The Open Road to Reform: Why Healthcare Needs Disruption, Innovation, and the Return of Real Competition

What's up everybody? It's David. I'm your host of Highway to Health podcast. Appreciate you being here. If you know anything about this podcast, you know we celebrate the people, the organizations that are committed to improving access to care, experience while getting that care, and of course the outcomes for our patient population. We've a cool episode today and it's the Highway to Health podcast. We've got the health care highways on our podcast. We're just a couple highwaymen. Right, Chris? That's right. Chris Wilson, president of health care highways. Thank you for being here. Welcome to Highway to Health. And I'm Johnny Cash, by the way, so if anybody knows. Let's hear it. What's your best? I don't have. Who is your favorite? We're going talk a little bit about these highwaymen because they were disruptors. They came in and attacked the establishment a little bit, went after, did it their own way, did it the right way. Willie, Waylon, Johnny, Chris, You got a favorite? I mean, my favorite was always Chris Christopherson, but I gotta give props to Willie for still being the last man standing. So Man. All of them are awesome in their own right. I agree with that. You know, I really enjoy Willie, but Waylon I thought was, pay kinda paved the way. Yeah. For sure. But I got a few questions about highways for you. Sure. Longest road trip? Longest road trip was definitely, from here all the way down to, Rosemary Beach in Florida in the northern panhandle. Yeah. I made that trip two weeks ago. Oh, awesome. How was it? It was awesome. Did you make the bridge in time at the Mobile Crossover Before traffic. I guess we did. Yeah. Because if we don't, you're stuck. That's the trick there. Good to know. Rosemary's awesome. Wonderful. I've only been once, and, I've gotta get back. Yeah. The only the only problem with Rosemary is you show up, it's all Dallas people. You're probably right. I do like the bikes, though. You just ride the bikes every Hundred percent. That's cool. Kids love it. Favorite or dream car For a road trip. Oh, my favorite dream car for a road trip. I mean, honestly, it'd probably be a Mercedes Sprinter Yeah. Van. Man. Yeah. Just decked out. Do you have a bunch of kids? I have two kids, a twenty five year old daughter and a twenty two year old son. So they're grown. But they could lay back, lounge Yeah. Do their thing. No lie, we have four kids at home and I told my wife we can have more kids if I can get a Sprinter van. Hundred percent. I just wanna ride drive one of those big things. I can't believe you said that. I'm the same way. It's the ultimatum. More kids is fine, but I get to drive one of those sweet things. Yeah. Exactly. That's awesome. Can't believe it's taken us this long to get together. Healthcare highways, highway to health. We celebrate the disruptors. Like the highwaymen. The highwaymen, you guys are doing some disruptive things and health care challenging the status quo. We're gonna get into those things. But one last question before we get started. What do you do to maintain your health physically, mentally? You stay at top of your game. How do you do So For forty years, I always was in the gym lifting weights. Yeah. And You can tell. Yeah. Well, almost it's almost converting to, you know, the wrong side of of not not muscle. Just say that. But you find yourself in a rut doing the same thing over and over again. So I've made a conscious effort this year. I'm not getting any younger, is to try to shed some weight. And so I've moved to military calisthenics in the morning. But what I find is where I need that break to be healthy mentally is at the end of the day. Okay. You go hard, you have dinners, you have maybe cocktails, entertaining, And so I take long walks at the end of the day. It clears my mind, settles my mind, and lowers my heart rate. And helps me with that cardio aspect of burning calories, but I also find I think more clearly When I'm walking and when my mind shut down, and then that triggers to sleeping better. Good. And I know that research says if you sleep well, you recover well, and you'll be healthier the next day. So those are my tricks to the trade. I'm still in the first couple months of that. And gotta stay with it to make sure I see the results. Any music while you walk or you just want you just wanna be away from it all? I started with music, but now I'm on podcast. Yeah. And I'm a crime scene podcast junkie. I love the mysteries, and it reminds me that you have to be very careful of who you trust. And some of the people most closest to you can do crazy things in this world. And so I listen to those probably too much when I'm walking. But definitely, if not that, I hit the classic rock remix that I have or Texas Country remix. Oh, yeah. Texas Country is good for me too. Highwaymen's on there. Alright. I bet. I bet. You shared something recently on LinkedIn. I I loved it. And, if if you didn't see it, guys, I want you to share it, Chris, with us now. You talked about how Yellowstone is reintroducing wolves, to that ecosystem. And you compared it to health care and what health care highways is doing. Share a little bit more about that. Yeah. So that was called the trophic cascade. And what happened in Yellowstone is they removed wolves decades ago, and what they didn't realize is the deer took over the population and ate all, the vegetation. So what the wolves were is really competition for to maintain the ecosystem, if you will. When you remove competition, there are consequences to the ecosystem. Healthcare is dominated by I wouldn't call them deer, but they're dominated by four health plans, primarily the Blues, nationally, UnitedHealthcare, Aetna, and Cigna. And there's even competition or limited competition inside of where they compete for business. If you move into the fully insured spectrum of business, the blues dominate most states, and the blues can't even compete against one another. There's a couple dozen blues plans across the country, and that's where you're starting to see the antitrust lawsuits and the competition. And so there's been a lack of real competition and real innovation. And we know when there's lack of competition in a market, especially healthcare, costs go up. Yep. And that's why you've seen limited mergers and acquisitions also from the provider side. You saw a lot of acquisitions previously, let's say with Optum buying up physicians and we saw cost rise. When hospitals acquire physicians, costs rise. And so the more competition is limited, the more there's an increase cost for healthcare. And so we wanted to put out An analogy that says we need to reintroduce competition, But it's not more of the same. It's gotta be different and it's gotta be innovative. Yep. And we do own that moniker of being disruptors, but sometimes that gets a negative connotation. And really what we're trying to say is we want to fight to lower healthcare costs. We want to fight to improve health care outcomes. We want to fight to make providers healthy. They don't have to be fighting all the time for the reimbursements if we're more transparent. They can do that in partnership with employers. There is a model that exists where everybody can benefit, But it's not the model that is predominantly owning the healthcare space today. So what does it look like? What does reintroducing competition to this space look like? So it looks like being very, very engaged in your health plan. If you think about healthcare, today it's A top three expenditure for employers. Yep. So it should be at the C suite level of the decision making. And for some reason, and I understand where it came from, but business owners, CEOs, CFOs have so many other things pulling at them. They've kind of pushed healthcare over to the human resource side of the house. Human resources is very capable of assessing benefits, but their whole main core responsibility is to protect their employees, Right. Yep. And somebody's got to be looking at the financial aspects of the healthcare spend. And there are teams that could work in partnership with human resources to make those decisions. I will tell you, the more engaged employers are with their health care plans and their spending, the better results we see on lowering trend. We have clients that exist today that are large national employers that are outperforming trend year over year for over a decade, without cutting benefits. Right. They're also making those decisions, not relying on a third party or a quasi consultant to make those decisions. They're leading the charge and asking their consultants to execute on their game plan. They're setting the standard. They're setting we must cut X amount of healthcare just like they do the rest of their business. Okay, that's where my mind was going. Top three expenditure. If you're going if you're if you're a sales guy and you're talking about that big of a budget item You're dealing with the c suite. To get that kind of decision made. So why is this the exception? Is it what what do you see? Why would this be the exception in in the CEO or the c suite's realm of responsibilities where they delegate this big of a decision? Yeah. I think it's a climate of where we came from of healthcare is confusing and so it was always something that we didn't want to engage in and we didn't want we just kind of gave it to somebody else to make it their their, not problem, but their burden, if you will, to manage. Cost grew. We used to be able to afford premiums when they were two hundred dollars a month. Right. You know? Now they're rising rapidly. Oh, yeah. But CFOs are out negotiating the leases of their buildings. They're involved in the decision of hiring and firing and setting salaries. Healthcare's right there and it's one of those conversations of asking questions. I would also say human resources isn't the problem. Oftentimes they don't have the staff. Sure. Or the analytic team to go out and do the work, so they rely heavily on their consultants. So these employers that are outperforming trend hire staff inside of whatever department it is to actually run and manage the health plan. They take more ownership of the health plan. The more you invest in your own health plan, the better results you're going to have. They dig into vendor relationships. I'll give you a great example. We have a very large national employer that's in forty seven states And they will not allow any staff running the health plan internally to receive any benefits from benefits consulting or vendors. Yeah. No gifts, no trips, very modest on lunches so that they're not conflicted in those decisions. Makes sense. Because friendships are born when you work together, and you just don't want those to cross the line of making those good decisions. I will say another aspect that you're starting to see right now in healthcare, The reason understanding that relationship is so critical is fiduciary liability, Right. When you're a self funded health plan, and most of these employers of size are a self funded health plan, They have a fiduciary liability to do the best interest of the plan and operate in the best interest of their members. That goes to how you curate your decisions, How you go to bid. How you make those decisions. Compensation that may be going out to other vendors or consultants that could be going back to the plan. Right. And so you're going to see disruption in the market. You're starting to see it with PBMs today. K. Around rebates. Yep. Members are walking into the store and saying my cash price was less than my insurance price. Oh, yeah. How did we not get that in the curation process? Right. Right. In the RFP process. There's lawsuits right now going after those. Yep. You hear those stories all the time, and we all have a personal story probably. Of the benefits just don't match up with the cost. Do you think it's How much of it is about health literacy, understanding what their options are, what their benefits actually mean, and how much of that health, the lack of that health literacy literacy, kind of pushes them to be a little standoffish, rely on a consultant more than they Would probably even like, is the health literacy part the biggest Biggest challenge? I think it is a challenge, but I would say, human resource teams know they're smart. They know their benefits. Right? Yeah. They don't have the team and the resource. I think it's them to dig in and understand and then you start to Put on vendors and point solutions that they have to manage. It's a very daunting task. And I'm not saying there's not a role for a benefits consultant. I think they do that very well, and they can be aligned. I think health literacy is a challenge at the member level of communicating downstream the benefits to the members because health care is confusing the way we do it in this country. It's very confusing. And so I I I'm just saying that owning the vision and the purpose of what we're trying to accomplish has to be C suite sponsored down through that team. Then we've got to support our human resources team with actual teams to execute. And, I think your vendors have to partner with your consultant and your benefits team to actually communicate, but member literacy is a challenge. But I would say that's not what's driving healthcare cost. Okay. Right? That's not. Healthcare, expenditures are up. Usage is up this year. A lot of people think it's the lag effect from lack of access and lack of care through COVID. I can see that finally starting to hit. It's also new innovation of new meds, GLP-1s, specialty pharmacy, more diagnosis earlier. There's a lot going on with usage. So there's a lot that needs to change in how we structure our benefits in this country. Yeah. So I wouldn't necessarily point at health literacy. I think it's a big problem for member experience, navigation. There's probably some optimization of efficiency that can be Obtained? That's an interesting perspective because I see it all the time. We've been in healthcare and so we with our families, understand how to utilize healthcare. In a cost effective way. You know, with kids playing sports, You know, I tell the people I work with all the time about don't go to the ER, you know. I always have seen that as a big part of the cost of healthcare Problem. But you see bigger problems. You see bigger opportunities for optimization. Correct. I would say they're like, you just gave a great example. My twenty five year old daughter a couple years ago was really, really sick and she was home with me visiting from out of town, and she wanted to go to ER. And I said, do you really need to go to the And she's like, Yeah, I feel really, really sick. And I'm like, You're gonna get a big bill if we go to the ER. Right. And we had a five hundred dollars copay. If we can go to urgent care You know, it's gonna save us money, but we could get in the ER immediately, and I think the urgent care was away. And so she's like, No, I really think we need to go. So we went. And my thought was you hate not to go if they really need to go. Oh yeah, that's the, Yeah. My second thought was, I'm gonna let the bill come to her so she has an experiential learning episode. We We went in. It was something. It probably wasn't emergency room based, and the consumer made a decision to buy, right? Right. But there was a low barrier to entry to make that decision. Right. For her. We could afford the five hundred dollars. It's still a lot, But When the bill came and she saw how much they charged, she's like, woah. For for two hours, I mean, the minute you walk in that door. Oh, yeah. Right? There's an expenditure. So now she makes different decisions and we ended up negotiating most of the expense down, being an educated consumer. There's your point of health literacy, it's almost after the fact knowing how to deal with those bills. That's very true. So I would say that's more advocacy that's lacking in the industry. But that is an expenditure of understanding, I'm also gonna say or argue that that's also a product of the structure of how we're billing our cost. Yeah. That should not have been a ten thousand dollars expense. Right? Right. But that's just a very microcosm of the issue. The issue is how hospitals are reimbursed by the federal government for Medicaid and Medicare and they're always trying to make it up through the commercial market because they're not getting paid adequate amounts from the federal government and now you're seeing more cuts come to them. So it is a problem in the reimbursement methodologies across a system. Okay. Can can we pause right there and explain a little bit more about the reimbursement for Medicare, Medicaid, and then how they're trying to build, you know, trying to recoup those margins on the commercial side because I think this is a huge piece to this conversation. Sure. So hospitals operate at different levels of efficiencies, right? Just like any other industry. Right. And the government has determined what their one hundred percent of Medicare is the reimbursement level they're going to pay off system. That hospital may not be operating at that level. Most aren't. Right. Right. But they get tax credits and other things and other incentives to take Medicaid patients. They get Medicare Advantage plans that they partner with. They get value based agreements. They try to make it up in other ways. But let's just assume that that's not making them whole for the amount of Medicaid population. So they've got to make that up somewhere else, Right. They build all their margin into commercial health insurance reimbursement plans. Right. Which is part part of the problem because they're now friend and foe to the insurance companies. The insurance company is actually paying them the reimbursements at a profit level for fully insured business and self funded business, but the hospital always wanting more because they have the burden of potential Medicaid cuts and Medicare cuts. So it's this tension but these large insurance companies are also their largest payers for the commercial space. So there's this fight of how they negotiate language and how they trade dollars to offset. I would say the way the federal government reimburses providers has basically created a healthcare tax on employers because we're overpaying for services due to the deficit being paid for federal That's a great way to describe And that's what we're fighting with. And the argument is what's enough and what's and so you saw a movement into reference based pricing over the last decade of trying to set, we're gonna tell you what's fair. Why are you telling us what's fair? Well, hospitals took that for a while and then they finally all pushed back and said, If we don't have a contract with you, a network contract, we're not going to see your patients. Yep. Right, so they took back control of that RBP side, but that was a whole Enough is enough because some hospitals are billing it five hundred percent of Medicare, some three hundred percent, some a thousand. If you're the only hospital in town, no competition. Exactly. You bill what you want. And therein lies the lack of competition. So all this goes back to you have to understand healthcare at a macro level to understand it at a micro level. Yep. And that's hard for anybody. It's complicated. And the game's always changing. Yeah. And they're smart people in charge of the game. Yeah. With a lot of dollars on the line. I would say I was a consultant for twenty years though and I never knew any of this stuff until I joined Healthcare Highways and we dug into the contract components, it's just not taught and it's not out there. Now, the administration has done a good job of pushing transparency. It's nowhere near where it needs to be. But now there's AI, there's companies out there scrubbing machine readable files, digging into cost, we have a opportunity to effect change in the next five years in a very, very positive way. We're almost to the point where it has to happen. It has to. Because every side of This problem is facing some real some real stress. Like, we're all We're all at the limit. Patients are sitting there demanding change. Demanding action. But hospitals who might have the most leverage Believe it or not, are working off of five, six percent margin at the most. If we keep moving in this direction Access to the care we need is going be hard to find. And so And so The system, the entire system, is facing pressure from almost every angle. Yeah. Except for maybe the payer angle. I don't know. What no. They're they're feeling it there too. Are they? I would say we're at a crossroads right now. You're going to see What they're doing with cutting Medicare and Medicaid is really not a healthcare Bill. It's really a greater economic strategy they're trying to execute on, But it's affecting healthcare in a very meaningful way. If you cut, so let's take rural hospitals that are operating and seeing Medicaid patients and Medicare patients. If you cut back and take away their tax credits and their incentives, they can choose to stop seeing that care or shut their doors. Right. You've already started to see hospitals close. You're going to see more hospital closures in the next two years. It's just economics. Then you have a limited access of care and you have a real problem and then that care's got to go somewhere. Where's it gonna go? It's gonna come into the urban markets and and leave the rural markets. And so access is only going get worse. So you're either going to have to source care from overseas and recruit people through the visa program, which they are doing. And grow primary care access. You can't Invent it. Right. So you're gonna have access there, but you're also going to see a movement away from facility based acute care. And you're going to see more care done at home or more care done at ASCs and I think you're going to see less hospitals built through brick and mortar and the technology is going to change. But the reason it's got to change If nothing happens and it's only twenty, thirty, it's only five years away, Medicare is insolvent. It can't sustain itself. So what happens when When they don't fund it or they pull from the general fund to try to fund it. We can't rely on that. And I would tell you, recent studies show that the US has a culture, and I'm not saying it's right or wrong, that you even heard today that healthcare is a right. Yep. Right? Yep. Well, challenge is of what level is a right? Like, yeah, we have included so much in the bucket of healthcare. Where do we we have no limits. Everybody gets the same amount of care, they're insured or uninsured, or have a Cadillac plan or bronze plan. And so I think you're going to see us look at models like Europe has and other countries where they provide government sponsored health care but only to a certain level. Yeah. Then you have to buy commercial insurance on top of that. And whether we like it or not, it's not our culture, but we can't continue to finance infinitely with no limits and throw everything in here and say everything's covered And really, that's what ACA did is it eliminated a lot of the checks and balances of healthcare. Mental health parity was introduced and now we have the biggest mental health crisis that we've seen in our lifetime. And so we have so many factors rising in costs with no restraints of spending. Yep. Affordable care turned into really expensive care. It's very true. And I'm not saying it's just such a sensitive topic. You have a hard time having these conversations. Anybody does. Because it's hard to say somebody or a group, whatever, You have to cut their coverage at this you know, that is a that is a very controversial conversation. But without having that conversation, there's no limit to the tab that can be run up. And that's where it's hard to cover. And then everybody it just gets more expensive for everybody. I would say another controversial topic that we should talk about is understanding what we really have. I would argue we have sick care, not healthcare. One hundred percent. Right. And until we have that conversation, you can't have the other conversation. It's true. So if there's no consequence to how we choose to make our decisions, and we just fund it infinitely. They talk about GLP-one. Costs have actually gone up for people. Not GLP-one costs. If you remove the cost of taking GLP-1s, the side effects or other costs associated with a lot of that population, their cost to for them has actually gone up. So you're saying Patients that are on GLP-1s, the cost of their care is actually more expensive than it was prior to them on GLP-one. I just left an advisory meeting national advisory meeting last last weekend that showed the stats that the cost of caring for those individuals has not gone down, Removing the cost of the drug, It's actually gone up. So what's happening there? And so they're saying, we haven't learned all the side effects and all the other issues it's creating and the cost, but the problem an employer has, if you're choosing to make decisions, how long are you going to have that employee on your health plan? Right. Right? Infinitely? Because you might invest in their care if they're going to get healthier and get Well, but if they're gone in five years, There there's this controversial topic of consumerism's missing at the member level. Employers have to make decisions on a population. Sure. That's gonna turn and churn. Yep. Somebody might leave to get a different job and make more money, might relocate, might retire. And so there's no consumerism in our sick care health plans And I think that is what's driving all the costs. If you're at an employer and you meet your deductible, what are you thinking? Well, I better get everything done this year. Already got my deductible, right? So there's this incentive model of get it all done once you max out, which very logical from a member perspective. I do it. If I have to have a surgery or something, I'm like, what else can I get done? Exactly. And I think we gotta rethink the model of moving away from how do we incent people to get healthy and well holistically from the mind to the body? That's why I asked the question at the beginning of every podcast because part of this is our own responsibility. We've gotta we've gotta find a way. If you're if you're not gonna do it for yourself, good luck finding somebody that's gonna do it for you. But then there's barriers along the way. Right? And and that's what we're that's what we're discussing. But what is a more sustainable model? Is it value based? Is it I mean, is that the biggest shift, value versus volume? What's what's the more sustainable model? What's that shift that? Because you see it every day. So where do you see it happening? I think value is important. I think it should be something we should be doing regardless. I think, a lot of providers are doing that regardless of their membership. I really think the biggest opportunity to control cost is is providers and systems partnering with employers, working together. Right now we call it managed care. Yeah. But ninety percent or eighty five percent of all health plans, you can go wherever you wanna Everybody's in your network, Right. We're starting to point out this person's high quality or this facility's high quality, but really we're shifting care. And they can go wherever they want to go. You know the biggest determinant of where you go for healthcare is Two two Decisions. Can I guess? Please. I don't think it's cost for most of the population. I would say it's proximity and familiarity. Yeah. It's either referral from a friend or a loved one or someone you know or where you live or work. Right. Period. So what if the most expensive hospital builds across the street, builds the most expensive? Well, they're right across the street. It's kinda like a gym. You go to a gym within a mile radius of your home, right, if if it's there. That's not ideal, but when you're sick, you want to drive across town and you know, go to a cheaper facility or do you even think about Right. Okay. So the problem is we've got to partner and say, this is where you're gonna go get your care. And in exchange for that, we're gonna give you the lowest price point in the market and we're gonna treat your patients. We're gonna report on the value. Quality. We're going to make sure your employees have access to care timely. We're going to make sure that new patients can be seen. We're going to partner almost like a clinic model. There's a lot of employers doing on-site or near site clinics. But we've got to change the way we think about cost and say what do systems want? They they wanna have more people through their doors. One hundred percent. And in exchange for that, they're gonna give you a lower cost. But if you're getting a third, a third, a third, they're getting the membership they're gonna get based on proximity. That's it. We see a lot of success across the country. We're doing this in multiple states where we partner employers again being part of the solution. Right? With systems to work together to have community based health plans And know what's great about that too is, like, the member would appreciate it. Right. If I know I can get good quality Good access. And you tell me where to go? That takes a lot of the guessing work out of You know what? It solves a lot of that health challenge that we were talking about at the beginning at the member level. Tell me where to go. You know, when I have an issue with my car and I don't know much about my car, you know, you ask your dad, you ask your buddy, whatever, and they tell you where to go and you go. And Now. Then make sure you get your oil changed if you have dad that's on you about that or do you change it yourself? But five years from now we've got to be able to look back and say okay are we getting the quality? Are we getting value out of this relationship, out of this managed relationship? But I think the member experience would improve through that. Well, I think the member experience would improve, but also there's accountability now. You could say, we're gonna partner and here's what we wanna do first year in measure in the And the employer can say, here's our problem. We wanna tackle this first, and we can measure it, report on it, and then go after issue number two and issue number three around engagement. But there's also, when you do that, members want direction, but they also want choice. You could easily say, we're gonna partner with this system. We're gonna sponsor the plan. You're not gonna pay anything to go here. But if you want to go to somewhere else, you can buy up and pay a higher premium. You've now introduced consumerism. Yeah. You've given choice. Now the human resource team and the C suite team didn't make the decision. They just said, We're gonna sponsor this plan. But there's alignment in that system to now compete for that membership and solve the problem on value. Yeah. Right? You solve the cost equation by setting up the narrow network. Yep. And now you're competing on value and you're starting to partner on, Hey, we've got a very large amount of our population that's going to the chiropractors. Can we look at physical therapy or wellness or other things that keep them out? Or we've got a large musculoskeletal problem or whatever it is. And you can start to tackle those things and lower those costs. But I think not inviting the people that actually provide the healthcare to solve the problem is a mistake. It's a good way to look at it. It almost sounds counterintuitive when thinking about bringing competition into it, know, telling somebody where to go. But where the competition happens is on the provider side. Because they're fighting for your business. And if they can get your business with quality and cost, effectiveness, then they get all your business. Still providing choice for the member at a cost. You can choose to pay more and go somewhere else And some people would elect to do that. But then the employer's not on the hook for it. Right. You're probably seeing this done well in certain places. Who you don't have to share who. Yeah. But is this kind of the model that you're seeing implemented, this disruptive model, this change of or this shift. At certain places around the country? Yeah. We we've partnered, I mean, proudly in the Baton Rouge market. The Baton Rouge General Hospital is a local community hospital. Really championed this Statewide. It's probably important in that area. Very. They have a very large system they compete against across the street. Actually, two large systems. They're thriving, but they're partnering with local employers and they lower cost every time in this model. We see it in Kansas City where we partnered with, KU Medical. North Kansas City Hospital and AdventHealth in a partnership. And we, start to move the market, but really it's their brand, their facilities, their quality. In local municipalities are very interested in lowering their costs. Like, they're budget sensitive, right? And so lots of times that's where we start, But it also, back to the leverage point, pulls them out of a leveraged position with these carriers where they can now have a parent to parent relationship instead of a parent child relationship. There you go. I would say the carriers have more leverage over the payers because they can dictate whether they're in network or out of network in those negotiations and they still have the membership. Where The systems are at risk of going out of network and losing that membership. It's a sensitive thing. They both have power. It's just you work with the employer, the employer is the customer and user for most commercial plans and they make those decisions. You can really neuter the impact because they can go move their insurance administration to somebody else. Right? They have the levers. And so we see that happening across the country. We're doing it in New York. We're doing it in Florida. We're doing it in Kansas City. We're doing it in Texas, Oklahoma, Louisiana. And probably a market near you soon. But, it's really, there's a playbook to do it and execute, But It's gotta be thoughtful. Right. You just can't go in there and say we're gonna do this. There's been a lot of tried and a lot in haven't succeeded in the market, and you have to understand the dynamics. You need the consultants. You need the human resource team with you. We just want broader engagement across all levels to partner. And I'd also tell you one thing that's missing, and this was a knock to me when a hospital executive said, You partner with us. When's the last time you've been in our facilities? And I'm like, I don't know that I've ever been in your facilities. He's like, I know. We're going to do a tour today. He took me on a tour, showed me the birthing unit. He showed me the new Burn unit. He showed me the cancer unit and it was an moment. Yeah. We should be in all of our facilities selling the care. Oh, Selling to facilities, selling to I met the staff, right? When's the last time we've been in any of these facilities to see their capabilities? And a lot of them have really, really good capabilities. Right. That I was never aware of. And so that was my moment. We make mistakes just like anybody else, but we don't make them twice. So we learn from it. Oftentimes what we do, you asked what we're doing, We will host brokers and employers to come to the facilities that we're partnering with, spend a day, educate them on all the capabilities, meet the team at the doctor's office, CEO, CFO, Chief Medical Officer, let them ask questions and That's important. And that is a very positive interaction in the community. Yeah. We can get disconnected, and it'd be numbers on a page or Yeah. Whatever the case may be. That's good. What's one thing? So whoever's listening to this, we've talked about a lot. When they go home tonight and they sit down at the dinner table. What's the one thing that you want them to be able to remember and and share. I want employers to realize that they have the power to change healthcare. It's really in their purview to go out and lead in the market Place. You have more opportunity to make change than you realize. If you don't have the resources, you can engage your consulting team and vendors that are out there trying to disrupt the market. There are consultants that want to move and change healthcare as well, the very good ones. But you have to set The goals and the things you want to tackle. There's data out there and if you're not getting it, you need to ask yourself, do we have the right administrator? Are they really partnering with us? Or why aren't we not getting this information? But change is out there and attainable. We've got several opportunities that we could point to across the country that are Doing very robust changes in healthcare And I think it's very, very positive. We also wanna make sure that we care about our members and we understand that they deserve the opportunity to have the lowest possible cost of access of care and that's attainable. I would also like to say to benefits consultants, The economic system you play in is prohibitive from innovation and change. And it takes bold action to break through those barriers. But there are opportunities for consultants to work off of value, to bring more value to their clients and still make a good wage and a good compensation for their work. And I think oftentimes these consultants, you're struggling with bandwidth as well. And I would say that partnering with your client and really changing your compensation model around value is an opportunity for you to transform the market. Well said. Change is out there, and it's happening. You guys are a big part of it. Thank you for being here. Thank you for having me. Alright. See y'all. Thank you.