1 00:00:02,240 --> 00:00:05,059 This is where health insurance leadership comes together. 2 00:00:05,279 --> 00:00:09,039 Becker's fourth annual spring payer issues roundtable brings 3 00:00:09,039 --> 00:00:12,259 together over 400 payer and health plan executives 4 00:00:12,400 --> 00:00:16,574 and more than 100 speakers to Chicago April. 5 00:00:16,875 --> 00:00:19,755 This year's event includes keynote conversations with the 6 00:00:19,755 --> 00:00:23,035 industry's top leaders and former president George W. 7 00:00:23,035 --> 00:00:25,675 Bush. For the full agenda and event details, 8 00:00:25,675 --> 00:00:27,870 visit beckershospitalreview.com 9 00:00:27,949 --> 00:00:29,310 and click on the events tab in the 10 00:00:29,310 --> 00:00:31,470 upper right. We're looking forward to hosting you 11 00:00:31,470 --> 00:00:32,609 here in Chicago. 12 00:00:33,950 --> 00:00:36,030 Hello, everyone, and welcome to the Becker's Healthcare 13 00:00:36,030 --> 00:00:38,909 Podcast. I'm Scott King. Thrilled today to be 14 00:00:38,909 --> 00:00:41,490 joined by a very special guest, doctor Dominique 15 00:00:41,549 --> 00:00:43,170 Chauby, vice president, 16 00:00:43,524 --> 00:00:46,245 clinical affairs with Clover Health. Doctor Chauby, how 17 00:00:46,245 --> 00:00:47,365 are you doing today? Thanks so much for 18 00:00:47,365 --> 00:00:50,105 joining us. Oh, thank you so much, Scott, 19 00:00:50,164 --> 00:00:52,425 and, thank you for giving me this opportunity 20 00:00:52,725 --> 00:00:53,945 to share my perspectives. 21 00:00:54,885 --> 00:00:56,260 Oh, no. It's wonderful to have you, and, 22 00:00:56,260 --> 00:00:57,460 you know, we're gonna we're gonna need your 23 00:00:57,460 --> 00:00:58,979 perspective, but there's a lot going on in 24 00:00:58,979 --> 00:01:01,219 health care right now. So, before we get 25 00:01:01,219 --> 00:01:02,340 to, you know, some of the topics I 26 00:01:02,340 --> 00:01:04,020 wanted to ask you about, I was wondering 27 00:01:04,020 --> 00:01:05,060 if you could please just tell us a 28 00:01:05,060 --> 00:01:06,819 little bit about your your background in health 29 00:01:06,819 --> 00:01:08,520 care and your your journey there. 30 00:01:08,834 --> 00:01:08,995 Sure. 31 00:01:09,715 --> 00:01:12,594 So as you mentioned, I'm Damanjeet Chabe. I'm 32 00:01:12,594 --> 00:01:15,174 the vice president of clinical affairs 33 00:01:15,635 --> 00:01:16,935 at Clover Health. 34 00:01:17,474 --> 00:01:20,045 Been with Clover since November 35 00:01:20,045 --> 00:01:20,935 2021. 36 00:01:21,170 --> 00:01:22,310 But prior to that, 37 00:01:22,769 --> 00:01:24,369 you know, I've been in the health care 38 00:01:24,369 --> 00:01:26,849 industry for more than twenty five years on 39 00:01:26,849 --> 00:01:29,170 the health care system side as a physician 40 00:01:29,170 --> 00:01:29,670 leader 41 00:01:30,129 --> 00:01:31,329 in a variety of, 42 00:01:31,969 --> 00:01:32,869 you know, roles. 43 00:01:33,405 --> 00:01:33,884 And, 44 00:01:34,364 --> 00:01:37,584 and, actually, I think one of my passion 45 00:01:37,724 --> 00:01:38,545 really is 46 00:01:39,084 --> 00:01:40,864 how do we deliver the best, 47 00:01:41,805 --> 00:01:44,064 quality care to our Medicare beneficiaries. 48 00:01:44,924 --> 00:01:48,145 And that's really, I think, all my experience 49 00:01:48,829 --> 00:01:50,290 is kind of coming together, 50 00:01:50,909 --> 00:01:53,409 you know, in my position here at Yover. 51 00:01:54,269 --> 00:01:56,370 Thanks for sharing that info. You know, definitely 52 00:01:56,909 --> 00:01:58,750 paints a picture on why your perspective is 53 00:01:58,750 --> 00:02:00,750 unique here. And the first thing I wanted 54 00:02:00,750 --> 00:02:02,049 to ask you about is, 55 00:02:02,395 --> 00:02:04,575 you know, how are your relationships with providers 56 00:02:04,635 --> 00:02:05,135 changing 57 00:02:05,594 --> 00:02:08,474 as both sides face cost pressure and, you 58 00:02:08,474 --> 00:02:10,175 know, workforce shortages specifically? 59 00:02:10,955 --> 00:02:11,455 Yeah. 60 00:02:11,914 --> 00:02:13,995 I think that's a great question. I would 61 00:02:13,995 --> 00:02:16,094 say the short answer is that, 62 00:02:16,460 --> 00:02:18,780 you know, the rising cost pressure and workforce 63 00:02:18,780 --> 00:02:19,280 shortages, 64 00:02:19,659 --> 00:02:22,300 I they are, and they will continue to 65 00:02:22,300 --> 00:02:23,040 shift away. 66 00:02:23,419 --> 00:02:25,900 My my sense really is that, you know, 67 00:02:25,900 --> 00:02:27,900 we are gonna see a shift away from 68 00:02:27,900 --> 00:02:30,080 a simple fee for service contracting 69 00:02:30,855 --> 00:02:33,115 towards people thinking more deeply 70 00:02:33,735 --> 00:02:34,235 about, 71 00:02:34,534 --> 00:02:36,235 you know, either risk sharing 72 00:02:36,694 --> 00:02:38,235 or operational partnerships, 73 00:02:38,855 --> 00:02:41,355 whether those are kind of like joint ventures 74 00:02:41,655 --> 00:02:44,215 or value based primary care or home based 75 00:02:44,215 --> 00:02:44,875 care models. 76 00:02:45,379 --> 00:02:47,319 And for us at Clover Health, 77 00:02:47,699 --> 00:02:49,800 I think our unique and very differentiated 78 00:02:50,260 --> 00:02:50,760 model, 79 00:02:51,379 --> 00:02:54,199 which is an MA plan, but is leveraged 80 00:02:54,659 --> 00:02:56,280 with a technology platform 81 00:02:56,659 --> 00:02:59,240 and a very mature home based care model 82 00:02:59,540 --> 00:03:02,175 are the foundational strengths, you know, that are 83 00:03:02,175 --> 00:03:04,735 driving this value based relationship with our primary 84 00:03:04,735 --> 00:03:05,474 care providers 85 00:03:06,014 --> 00:03:08,435 and that support our home based care model. 86 00:03:08,814 --> 00:03:11,215 And, really, I think to my mind, you 87 00:03:11,215 --> 00:03:14,894 know, I actually would love to, even, give 88 00:03:14,894 --> 00:03:16,034 more color to this 89 00:03:16,400 --> 00:03:17,840 because first, our, 90 00:03:18,639 --> 00:03:21,060 you know, our, Clover Assistant Technology, 91 00:03:21,360 --> 00:03:23,379 right, that our platform 92 00:03:23,759 --> 00:03:25,699 really is a physician enablement, 93 00:03:27,199 --> 00:03:27,939 AI platform. 94 00:03:28,400 --> 00:03:31,120 And it kind of unifies data from more 95 00:03:31,120 --> 00:03:31,860 than 100, 96 00:03:32,215 --> 00:03:33,034 you know, sources, 97 00:03:33,334 --> 00:03:33,834 EHRs, 98 00:03:34,134 --> 00:03:34,634 HIEs, 99 00:03:35,014 --> 00:03:36,555 labs, pharmacy claims, 100 00:03:37,094 --> 00:03:38,314 and really surfaces 101 00:03:38,935 --> 00:03:39,754 very specific, 102 00:03:40,055 --> 00:03:41,034 patient specific 103 00:03:41,655 --> 00:03:44,430 guideline aligned insights at the point of care. 104 00:03:44,669 --> 00:03:46,049 So you can well imagine 105 00:03:46,349 --> 00:03:49,169 physicians, primary care physicians who are so busy 106 00:03:49,389 --> 00:03:50,289 in their offices, 107 00:03:50,829 --> 00:03:53,169 for them to get this meaningful data, 108 00:03:54,109 --> 00:03:56,849 you know, is extremely valuable, and it helps 109 00:03:56,909 --> 00:03:59,569 in this cost equation and this very resource 110 00:04:00,224 --> 00:04:00,724 scarce 111 00:04:01,985 --> 00:04:04,944 environment because how do they even know many 112 00:04:04,944 --> 00:04:06,644 a times who got admitted, 113 00:04:07,025 --> 00:04:08,004 who got discharged, 114 00:04:08,625 --> 00:04:10,004 what was the discharge diagnosis, 115 00:04:11,344 --> 00:04:13,044 which patient is at high risk, 116 00:04:13,400 --> 00:04:15,740 which patient hasn't had their screening mammogram. 117 00:04:16,360 --> 00:04:18,620 So I think that's a huge value add. 118 00:04:18,920 --> 00:04:20,759 You know, we we help them find that 119 00:04:20,759 --> 00:04:21,819 needle in the haystack 120 00:04:22,360 --> 00:04:24,120 so that they can focus on the clinical 121 00:04:24,120 --> 00:04:27,160 care. And secondly, I would say that our 122 00:04:27,160 --> 00:04:28,860 Clover home care program 123 00:04:29,714 --> 00:04:32,274 really is helping support this cost pressure and 124 00:04:32,274 --> 00:04:35,235 work shortage issue Mhmm. Because we, you know, 125 00:04:35,235 --> 00:04:37,974 we have a we have an MD, NP, 126 00:04:38,754 --> 00:04:41,974 led longitudinal care, which is delivered at home 127 00:04:42,194 --> 00:04:43,654 at no cost to the patient. 128 00:04:44,009 --> 00:04:46,410 It's really tailored to the medical and social 129 00:04:46,410 --> 00:04:47,550 needs of our members 130 00:04:48,009 --> 00:04:50,810 and supports them across their health care journey, 131 00:04:50,810 --> 00:04:52,909 meaning from an acute crisis 132 00:04:53,529 --> 00:04:55,229 to a chronic disease management, 133 00:04:56,384 --> 00:04:59,125 trans you know, from palliative care at home 134 00:04:59,425 --> 00:05:01,285 to transitioning them to hospice. 135 00:05:01,665 --> 00:05:02,165 So 136 00:05:02,625 --> 00:05:04,084 imagine that the synergistic 137 00:05:04,384 --> 00:05:07,125 model that we have, that primary care, 138 00:05:07,584 --> 00:05:08,884 you know, in the office 139 00:05:09,439 --> 00:05:09,939 supported 140 00:05:10,399 --> 00:05:11,279 by, you know, 141 00:05:12,879 --> 00:05:15,839 supported by, like, care at home for the 142 00:05:15,839 --> 00:05:18,240 elderly, for the frail, for the ones who 143 00:05:18,240 --> 00:05:18,899 are, like, 144 00:05:19,519 --> 00:05:22,339 with advanced illness, limited life expectancy. 145 00:05:23,224 --> 00:05:25,865 I mean, that really is a model that 146 00:05:25,865 --> 00:05:26,365 combines, 147 00:05:27,305 --> 00:05:29,384 you know, the best of both worlds so 148 00:05:29,384 --> 00:05:31,224 that we can make a huge difference in 149 00:05:31,224 --> 00:05:32,284 our patient population. 150 00:05:33,464 --> 00:05:34,664 You know, I've I've spoken with a lot 151 00:05:34,664 --> 00:05:36,425 of people on the payer side recently, and 152 00:05:36,425 --> 00:05:37,485 they're kinda categorizing 153 00:05:38,399 --> 00:05:40,480 that, you know, the the payer provider relationship 154 00:05:40,480 --> 00:05:41,540 now is a lot 155 00:05:42,240 --> 00:05:44,199 less transactional than it used to be. It's 156 00:05:44,199 --> 00:05:45,920 a lot more kinda coming from an area 157 00:05:45,920 --> 00:05:48,240 of of problem solving with you just you 158 00:05:48,240 --> 00:05:49,600 know, some of the pressures we you just 159 00:05:49,600 --> 00:05:51,199 talked about that Yeah. Kind of both sides 160 00:05:51,199 --> 00:05:52,800 are facing. Is is that what you're seeing, 161 00:05:52,800 --> 00:05:55,215 doctor Chabi? Is kind of Yes. Everyone's getting 162 00:05:55,215 --> 00:05:57,535 together to problem solve more now? I think 163 00:05:57,535 --> 00:05:59,694 so. I think I I I totally agree 164 00:05:59,694 --> 00:06:01,395 with you. I think we see that. 165 00:06:01,775 --> 00:06:03,715 You know, we need to problem solve together. 166 00:06:03,775 --> 00:06:06,254 I think people realize that we have built 167 00:06:06,254 --> 00:06:07,235 lots of silos. 168 00:06:07,615 --> 00:06:09,715 Right? And, you know, 169 00:06:10,550 --> 00:06:12,389 each one does their own thing within their 170 00:06:12,389 --> 00:06:13,209 own silos, 171 00:06:13,910 --> 00:06:15,990 and we are not able to do this 172 00:06:15,990 --> 00:06:16,490 horizontal 173 00:06:16,790 --> 00:06:17,290 connectivity, 174 00:06:18,709 --> 00:06:20,790 as we really would like to do and 175 00:06:20,790 --> 00:06:23,050 kind of reduce this fragmentation of care. 176 00:06:23,995 --> 00:06:25,555 And, you know, so people are vying for 177 00:06:25,555 --> 00:06:26,495 the same resources. 178 00:06:26,875 --> 00:06:29,274 Right? And they're trying to solve the same 179 00:06:29,274 --> 00:06:31,354 problems. So why don't we get, you know, 180 00:06:31,354 --> 00:06:33,055 kind of combine our efforts, 181 00:06:33,754 --> 00:06:35,375 for problem solving that? 182 00:06:36,129 --> 00:06:36,629 Absolutely. 183 00:06:37,089 --> 00:06:38,529 And the other thing I wanna ask you, 184 00:06:38,529 --> 00:06:40,290 where do you see the biggest gap today 185 00:06:40,290 --> 00:06:41,589 between payer strategy 186 00:06:42,050 --> 00:06:43,350 and operational execution? 187 00:06:44,770 --> 00:06:47,330 I, you know, I think I think plans 188 00:06:47,330 --> 00:06:50,050 realize. Right? I think plans know that they 189 00:06:50,050 --> 00:06:51,270 must manage utilization, 190 00:06:52,925 --> 00:06:53,425 because 191 00:06:53,964 --> 00:06:54,845 I what 192 00:06:55,245 --> 00:06:58,605 and they cannot consistently intervene. Right? Early, in 193 00:06:58,605 --> 00:07:00,464 person, and with clinical authority. 194 00:07:00,845 --> 00:07:03,485 So what I'm seeing is that there is 195 00:07:03,485 --> 00:07:03,985 this, 196 00:07:04,490 --> 00:07:06,490 you know, that even though that most MA 197 00:07:06,490 --> 00:07:08,810 plans, I would say, usually will have very 198 00:07:08,810 --> 00:07:10,910 similar strategies, right, on paper. 199 00:07:11,290 --> 00:07:14,430 But where peep where plans can fail 200 00:07:15,050 --> 00:07:17,709 is when you do not translate those strategies 201 00:07:17,930 --> 00:07:19,870 into kind of reliable, repeatable 202 00:07:20,224 --> 00:07:20,724 execution, 203 00:07:21,664 --> 00:07:23,425 so that you can kind of deliver the 204 00:07:23,425 --> 00:07:25,104 right care to the right member at the 205 00:07:25,104 --> 00:07:27,345 right time. So let's kind of, like you 206 00:07:27,345 --> 00:07:28,625 know, I was thinking that, 207 00:07:29,024 --> 00:07:31,264 like, when we think about this, you know, 208 00:07:31,264 --> 00:07:33,204 what are some of kind of, like, illustrative 209 00:07:33,504 --> 00:07:34,004 examples? 210 00:07:34,740 --> 00:07:37,540 So let's just say that, you know, on 211 00:07:37,540 --> 00:07:39,160 on paper, a strategy 212 00:07:39,699 --> 00:07:41,779 may very well be that, right, we need 213 00:07:41,779 --> 00:07:42,759 to manage utilization. 214 00:07:43,860 --> 00:07:44,360 But 215 00:07:44,660 --> 00:07:47,139 how do we reduce these avoidable admissions or 216 00:07:47,139 --> 00:07:49,620 readmissions through a value based care or a 217 00:07:49,620 --> 00:07:50,360 home based 218 00:07:50,795 --> 00:07:52,254 services and better coordination. 219 00:07:52,955 --> 00:07:53,455 Because 220 00:07:53,915 --> 00:07:56,254 we find that even though that's the idea, 221 00:07:56,314 --> 00:07:57,375 but in the execution, 222 00:07:58,714 --> 00:08:00,334 the reality is that 223 00:08:00,875 --> 00:08:03,660 we sometimes, the MA plan, don't even know, 224 00:08:04,220 --> 00:08:06,879 you know, who those high risk members are. 225 00:08:06,939 --> 00:08:09,899 And even if you identify them, then you 226 00:08:09,899 --> 00:08:12,620 actually are identifying the event after it has 227 00:08:12,620 --> 00:08:15,259 actually already happened. And then when you do 228 00:08:15,259 --> 00:08:16,160 oppose discharge 229 00:08:16,625 --> 00:08:19,205 kind of an outreach, it can be delayed. 230 00:08:19,504 --> 00:08:20,884 And, really, it's telephonic. 231 00:08:21,425 --> 00:08:23,745 Majority of the time, that's really what happens. 232 00:08:23,745 --> 00:08:25,605 Right? And it's nonclinical. 233 00:08:26,064 --> 00:08:27,824 Or if it is clinical, then it's a 234 00:08:27,824 --> 00:08:29,745 kind of a low authority. It's an RN 235 00:08:29,745 --> 00:08:32,404 based care management based phone calls, 236 00:08:33,049 --> 00:08:35,629 who really don't have any prescribing power. 237 00:08:36,330 --> 00:08:38,570 So I feel that the interventions then become 238 00:08:38,570 --> 00:08:40,730 too late. They are too weak. And the 239 00:08:40,730 --> 00:08:43,789 execution gap really becomes, I think, this decisive 240 00:08:43,929 --> 00:08:46,409 clinical action, which I think is just so 241 00:08:46,409 --> 00:08:46,909 important. 242 00:08:47,355 --> 00:08:48,975 Because if we don't control 243 00:08:49,434 --> 00:08:52,495 the clinical capacity and how that clinical capacity 244 00:08:52,634 --> 00:08:53,695 actually acts, 245 00:08:54,394 --> 00:08:57,034 that is really the gap which I see 246 00:08:57,034 --> 00:08:59,534 because you really can't phone coach your way 247 00:08:59,754 --> 00:09:02,174 out of, you know, like, this acute instability. 248 00:09:05,089 --> 00:09:07,829 And having joint you know, like, having delegation, 249 00:09:08,449 --> 00:09:09,990 working with vendors sometimes, 250 00:09:10,370 --> 00:09:13,029 having value based contracts don't necessarily 251 00:09:13,409 --> 00:09:14,470 guarantee execution. 252 00:09:15,105 --> 00:09:16,784 So I think that's where the gap could 253 00:09:16,784 --> 00:09:17,845 be because 254 00:09:18,225 --> 00:09:20,644 everyone's busy. Health systems are inpatient 255 00:09:21,345 --> 00:09:21,845 centric. 256 00:09:22,144 --> 00:09:23,445 PCPs are overloaded. 257 00:09:24,225 --> 00:09:25,825 You know, and there's home you know, and 258 00:09:25,825 --> 00:09:27,924 home health has its own capacity constraints. 259 00:09:28,384 --> 00:09:30,839 So I it all becomes like, you know, 260 00:09:30,839 --> 00:09:33,159 what we think about the strategy as home 261 00:09:33,159 --> 00:09:36,200 based care, for example, but the operation actually 262 00:09:36,200 --> 00:09:38,679 becomes just a telephonic care. And we have 263 00:09:38,679 --> 00:09:40,039 to kind of, like I think that be 264 00:09:40,200 --> 00:09:41,740 that is kind of, like, the biggest, 265 00:09:42,919 --> 00:09:44,539 observations that I've had. 266 00:09:45,044 --> 00:09:46,904 And that is why I feel that 267 00:09:47,524 --> 00:09:50,085 even having data, you can have risk models, 268 00:09:50,085 --> 00:09:52,245 you can have predictive analytics, you can have 269 00:09:52,245 --> 00:09:52,745 dashboards. 270 00:09:53,445 --> 00:09:56,404 But if those insights don't actually reach your 271 00:09:56,404 --> 00:09:57,625 frontline clinicians, 272 00:09:58,799 --> 00:10:00,740 those alerts are really not actionable. 273 00:10:01,440 --> 00:10:03,220 And they have to be in real time. 274 00:10:04,080 --> 00:10:07,519 So, otherwise, analytics without this activation is just 275 00:10:07,519 --> 00:10:10,159 kind of reporting. So what we do differently 276 00:10:10,159 --> 00:10:12,820 at Clover, honestly, is we have our own 277 00:10:12,960 --> 00:10:14,100 clinical teams, 278 00:10:15,495 --> 00:10:19,014 and we act on within few days on 279 00:10:19,014 --> 00:10:20,554 our ADT feed notifications. 280 00:10:21,414 --> 00:10:24,475 And we really have, you know, clinicians 281 00:10:25,174 --> 00:10:28,134 who are prescribing clinicians at the center of 282 00:10:28,134 --> 00:10:28,954 these transitions, 283 00:10:29,879 --> 00:10:32,120 so that we don't merely treat these post 284 00:10:32,120 --> 00:10:33,019 discharge events, 285 00:10:33,559 --> 00:10:35,960 you know, as care management task, but we 286 00:10:35,960 --> 00:10:36,620 are actually 287 00:10:38,279 --> 00:10:39,660 treating these post discharge, 288 00:10:40,680 --> 00:10:43,399 you know, events as medical events. And then 289 00:10:43,399 --> 00:10:44,379 our CA technology 290 00:10:45,245 --> 00:10:48,684 really helps to surface those actionable information at 291 00:10:48,684 --> 00:10:51,004 the point of care, which I think is 292 00:10:51,004 --> 00:10:53,345 really, really, really important. Because 293 00:10:53,804 --> 00:10:55,664 as you know, in the MA world, 294 00:10:56,044 --> 00:10:57,024 you know, you can't 295 00:10:57,750 --> 00:11:01,049 reprice midyear. You can't negotiate your way out. 296 00:11:01,830 --> 00:11:04,090 I think coding has its own drawbacks. 297 00:11:05,190 --> 00:11:06,809 So you have to change utilization. 298 00:11:07,429 --> 00:11:10,009 So you say that we wanna manage utilization, 299 00:11:10,845 --> 00:11:13,164 but do we truly have the wherewithal, or 300 00:11:13,164 --> 00:11:15,105 do we have really the operational, you know, 301 00:11:17,004 --> 00:11:18,225 I think the operational, 302 00:11:19,884 --> 00:11:21,985 insights or the operational execution 303 00:11:22,924 --> 00:11:25,345 in a way that it really matters? Because 304 00:11:25,649 --> 00:11:28,690 utilization will only change when someone shows up 305 00:11:28,690 --> 00:11:30,549 early and fixes the problem. 306 00:11:31,889 --> 00:11:34,370 What's one investment or initiative you believe will 307 00:11:34,370 --> 00:11:36,690 most reshape how health plans operate over the 308 00:11:36,690 --> 00:11:38,069 next two to three years? 309 00:11:39,585 --> 00:11:41,445 So, Scott, I think in my view, 310 00:11:42,304 --> 00:11:43,125 MA winners, 311 00:11:45,105 --> 00:11:47,125 over the next three years will invest 312 00:11:47,904 --> 00:11:49,424 kind of, like, I think in maybe in 313 00:11:49,424 --> 00:11:52,160 fewer bets, but execute it deeply because we 314 00:11:52,160 --> 00:11:54,240 just talked about it. Right? What's the difference 315 00:11:54,240 --> 00:11:55,860 between strategy and operations? 316 00:11:56,399 --> 00:11:58,660 And so you have to execute deeply. 317 00:11:59,120 --> 00:12:01,220 And while the traditional thought process, 318 00:12:02,320 --> 00:12:04,019 centers around making choices 319 00:12:04,924 --> 00:12:07,004 or selecting from an array of goals that 320 00:12:07,004 --> 00:12:09,184 are always important, growth, profitability, 321 00:12:10,125 --> 00:12:11,105 member experience, 322 00:12:11,485 --> 00:12:11,985 retention, 323 00:12:12,684 --> 00:12:14,784 or kind of like the heaters and stars, 324 00:12:14,924 --> 00:12:15,584 you know, 325 00:12:16,524 --> 00:12:18,049 or managing cost via 326 00:12:19,149 --> 00:12:20,610 I think these are just traditional 327 00:12:21,230 --> 00:12:21,730 foundational 328 00:12:22,110 --> 00:12:22,610 principles. 329 00:12:23,950 --> 00:12:27,809 However, I feel that if MA plans 330 00:12:28,509 --> 00:12:31,570 can bet on executing a care delivery model 331 00:12:32,195 --> 00:12:34,215 that leverages data and technology, 332 00:12:35,154 --> 00:12:37,654 care that is anchored in primary care, 333 00:12:38,115 --> 00:12:40,514 care that is rooted in a mastery of 334 00:12:40,514 --> 00:12:41,815 chronic disease management, 335 00:12:42,434 --> 00:12:44,695 and care that is delivered at home. 336 00:12:45,250 --> 00:12:47,250 Because if we do that well and we 337 00:12:47,250 --> 00:12:50,309 execute that well, I believe that's where quality, 338 00:12:50,690 --> 00:12:53,269 cost, and member trust intersect. 339 00:12:54,050 --> 00:12:56,370 So I I think if we can bet 340 00:12:56,370 --> 00:12:58,950 on that, and it all comes to, 341 00:12:59,315 --> 00:13:02,115 do we have a care delivery model that 342 00:13:02,115 --> 00:13:03,254 meets those needs? 343 00:13:03,875 --> 00:13:05,174 That's really how 344 00:13:05,714 --> 00:13:08,274 powerful it can be to reshape and build 345 00:13:08,274 --> 00:13:10,835 upon, you know, the traditional health plan models 346 00:13:10,835 --> 00:13:12,914 because we know the population is aging. Right? 347 00:13:12,914 --> 00:13:15,269 It's aging fast. We have, like, more than 348 00:13:15,269 --> 00:13:17,429 fifteen percent of people above the age of 349 00:13:17,429 --> 00:13:18,250 85. 350 00:13:18,710 --> 00:13:20,730 There's a huge chronic disease burden. 351 00:13:21,190 --> 00:13:24,250 We also know that chronic disease and multimorbidity 352 00:13:24,710 --> 00:13:26,169 is a primary driver 353 00:13:26,470 --> 00:13:27,210 of Medicare 354 00:13:27,750 --> 00:13:28,250 utilization. 355 00:13:29,455 --> 00:13:31,054 We know that if we don't manage it 356 00:13:31,054 --> 00:13:33,634 well, if we don't manage chronic disease well, 357 00:13:33,855 --> 00:13:37,154 it's directly linked to frequent ER visits, 358 00:13:37,455 --> 00:13:39,075 preventable hospital admissions, 359 00:13:40,095 --> 00:13:42,575 higher readmission rates, and just a very poor 360 00:13:42,575 --> 00:13:43,475 patient experience. 361 00:13:43,940 --> 00:13:47,320 I have seen the cycle of inpatient, outpatient, 362 00:13:48,179 --> 00:13:49,159 you know, very 363 00:13:49,539 --> 00:13:50,039 closely, 364 00:13:50,899 --> 00:13:52,360 and I've always been 365 00:13:52,740 --> 00:13:54,980 looking to see how can I impact and 366 00:13:54,980 --> 00:13:55,959 make that better, 367 00:13:56,740 --> 00:13:57,240 because 368 00:13:58,004 --> 00:13:58,985 I you know, 369 00:14:00,085 --> 00:14:02,004 this is this kind of, I think, is 370 00:14:02,004 --> 00:14:04,725 that if if if the MA plans can 371 00:14:04,725 --> 00:14:06,504 invest in this effective 372 00:14:06,965 --> 00:14:09,764 care delivery system, I think we'll all reap 373 00:14:09,764 --> 00:14:11,865 the benefits of managing the utilization 374 00:14:12,245 --> 00:14:13,304 and actually, 375 00:14:13,950 --> 00:14:16,670 member trust in us? Because the more trust 376 00:14:16,670 --> 00:14:19,330 we have, if it's a trust driven relationship, 377 00:14:20,350 --> 00:14:21,090 you know, 378 00:14:21,629 --> 00:14:23,809 it it it really makes a difference. 379 00:14:24,110 --> 00:14:26,029 If yeah. You know, I'm happy to actually 380 00:14:26,029 --> 00:14:28,154 share a little, you know, a story to 381 00:14:28,154 --> 00:14:30,795 illustrate what I'm talking about because I was 382 00:14:30,795 --> 00:14:33,195 recently accompanying our clinical team during a home 383 00:14:33,195 --> 00:14:33,695 visit. 384 00:14:34,154 --> 00:14:36,495 And prior to the actual visit, our clinicians 385 00:14:36,634 --> 00:14:39,615 had visibility into this meaningful information 386 00:14:39,915 --> 00:14:42,649 about our patient. So our technology platform had 387 00:14:42,649 --> 00:14:45,529 surfaced, what her existing conditions were, that they 388 00:14:45,690 --> 00:14:47,769 you know, the patient was discharged recently from 389 00:14:47,769 --> 00:14:49,870 the hospital after a surgical procedure. 390 00:14:50,490 --> 00:14:52,750 The patient had some, a colon surgery, 391 00:14:53,610 --> 00:14:55,769 and really had a colostomy, which is, like, 392 00:14:55,769 --> 00:14:57,845 let's just say, you know, it creates a 393 00:14:57,845 --> 00:14:59,784 stoma and an opening in the abdomen, 394 00:15:00,325 --> 00:15:02,565 which is connecting the intestine from the inside 395 00:15:02,565 --> 00:15:03,384 to the outside. 396 00:15:03,924 --> 00:15:05,924 And she was not a happy camper at 397 00:15:05,924 --> 00:15:06,424 all. 398 00:15:06,964 --> 00:15:08,745 You know, this person was, 399 00:15:09,259 --> 00:15:10,660 you know, when we reached in you know, 400 00:15:10,660 --> 00:15:12,259 when we were in the home, we found 401 00:15:12,259 --> 00:15:14,360 her despondent. We found her overwhelmed, 402 00:15:15,059 --> 00:15:17,299 unable to walk, not taking care of her 403 00:15:17,299 --> 00:15:17,799 colostomy, 404 00:15:18,820 --> 00:15:21,299 for her surgical instructions, not picking up the 405 00:15:21,299 --> 00:15:23,620 phone from her doctor's office, not taking her 406 00:15:23,620 --> 00:15:24,120 medications. 407 00:15:24,740 --> 00:15:26,394 And and the family was just urging her 408 00:15:26,394 --> 00:15:27,934 to go back to the emergency room. 409 00:15:28,394 --> 00:15:30,154 And this team, you know, like our home 410 00:15:30,154 --> 00:15:32,554 care team, they assessed and they managed all 411 00:15:32,554 --> 00:15:33,774 those medical concerns, 412 00:15:34,235 --> 00:15:36,815 whether it was a colostomy bag, provided education, 413 00:15:37,034 --> 00:15:39,779 or the DM me, connected to her to 414 00:15:39,779 --> 00:15:42,500 our behavioral health team, called the primary care 415 00:15:42,500 --> 00:15:44,820 physician, who, by the way, was not even 416 00:15:44,820 --> 00:15:47,080 aware that the patient had surgery, 417 00:15:47,460 --> 00:15:50,040 called the surgeon's office, arranged transportation, 418 00:15:50,980 --> 00:15:53,325 called the daughter. So you can just, you 419 00:15:53,325 --> 00:15:54,625 know, if you just sense 420 00:15:55,245 --> 00:15:57,325 all the things that are happening when you're 421 00:15:57,325 --> 00:15:59,884 actually in the member's home and you are 422 00:15:59,884 --> 00:16:02,764 problem solving and you are actually resolving those 423 00:16:02,764 --> 00:16:03,264 issues, 424 00:16:03,725 --> 00:16:05,940 this cannot be done if you don't have, 425 00:16:06,500 --> 00:16:09,480 you know, a clinical team exercising 426 00:16:09,779 --> 00:16:11,480 not only good clinical judgment, 427 00:16:11,860 --> 00:16:14,360 but actually executing on the clinical care. 428 00:16:15,220 --> 00:16:17,559 While these are everyday stories, by the way, 429 00:16:17,620 --> 00:16:20,600 let's not forget that these are powerful examples 430 00:16:20,774 --> 00:16:22,555 of the right care at the right time 431 00:16:23,014 --> 00:16:25,434 because they do contribute to good outcomes. 432 00:16:25,894 --> 00:16:27,915 And, really, my thesis is that, 433 00:16:28,455 --> 00:16:30,535 you know, our kind of, like, our CLOVER 434 00:16:30,535 --> 00:16:31,035 advantage 435 00:16:31,495 --> 00:16:33,835 is that it's PCP centric care. 436 00:16:34,455 --> 00:16:36,315 And that's why, you know, we are supporting 437 00:16:36,959 --> 00:16:39,059 how to identify, how to manage. 438 00:16:39,439 --> 00:16:41,919 And this this kind of strategy that we 439 00:16:41,919 --> 00:16:44,019 were talking about, like bridge the silos 440 00:16:44,559 --> 00:16:47,059 between the providers, patients, and the systems 441 00:16:47,600 --> 00:16:48,339 is probably 442 00:16:48,799 --> 00:16:50,879 is probably key. So I think that any 443 00:16:50,879 --> 00:16:51,379 plans 444 00:16:51,845 --> 00:16:53,785 that will, you know, kind of, 445 00:16:54,404 --> 00:16:55,384 plans that will 446 00:16:55,924 --> 00:16:56,424 invest 447 00:16:57,045 --> 00:16:59,144 in an effective care delivery system 448 00:16:59,684 --> 00:17:01,465 will surely reap the benefits, 449 00:17:02,165 --> 00:17:03,764 you know, in the years to come for 450 00:17:03,764 --> 00:17:04,904 managing their population. 451 00:17:06,130 --> 00:17:07,809 I appreciate you sharing that story. That's such 452 00:17:07,809 --> 00:17:09,730 a good example of of your team just, 453 00:17:09,730 --> 00:17:11,730 you know, willing to go above and beyond, 454 00:17:11,970 --> 00:17:13,329 for a member. I I think that says 455 00:17:13,329 --> 00:17:16,369 a lot about about, Clover's operations and what 456 00:17:16,369 --> 00:17:17,970 they're willing to do for members. So thank 457 00:17:17,970 --> 00:17:19,589 you for sharing that. And 458 00:17:19,934 --> 00:17:22,095 the next question I have for you, doctor 459 00:17:22,095 --> 00:17:22,595 Shabi, 460 00:17:23,055 --> 00:17:25,535 is if you could change one regulatory or 461 00:17:25,535 --> 00:17:28,674 industry practice tomorrow to improve affordability and access, 462 00:17:29,055 --> 00:17:30,355 what would it be and why? 463 00:17:31,455 --> 00:17:33,509 Yeah. I think there are lots. But, like, 464 00:17:33,509 --> 00:17:35,430 maybe the one thing that I think, Scott, 465 00:17:35,430 --> 00:17:37,830 I feel that is really important. I think 466 00:17:37,830 --> 00:17:39,450 if the industry and CMS, 467 00:17:40,789 --> 00:17:42,710 even though that we have made progress, let's 468 00:17:42,710 --> 00:17:44,950 just say, if if we can make the 469 00:17:44,950 --> 00:17:46,809 ability to exchange data, 470 00:17:47,835 --> 00:17:49,654 you know, via via the FHIR, 471 00:17:50,595 --> 00:17:51,815 and based APIs 472 00:17:52,515 --> 00:17:55,154 among providers and peers, like, really make it 473 00:17:55,154 --> 00:17:56,214 a ground reality, 474 00:17:57,634 --> 00:17:59,875 you know, it'll be a huge opportunity to 475 00:17:59,875 --> 00:18:01,559 improve care and cut cost. 476 00:18:02,600 --> 00:18:04,059 You know, while there is progress, 477 00:18:04,519 --> 00:18:06,940 I still don't think that we, 478 00:18:07,559 --> 00:18:08,220 you know, 479 00:18:08,759 --> 00:18:10,620 we are where we need to be because 480 00:18:11,720 --> 00:18:13,240 I I think day to day, we don't 481 00:18:13,240 --> 00:18:13,740 realize 482 00:18:14,200 --> 00:18:15,500 how this interoperability 483 00:18:16,804 --> 00:18:18,984 allows us to bring the most sophisticated 484 00:18:19,444 --> 00:18:20,265 care coordination, 485 00:18:21,444 --> 00:18:24,404 to any provider, right, anywhere. And even if 486 00:18:24,404 --> 00:18:26,345 that provider is not part of an integrated 487 00:18:26,404 --> 00:18:27,144 health system. 488 00:18:27,845 --> 00:18:29,845 So I think if we could just, you 489 00:18:29,845 --> 00:18:32,929 know, get health care industry and CMS to 490 00:18:32,929 --> 00:18:33,750 support that, 491 00:18:34,289 --> 00:18:36,950 because smaller plans and independent clinicians, 492 00:18:37,490 --> 00:18:39,509 you know, they cannot compete if vertically 493 00:18:39,809 --> 00:18:40,309 integrated, 494 00:18:41,329 --> 00:18:41,990 you know, 495 00:18:42,690 --> 00:18:44,690 with their I mean, they cannot compete with 496 00:18:44,690 --> 00:18:46,255 this vertical integration, 497 00:18:46,875 --> 00:18:47,375 programs, 498 00:18:48,075 --> 00:18:50,095 because they have proprietary data advantages. 499 00:18:50,474 --> 00:18:52,554 And I think all the examples that I 500 00:18:52,554 --> 00:18:53,934 gave you, like, 501 00:18:54,634 --> 00:18:57,515 to just know what is happening with our 502 00:18:57,515 --> 00:19:00,250 members, when, where, so that we can intervene 503 00:19:00,470 --> 00:19:03,029 at the right time is just critical to, 504 00:19:03,429 --> 00:19:05,990 you know, providing the best care. So I 505 00:19:05,990 --> 00:19:08,649 I think that, to my mind, is really 506 00:19:08,789 --> 00:19:10,950 very important. And, of course, you know, like, 507 00:19:10,950 --> 00:19:12,569 can we revise our, 508 00:19:13,144 --> 00:19:15,644 you know, STAR measures to be more meaningful? 509 00:19:15,865 --> 00:19:18,284 You know? I think that's another opportunity. 510 00:19:18,825 --> 00:19:20,825 I mean, if you look at medication adherence 511 00:19:20,825 --> 00:19:23,085 measure, which I've been delving very deeply, 512 00:19:23,865 --> 00:19:26,424 have been involved very deeply in managing some 513 00:19:26,424 --> 00:19:27,404 of those measures, 514 00:19:28,100 --> 00:19:29,559 and understanding them. 515 00:19:30,019 --> 00:19:31,480 You know, there's so much duplication. 516 00:19:31,779 --> 00:19:33,539 There is there's so much at odds with 517 00:19:33,539 --> 00:19:35,880 each other, although they are well intended. 518 00:19:36,820 --> 00:19:40,100 But I I don't think that we actually 519 00:19:40,100 --> 00:19:41,720 measure actual adherence. 520 00:19:42,554 --> 00:19:44,575 Maybe we are just measuring dispensing. 521 00:19:45,434 --> 00:19:46,575 Having said that, 522 00:19:47,194 --> 00:19:49,534 I think claims data analysis 523 00:19:49,994 --> 00:19:50,734 is never, 524 00:19:51,595 --> 00:19:53,294 you know, the best, 525 00:19:53,914 --> 00:19:55,454 way forward to understand 526 00:19:55,755 --> 00:19:56,255 why 527 00:19:56,710 --> 00:19:58,549 why people are being treated the way they 528 00:19:58,549 --> 00:20:00,230 are being treated and why they are not 529 00:20:00,230 --> 00:20:02,230 being treated with certain drugs if they are 530 00:20:02,230 --> 00:20:04,150 not being treated. So, I I mean, I 531 00:20:04,150 --> 00:20:06,170 think there's always room to improve, 532 00:20:06,710 --> 00:20:08,330 you know, how you know, measurements. 533 00:20:08,710 --> 00:20:09,190 But, 534 00:20:09,955 --> 00:20:12,515 I would think that the most important thing 535 00:20:12,515 --> 00:20:13,734 to my mind is 536 00:20:14,355 --> 00:20:15,255 shared data. 537 00:20:15,955 --> 00:20:18,055 Share the data in a visible way 538 00:20:18,434 --> 00:20:21,955 because it would impact so much in terms 539 00:20:21,955 --> 00:20:24,390 of access, in terms of cost, and in 540 00:20:24,390 --> 00:20:25,930 terms of driving quality. 541 00:20:26,869 --> 00:20:28,309 And the last question I have for you, 542 00:20:28,309 --> 00:20:29,210 doctor Chawbi, 543 00:20:29,670 --> 00:20:31,930 what issue is putting the most pressure 544 00:20:32,309 --> 00:20:34,330 on health plan margins right now, 545 00:20:34,710 --> 00:20:36,950 and how are you responding differently in in 546 00:20:36,950 --> 00:20:38,090 2026? 547 00:20:39,315 --> 00:20:42,035 Well, I I think everyone is probably, you 548 00:20:42,035 --> 00:20:45,255 know, facing rising medical cost, right, including including 549 00:20:45,394 --> 00:20:46,775 prescription drug cost. 550 00:20:47,474 --> 00:20:49,394 And, of course, for every, I I think, 551 00:20:49,394 --> 00:20:51,714 for every plan that kind of predicts and, 552 00:20:51,714 --> 00:20:52,375 you know, 553 00:20:53,250 --> 00:20:53,750 plans 554 00:20:54,289 --> 00:20:56,390 for growth and managing cost, 555 00:20:56,930 --> 00:20:57,650 I don't know whether, 556 00:20:59,410 --> 00:21:00,150 does utilization 557 00:21:00,609 --> 00:21:02,390 outpace the premium growth, 558 00:21:03,089 --> 00:21:05,750 and then the headwinds for all payers, 559 00:21:06,369 --> 00:21:07,684 which, you know, 560 00:21:07,984 --> 00:21:10,644 some are known and some are potentially unknown. 561 00:21:11,105 --> 00:21:14,144 But, you know, I do think prescription drug 562 00:21:14,144 --> 00:21:14,644 cost, 563 00:21:15,505 --> 00:21:16,244 are playing, 564 00:21:17,105 --> 00:21:19,284 they're a major structural pressure point. 565 00:21:20,144 --> 00:21:21,444 You know, we know that 566 00:21:21,779 --> 00:21:24,019 the Inflation Reduction Act, I think it has 567 00:21:24,019 --> 00:21:25,240 put, more, 568 00:21:25,700 --> 00:21:26,200 responsibility. 569 00:21:26,900 --> 00:21:29,059 So plans need to bear a much larger 570 00:21:29,059 --> 00:21:30,820 share of the drug cost. And I think 571 00:21:30,820 --> 00:21:34,279 the other thing is as we innovate, as, 572 00:21:34,500 --> 00:21:36,039 you know, science and technology, 573 00:21:37,355 --> 00:21:38,095 you know, 574 00:21:38,795 --> 00:21:40,095 give us more options. 575 00:21:40,955 --> 00:21:42,734 The high cost specialty drugs, 576 00:21:43,195 --> 00:21:46,154 you know, oncology, obesity, or the GLP ones 577 00:21:46,154 --> 00:21:47,934 are, you know, growing rapidly 578 00:21:48,634 --> 00:21:49,695 and can 579 00:21:50,315 --> 00:21:52,414 influence the increase in spend per member. 580 00:21:53,650 --> 00:21:55,650 But at the same time, that is why 581 00:21:55,650 --> 00:21:56,630 I think that, 582 00:21:57,089 --> 00:22:00,230 you know, it's really important that we have 583 00:22:01,009 --> 00:22:02,869 a better relationship with our providers. 584 00:22:03,410 --> 00:22:05,109 We think about cost management 585 00:22:05,794 --> 00:22:06,294 outside 586 00:22:06,835 --> 00:22:07,815 just, you know, 587 00:22:08,674 --> 00:22:09,174 standard 588 00:22:09,714 --> 00:22:12,615 rate negotiations because we have to focus on, 589 00:22:12,674 --> 00:22:14,375 are we delivering the right care? 590 00:22:15,394 --> 00:22:17,394 And, yes, you have to have good data 591 00:22:17,394 --> 00:22:19,559 and analytics. You know, you have to invest, 592 00:22:20,039 --> 00:22:21,960 so that you can identify who are the 593 00:22:21,960 --> 00:22:24,519 high drivers of the utilization and really tailor 594 00:22:24,519 --> 00:22:25,180 the interventions 595 00:22:25,799 --> 00:22:26,860 according to that. 596 00:22:27,640 --> 00:22:28,620 So while, 597 00:22:29,080 --> 00:22:31,820 many plans are tightening their portfolios, 598 00:22:32,585 --> 00:22:34,984 you know, to focus on more profitable markets 599 00:22:34,984 --> 00:22:35,724 and population, 600 00:22:36,585 --> 00:22:38,744 given these constraints that we are just talking 601 00:22:38,744 --> 00:22:39,724 about, utilization, 602 00:22:41,065 --> 00:22:42,285 you know, and revenue, 603 00:22:42,984 --> 00:22:43,964 we at Clover 604 00:22:44,424 --> 00:22:48,125 are taking a strategic approach of measured growth, 605 00:22:48,799 --> 00:22:50,960 because we have a strong conviction in our 606 00:22:50,960 --> 00:22:51,859 model of care. 607 00:22:52,480 --> 00:22:54,319 We've seen about 53% 608 00:22:54,319 --> 00:22:55,299 growth this year, 609 00:22:55,920 --> 00:22:58,319 but we also have had 95 610 00:22:58,319 --> 00:22:58,819 retention. 611 00:23:00,000 --> 00:23:03,444 We've had favorable, you know, impact of our 612 00:23:03,664 --> 00:23:04,404 four stars. 613 00:23:05,105 --> 00:23:07,105 And we also see a very strong and 614 00:23:07,105 --> 00:23:08,644 improved cohort economics, 615 00:23:09,265 --> 00:23:09,924 to say. 616 00:23:10,704 --> 00:23:12,005 So I think that 617 00:23:12,625 --> 00:23:14,909 and the reason we see that is because 618 00:23:14,909 --> 00:23:17,549 we have this differentiated layering of our Clover 619 00:23:17,549 --> 00:23:18,450 Assistant technology 620 00:23:19,149 --> 00:23:21,789 and the clinical services that are in house. 621 00:23:21,789 --> 00:23:23,889 Right? It you know, it's our teams 622 00:23:24,429 --> 00:23:25,250 who manage. 623 00:23:25,710 --> 00:23:28,829 So while our Clover Assistant technology is an 624 00:23:28,829 --> 00:23:30,049 AI leader in MA, 625 00:23:30,644 --> 00:23:33,045 it supports the physicians in improved, you know, 626 00:23:33,045 --> 00:23:34,904 better quality care. We see outcomes 627 00:23:35,285 --> 00:23:37,865 for we see better outcomes. If our physicians 628 00:23:37,924 --> 00:23:39,865 use our Clover Assistant technology, 629 00:23:40,164 --> 00:23:43,365 we see better outcomes for diabetes, chronic kidney 630 00:23:43,365 --> 00:23:43,865 disease, 631 00:23:44,329 --> 00:23:46,089 for example. So I think that's a great 632 00:23:46,089 --> 00:23:46,589 differential. 633 00:23:46,970 --> 00:23:48,329 And then we have a very strong and 634 00:23:48,329 --> 00:23:51,470 mature home based MDNP driven clinical program 635 00:23:51,769 --> 00:23:54,730 that uses our technology and cost effectively manages 636 00:23:54,730 --> 00:23:55,230 care, 637 00:23:55,769 --> 00:23:57,769 for a rising risk and the highest risk 638 00:23:57,769 --> 00:23:59,150 patient population. So 639 00:23:59,515 --> 00:24:02,394 I think to I would say that we 640 00:24:02,394 --> 00:24:03,214 are responding, 641 00:24:03,595 --> 00:24:04,095 therefore, 642 00:24:04,394 --> 00:24:05,294 very purposefully 643 00:24:06,154 --> 00:24:07,134 and with intention, 644 00:24:07,914 --> 00:24:09,375 understanding our strengths, 645 00:24:10,634 --> 00:24:11,940 while also being very 646 00:24:12,500 --> 00:24:15,240 cognizant of all these potential headwinds, 647 00:24:16,179 --> 00:24:17,319 you know, for sure. 648 00:24:17,940 --> 00:24:19,460 Well, I think it's the right way to 649 00:24:19,460 --> 00:24:21,379 to move forward right now. And and, doctor 650 00:24:21,379 --> 00:24:22,980 Chawbi, thank you so much for joining the 651 00:24:22,980 --> 00:24:24,740 podcast and for your time and and all 652 00:24:24,740 --> 00:24:26,579 your great insights. Really looking forward to having 653 00:24:26,579 --> 00:24:28,875 you speak at our spring payer issues roundtable 654 00:24:28,875 --> 00:24:29,535 in April. 655 00:24:29,914 --> 00:24:32,335 Likewise. Thank you for giving me this opportunity, 656 00:24:32,475 --> 00:24:32,975 Scott.