique 62 00:02:22,849 --> 00:02:24,310 agent visitors a month. 63 00:02:24,610 --> 00:02:25,909 I really got my 64 00:02:26,385 --> 00:02:29,685 education in the insurance ecosystem from managing that, 65 00:02:30,305 --> 00:02:31,685 managing that community. 66 00:02:32,544 --> 00:02:35,185 I also got a job at a trade 67 00:02:35,185 --> 00:02:35,685 association's 68 00:02:36,145 --> 00:02:39,260 insurance program called the ABC Insurance Trust, and 69 00:02:39,260 --> 00:02:41,260 I was there for about fifteen years climbing 70 00:02:41,260 --> 00:02:43,599 through the ranks, eventually took over as CEO 71 00:02:44,060 --> 00:02:45,900 until about four years ago when I moved 72 00:02:45,900 --> 00:02:47,599 over to be the CEO of NCD. 73 00:02:48,060 --> 00:02:50,960 So NCD is a product development and distribution 74 00:02:51,260 --> 00:02:54,159 company. We partner with leading insurers to build 75 00:02:54,405 --> 00:02:56,424 interesting supplemental health products 76 00:02:57,044 --> 00:02:59,384 and then to work with Medicare and ACA 77 00:02:59,444 --> 00:03:02,164 distributors to have them distribute it. So really 78 00:03:02,164 --> 00:03:04,185 no one is in the business of exclusively 79 00:03:04,405 --> 00:03:07,625 selling dental or vision or stand alone supplemental 80 00:03:07,764 --> 00:03:08,504 health coverage, 81 00:03:09,159 --> 00:03:11,400 And so we build products and partner with 82 00:03:11,400 --> 00:03:11,900 distribution 83 00:03:12,280 --> 00:03:14,360 in both of these markets, and that's why 84 00:03:14,360 --> 00:03:16,460 we pay so much attention to the regulatory. 85 00:03:17,879 --> 00:03:20,280 Fantastic. Well, Sam, Brett, like I said, we 86 00:03:20,280 --> 00:03:22,439 really appreciate you both taking the time to 87 00:03:22,439 --> 00:03:24,664 chat with us today. I wanna get started 88 00:03:24,724 --> 00:03:28,004 by talking about regulatory, Sam. There's there's obviously 89 00:03:28,004 --> 00:03:30,084 a lot going on in Washington right now 90 00:03:30,084 --> 00:03:32,104 and certainly a lot that will be affecting 91 00:03:32,485 --> 00:03:35,284 the health plans and the leadership listening in 92 00:03:35,284 --> 00:03:36,664 right now. So 93 00:03:37,090 --> 00:03:38,849 let's level set for a for a moment, 94 00:03:38,849 --> 00:03:40,290 and and can you talk to us a 95 00:03:40,290 --> 00:03:41,669 little bit about some of the key 96 00:03:42,050 --> 00:03:44,389 regulatory shifts within under the ACA, 97 00:03:44,849 --> 00:03:47,250 that health plans should be preparing for right 98 00:03:47,250 --> 00:03:48,629 now from your perspective? 99 00:03:49,655 --> 00:03:51,735 Yeah. Well, the the timing for the question 100 00:03:51,735 --> 00:03:53,834 couldn't be better because the new regulations 101 00:03:54,134 --> 00:03:54,875 just dropped 102 00:03:55,735 --> 00:03:58,455 a couple days ago around the ACA, and 103 00:03:58,455 --> 00:04:00,534 these are the first regulations that the Trump 104 00:04:00,534 --> 00:04:02,074 administration has dropped. 105 00:04:02,534 --> 00:04:05,194 And it was no surprise. Actually, Peter Nelson, 106 00:04:05,949 --> 00:04:08,909 had telegraphed his views pretty clearly in some 107 00:04:08,909 --> 00:04:11,710 white papers he had released, and lo and 108 00:04:11,710 --> 00:04:14,030 behold, the regulations really seem to, 109 00:04:14,590 --> 00:04:15,889 to shape around that. 110 00:04:16,509 --> 00:04:18,910 And I would call it mostly a vibe 111 00:04:18,910 --> 00:04:21,745 shift before you get into any specificity of 112 00:04:21,745 --> 00:04:23,444 what the new regulations are. 113 00:04:23,745 --> 00:04:24,884 The previous administration 114 00:04:25,425 --> 00:04:28,144 seemed to focus on growth of the ACA 115 00:04:28,144 --> 00:04:28,964 at all costs, 116 00:04:29,504 --> 00:04:32,670 that growing this program will instantiate it. It 117 00:04:32,670 --> 00:04:35,629 will lock it in. It's, a public good, 118 00:04:35,629 --> 00:04:37,009 and there's a lot of 119 00:04:37,389 --> 00:04:39,870 philosophical reasons for it. But most of the 120 00:04:39,870 --> 00:04:40,370 regulations 121 00:04:41,949 --> 00:04:44,615 that they put out of the the four 122 00:04:44,615 --> 00:04:47,175 years of the Biden administration were really designed 123 00:04:47,175 --> 00:04:50,715 to shore up or strengthen the ACA marketplaces 124 00:04:51,014 --> 00:04:52,955 in the way that they felt was appropriate. 125 00:04:54,455 --> 00:04:54,955 Whereas 126 00:04:55,895 --> 00:04:58,779 right now, the new regulations that dropped are 127 00:04:58,779 --> 00:05:01,759 really focused on cleanup and integrity. 128 00:05:02,699 --> 00:05:04,860 So, really, a lot of people assumed, and 129 00:05:04,860 --> 00:05:06,620 there was a lot of ink spilled around 130 00:05:06,620 --> 00:05:08,699 how the Trump administration would look to hurt 131 00:05:08,699 --> 00:05:10,379 the market or would look to get rid 132 00:05:10,379 --> 00:05:11,199 of the ACA. 133 00:05:11,714 --> 00:05:14,035 And I think they were pretty clear that 134 00:05:14,035 --> 00:05:15,175 that wasn't their intent, 135 00:05:15,555 --> 00:05:16,995 and you can start to see that play 136 00:05:16,995 --> 00:05:18,855 out now with some of these new regulations 137 00:05:19,074 --> 00:05:22,035 that, yes, we might see growth slow or 138 00:05:22,035 --> 00:05:23,574 more likely some shrinkage, 139 00:05:24,379 --> 00:05:26,319 but their focus is less on, 140 00:05:27,099 --> 00:05:30,060 getting rid of the marketplaces and more around 141 00:05:30,060 --> 00:05:32,479 making them economically viable 142 00:05:32,939 --> 00:05:34,860 and removing a lot of the waste, fraud, 143 00:05:34,860 --> 00:05:35,599 and abuse. 144 00:05:36,555 --> 00:05:38,795 You know, the the big debate in DC 145 00:05:38,795 --> 00:05:41,675 is around the extension of subsidies. That was 146 00:05:41,675 --> 00:05:44,555 the thing that really grew the ACA more 147 00:05:44,555 --> 00:05:45,295 than anything. 148 00:05:45,834 --> 00:05:48,334 And, actually, the new regulations could signal 149 00:05:49,189 --> 00:05:51,449 perhaps that there's some view that the subsidies 150 00:05:51,509 --> 00:05:53,669 might extend because a lot of the new 151 00:05:53,669 --> 00:05:55,050 regulations that dropped, 152 00:05:55,350 --> 00:05:58,389 which would not go into effect until 2026, 153 00:05:58,389 --> 00:06:00,629 which is when the subsidies end, are really 154 00:06:00,629 --> 00:06:01,610 designed around 155 00:06:02,384 --> 00:06:04,884 tweaking elements of those subsidized members. 156 00:06:05,985 --> 00:06:08,224 Fascinating. Okay. So from a bird's eye level, 157 00:06:08,224 --> 00:06:10,805 Sam, you're you're basically saying the Biden administration 158 00:06:11,024 --> 00:06:12,724 really focused on the growth 159 00:06:13,024 --> 00:06:15,204 of the ACA, and now the Trump administration 160 00:06:15,504 --> 00:06:16,884 is focused on integrity 161 00:06:17,470 --> 00:06:18,529 under that program. 162 00:06:18,910 --> 00:06:21,230 And it's there were possibly seen signals of 163 00:06:21,230 --> 00:06:23,629 an extension of the premium tax credits, which 164 00:06:23,629 --> 00:06:25,389 would certainly be very good news for health 165 00:06:25,389 --> 00:06:26,370 plans and hospitals 166 00:06:26,829 --> 00:06:27,810 all over the country. 167 00:06:28,189 --> 00:06:29,949 But, Brett, would love your take here as 168 00:06:29,949 --> 00:06:30,449 well. 169 00:06:31,055 --> 00:06:34,194 Yeah. Of course. And, you know, recognizing that 170 00:06:34,415 --> 00:06:36,814 we at NCD bring the perspective of a 171 00:06:36,814 --> 00:06:37,714 dental provider, 172 00:06:38,175 --> 00:06:40,175 one of the things that we track really 173 00:06:40,175 --> 00:06:42,514 closely with regulation is the interplay 174 00:06:42,895 --> 00:06:46,110 of dental and other supplemental benefits in the 175 00:06:46,110 --> 00:06:47,009 ACA market. 176 00:06:47,790 --> 00:06:50,290 An example of this is is last year, 177 00:06:50,350 --> 00:06:51,490 the Biden administration 178 00:06:51,870 --> 00:06:54,590 enabled states for the first time to include 179 00:06:54,590 --> 00:06:55,410 adult dental 180 00:06:55,790 --> 00:06:58,670 as an essential health benefit benefit for plan 181 00:06:58,670 --> 00:07:00,764 years as early as 2027. 182 00:07:01,324 --> 00:07:02,944 Though a number of complicated 183 00:07:03,485 --> 00:07:06,125 questions remain regarding how this is gonna ultimately 184 00:07:06,125 --> 00:07:06,944 be administered, 185 00:07:07,324 --> 00:07:10,205 such as, you know, what what will a 186 00:07:10,205 --> 00:07:11,585 reference plan look like? 187 00:07:12,365 --> 00:07:14,605 And with the change in administration, for us, 188 00:07:14,605 --> 00:07:16,639 it's gonna be really interesting to see how 189 00:07:16,639 --> 00:07:17,620 the current administration 190 00:07:18,000 --> 00:07:19,220 addresses this proposal 191 00:07:19,759 --> 00:07:21,439 and others like it that are set to 192 00:07:21,439 --> 00:07:23,220 go in effect in future years, 193 00:07:24,160 --> 00:07:26,000 and and to see, you know, will this 194 00:07:26,000 --> 00:07:28,800 interplay of dental and ACA offerings really play 195 00:07:28,800 --> 00:07:30,500 out, or will the administration 196 00:07:30,800 --> 00:07:32,180 change directions there? 197 00:07:33,014 --> 00:07:35,175 Yeah. Absolutely. It's it's interesting to think about. 198 00:07:35,175 --> 00:07:37,014 And, you know, one thing I wanna do, 199 00:07:37,014 --> 00:07:38,775 Brett, is step back for a second for 200 00:07:38,775 --> 00:07:40,395 our audience. I think this would be helpful, 201 00:07:40,855 --> 00:07:42,694 to ask you what the state of ACA 202 00:07:42,694 --> 00:07:45,995 market enrollment is right now, because Sam mentioned 203 00:07:46,279 --> 00:07:48,460 the growth that happened on the previous administration. 204 00:07:49,240 --> 00:07:51,259 Have have you all been seeing any notable 205 00:07:51,480 --> 00:07:53,639 year over year trends up until this point 206 00:07:53,639 --> 00:07:56,279 in terms of who is enrolling in ACA 207 00:07:56,279 --> 00:07:56,779 plans? 208 00:07:57,720 --> 00:08:00,460 Yeah. Great question. And as Sam had mentioned, 209 00:08:00,759 --> 00:08:01,420 you know, 210 00:08:02,085 --> 00:08:05,064 CMS's own communications over the last four years 211 00:08:05,205 --> 00:08:08,264 have consistently put that emphasis on growth. 212 00:08:08,645 --> 00:08:11,205 Right? With the market today now at an 213 00:08:11,205 --> 00:08:12,585 all time high with over 214 00:08:12,964 --> 00:08:13,785 20,000,000 215 00:08:13,845 --> 00:08:15,464 Americans enrolled in the ACA. 216 00:08:16,610 --> 00:08:18,949 The thing that's most notable about growth, 217 00:08:19,730 --> 00:08:22,209 over the last year is that that we've 218 00:08:22,209 --> 00:08:22,709 seen 219 00:08:23,250 --> 00:08:25,189 both states that run their own exchanges 220 00:08:25,810 --> 00:08:27,430 see the greatest level of growth 221 00:08:27,970 --> 00:08:30,149 as well as the fact that states that 222 00:08:30,794 --> 00:08:34,235 typically have voted Republican in presidential elections have 223 00:08:34,235 --> 00:08:37,355 actually seen the strongest growth in in recent 224 00:08:37,355 --> 00:08:37,855 years. 225 00:08:38,794 --> 00:08:39,294 And 226 00:08:39,835 --> 00:08:41,995 it it it's gonna be really interesting to 227 00:08:41,995 --> 00:08:43,375 see how that trend evolves, 228 00:08:44,269 --> 00:08:45,730 going forward from here, 229 00:08:46,269 --> 00:08:48,509 particularly in light of Sam's point about the 230 00:08:48,509 --> 00:08:51,710 shift in focus from growth to stability and 231 00:08:51,710 --> 00:08:53,490 integrity of the ACA market. 232 00:08:54,590 --> 00:08:56,450 We definitely see some early indications 233 00:08:56,830 --> 00:08:58,129 that the Trump administration 234 00:08:58,910 --> 00:09:01,404 is focusing on issues like 235 00:09:01,945 --> 00:09:04,044 risks with auto enrollment. And 236 00:09:04,504 --> 00:09:07,304 while it's hard to be declarative about what 237 00:09:07,304 --> 00:09:10,764 specifically will happen, we certainly have the expectation 238 00:09:11,144 --> 00:09:11,644 that 239 00:09:12,105 --> 00:09:12,924 growth will 240 00:09:13,309 --> 00:09:16,129 likely meaningfully decelerate and and potentially 241 00:09:16,669 --> 00:09:18,289 even see enrollment decline 242 00:09:18,990 --> 00:09:21,070 in the upcoming year. I would add to 243 00:09:21,070 --> 00:09:21,570 that 244 00:09:21,950 --> 00:09:23,789 that we clearly saw that some of the 245 00:09:23,789 --> 00:09:25,409 broker enforcement rules 246 00:09:25,835 --> 00:09:28,894 that were put in place in response to 247 00:09:29,195 --> 00:09:31,835 really the wave of fraud that did come 248 00:09:31,835 --> 00:09:34,254 out of, you know, some of the easy 249 00:09:34,955 --> 00:09:35,455 additions 250 00:09:36,634 --> 00:09:39,434 to the ACA since the premium subsidies were 251 00:09:39,434 --> 00:09:39,934 created, 252 00:09:40,919 --> 00:09:43,899 that a lot of that did shift where 253 00:09:44,919 --> 00:09:47,480 there was less new business being written on 254 00:09:47,480 --> 00:09:48,779 healthcare.gov, 255 00:09:49,159 --> 00:09:52,039 but the total number of enrollees through the 256 00:09:52,039 --> 00:09:54,600 federal exchanges did still grow because of how 257 00:09:54,600 --> 00:09:56,220 easy it was to auto enroll. 258 00:09:56,595 --> 00:09:58,454 And so one of the very interesting 259 00:09:58,914 --> 00:10:02,115 pieces of the new regulatory proposal that was 260 00:10:02,115 --> 00:10:04,834 just put out is the requirement that there 261 00:10:04,834 --> 00:10:06,834 be a de minimis $5 262 00:10:06,834 --> 00:10:08,615 fee for anyone who, 263 00:10:09,209 --> 00:10:12,169 had no cost share previously, but who had 264 00:10:12,169 --> 00:10:13,230 not affirmatively 265 00:10:14,329 --> 00:10:16,190 resigned up to a new plan. 266 00:10:16,570 --> 00:10:18,350 And so I do think plan executives 267 00:10:19,129 --> 00:10:20,829 do have to take a look at 268 00:10:21,129 --> 00:10:23,129 what are the signals in their current book 269 00:10:23,129 --> 00:10:23,789 of business 270 00:10:24,404 --> 00:10:28,004 that some portion, maybe some small portion of 271 00:10:28,004 --> 00:10:28,664 their membership 272 00:10:29,044 --> 00:10:31,044 might not really even realize that they're in 273 00:10:31,044 --> 00:10:33,125 a health plan and therefore, of course, have 274 00:10:33,125 --> 00:10:33,784 no utilization. 275 00:10:34,804 --> 00:10:37,605 And if the $5 fee is gonna kick 276 00:10:37,605 --> 00:10:39,704 a bunch of those people out because 277 00:10:40,179 --> 00:10:42,259 they will either get rid of fraud or 278 00:10:42,259 --> 00:10:44,100 they'll realize they had a plan that they 279 00:10:44,100 --> 00:10:46,420 didn't think they had or maybe they qualify 280 00:10:46,420 --> 00:10:47,240 for Medicaid, 281 00:10:48,019 --> 00:10:49,960 then what does that do to their potential 282 00:10:50,100 --> 00:10:51,960 MLR? And so I think that 283 00:10:52,345 --> 00:10:54,105 there's a lot of focus in the new 284 00:10:54,105 --> 00:10:55,004 proposed regulations 285 00:10:55,465 --> 00:10:57,865 that have a lot of impact around program 286 00:10:57,865 --> 00:10:58,365 integrity 287 00:10:59,065 --> 00:11:00,684 that smart plan 288 00:11:01,384 --> 00:11:02,845 administrators and insurers 289 00:11:03,465 --> 00:11:05,884 right now have a war room thinking about 290 00:11:06,110 --> 00:11:08,350 how do we project our MLR and price 291 00:11:08,350 --> 00:11:11,090 our plans prop properly for 2026. 292 00:11:12,029 --> 00:11:14,350 So, Sam, let me come back to, something 293 00:11:14,350 --> 00:11:17,490 you had mentioned earlier. Peter Nelson being appointed 294 00:11:17,550 --> 00:11:21,085 to lead the Center for Consumer Information and 295 00:11:21,085 --> 00:11:22,384 Insurance Oversight. 296 00:11:23,004 --> 00:11:24,524 As you know, he's an he's an ACA 297 00:11:24,524 --> 00:11:26,285 expert. He has a lot of knowledge about 298 00:11:26,285 --> 00:11:28,465 state innovation waivers, price transparency, 299 00:11:29,004 --> 00:11:29,745 health reimbursement 300 00:11:30,045 --> 00:11:30,545 arrangements. 301 00:11:32,000 --> 00:11:33,939 So so what do you think his appointment 302 00:11:34,079 --> 00:11:36,879 means for for the insurers listening in and 303 00:11:36,879 --> 00:11:38,959 for the consumers and the members that they 304 00:11:38,959 --> 00:11:39,459 serve? 305 00:11:40,559 --> 00:11:42,480 Yeah. You know, I have a huge amount 306 00:11:42,480 --> 00:11:45,214 of respect for Peter Nelson. He's been writing 307 00:11:45,214 --> 00:11:47,534 and thinking about and talking about the ACA 308 00:11:47,534 --> 00:11:49,695 and health care more broadly for a really 309 00:11:49,695 --> 00:11:50,434 long time. 310 00:11:51,054 --> 00:11:53,774 And in many ways, his appointment is really 311 00:11:53,774 --> 00:11:57,134 good news for health insurers because he's been 312 00:11:57,134 --> 00:12:00,230 pretty clear about what he sees as potentially 313 00:12:00,289 --> 00:12:00,789 broken 314 00:12:01,809 --> 00:12:03,190 in the healthcare ecosystem 315 00:12:03,570 --> 00:12:05,429 and in particular in ACA 316 00:12:06,129 --> 00:12:08,210 and what are some of those ways that 317 00:12:08,210 --> 00:12:09,029 it can be, 318 00:12:09,570 --> 00:12:11,490 it can be addressed. And so he's put 319 00:12:11,490 --> 00:12:12,309 out publications 320 00:12:13,375 --> 00:12:15,235 that specifically talk about 321 00:12:15,934 --> 00:12:18,335 why the ACA structure or some of the 322 00:12:18,335 --> 00:12:21,475 regulatory structure has an extra cost to consumers 323 00:12:23,215 --> 00:12:25,555 with even pretty specific calculations 324 00:12:26,220 --> 00:12:30,000 of what each of these new laws, whether 325 00:12:30,539 --> 00:12:31,279 they're preenrollment 326 00:12:31,819 --> 00:12:32,319 SEPs 327 00:12:33,500 --> 00:12:36,959 or allowing states to update and modernize their 328 00:12:37,100 --> 00:12:38,480 essential health benefits 329 00:12:39,444 --> 00:12:42,804 or narrow de minimis variation actuarial values. There's 330 00:12:42,804 --> 00:12:45,044 any number of them where he's very specific 331 00:12:45,044 --> 00:12:47,284 in his analysis of what the premium impact 332 00:12:47,284 --> 00:12:48,184 is gonna be. 333 00:12:48,644 --> 00:12:51,384 So while the regulations that were just released 334 00:12:52,019 --> 00:12:54,340 come out of a playbook that you can 335 00:12:54,340 --> 00:12:56,500 find in his previous writings, I think a 336 00:12:56,500 --> 00:12:58,580 lot of smart insurers are saying, alright. Let 337 00:12:58,580 --> 00:13:00,660 me read everything he's written. Let me listen 338 00:13:00,660 --> 00:13:03,639 to everything he's been recorded as saying. Because, 339 00:13:04,504 --> 00:13:06,764 he has been pretty clear about his perspective 340 00:13:06,825 --> 00:13:07,644 for a while. 341 00:13:08,585 --> 00:13:11,725 I think the other thing that's becoming clear 342 00:13:11,785 --> 00:13:13,485 is to the point I made earlier, 343 00:13:13,785 --> 00:13:16,184 there was a lot of ink spilled when 344 00:13:16,184 --> 00:13:17,245 there was an election 345 00:13:17,769 --> 00:13:19,950 going on, and there was maybe a political 346 00:13:20,089 --> 00:13:21,629 reality to the discussion 347 00:13:22,730 --> 00:13:23,230 that 348 00:13:23,929 --> 00:13:25,070 the Republicans 349 00:13:25,450 --> 00:13:28,649 wanted to scrap the ACA or wanna get 350 00:13:28,649 --> 00:13:29,629 rid of the ACA. 351 00:13:30,125 --> 00:13:32,365 But to Brett's point, some of the growth 352 00:13:32,365 --> 00:13:35,245 in red states that the ACA has seen 353 00:13:35,245 --> 00:13:37,664 and where the population that is being subsidized 354 00:13:37,964 --> 00:13:38,945 right now lies, 355 00:13:40,044 --> 00:13:40,865 and given 356 00:13:41,325 --> 00:13:42,865 the two year cycle for 357 00:13:43,230 --> 00:13:45,490 Congress and the slim majority, 358 00:13:46,589 --> 00:13:47,089 it's 359 00:13:47,389 --> 00:13:49,089 very hard to imagine, 360 00:13:50,190 --> 00:13:52,450 any kind of wholesale change 361 00:13:53,149 --> 00:13:55,629 that's going to really hurt a lot of 362 00:13:55,629 --> 00:13:58,450 those people who are being subsidized right now. 363 00:13:58,835 --> 00:14:01,315 So it's somewhat of a contrarian take, I 364 00:14:01,315 --> 00:14:03,235 think, from the rest of the market. It 365 00:14:03,235 --> 00:14:06,035 does seem like many people think the premium 366 00:14:06,035 --> 00:14:07,654 subsidies will not be extended, 367 00:14:08,434 --> 00:14:11,475 but I would bet actually that the premium 368 00:14:11,475 --> 00:14:13,014 subsidies may be extended, 369 00:14:13,449 --> 00:14:15,389 maybe with some tweaks like, 370 00:14:16,250 --> 00:14:17,230 work requirements. 371 00:14:18,009 --> 00:14:18,509 And 372 00:14:18,889 --> 00:14:20,889 so it does not appear that they're looking 373 00:14:20,889 --> 00:14:22,350 to undermine the ACA 374 00:14:22,889 --> 00:14:24,669 as much as they are looking to, 375 00:14:25,924 --> 00:14:26,825 really focus 376 00:14:27,205 --> 00:14:27,705 on 377 00:14:28,164 --> 00:14:31,284 not being wasteful and not allowing fraud, some 378 00:14:31,284 --> 00:14:32,184 of which has 379 00:14:33,125 --> 00:14:34,985 propagated over the last few years. 380 00:14:35,524 --> 00:14:37,445 No. Your your point is well heard, Sam. 381 00:14:37,445 --> 00:14:39,205 And it's certainly it's an argument we've heard 382 00:14:39,205 --> 00:14:42,879 from insurance executives on earnings calls with investors 383 00:14:43,019 --> 00:14:44,160 talking about the sustainability 384 00:14:44,540 --> 00:14:45,680 of of the ACA 385 00:14:46,220 --> 00:14:49,259 moving forward and and the popularity of of 386 00:14:49,259 --> 00:14:50,720 that program with, 387 00:14:51,180 --> 00:14:53,279 with people in Republican led states. 388 00:14:53,914 --> 00:14:56,554 It even specifically mentioned among Trump supporters specifically, 389 00:14:56,554 --> 00:14:58,394 and and that's certainly been an argument that's 390 00:14:58,394 --> 00:15:01,274 been used when discussing Medicaid cuts or potential 391 00:15:01,274 --> 00:15:03,674 cuts as well. So it's it's an interesting, 392 00:15:04,154 --> 00:15:06,074 it's interesting to hear your perspective on that 393 00:15:06,074 --> 00:15:07,914 in terms of what could happen to the 394 00:15:07,914 --> 00:15:08,735 to the subsidies. 395 00:15:10,250 --> 00:15:11,850 But, Brett, I wanna I wanna I do 396 00:15:11,850 --> 00:15:13,289 wanna switch gears in just a sec, but 397 00:15:13,289 --> 00:15:14,649 I'd also wanna get to the crux of 398 00:15:14,649 --> 00:15:16,829 things, before we move on from the ACA. 399 00:15:17,289 --> 00:15:19,209 Given all these changes that we've talked about 400 00:15:19,209 --> 00:15:21,610 today that have been announced or that could 401 00:15:21,610 --> 00:15:23,709 be on the horizon in this market, 402 00:15:24,414 --> 00:15:25,235 How should 403 00:15:25,774 --> 00:15:29,235 marketplace plans be thinking right now about repositioning 404 00:15:29,375 --> 00:15:29,875 themselves 405 00:15:30,254 --> 00:15:32,975 for long term success over the next few 406 00:15:32,975 --> 00:15:33,475 years? 407 00:15:34,174 --> 00:15:36,274 Yeah. That's a great question. And 408 00:15:36,975 --> 00:15:38,434 when when you think about 409 00:15:38,980 --> 00:15:41,059 those in the market who are ACA focused, 410 00:15:41,059 --> 00:15:43,779 you know, obviously, you have you have carriers, 411 00:15:43,779 --> 00:15:44,919 but you also have, 412 00:15:45,700 --> 00:15:47,860 distributors who have who over the last few 413 00:15:47,860 --> 00:15:49,559 years have largely built their business 414 00:15:50,419 --> 00:15:52,980 serving the ACA markets and in in enrolling 415 00:15:52,980 --> 00:15:53,480 individuals, 416 00:15:54,605 --> 00:15:55,245 in ACA plans. 417 00:15:56,445 --> 00:15:58,764 Our view is that right now is really 418 00:15:58,764 --> 00:16:01,184 the time for those ACA focused distributors 419 00:16:02,125 --> 00:16:05,585 to add resiliency to their businesses through diversification. 420 00:16:07,159 --> 00:16:08,839 You know, now is the time for them 421 00:16:08,839 --> 00:16:12,440 to expand their horizons beyond, you know, just 422 00:16:12,440 --> 00:16:13,500 considering themselves 423 00:16:13,879 --> 00:16:14,860 ACA distributors 424 00:16:15,480 --> 00:16:17,320 and and really thinking about the ways they 425 00:16:17,320 --> 00:16:19,720 can more broadly serve the needs of their 426 00:16:19,720 --> 00:16:20,220 clients 427 00:16:20,865 --> 00:16:23,105 through through the sale of a number of 428 00:16:23,105 --> 00:16:25,924 related ancillary health products that frequently, 429 00:16:26,304 --> 00:16:27,284 you know, complement 430 00:16:27,745 --> 00:16:28,965 ACA plan coverage. 431 00:16:30,544 --> 00:16:33,105 Additionally, by by by diversifying their book of 432 00:16:33,105 --> 00:16:35,445 business, they can also create additional value 433 00:16:35,929 --> 00:16:37,070 for for their clients, 434 00:16:37,850 --> 00:16:40,490 and and deepen their relationship with their their 435 00:16:40,490 --> 00:16:42,649 client base by by solving a greater number 436 00:16:42,649 --> 00:16:43,629 of of needs. 437 00:16:44,570 --> 00:16:46,970 And, you know, obviously, there there's a range 438 00:16:46,970 --> 00:16:48,884 of compelling ancillary health products. 439 00:16:49,764 --> 00:16:52,404 You know, at NCD, we're we're particularly partial 440 00:16:52,404 --> 00:16:54,485 to dental and and vision being some of 441 00:16:54,485 --> 00:16:56,725 the the most notable. But but there there 442 00:16:56,725 --> 00:16:59,544 really is a a broad opportunity for ACA 443 00:16:59,605 --> 00:17:02,490 participants to think about these these these other 444 00:17:02,490 --> 00:17:04,750 products and how how they can bring them 445 00:17:04,970 --> 00:17:06,029 bring them to clients, 446 00:17:06,730 --> 00:17:08,190 in in the months ahead. 447 00:17:08,730 --> 00:17:10,509 Absolutely. Yeah. No. It's great advice, 448 00:17:10,890 --> 00:17:12,670 for for everyone listening in. 449 00:17:13,049 --> 00:17:14,970 I do wanna switch gears here and and 450 00:17:14,970 --> 00:17:17,865 talk about Medicare Advantage because, obviously, it's been 451 00:17:17,865 --> 00:17:19,965 a wild year for that program, 452 00:17:20,585 --> 00:17:22,605 and certainly for for carriers, 453 00:17:23,224 --> 00:17:24,365 in Medicare Advantage. 454 00:17:25,224 --> 00:17:27,785 We've seen enrollment growth slow now that the 455 00:17:27,785 --> 00:17:29,069 the data is out, 456 00:17:30,029 --> 00:17:30,769 slow to, 457 00:17:31,149 --> 00:17:33,309 at least the the the lowest it's been 458 00:17:33,309 --> 00:17:34,529 in decade in a decade. 459 00:17:35,309 --> 00:17:36,769 Plan benefits are shrinking. 460 00:17:37,389 --> 00:17:39,389 Millions of seniors are being left with coverage 461 00:17:39,389 --> 00:17:41,409 gaps, certainly within dental care. 462 00:17:41,804 --> 00:17:43,804 So, Brett, how do you think this shift 463 00:17:43,804 --> 00:17:46,845 within MA is impacting the demand for stand 464 00:17:46,845 --> 00:17:47,825 alone dental, 465 00:17:48,204 --> 00:17:49,984 vision, and hearing plans? 466 00:17:51,085 --> 00:17:51,904 Yeah. That's 467 00:17:52,204 --> 00:17:53,904 that's a great question. And and 468 00:17:54,284 --> 00:17:56,065 it's worth calling out that these reductions, 469 00:17:56,365 --> 00:17:58,819 you know, don't look the same in in 470 00:17:58,819 --> 00:17:59,639 every market. 471 00:18:00,019 --> 00:18:02,419 Right? Sometimes they take the form of the 472 00:18:02,419 --> 00:18:03,559 removal of a benefit 473 00:18:04,419 --> 00:18:05,159 in entirety. 474 00:18:05,779 --> 00:18:08,740 But but even more commonly, particularly for benefits 475 00:18:08,740 --> 00:18:09,480 like dental, 476 00:18:10,259 --> 00:18:11,000 these reductions, 477 00:18:11,595 --> 00:18:13,595 you know, you know, they may be hard 478 00:18:13,595 --> 00:18:14,954 to see, but they really take the form 479 00:18:14,954 --> 00:18:17,194 of the benefits being called out, you know, 480 00:18:17,194 --> 00:18:19,694 whether it's through network changes and reductions, 481 00:18:21,275 --> 00:18:23,214 lower total benefit value, 482 00:18:23,799 --> 00:18:26,140 the removal of certain services, you know, 483 00:18:26,440 --> 00:18:27,660 for example, implants 484 00:18:28,119 --> 00:18:31,480 from included coverage. And and across all these 485 00:18:31,480 --> 00:18:33,240 types of changes, we really view them as 486 00:18:33,240 --> 00:18:35,799 a as a potential opportunity for the stand 487 00:18:35,799 --> 00:18:36,940 alone dental market, 488 00:18:37,595 --> 00:18:39,775 for for NCD and others as well. 489 00:18:40,315 --> 00:18:41,775 And really the reason is 490 00:18:42,715 --> 00:18:44,894 as these benefits are pulled back, we believe 491 00:18:45,275 --> 00:18:48,234 many Medicare Advantage members are gonna reassess their 492 00:18:48,234 --> 00:18:49,134 dental needs, 493 00:18:50,259 --> 00:18:52,339 and and what coverage they need and and 494 00:18:52,339 --> 00:18:54,759 consider adding a stand alone dental plan 495 00:18:55,220 --> 00:18:57,700 to their coverage separate from their Medicare Advantage 496 00:18:57,700 --> 00:18:58,200 coverage. 497 00:18:58,740 --> 00:18:59,240 And 498 00:19:00,500 --> 00:19:03,220 we believe for a significant segment of Medicare 499 00:19:03,220 --> 00:19:05,319 Advantage members with these benefit pullbacks, 500 00:19:05,835 --> 00:19:08,154 there's there's gonna be strong value for them 501 00:19:08,154 --> 00:19:10,554 to pay, you know, a small premium for 502 00:19:10,554 --> 00:19:12,575 that additional standalone dental plan, 503 00:19:13,515 --> 00:19:16,474 rather than having, you know, included but highly 504 00:19:16,474 --> 00:19:17,934 limited dental coverage, 505 00:19:18,759 --> 00:19:20,920 as as their only way to access, you 506 00:19:20,920 --> 00:19:22,460 know, critical dental services. 507 00:19:23,559 --> 00:19:25,240 And and so we've we view that as 508 00:19:25,240 --> 00:19:27,559 a a really intriguing, you know, development on 509 00:19:27,559 --> 00:19:30,440 the horizon for the market. Yeah. Absolutely. So 510 00:19:30,440 --> 00:19:32,054 it sounds like the time is ripe for 511 00:19:32,054 --> 00:19:34,315 the growth of stand alone dental plans. 512 00:19:34,615 --> 00:19:36,075 Anything you'd add there, Sam? 513 00:19:36,774 --> 00:19:38,694 Yeah. I would say it's an open question 514 00:19:38,694 --> 00:19:41,654 whether Medicare Advantage Plans should, in fact, cover 515 00:19:41,654 --> 00:19:44,054 all the supplemental benefits that they have or 516 00:19:44,054 --> 00:19:46,349 not. You know, it certainly wasn't the original 517 00:19:46,410 --> 00:19:49,210 intent, and there are trade offs. There's certainly 518 00:19:49,210 --> 00:19:50,809 a lot of nice things, and they've been 519 00:19:50,809 --> 00:19:51,630 very effective 520 00:19:52,009 --> 00:19:53,309 from a marketing standpoint. 521 00:19:53,929 --> 00:19:56,250 When I think about what policy makers, in 522 00:19:56,250 --> 00:19:56,750 particular, 523 00:19:57,049 --> 00:20:00,154 legislators could think about, one interesting idea we 524 00:20:00,154 --> 00:20:01,934 haven't really seen floated is 525 00:20:02,394 --> 00:20:03,134 that many, 526 00:20:03,994 --> 00:20:07,934 many people who receive their supplemental health benefits 527 00:20:08,234 --> 00:20:10,154 when they're working get to pay for it 528 00:20:10,154 --> 00:20:12,490 with pretax dollars through a section one twenty 529 00:20:12,490 --> 00:20:14,990 five plan or because the company pays for 530 00:20:15,289 --> 00:20:17,769 it. Whereas when you retire, you really can't. 531 00:20:17,769 --> 00:20:19,309 And so if you're going 532 00:20:20,250 --> 00:20:23,289 to have the economics of Medicare Advantage make 533 00:20:23,289 --> 00:20:26,509 it difficult to embed additional supplemental plans, 534 00:20:26,944 --> 00:20:28,785 then perhaps there could be a tax break 535 00:20:28,785 --> 00:20:29,765 for those dollars. 536 00:20:30,224 --> 00:20:30,724 Currently, 537 00:20:31,105 --> 00:20:33,984 it's only dollars you spend in excess of 538 00:20:33,984 --> 00:20:35,365 7.5% 539 00:20:35,505 --> 00:20:37,664 of your modified adjusted gross income that are 540 00:20:37,664 --> 00:20:38,404 tax deductible. 541 00:20:39,109 --> 00:20:41,590 So it effectively costs more for those people 542 00:20:41,590 --> 00:20:44,070 who are not actively in the workforce to 543 00:20:44,070 --> 00:20:46,090 actually ensure some of those needs. 544 00:20:47,190 --> 00:20:48,330 Understood. Understood. 545 00:20:49,430 --> 00:20:52,115 Okay. So we've we've gone through a lot, 546 00:20:52,115 --> 00:20:53,714 talked a lot about the ACA, talked a 547 00:20:53,714 --> 00:20:55,014 lot about Medicare Advantage. 548 00:20:55,714 --> 00:20:57,714 Anything else you both would mention in terms 549 00:20:57,714 --> 00:21:00,214 of the biggest potential regulatory considerations 550 00:21:00,674 --> 00:21:01,174 that 551 00:21:01,554 --> 00:21:04,454 our health plan and hospital system stakeholders 552 00:21:05,140 --> 00:21:06,819 really need to keep an eye on at 553 00:21:06,819 --> 00:21:07,720 the federal level. 554 00:21:08,259 --> 00:21:09,880 Brett, you wanna start us off there? 555 00:21:10,900 --> 00:21:12,759 Sure. Absolutely. Well, 556 00:21:13,140 --> 00:21:16,019 I think the the the most interesting potential 557 00:21:16,019 --> 00:21:17,559 trend is is 558 00:21:18,339 --> 00:21:20,679 not just the regulations are coming, but 559 00:21:21,365 --> 00:21:23,684 as the regulations come will be the the 560 00:21:23,684 --> 00:21:24,184 potential 561 00:21:24,644 --> 00:21:26,265 change in approach that 562 00:21:26,644 --> 00:21:27,144 that, 563 00:21:28,244 --> 00:21:29,545 private market participate 564 00:21:30,005 --> 00:21:31,144 participants take 565 00:21:31,525 --> 00:21:34,325 to competing in the Medicare Advantage and ACA 566 00:21:34,325 --> 00:21:34,825 markets, 567 00:21:35,720 --> 00:21:37,880 While not knowing, you know, all the ways 568 00:21:37,880 --> 00:21:40,440 regulations will change, I I think as they 569 00:21:40,440 --> 00:21:42,039 they come to market, one of the thing 570 00:21:42,039 --> 00:21:42,539 we're 571 00:21:43,080 --> 00:21:44,140 likely to see 572 00:21:44,519 --> 00:21:45,980 is that the general 573 00:21:46,359 --> 00:21:47,414 approach of 574 00:21:47,894 --> 00:21:51,015 more benefits, more supplemental benefits equals a better 575 00:21:51,015 --> 00:21:54,075 strategy actually could could very much change. And 576 00:21:54,295 --> 00:21:55,674 instead, we might see 577 00:21:56,215 --> 00:21:57,355 a number of 578 00:21:58,134 --> 00:21:58,634 ACA 579 00:21:59,015 --> 00:22:03,195 and Medicare Advantage participants intentionally focus more on 580 00:22:04,210 --> 00:22:05,429 core medical benefits 581 00:22:05,809 --> 00:22:08,690 and and really trying to differentiate there rather 582 00:22:08,690 --> 00:22:11,490 than through, you know, a a broad portfolio 583 00:22:11,490 --> 00:22:12,789 of supplemental benefits, 584 00:22:13,250 --> 00:22:16,024 which which has the potential to serve, you 585 00:22:16,024 --> 00:22:16,684 know, the 586 00:22:17,304 --> 00:22:19,944 needs of a segment of consumers who are 587 00:22:19,944 --> 00:22:20,444 looking, 588 00:22:20,744 --> 00:22:22,825 you know, not for for the buffet plan, 589 00:22:22,825 --> 00:22:24,585 but who are looking for the best medical 590 00:22:24,585 --> 00:22:26,265 plan. And then in turn, we'll be looking 591 00:22:26,265 --> 00:22:28,765 for, you know, alternative standalone options, 592 00:22:29,784 --> 00:22:30,444 to cover 593 00:22:30,769 --> 00:22:34,130 their their other health related needs. So that 594 00:22:34,210 --> 00:22:36,309 that's one really interesting trend, 595 00:22:36,849 --> 00:22:38,609 on the horizon that that I will be 596 00:22:38,609 --> 00:22:39,349 looking for. 597 00:22:39,730 --> 00:22:41,169 And, Sam, how about you? What are you 598 00:22:41,169 --> 00:22:43,169 keeping an eye on or any other final 599 00:22:43,169 --> 00:22:45,409 thoughts that you wanna share with our listeners 600 00:22:45,409 --> 00:22:45,909 today? 601 00:22:46,985 --> 00:22:50,045 Yeah. I'm certainly keeping an eye on some 602 00:22:50,265 --> 00:22:50,765 interesting 603 00:22:51,065 --> 00:22:53,065 ideas that would have been more out of 604 00:22:53,065 --> 00:22:53,805 the box, 605 00:22:54,105 --> 00:22:57,865 things like multiyear plans where plans can really 606 00:22:57,865 --> 00:22:58,365 invest 607 00:22:58,679 --> 00:23:02,359 in and make commitments to wellness and to 608 00:23:02,359 --> 00:23:04,059 really bending the cost curve, 609 00:23:04,599 --> 00:23:06,599 knowing that they will receive some of the 610 00:23:06,599 --> 00:23:08,220 benefits of the lower utilization 611 00:23:09,799 --> 00:23:12,279 rather than, you know, than some other insurer 612 00:23:12,279 --> 00:23:13,819 that people move over to. 613 00:23:14,184 --> 00:23:16,265 I think it'll also be interesting to see 614 00:23:16,265 --> 00:23:17,705 whether they take a look at some of 615 00:23:17,705 --> 00:23:18,924 the MLR regulations 616 00:23:20,025 --> 00:23:22,684 that, while well meaning, might effectively 617 00:23:23,384 --> 00:23:25,865 cap margin and therefore drive some of the 618 00:23:25,865 --> 00:23:26,365 consolidation 619 00:23:27,589 --> 00:23:30,330 and reduce some of the incentive from plans 620 00:23:30,549 --> 00:23:33,750 to really drive for better control of health 621 00:23:33,750 --> 00:23:34,490 care costs. 622 00:23:34,869 --> 00:23:36,470 So I think it's an exciting time to 623 00:23:36,470 --> 00:23:37,529 be in health care. 624 00:23:37,910 --> 00:23:39,750 And then the last thing would be the 625 00:23:39,750 --> 00:23:42,794 general zeitgeist in health care is that we 626 00:23:42,794 --> 00:23:45,355 spend too much money on it, and people 627 00:23:45,355 --> 00:23:47,515 are not very happy with it. And so 628 00:23:47,515 --> 00:23:49,355 I think, well, a lot of insurers are 629 00:23:49,355 --> 00:23:52,554 focused on automation and outsourcing and finding ways 630 00:23:52,554 --> 00:23:53,774 to reduce their costs. 631 00:23:54,740 --> 00:23:56,680 Sacrificing around member experience, 632 00:23:57,460 --> 00:23:59,480 does not seem like it's gonna pay dividends. 633 00:23:59,539 --> 00:24:01,480 And so I would certainly be encouraging 634 00:24:01,859 --> 00:24:04,660 this topic for another day, but for, smart 635 00:24:04,660 --> 00:24:06,680 health plans to be very mindful of that. 636 00:24:07,375 --> 00:24:08,894 Fantastic. Well, I think that's a great place 637 00:24:08,894 --> 00:24:11,615 to leave things. Sam, Brett, thank you very 638 00:24:11,615 --> 00:24:13,454 much for taking the time to sit down 639 00:24:13,454 --> 00:24:15,134 with us and for sharing your insights with 640 00:24:15,134 --> 00:24:18,035 our listeners. We really appreciate it. Thanks, Jacob. 641 00:24:18,619 --> 00:24:19,359 Thank you. 642 00:24:19,739 --> 00:24:21,419 And if you'd like to listen to more 643 00:24:21,419 --> 00:24:25,679 podcasts from Becker's Healthcare, you can visit beckershospitalreview.com.