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Evernorth brings the power of wonder and relentless

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innovation to create world class pharmacy, care, and

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benefit solutions.

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Barriers to care can lead to gaps in

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care, which can drive up the total cost

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of care. Our capabilities work seamlessly together to

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create innovative pharmacy care and benefit solutions for

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today and tomorrow.

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Our connected health services make the treatment, prediction,

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and prevention of health care's most complex conditions

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easier and more accessible as we drive organizations

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and people forward.

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This is Haley Recker with the Becker's Payer

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podcast, and we are recording live at the

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Becker's third annual spring care issues roundtable.

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Today, I am thrilled to be joined by

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Brian Smolich,

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VP of quality and managed care operations at

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Health Alliance Medical Plans. Brian, thank you so

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much for being with me today. Yeah. Thanks.

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Good morning. Good morning to you too. So

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before we begin, I'd like to have you

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just introduce yourself and share a little bit

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more about your background and your organization.

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Sure.

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So my name is Brian Smolich.

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I serve as vice president of quality and

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managed care operations for Healthline's medical plans

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and First Carolina Care. We're part of the

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Carle Health System, and we serve patients

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that are primarily located in, Central And Southern

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Illinois as well as North Carolina.

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I have responsibilities

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of,

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pharmacy,

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medical management,

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quality,

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and our member relations,

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appeals team

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at our health.

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Well, thank you so much for sharing a

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little bit about your background. Now to begin

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our conversation today, I'd like to kick it

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off by talking about balancing affordability and quality.

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So how is your organization

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innovating to manage the cost of care while

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maintaining or improving member outcomes?

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Yeah. So at Health Alliance Medical Plans and

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First Carolina Care, quality is at the center

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of everything that we do.

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You know, you you really have to put

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quality

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in front of cost and affordability.

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But, you know, we we do realize that

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if if you're not financially sound and and

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you're not able to balance

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premiums and and revenue with rising cost, then

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it's gonna be difficult to, you know, offer

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the plans and and benefits that you want

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to members.

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But for us, I mean, our people are

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exceptional. They

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have

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a wonderful,

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engagement with our members, our customer solutions team,

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our case management team, and our clinical platforms

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really take the view of working collaboratively with

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the provider to ensure patients have the best

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care.

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So far as innovation,

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you know, we've put a lot of focus

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in the biosimilar space at least on the

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pharmacy benefit side. That has really helped us

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reduce costs on medications

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without compromising

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patients'

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access to care or helping us to afford

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additional therapies that are newer or novel.

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I'd like to explore that a little bit

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further on the basis of member satisfaction as

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a whole. So what experience or engagement strategies

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have proven effective for your organization, and how

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are you measuring that success?

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Yeah. So our organization,

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tracks not only, on our our vertically integrated

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health system, the provider side MPS four, but

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we're also tracking health plan MPS four.

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And I think we do an exceptional job

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of engaging members through our customer solutions team.

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They also

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have the resources to tap into our clinical

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experts,

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So there's a lot more

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collaboration

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on individual patient cases,

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connecting the dots and getting patients access to

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our medical management team, a pharmacist,

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our population health or care coordination team. I

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think really making it easier for patients to

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navigate has been helpful.

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We've also utilized digital solutions

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and vendors,

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some of which, you know,

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have gamified,

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health care and and

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healthy behaviors like medication adherence,

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and we're seeing a lot of positive outcomes

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from member engagement through those digital platforms.

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The other benefit they provide for us is

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their high touch. You know, members will be

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in apps daily

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completing tech,

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activities and and earning rewards. And we can

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also then engage them with prompts and gaps

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in care and things that they need to

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do where that becomes much more difficult when

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you're trying to engage a member just telephonically

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and,

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the hesitancy

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to to pick up a phone. So I

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think we've really seen how how the digital

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solutions that we employ can supplement

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all the great work that our people are

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doing at the planet.

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Absolutely. And I'd like to pivot our conversation

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just a little bit to the imperative to

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reduce costs, improve quality, and advance health equity.

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So how do you approach aligning these priorities

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in your organization's strategic vision?

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I think it all goes back to quality,

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and,

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I I think our geography in in Central

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Illinois as well as in North Carolina,

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you know, our being a regional health plan,

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we

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directly interact on a daily basis with individuals

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that have our health care coverage. So I

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think that becomes the center of what you

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do. You you know that, you're improving the

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care within your communities, and that makes the

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work that we do very rewarding.

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I think,

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overall,

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we we look at approaches to reduce costs

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within,

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what we can control,

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but I think the general philosophy

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improving the care and access to health care

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in our communities and bettering,

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the population is kind of our North Star

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in knowing that this

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is health care that impacts those that we

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work with, our family, our friends, and and

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I think that really becomes impactful when you

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think about

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quality,

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in the patients we serve.

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And looking ahead, I wanna talk a little

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bit more about the future of the payer

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space. So what do you see are the

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biggest opportunities

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for payers to lead the charge in transforming

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care delivery and driving better outcomes for all

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stakeholders?

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And how can leaders take a step in

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this direction now?

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Yeah. I think,

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a big area of opportunity is to continuing

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to bridge the gap between providers and health

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plans.

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You know, for years

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and

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even today, there's oftentimes an adversarial

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approach, and I think that puts the patient

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in the middle of a lot of dynamics

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that make,

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navigating health care more difficult.

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I know at our health care organization, we're

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trying to work collaboratively with providers to pass

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more information,

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to make,

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you know, access to information that the health

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plan has easier and to reduce some of

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the burden in prior authorization,

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but really involving the provider and and finding

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a solution where we can work collaboratively with

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them to have a win win situation and

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and make

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all of the navigating of health care and

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promoting,

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you know, providers as as

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key resources in in a patient's health care

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journey as well as the provider recognizing that

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the health plan is trying to do the

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best interest in the patient and making sure

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that health care remains affordable. I'd like to

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see that dynamic happen, and I think it's,

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just continuing to build bridges with providers, trying

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to see how we can make their lives

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easier on providing

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access to care and reducing some of the

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the challenges that they face on a daily

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basis.

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Well, Brian, thank you so much for taking

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the time to have this conversation with me

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today. Again, this is Haley Becker with the

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Becker's Payer podcast recording live at the Becker's

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third annual spring payer issues roundtable. Thank you

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so much. Thank you.