1 00:00:02,240 --> 00:00:04,980 This is where health insurance leadership comes together. 2 00:00:05,279 --> 00:00:08,960 Becker's fourth annual spring payer issues roundtable brings 3 00:00:08,960 --> 00:00:10,500 together over 400 4 00:00:10,639 --> 00:00:13,039 payer and health plan executives and more than 5 00:00:13,039 --> 00:00:16,494 100 speakers to Chicago April. 6 00:00:16,875 --> 00:00:19,754 This year's event includes keynote conversations with the 7 00:00:19,754 --> 00:00:23,035 industry's top leaders and former president George W. 8 00:00:23,035 --> 00:00:25,675 Bush. For the full agenda and event details, 9 00:00:25,675 --> 00:00:27,754 visit beckershospitalreview.com 10 00:00:27,754 --> 00:00:29,195 and click on the events tab in the 11 00:00:29,195 --> 00:00:31,480 upper right. We're looking forward to hosting you 12 00:00:31,480 --> 00:00:32,619 here in Chicago. 13 00:00:33,960 --> 00:00:36,039 Hello, everyone, and welcome to the Becker's Healthcare 14 00:00:36,039 --> 00:00:38,519 Podcast. I'm Scott King, thrilled today to be 15 00:00:38,519 --> 00:00:40,939 joined by a very special guest, Rob Andrews, 16 00:00:41,000 --> 00:00:44,564 chief executive officer of Health Transformational Alliance. Rob, 17 00:00:44,564 --> 00:00:45,844 how are you doing today? Thanks so much 18 00:00:45,844 --> 00:00:48,004 for joining us. God, I'm doing great, and 19 00:00:48,004 --> 00:00:49,445 it it's nice to have a chance to 20 00:00:49,445 --> 00:00:51,604 be with you. I appreciate your time. And, 21 00:00:51,604 --> 00:00:52,804 you know, we have a lot of big, 22 00:00:53,284 --> 00:00:55,524 topics to get into here with with health 23 00:00:55,524 --> 00:00:58,480 plans and and, you know, the health in 24 00:00:58,480 --> 00:00:58,980 general 25 00:00:59,359 --> 00:01:02,000 across the board. But before we we dive 26 00:01:02,000 --> 00:01:03,520 into those, Rob, you just tell us a 27 00:01:03,520 --> 00:01:05,280 little bit about your your background and your 28 00:01:05,280 --> 00:01:06,099 career journey. 29 00:01:06,560 --> 00:01:08,640 Well, I had the honor of serving in 30 00:01:08,640 --> 00:01:10,099 the US House of Representatives, 31 00:01:10,915 --> 00:01:12,534 for about twenty five years, 32 00:01:13,555 --> 00:01:15,795 during which by the time the Affordable Care 33 00:01:15,795 --> 00:01:18,215 Act was enacted, and I was privileged to 34 00:01:18,515 --> 00:01:19,655 be a part of that, 35 00:01:20,594 --> 00:01:22,994 representing a district in New Jersey. When when 36 00:01:22,994 --> 00:01:25,734 I left the Congress, I started practicing law 37 00:01:26,479 --> 00:01:28,400 and was given the chance to represent a 38 00:01:28,400 --> 00:01:29,859 group of companies that 39 00:01:30,239 --> 00:01:33,759 were interested in binding together to form what 40 00:01:33,759 --> 00:01:34,979 became the HTA, 41 00:01:35,920 --> 00:01:38,479 which is a group that combines the data 42 00:01:38,479 --> 00:01:41,674 and the purchasing power and the experience and 43 00:01:41,674 --> 00:01:42,174 judgment 44 00:01:42,954 --> 00:01:45,055 of a lot of major American companies. 45 00:01:46,075 --> 00:01:48,015 We're now up to over 80 companies. 46 00:01:48,954 --> 00:01:51,215 And our our job really is to 47 00:01:51,674 --> 00:01:53,935 look for the highest value care, 48 00:01:54,819 --> 00:01:56,900 not the cheapest care, but the highest value 49 00:01:56,900 --> 00:01:58,979 care that produce the best results. So I've 50 00:01:58,979 --> 00:01:59,719 had a chance 51 00:02:00,500 --> 00:02:02,899 to experience health care as a as a 52 00:02:02,899 --> 00:02:03,399 dad, 53 00:02:04,099 --> 00:02:05,859 you know, as a parent, as now as 54 00:02:05,859 --> 00:02:06,519 a grandparent, 55 00:02:07,774 --> 00:02:09,155 as a public servant 56 00:02:09,614 --> 00:02:10,114 legislator, 57 00:02:10,414 --> 00:02:13,375 and now as someone, helping to lead the 58 00:02:13,375 --> 00:02:15,235 HTA. So I feel very blessed. 59 00:02:15,694 --> 00:02:17,694 That's certainly a lot of different perspectives with 60 00:02:17,694 --> 00:02:20,169 health care, and we appreciate you blending them 61 00:02:20,169 --> 00:02:22,250 to us for this podcast, Rob. And kind 62 00:02:22,250 --> 00:02:23,530 of the first topic I want to get 63 00:02:23,530 --> 00:02:24,189 to is 64 00:02:24,490 --> 00:02:27,069 how are your relationships with providers changing 65 00:02:27,849 --> 00:02:30,830 as both sides face cost pressure and workforce 66 00:02:30,889 --> 00:02:31,389 shortages? 67 00:02:32,145 --> 00:02:34,145 I think they're changing for the better because 68 00:02:34,145 --> 00:02:35,525 both sides see the 69 00:02:36,064 --> 00:02:36,564 opportunities 70 00:02:36,944 --> 00:02:40,064 that come with the challenges that, providers have. 71 00:02:40,064 --> 00:02:40,884 Well, everyone 72 00:02:41,185 --> 00:02:42,564 who listens to this podcast 73 00:02:42,865 --> 00:02:43,365 knows 74 00:02:44,145 --> 00:02:44,544 that, 75 00:02:45,639 --> 00:02:48,620 health care providers under extreme financial pressures, 76 00:02:49,879 --> 00:02:50,379 reimbursements 77 00:02:50,680 --> 00:02:51,180 are 78 00:02:51,479 --> 00:02:53,659 lagging, in some cases being cut. 79 00:02:54,439 --> 00:02:57,819 Demands are growing, particularly with an increasingly elderly 80 00:02:57,879 --> 00:02:58,379 population. 81 00:02:59,664 --> 00:03:02,384 It's hard to find and retain talented men 82 00:03:02,384 --> 00:03:04,564 and women to work in health care fields. 83 00:03:05,264 --> 00:03:07,264 It's a really tough time to be running 84 00:03:07,264 --> 00:03:10,324 a provider system or contributing to running one. 85 00:03:11,025 --> 00:03:13,344 At the same time, employers are beset by 86 00:03:13,344 --> 00:03:14,629 a series of challenges. 87 00:03:15,650 --> 00:03:18,370 The costs keep going up 9% last year 88 00:03:18,370 --> 00:03:19,430 across the market. 89 00:03:20,049 --> 00:03:22,549 The quality isn't necessarily going up. 90 00:03:23,409 --> 00:03:26,129 The demands and challenges of the employees in 91 00:03:26,129 --> 00:03:28,564 the workforce are as high as they've ever 92 00:03:28,564 --> 00:03:30,724 been. So I think what you're finding is 93 00:03:30,724 --> 00:03:33,364 provider systems and employers are looking for ways 94 00:03:33,364 --> 00:03:33,864 to 95 00:03:34,724 --> 00:03:36,245 take advantage of, 96 00:03:36,724 --> 00:03:38,965 was it Rahm Emanuel said, never let a 97 00:03:38,965 --> 00:03:41,150 good crisis go to waste. Right. 98 00:03:41,870 --> 00:03:44,269 The the there there's some critical problems have 99 00:03:44,269 --> 00:03:45,709 to be solved, and I think more and 100 00:03:45,709 --> 00:03:46,209 more 101 00:03:46,989 --> 00:03:49,069 employers and providers are looking for a way 102 00:03:49,069 --> 00:03:50,370 to solve them together. 103 00:03:50,830 --> 00:03:53,709 Not to the exclusion necessarily of carriers or 104 00:03:53,709 --> 00:03:54,849 PBMs, but 105 00:03:55,344 --> 00:03:57,824 probably with those groups playing a less important 106 00:03:57,824 --> 00:03:58,324 role 107 00:03:58,625 --> 00:04:01,604 and providers and employers playing a more prominent 108 00:04:01,664 --> 00:04:02,805 and primary role. 109 00:04:03,664 --> 00:04:05,664 So, Rob, you kinda think that because both 110 00:04:05,664 --> 00:04:08,849 providers and payers are are both under, you 111 00:04:08,930 --> 00:04:11,090 know, different kinds of pressures and challenges. There's 112 00:04:11,090 --> 00:04:12,469 almost a united front 113 00:04:12,849 --> 00:04:14,689 in that relationship with, like, we're both dealing 114 00:04:14,689 --> 00:04:15,969 with a lot right now. Let's just try 115 00:04:15,969 --> 00:04:17,970 to work together the best we can. Is 116 00:04:17,970 --> 00:04:19,430 that kinda what you've been seeing? 117 00:04:19,889 --> 00:04:21,569 I do. I I think it's evolving in 118 00:04:21,569 --> 00:04:22,790 that direction, and 119 00:04:23,464 --> 00:04:25,085 the math tells you why. 120 00:04:26,105 --> 00:04:29,004 By and large, provider systems are either operating 121 00:04:29,225 --> 00:04:30,925 at a very thin margin 122 00:04:31,785 --> 00:04:33,245 or an in nonexistent 123 00:04:33,545 --> 00:04:35,324 margin. They're operating in the red. 124 00:04:35,865 --> 00:04:36,365 Employers 125 00:04:36,745 --> 00:04:37,485 are paying, 126 00:04:38,750 --> 00:04:41,069 in some cases, double digits more than they 127 00:04:41,069 --> 00:04:43,230 paid in other years, but certainly in the 128 00:04:43,230 --> 00:04:44,370 high single digits. 129 00:04:44,990 --> 00:04:46,529 So where is the money going? 130 00:04:47,149 --> 00:04:49,230 Right? If you've got a an environment where 131 00:04:49,230 --> 00:04:52,269 employers are paying 9% more, but providers have 132 00:04:52,269 --> 00:04:53,170 seen their margins 133 00:04:53,794 --> 00:04:55,735 cut by two thirds or disappearing. 134 00:04:56,435 --> 00:04:58,595 You know, the money is is going, in 135 00:04:58,595 --> 00:04:59,814 some cases, to, 136 00:05:00,754 --> 00:05:04,354 middlemen who provide some important functions. I'm not 137 00:05:04,354 --> 00:05:05,334 in any way 138 00:05:06,035 --> 00:05:06,535 demeaning 139 00:05:07,154 --> 00:05:09,254 the work that some of those groups do. 140 00:05:09,850 --> 00:05:12,089 But is it the right share? Is it 141 00:05:12,089 --> 00:05:13,689 the right share? And I think the answer 142 00:05:13,689 --> 00:05:14,910 is usually no. 143 00:05:15,449 --> 00:05:17,769 So looking for a way to reallocate that 144 00:05:17,769 --> 00:05:19,069 money so the person, 145 00:05:19,769 --> 00:05:22,170 you know, seeing triaging the patient in the 146 00:05:22,170 --> 00:05:25,194 emergency room or doing physical therapy with the 147 00:05:25,194 --> 00:05:28,634 patient or performing surgery or delivering the baby 148 00:05:28,634 --> 00:05:29,134 or 149 00:05:29,514 --> 00:05:31,694 you're doing the actual healing work, 150 00:05:32,074 --> 00:05:33,754 that more of the money goes to the 151 00:05:33,754 --> 00:05:35,595 provider and less of it goes to the 152 00:05:35,595 --> 00:05:37,660 people in the middle. I think that's a 153 00:05:37,660 --> 00:05:40,319 common cause for employers and providers. 154 00:05:41,740 --> 00:05:43,579 I think you're right, Rob. And, you know, 155 00:05:43,579 --> 00:05:46,139 you you discussed real real allocating that that 156 00:05:46,139 --> 00:05:47,740 money, but where do you see the biggest 157 00:05:47,740 --> 00:05:49,680 gap today when you look at, 158 00:05:50,125 --> 00:05:53,024 you know, payer strategy and operational execution? 159 00:05:54,204 --> 00:05:56,464 I think the biggest gap is the, 160 00:05:57,324 --> 00:05:58,865 lack of meaningful competition 161 00:05:59,165 --> 00:05:59,985 among carriers. 162 00:06:00,764 --> 00:06:02,384 I think carriers should 163 00:06:02,845 --> 00:06:05,264 be competing on the basis of outcome. 164 00:06:06,040 --> 00:06:08,060 Who helps to make people healthier? 165 00:06:08,680 --> 00:06:11,020 Not on the basis of rates or discounts. 166 00:06:11,240 --> 00:06:12,620 Now discounts are important. 167 00:06:12,920 --> 00:06:15,500 No one wants to overpay for something, but 168 00:06:16,120 --> 00:06:18,620 I don't think anybody wants the cheapest mammogram 169 00:06:18,759 --> 00:06:20,699 for their daughter or their wife, 170 00:06:21,904 --> 00:06:24,064 or, you know, the cheapest cancer screening for 171 00:06:24,064 --> 00:06:26,884 their husband or their brother. I I I 172 00:06:27,104 --> 00:06:29,925 think if we could create a world where 173 00:06:30,704 --> 00:06:34,224 carriers competed on the basis of delivering great 174 00:06:34,224 --> 00:06:34,724 outcomes 175 00:06:35,660 --> 00:06:37,579 and providers were a part of that in 176 00:06:37,579 --> 00:06:40,000 a fair way, then I think employers and 177 00:06:40,220 --> 00:06:41,680 consumers would benefit. 178 00:06:42,779 --> 00:06:45,660 What's one investment or initiative you believe will 179 00:06:45,660 --> 00:06:48,379 most reshape how health plans operate over the 180 00:06:48,379 --> 00:06:49,680 next two to three years? 181 00:06:50,615 --> 00:06:52,454 I think it will be the emergence of 182 00:06:52,454 --> 00:06:54,774 technologies that can match the right drug with 183 00:06:54,774 --> 00:06:55,675 the right patient, 184 00:06:56,535 --> 00:06:59,514 which doesn't really happen very often now. Formularies 185 00:06:59,814 --> 00:07:00,475 are written, 186 00:07:00,854 --> 00:07:01,995 frankly, with economic 187 00:07:02,454 --> 00:07:02,954 considerations 188 00:07:03,254 --> 00:07:03,914 in mind. 189 00:07:05,100 --> 00:07:07,680 But we know from looking at at genetic 190 00:07:07,740 --> 00:07:09,759 studies and we know from looking at comorbidities, 191 00:07:10,939 --> 00:07:11,680 some drugs 192 00:07:12,060 --> 00:07:13,600 are incredibly beneficial 193 00:07:13,900 --> 00:07:14,879 for a patient. 194 00:07:15,180 --> 00:07:16,185 Many of them are. 195 00:07:16,745 --> 00:07:18,764 Some are expensive but ineffective, 196 00:07:19,464 --> 00:07:21,964 and a few can even have a harmful 197 00:07:22,904 --> 00:07:25,544 impact, particularly if if mixed with other drugs 198 00:07:25,544 --> 00:07:28,024 that that are the patient's taking. So I 199 00:07:28,024 --> 00:07:30,285 think you're gonna see the market move toward 200 00:07:31,199 --> 00:07:32,740 more personalized formularies 201 00:07:34,160 --> 00:07:35,139 where physicians 202 00:07:35,439 --> 00:07:36,979 and others writing prescriptions 203 00:07:38,000 --> 00:07:40,740 are privy to information that would help understand 204 00:07:41,360 --> 00:07:43,199 whether this is the right drug for the 205 00:07:43,199 --> 00:07:44,259 person. And 206 00:07:44,560 --> 00:07:46,319 that, I think, will lead to much better 207 00:07:46,319 --> 00:07:46,819 outcomes. 208 00:07:47,144 --> 00:07:48,524 Fewer cardiac incidents, 209 00:07:49,785 --> 00:07:50,764 you know, fewer 210 00:07:51,064 --> 00:07:51,544 gastro 211 00:07:52,024 --> 00:07:52,524 gastro 212 00:07:52,985 --> 00:07:53,485 incidence 213 00:07:54,024 --> 00:07:56,204 and so forth. I think that's something that's 214 00:07:56,504 --> 00:07:57,324 on the horizon 215 00:07:58,024 --> 00:07:59,564 and could be very positive. 216 00:08:00,579 --> 00:08:02,100 I think it's really interesting, Rob. You know, 217 00:08:02,100 --> 00:08:03,779 we talk about a lot of ways to 218 00:08:03,779 --> 00:08:05,319 use using emerging technology 219 00:08:05,939 --> 00:08:07,860 in the patient journey and and to personalize 220 00:08:07,860 --> 00:08:10,819 things more. But having that specific that right 221 00:08:10,819 --> 00:08:12,660 medication for a patient, now you said it's 222 00:08:12,660 --> 00:08:14,660 on the horizon. Do we think that that 223 00:08:14,660 --> 00:08:17,205 it's something that could happen sooner or rather 224 00:08:17,205 --> 00:08:18,964 than later with all the emerging tech we're 225 00:08:18,964 --> 00:08:19,464 seeing? 226 00:08:19,845 --> 00:08:21,685 I think it'll happen sooner rather than later 227 00:08:21,685 --> 00:08:22,584 for two reasons. 228 00:08:23,285 --> 00:08:24,345 The first is 229 00:08:24,884 --> 00:08:27,205 in in an economy where health care costs 230 00:08:27,205 --> 00:08:27,865 are burgeoning, 231 00:08:28,564 --> 00:08:31,040 drug costs are growing the most. It's the 232 00:08:31,040 --> 00:08:34,160 biggest pain point, whether it's GLP ones or 233 00:08:34,160 --> 00:08:34,559 or, 234 00:08:35,040 --> 00:08:35,940 you know, the immune 235 00:08:36,399 --> 00:08:37,540 autoimmune drugs. 236 00:08:38,000 --> 00:08:39,840 So there's a lot of attention being focused 237 00:08:39,840 --> 00:08:42,000 in the area. And then second is the 238 00:08:42,000 --> 00:08:43,379 advance of AI, 239 00:08:44,154 --> 00:08:46,975 the ability of AI to understand the relationship 240 00:08:47,514 --> 00:08:48,414 among drugs, 241 00:08:49,355 --> 00:08:50,815 drugs with certain comorbidities, 242 00:08:51,835 --> 00:08:54,174 the genetic characteristics of the patient. 243 00:08:54,634 --> 00:08:55,294 I think 244 00:08:55,674 --> 00:08:56,174 pharmacogenomics, 245 00:08:56,875 --> 00:08:59,850 which was fairly exotic and expensive a decade 246 00:08:59,850 --> 00:09:00,350 ago, 247 00:09:00,730 --> 00:09:02,889 will become a lot more common and less 248 00:09:02,889 --> 00:09:03,389 expensive. 249 00:09:04,330 --> 00:09:06,350 It'll be used by more providers, 250 00:09:07,049 --> 00:09:09,049 and it'll lead to better outcomes. That that's 251 00:09:09,049 --> 00:09:10,970 something I think is on the pretty near 252 00:09:10,970 --> 00:09:11,790 term horizon. 253 00:09:12,975 --> 00:09:14,754 If you could change one regulatory 254 00:09:15,134 --> 00:09:17,075 or industry practice tomorrow 255 00:09:17,774 --> 00:09:20,095 to improve affordability and excess, what would it 256 00:09:20,095 --> 00:09:20,914 be and why? 257 00:09:21,774 --> 00:09:25,134 Gag clauses and agreements between providers and network 258 00:09:25,134 --> 00:09:25,634 builders 259 00:09:26,120 --> 00:09:26,519 and, drug, 260 00:09:27,240 --> 00:09:28,860 PBMs in the case of drugs. 261 00:09:29,879 --> 00:09:32,699 Markets I think markets fundamentally work, 262 00:09:33,559 --> 00:09:36,940 and markets work when there is meaningful transparency 263 00:09:37,320 --> 00:09:40,059 for people who are buyers in that market. 264 00:09:40,875 --> 00:09:42,975 We have erratic transparency 265 00:09:43,355 --> 00:09:44,095 right now. 266 00:09:44,875 --> 00:09:47,355 A lot of payers, whether they're employers or 267 00:09:47,355 --> 00:09:48,654 health plans or individuals, 268 00:09:49,595 --> 00:09:51,535 don't really know what they're paying. 269 00:09:51,915 --> 00:09:54,254 There's this vast difference between the, 270 00:09:54,590 --> 00:09:56,669 you know, the the charge that's on your 271 00:09:56,669 --> 00:09:58,750 bill, the charge rate, and what's really being 272 00:09:58,750 --> 00:09:59,250 paid. 273 00:09:59,870 --> 00:10:02,350 You can't have an effective market unless people 274 00:10:02,350 --> 00:10:04,590 know what the real cost is that they're 275 00:10:04,590 --> 00:10:06,269 being asked to bear and what the benefit 276 00:10:06,269 --> 00:10:07,330 of it is. So 277 00:10:07,710 --> 00:10:08,529 I I think 278 00:10:08,845 --> 00:10:11,105 a legislative approach that would, 279 00:10:11,804 --> 00:10:13,264 you know, open the kimono, 280 00:10:14,684 --> 00:10:16,705 let let pricing be known, 281 00:10:17,325 --> 00:10:19,485 I think would disrupt the industry in a 282 00:10:19,485 --> 00:10:21,345 positive way, and I think it's coming. 283 00:10:22,240 --> 00:10:23,279 The last thing I want to ask you, 284 00:10:23,279 --> 00:10:24,100 Rob, what's 285 00:10:24,720 --> 00:10:26,559 what is the issue you think is putting 286 00:10:26,559 --> 00:10:28,879 the most pressure on health plan margins right 287 00:10:28,879 --> 00:10:29,379 now, 288 00:10:30,000 --> 00:10:32,500 and how are you going to respond differently, 289 00:10:32,559 --> 00:10:34,160 or or have you even started to respond 290 00:10:34,160 --> 00:10:35,700 differently in 2026? 291 00:10:36,464 --> 00:10:38,065 When you say health plans, do you mean 292 00:10:38,065 --> 00:10:39,764 employer sponsored health plans? 293 00:10:40,384 --> 00:10:43,184 Yes. Yeah. I think what's putting the most 294 00:10:43,184 --> 00:10:46,944 pressure now is, GLP ones in the short 295 00:10:46,944 --> 00:10:47,444 run. 296 00:10:48,399 --> 00:10:50,720 Many more people are taking these drugs. They're 297 00:10:50,720 --> 00:10:51,860 still very expensive. 298 00:10:52,480 --> 00:10:54,959 They have good benefits. I mean, they they 299 00:10:54,959 --> 00:10:55,459 do 300 00:10:56,159 --> 00:10:58,080 work for a lot of consumers in a 301 00:10:58,080 --> 00:11:00,100 lot of situations. So I think that 302 00:11:00,654 --> 00:11:03,235 what you're gonna see is employers looking toward 303 00:11:04,174 --> 00:11:06,335 creative ways to take advantage of some of 304 00:11:06,335 --> 00:11:07,394 the direct pricing 305 00:11:07,774 --> 00:11:09,794 that's being offered by the drug manufacturers. 306 00:11:10,654 --> 00:11:11,695 You can't read, 307 00:11:12,174 --> 00:11:12,674 Becker's 308 00:11:13,375 --> 00:11:15,214 any day and not read a story about 309 00:11:15,214 --> 00:11:16,115 a drug company 310 00:11:16,970 --> 00:11:19,690 that's offering a price for GLP one through 311 00:11:19,690 --> 00:11:22,569 its consumer portal that's, like, less than half 312 00:11:22,569 --> 00:11:25,049 of what employers are paying in their health 313 00:11:25,049 --> 00:11:27,949 plans. Well, that's just not gonna sustain itself. 314 00:11:28,169 --> 00:11:28,829 If a 315 00:11:29,144 --> 00:11:30,745 if a drug is being sold for a 316 00:11:30,745 --> 00:11:31,785 $190 317 00:11:31,785 --> 00:11:33,465 a month to someone who puts their credit 318 00:11:33,465 --> 00:11:34,205 card down, 319 00:11:34,745 --> 00:11:36,184 but it's $500 320 00:11:36,184 --> 00:11:38,925 a month net of rebates for employer plan, 321 00:11:39,465 --> 00:11:41,625 employers are gonna do something to change that. 322 00:11:41,625 --> 00:11:43,485 They're either gonna work around it and 323 00:11:43,820 --> 00:11:46,220 try to reimburse the consumer, or they're gonna 324 00:11:46,220 --> 00:11:48,080 insist that the PBMs and 325 00:11:48,539 --> 00:11:49,279 the manufacturers 326 00:11:49,980 --> 00:11:51,759 normalize that price. So 327 00:11:52,139 --> 00:11:53,980 I think that's what's putting a lot of 328 00:11:53,980 --> 00:11:55,740 pressure on, and that's the direction in which 329 00:11:55,740 --> 00:11:57,875 you'll see it go. Rob, thanks so much 330 00:11:57,875 --> 00:11:59,315 for joining us on the podcast. It was 331 00:11:59,315 --> 00:12:01,315 a great conversation. Look forward to having you 332 00:12:01,315 --> 00:12:03,235 speak, in the spring at our Payor Issues 333 00:12:03,235 --> 00:12:05,554 Roundtable. Scott, I'm sure Chicago will be a 334 00:12:05,554 --> 00:12:07,554 great experience, and thank you for making it 335 00:12:07,554 --> 00:12:08,054 so.