Tackling Rising Healthcare Costs: Strategies for Advisors and Benefits Leaders

Sponsored by Garner Health Join senior executives in healthcare benefits for an in-depth discussion focused on the critical issue of rising healthcare costs. This session will provide a platform for candid discussions and examples on how to effectively mitigate costs. Participants will share real-world insights, explore cost reduction strategies, and collaborate on solutions to ensure sustainable benefits programs that support employee health and organizational success. Participants will leave the session with actionable strategies, new solutions, and a network of peers to support their efforts in creating cost-effective benefits programs. What you'll learn Understand the key drivers of healthcare costs and how they impact benefits programs and business health. Share effective strategies for controlling healthcare expenses without compromising employee benefits. Discuss practical approaches, including clinical management, network strategies, and plan design, that can help reduce costs. Learn about the most innovative vendors tackling both cost and quality. Explore ways to engage employees in managing their healthcare costs through education and incentives

Transcription:

Kirk Czonstka (00:09):

As we're going to get started in just about 30 seconds or so, Heather's doing a great job of letting folks know, but this is going to be kind of a collaborative round table type of a discussion today. So try to sit together in groups so that there could be some good group sharing throughout the presentation so it's not lost on me right down the hall. There's a very provocative conversation going on around politics in the workplace. I promise this will be more of like a nonpartisan type of discussion, not as provocative, but probably much more important in terms of how do we actually address rising healthcare costs. As many of you're brokers in the room, many of you're employers in the room, what are some ideas that we can call kind of collaborate on to help one another out here? Just by show of hands, before I introduce myself, how many of you are coming from the employer HR side?

(01:04):

How about from the broker advisor side? Okay, cool. And probably a few others maybe from the vendor side. So by way of introduction, I'm Kirk Czonstka. I am the Senior Vice President of Strategic Alliances with Garner Health. I joined Garner back in November. I'm leading our consultant relationship strategy nationally as well as our health plan and non-health plan distribution partnership strategy. So really excited to be here. I too am a former consultant. I was with Mercer for about 16 years before coming over to Garner. Most recently managed their Pacific Northwest practice. So what we're talking about today is an issue that I had to pay attention to on a very much a daily basis as I was out working with our customers and with our prospects as well. So we're excited about today's discussion. I dunno if there's any other round tables that happened yesterday and today, but the whole idea is let's get everybody else to talk to each other amongst your table.

(01:57):

So if you haven't done so already, make sure that in the first minute that we get a chance to break out, introduce yourselves to one another, get to know where each other is from, and then we'll have a couple of minutes for a few different topics that we've got listed out here to really dive into some creative ideas on how can we leverage transparency data, how can we leverage data on provider performance, quality improvements, so on and so forth. The idea here is let's take about five minutes amongst the tables as we go through each of these three separate topical areas, share some ideas, share some best practices, have some good conversation, and then we'll probably take another three or four minutes after that five minute discussion to do some group share. So I'll probably call on a table or two to let us know what you were talking about and see if we can take any good ideas from those discussions.

(02:45):

Sound good? Awesome. Alright, so really to kind of kick us off with some context here, two charts that I think are really important to sort of introduce here. Number one, the chart on the left. We're looking at annual healthcare costs, which continue to rise, continue to forecast to rise as well on a year over year basis. And that combination alongside of the fact that employers have continued to cost shift to really address and combat that trend at the employee level. We've now reached this level a couple of years ago where health plan out-of-pocket costs are actually more expensive than the average cash that employees and their families have on hand. So virtually you've got a lot of employees across the country walking around functionally uninsured, even if they're enrolled in employer sponsored healthcare coverage. So how can we really address the fact that trend continues to increase at significant rates?

(03:38):

Not expected to slow down anytime soon, but from an attraction, retention, quality of life perspective, there's not really much more room to go from an employee cost sharing perspective as well. So some of those traditional cost management strategies are just going to become more and more difficult, if not impossible, as that trend continues to increase. So by way of background, garner at our core, we're a data and analytics company. We've amassed literally the largest data set of claims in the country. It's about 75% of all claims flowing through the US and we've really taken a deep look to gain some insights on when we have access to all this data on doctor claims, what are the main things that are going to drive the biggest impact on reducing the total cost of care from an episode perspective? And as we look at the data, it turns out it's actually very clear that making sure that your employees as patients are seeing the highest performing individual physician is largely going to be a lot more impactful than even picking the right health system, the right physician group, the right PBM, so on and so forth.

(04:44):

And if you think about it, it makes sense. Patients trust their doctors on what tests that they should be getting, what prescription drugs they should be picking up from the pharmacy, should they get surgery, if they're getting surgery or having a procedure, where should that surgery or procedure actually be being handled at? Typically patients trust what their doctors tell them. They're not going to go out and research all that stuff themselves. What the data that Garner collected also really demonstrates is that individual doctor performance varies significantly from doctor to doctor, even within the same facility. So depending on which doctor I choose down the hall from one another, my outcomes could be significantly different. The cost of that episode can be significantly different as well. And that's true even at the biggest brand name hospitals in the country. So this is a case study that we like to show.

(05:30):

It's actually an employee of ours whose father was diagnosed with colon cancer a couple of years ago, faced with this really scary diagnosis, did what most people do, go out, do some research, he stumbled upon the US News and World Report, the top hospitals report to figure out I got to go get part of my colon removed. Where's the facility that I'm going to have the lowest likelihood of a complication, the highest likelihood of a success at the end of the day? So when you look at the chart on the left, it becomes very clear that if I can get on the plane and fly to Mayo Clinic, I have the means to do that. I'm going to do that and I'm going to have the best outcomes. But when we actually drill into our 320 million patient care journeys worth of data, it also becomes very clear that even at Mayo Clinic, there's a really, really high chance that I'm going to see a doctor that has a very, very low performance and a high complication rate.

(06:17):

And that's truly across every health system in the country, across every geography, across every kind of care need, not just surgical oncology. So certainly presents a major challenge. There's a couple of solutions that have been out there over the years that employers have taken advantage of that consultants and brokers are talking about. Those might be things like narrow networks which come with their own set of challenges. When we think about the slide here on the screen, there's other types of solutions like digital nav solutions, transparency solutions, et cetera, low friction to put into place. But the reality is patients really aren't taking advantage of those tools. So there's not a lot of ROI that employers are getting by putting those types of solutions in place.

(06:59):

So what we really want to do is, given that problem statement, the fact that individual doctor performance matters more than anything else, that doctor performance varies significantly even amongst the best hospitals in the country. What kind of ideas can we come up with? What kind of strategies can we come up with collectively here today? First starting out with some questions around healthcare transparency and provider performance that could ultimately help reduce costs both in the first year that they're implemented. But I think really importantly, not just serve as a one year bandaid, something that can sustainably manage trend over time so that we can start to bend the cost curve in that first graph that we had up on the screen. So what we're going to do, we're going to do a five minute breakout session. I've got 1140 on my watch right now. Ask all of you to get to know one another at your table first and foremost, but really tackle the two questions that we've got here on the slides, really looking at what are some of the metrics that really should be tracked and made transparent to patients to help them really evaluate where they're going to get their care and what ways are patients using provider data today to make more informed healthcare decisions.

(08:07):

So amongst yourselves, have a couple of minutes of conversation and then we'll regroup here in about four or five minutes to do some group share. Alright guys, who wants to be the brave first table and talk a little bit about the first question We'll hear from one table about question one and then another table about question two here. Anybody want to volunteer for question one? We got a take her up here, Heather.

Audience Member 1 (08:55):

Okay. Yep.

Kirk Czonstka (08:56):

What'd you come up with guys?

Audience Member 1 (08:58):

So we talked about a couple things. Reviews from patients because everybody likes Amazon and Yelp reviews. So maybe average time spent with each patient and cost compared to the average cost. And then maybe perhaps peer reviews by nurses or people that work with them.

Kirk Czonstka (09:15):

Got it. Good Share. Good share. And you're thinking about that across the gamut of primary care and specialty care and yeah. Okay. Anybody else want to share?

Presenter (09:27):

I didn't share, but I was thinking when I was in grad school you had rate my professors. So same thing for doctors. Yeah, anybody else?

Kirk Czonstka (09:42):

All right, question number two. How are folks using this type of data right now to make more informed healthcare decisions? What are they doing now? What other types of options might exist? Go ahead.

Audience Member 2 (09:55):

I'll share. I have feelings. So we were just discussing this that a lot of things that people use are essentially something like Google reviews a lot of those for doctors, and we were discussing the inherent negative bias in reviews, and you have to think about that if you have a good experience. And she was just saying that she would be maybe suspicious if she had a good experience, rate me on Google. Whereas if you have a bad experience and you're angry at the doctor or whatever it is, you're more likely to review 'em. So there's going to be a natural skew in that. And then of course there's also people have their own issues, et cetera. So I think that that's one way that people are using it, but I think that it's hit or miss in terms of effectiveness.

Kirk Czonstka (10:35):

One of the things that hasn't come up in any of the two discussions so far is anything around quality. Did anybody talk about quality metrics? Yes. What kind of stuff did you guys talk about?

Audience Member 2 (10:47):

Oh yeah, sorry. I'll go on. That was actually our first thing. So we didn't have anything specific because we were really questioning about how do you get to these metrics? How do you get to them by state? Is it cost? Is it a success rate? How do you account for chronic conditions? Say you have somebody who has four or five comorbid conditions, how do you determine then what is the outcome based on that? So I work in research, so I inherently was like, I have so many questions. And so I think that's a real challenge. How do you get to that? And then the next level is once, say you get to something that you think is good, how do you get people to trust it, to believe it, and to not think that you have ulterior motive to present them with that information

Kirk Czonstka (11:27):

And then to actually use that information to change their behavior. Right. Yep. Good, good. Anybody else love to hear from, we got another one raising their hand at the back.

Audience Member 3 (11:41):

We talked a little bit about how performance is important to know, so you're getting good treatment, but there's also, we want to know the cost associated with different performance as well. Kind of like what was talked about in the keynote, if you want to lower cost a lower performance solution, you can go for that because you have the data versus a high cost, maybe higher success rate solution.

Kirk Czonstka (12:00):

Yep. Great. Great. So I just want to talk a little bit about how we think about data. We think about it very differently than a lot of others. Historically there's been this idea of, and a lot of the different ranking tools and some of the different carrier designated programs are built around this methodology called episode grouper methodology that is supposed to be looking at cost and quality at the end of the day, but we find it's a relatively non-transparent way of doing so. And oftentimes doctors could actually get dinged unfairly if they end up seeing a sick couple of patients one year versus the next. Really through no fault of their own, they're seeing less healthy patients and those patients might not be able to take generic drugs because they're allergic or might have multiple comorbid conditions that are driving that episode methodology. That is what's being used to rank doctors historically.

(12:50):

What we believe in really strongly is that you do need to take advantage of data. So I mentioned the fact that we're collecting about 320 million journeys of patient care journeys across the country, and we're literally looking at what we call our bottom up approach. What is every single decision that a doctor is making, whether it's a primary care doc, a dermatologist, or an interventional cardiologist, what decisions are they making that we can ultimately look at and see within the claim data that's being collected? So we believe really strongly, there's a couple of different things that tie into both costs, which we weight at about 50%, and then quality, which we weighted at about the other 50%. So from a quality perspective, it's looking at things like process. Are these doctors jumping right to a knee replacement for a patient when it might be much more efficient and much more optimal based on what that patient's presenting to go to physical therapy instead?

(13:39):

Significant cost difference, significant quality of life difference keeps, gets people back to work sooner rather than later, so on and so forth. We also really think it's important to look at doctor decisions around things like where to send certain procedures. So site of care steerage is a key thing that we like to look at within data because that has a major impact on what the cost of an episode is. And then certainly things like complication rates and revision rates and pain relief rates as well. So we like to take a very metric and data-driven perspective on how we ultimately identify the best doctors using a series of metrics that we're collecting through data. Any questions on that?

(14:26):

Okay, great. So the next one, let's talk about just cost reduction strategies and quality improvement strategies as well. So we'll give again everybody about five minutes to kind of work through these two questions. The first one being, what are some of the more successful strategies that are out there at addressing really high renewals, which I know a lot of employers are continuing to experience this year, but I think really importantly, what are the strategies that are out there that are not just one year, but instead actually something that can sustain cost trend reduction over time? And then I think a really provocative one could be what role do employees and their families actually play in achieving those cost reductions and that improvement in quality when they're going out and seeking healthcare as well? So let's regroup here in about five minutes and do a readout. All right. We're going to flip it around a little bit and start with the second question first, who wants to start out by talking about what, if any role employees and their dependences as well play in achieving cost reduction and I improvement in quality? Yeah, go ahead.

Audience Member 4 (15:46):

I can speak to that. You got too all the options. So one of the things that we talked about in our group was the ways that improving the education for employees of their options as well as improving the adoption utilization of preventative care can help drive down their own costs in addition to obviously their employer's costs. So whether it's through technology or what have you, just making that experience for the employee easy and clear. So it is on them, of course, to utilize that knowledge once they have it. But as employers, it's also on the companies to make sure, hey, are we doing our part to make sure that information is easy to access and then also easy to use.

Kirk Czonstka (16:32):

Do you think it's important for employees to do research on where they get their care?

Audience Member 4 (16:36):

Well, I think if the employer is doing a good job of making that information front and center and accessible, it's not something that the employee needs to sort of proactively go out and do additional work for. Technology can bring that to them. So yes, I think there is an obligation for the employee to take advantage of the resources that are available to them, but if an employer group isn't using all the technology that we have available now to make that process easy and not time consuming or confusing, then it's not the employee's fault for falling through because the employer hasn't set them up for success.

Kirk Czonstka (17:15):

Thanks for sharing. Oh, go ahead. Another one.

Audience Member 5 (17:21):

Thank you. I think fundamentally employees play the biggest role in achieving cost reductions. Their decisions directly affect your cost as employers directly, not like correlated or inversely. They literally define what they are. And I think that increasing access actually plays a role in helping reduce costs. I think that fundamentally, I have a lot in our advising practice, we have lots of employers that look at their high risk employees as like the problem, right? Like, oh man, you're the sick ones. You're driving all of our costs. Holy cow, what are we going to do with you? They don't tell 'em that directly, but they tell me. But what we try and do in our practice is we say, look, rather than looking at these employees as the problem, we look at them as the opportunities. You might be staring at half a million in risk. I look at that as, oh, maybe we can get 300 grand off that.

(18:09):

What could we do to reduce that? Instead of acting like it's this fixed thing? Like, oh no, I have unhealthy people. Oh shoot, we're dead forever. And so I think that it takes a bit of a mindset shift to then implement strategies and programs to help those employees make better decisions. But on the flip side, to act like employees are magically going to wake up one day and just decide to become healthcare navigation people and just engage with the wonderful PEPM tools that you add on as employers, that would be foolish. But I think there's a middle ground we can try and shoot for, right? We're building enough incentives, creating strategies in programs in place, and then doing our jobs to help them engage. But I think they play the biggest role.

Kirk Czonstka (18:46):

I love that perspective. That was awesome. Thanks for sharing. Anybody else on the role that employees play? We got someone in the back over there. It's Jed back there

Audience Member 6 (18:58):

Going off. What the other individual is talking about is there's a saying, it says plans don't have loss ratios. People do. And I think, again, if you can design plans that will change the behavior of your employees, I think that's going to have the cost impact because addressing double digit renewals is addressing large claimants and future large claimants. And so if you can provide a way that addresses getting employees to care and breaking down barriers to care, then that's going to potentially prevent that next large claimant.

Kirk Czonstka (19:46):

Thanks everybody for sharing. Really, really good discussion on that one. Let's take the first question here. What are some of the strategies that have been out there that either you're talking to your employer clients about, or maybe you on the employer side are leveraging right now that have been really successful at managing this double digit renewal that a lot of employers are seeing right now and doing so in a sustainable way? Some group share on those ideas I think will be super helpful for everybody in the room. Who wants to go first?

Audience Member 7 (20:22):

I was just sharing that understanding your employee population. My work, I work for Salk Institute and we have a specific departments that have Mexican nationals implementing a medical plan that Mexican nationals can have access in Tijuana, so that way they can also make the most out of the benefits and then also the premiums would be low as well.

Kirk Czonstka (20:47):

I love that. That's awesome. Thanks for sharing. Yeah. Anybody else? I know some people are talking reference based pricing. That was one of the things I was getting thrown around. What other strategies are you guys talking about or doing today? Okay, one of the things that we look at is how do we ultimately address the right hand side of the slide? So we talked about the trend, we talked about the fact that putting more and more onus onto the backs of employees is not going to be a successful approach for a number of different reasons, but there's a lot of inefficient spending that's happening right now. So how do you ultimately focus in on what's perceived as low value care or waste or unnecessary type of care and try to remove that out of your plan? Because ultimately, if you can attack that 30% of spending with a strategy that's sustainable, that's going to significantly impact that line on the left without impacting the line in the middle any further too. So we've got one more section, really more around innovation focused on outcome focused care. So let's take a couple of minutes talk about what are some of the strategies that can be implemented that ensure that outcome focused care navigation continues to be patient centered, and then what type of incentives, financial or otherwise are going to be the most effective at getting people to actually change behaviors to lead to cost savings, to lead to improved quality outcomes. So take a couple of minutes to stew on those.

(22:31):

Okay. Let's bring it home with the last two questions here before we let everybody break for lunch. So which brave group wants to go first on the first questions here really around strategies that are focused on outcomes and care navigation that remain patient centered? Who wants to go first? Everybody was so good at volunteering the first two sections.

Presenter (23:07):

I'm just going to give the mic to somebody. Should I just

Kirk Czonstka (23:09):

Yeah, sure. No,

Presenter (23:11):

Just seriously. Anybody please?

Kirk Czonstka (23:16):

No, I already, all right. We got a hand raise here.

Audience Member 8 (23:19):

There we Go.

Presenter (23:21):

If not, I was giving it to Rachel again

Audience Member 8 (23:25):

For the record. We focused on the second question. So I'm just kind of spitballing here speaking for myself, not my table I guess I should say. But when I saw that question, my immediate thought, so many people are skeptical of the healthcare system in general. It's like who owns that care navigation software, like transparency around, and I know this isn't a strategy technically, but if my employer offers me something, it's like, oh yeah, this is going to help you identify which doctor to go to, all that sort of stuff. My radar's up. It's like, okay, who's getting paid off of this, basically, right. So I guess the strategy there would be transparency around why and then ensuring it is patient centered in that it isn't just, oh, this is Anthem's care navigation tool. Right? So again, not speaking for the table that's just spitballing here,

Kirk Czonstka (24:24):

What type of transparency would make you more comfortable about using some tools like that?

Audience Member 8 (24:31):

I mean, even going down to the level of just understanding, it's like, okay, what are the incentives behind this? I mean, clearly I have the incentive of being able to see, and I assume from your platform it's like, okay, I'm looking at the doctors, I'm looking at the ratings. I'm looking at costs and outcomes and all that, but are the doctors incentivized there? I think another thing is just understanding the transparency around that data and what's going into, again, I'm just going off of the flyer here, but it looks like you're just given a score one out of a hundred. It's like, yeah, what are we really looking at here? Are these things I care about or are these things my insurer or employer cares about?

Kirk Czonstka (25:11):

Yeah. So giving you the ability to drill in and actually truly understand why something's being recommended or surfaced to you

(25:17):

As opposed

(25:17):

To just taking it at

Audience Member 8 (25:18):

Face value. What outcome outcome are we talking about here? Are they my outcomes or are they someone else's

Kirk Czonstka (25:23):

Outcomes? Yeah. Yeah. Good. Anybody else got a hand raise again?

Audience Member 9 (25:34):

Hi there. One thing we talked about was using plan design just to create incentives. So one thing could be recognizing that with a lot of plans, if you just have a PPO structure, you've got two hospitals in your area, you've got a baby on the way and they're at the same tier in the network, you're going to pay the same amount to go there. But your employer can figure out that, well, we know that basically NICU rates are lower to go to hospital A. We know it's less expensive to go to hospital A, but because the employee is the same cost share regardless of the facility they go to, they don't really have an incentive to choose one or the other besides just personal preference and other things. And so as an employer, you can try to be a little bit more intentional with the way you designed the plan and say, Hey, you know what? I'm in Los Angeles. We were saying go to UCLA, it's free. Go have your baby there. It's a free delivery, free everything. If you want to go to Cedars-Sinai, that's great, but you're going to have to pay a little bit more because we see this in the data. Yep.

Kirk Czonstka (26:28):

Good. Yeah, thank you for sharing.

Audience Member 10 (26:31):

I really appreciate your comments. I was going to say almost the exact same thing, but yeah, we've actually done that specifically. So I'm from Idaho, I know they have brokers there too. In southeast Idaho, we have three of the larger independently owned health systems as clients of ours, and there's about two or three other bigger nationally owned health systems. And we've done analysis. And our clients are the ones that have lower cost, higher quality of care. And so we basically did that where we created kind of a three tier network system where your tier two middle tier is your just normal blue or whatever. We have our own consortium of employers, self-funded employers, and we have a blue that administers it. And so that tier two is just the normal network. But if you choose to go to one of the higher quality, lower cost facilities, we'll cut your deductible in half your copays, your co-insurance, well instead we'll give you a carrot and not the stick, right?

(27:24):

Instead of a narrow network model where it's you got to go here or you're going to die. And so we found that to be super effective because employees feel like they have options and they don't feel like they have to go somewhere. But over time, through enough culture shift through OE and different messaging to the employees, we've seen a huge, huge increase in cost savings. They tend to figure out, oh wow, this is a lower cost, higher quality facility. This is great. And they keep going there because once an employee makes that decision, they tend to stick with it for some time.

Kirk Czonstka (27:56):

What happens if you're living in an area where there's only one health system?

Audience Member 10 (28:01):

I would say it's certainly very tough, but you could explore, I don't know, I think it's hard to find an employer that has just one population in one spot that's that large, but you have virtual options. You've got, I think at that point the conversation becomes more about case by case, high claims management and engaging with those members. If they're going to go there, they're going to go there. If they don't have a choice, that's where they're going to go. Obviously there's outsourced medical tourism stuff to higher quality facilities, which has been super successful with the Mayo Clinic and another large groups. But I think your highest odds of having an impact in that scenario would be to drill down on whatever navigation case management tools and programs you have in place to help those members get the best care possible.

Kirk Czonstka (28:47):

Yeah. Thanks for sharing. I'm going to put you on the spot there a little bit. Alright. Sounds like the second question here might be a little bit meatier. I know this table seemed to focus on the second one. Who wants to share out around incentives that are most effective at actually getting people to change behavior? Who wants to start?

Audience Member 11 (29:06):

We were talking about ways to bring in more community with your employees. So doing things like trying to find more healthy means. We started talking a lot about how there are a lot of additives and foods that attribute often to health issues. And if we could do things with our teams like, Hey, on the afternoons on Fridays, we're going to have everybody bring in one item that's non additive food that they make at home. I like to make my own dough with selina flour. That's natural and stuff like that. Doing stuff like that and having educational meetings with our teams on ways that we could cook more holistically, have more holistic options that help us not have to be on long-term medications sometimes for things that we need to treatment with.

Kirk Czonstka (29:58):

I love that. I love that. Food as medicine, preventive food as medicine. Right. Very cool. Who else? Let's got one more table to share

Presenter (30:12):

Please. Somebody share. I'm going to go stick this microphone in your face. Okay, there we go.

Audience Member 12 (30:19):

Thanks, Joe. So I think a lot of employers are hesitant to try to tell employees what to do, but at the end of the day, most employees in our system is complicated and we're ignorant. Everything from copays and co-insurance and deductibles. And so a lot of people don't know, don't have information to make informed decisions. And so communication strategies are key and how do you get employees to that question? Number two, you make it more effective from a cost standpoint. So can we lower your deductibles or can we make something free if you do this? And so when you want to help employees choose better, that seems to be the easiest way to do it.

Kirk Czonstka (31:17):

Thanks Joe. Yeah. We've found with our own research that if you're talking about a financial incentive, it takes about a thousand dollars an offer of about a thousand dollars to ultimately influence people's decisions on where they access care. So I want to just close a little bit with, obviously we're talking questions around transparency and cost reduction and quality improvement. We talked a little bit about the idea that the individual doctor is really the most important decision that somebody could be making. We've actually been able to identify within our data, if we can get somebody to see one of the top 20% of doctors in their network, in their geography, regardless of the type of care need, it's not a negligible savings impact. Number one, those doctors are diagnosing more accurately the first time they're seeing fewer readmissions. They're sending people to much more appropriate and efficient sites of care.

(32:05):

So instead of sending somebody down the hall for an inpatient MRI, they're more likely to show patterns and claim data to send them to freestanding MRI clinics that are a quarter of the cost that they otherwise would be. So we really look at ourselves. I imagine many of, you're probably not familiar with us right now. We are what we consider to be a simple plan edition. So Garner has sort of deployed what I think is a pretty novel approach where regardless of the size of an organization, regardless of whether the group is fully insured or self-funded, we layer on right on top of the existing carrier, right on top of the existing network and right on top of the existing plan design. And the whole idea is let's make it easy using some really accurate and comprehensive data analytics to find who are the best doctors in their geography in their existing network, and then let's get them to use those doctors by reimbursing their out-of-pocket expenses if they go to see a doctor that garner recommends their network.

(32:57):

So the whole idea is if I need to go see a knee doctor because I have knee pain, I use Garner to find care who the recommended knee doctors are in my geography. If I have an office visit cost share, if I get sent for pain medication, if I have to do physical therapy, x-rays, surgery, you name it, we know that those doctors are more likely to practice more optimal care patterns and reduce the total cost of care. So let's reimburse the member for those out-of-pocket expenses if they're going to doctors that have truly based on data-driven insights demonstrated that they can save money over time from a quality and a process from perspective. So I think it's a pretty cool way to create a win-win solution win for the employee because they're getting their out-of-pocket expenses reimbursed up to a certain incentive level that the employer configures themselves with the help of their broker or advisor.

(33:44):

And then there's obviously a clear win from an employer perspective or from a fully insured plan perspective because as we get more and more people to use that information, there's that average 27% savings per episode too, I think is really, really remarkable is that it's very impactful in terms of how we help people out from a condition perspective too, because we're looking at every single subspecialty of care that somebody would seek throughout the year with the exception of a true emergency. It could be largely impactful on a number of different specific conditions and problems that people have as well. So just a few sort of listed out here, myself, Jared, Connor, were in the other room, would love to talk to you more about what Garner's doing and just really appreciate the good activity and collaboration today. And hopefully you got a chance to meet some new people over the last couple of minutes too. So thanks so much.