Jim Skogsbergh 0:03
You’re going to see us making some investments in health-related businesses all designed to make us a destination health company. That you don’t look to us just for hospital services or just for doctor services or just for home care services, but look to us for all your healthcare needs.
Gary Bisbee 0:21
That was Jim Skogsbergh, President and CEO Advocate Aurora Health discussing the fact that despite the COVID crisis Advocate Aurora is continuing on its strategic path of transforming the core, placing the consumer first, and providing services for the whole person’s health. I’m Gary Bisbee and this is Fireside Chat. The newly merged Advocate Aurora Health is two and one half years old and COVID has been present for six months or 20% of that time. Jim believes that responding to COVID has brought both organizations and the 75,000 employees and staff closer together. Jim and the Advocate Aurora board believed it was important to respond to COVID in a considered manner and not overreact in the short term. As Jim said, he did not want to solve for June and change the approach in July. Jim emphasized the importance of scale in Advocate Aurora’s response to COVID and his long held belief in the benefits of consolidation. Let’s listen.
Jim Skogsbergh 1:21
All those things have to result in improved performance. It’s not just getting big for bigness sake. If you can’t execute around the scale, then it does you no good and in some cases might be an anchor that you’ve gotta be careful of. But we are proponents of the scale argument. I have a long believed in this industry we spend way too much time fighting among ourselves. We should be working together. There are other people that we could be competing with rather than ourselves. I’m a big believer in stronger together.
Gary Bisbee 1:47
Jim provided his thoughts about the characteristics of leaders in a crisis and his pride in the leadership displayed by the Advocate Aurora employees and staff. He spoke about the importance of health equity as follows.
Jim Skogsbergh 2:00
We’ve made health equity a strategic priority. I guarantee you, Gary. It is the topic of conversation at our board meetings, THE topic of conversation at our board meetings. So it occupies a lot of time and energy and we are putting resources and time, energy around it and frankly, some structure and a process. We’re big on trying to address those social determinants of health. You’re going to hear a lot more about it from us in ’21 and beyond.
Gary Bisbee 2:27
I’m delighted to welcome Jim Skogsbergh to the microphone. Good afternoon, Jim and welcome.
Jim Skogsbergh 2:36
Hey, thanks Gary. Great to be with you. Looking forward to the conversation.
Gary Bisbee 2:38
Well, we’re pleased to have you at this microphone. Let’s start by learning about Advocate Aurora Health, particularly what’s changed since the COVID crisis and then discuss longer term effects of COVID on large health systems and consumers, and wrap up with your view of leadership in a crisis. Looking back six months ago, what’s been the major impacts from the COVID outbreak on Advocate Aurora Health, Jim?
Jim Skogsbergh 3:02
Yeah, well, gosh, Gary, where to start. Keep in mind that Advocate Aurora Health’s only about two and a half years old. So six months of that two and a half years has been COVID and I’ve told others that our organization sort of entered into COVID with the newly merged entity striving very hard to become one and doing all those things that are appropriate and necessary to integrate and moving along very nicely. But boy, COVID has certainly accelerated it. If we went into COVID with two organizations striving to become one, we come out of COVID as one very strong, cohesive organization. So super proud of the 75,000 team members and the medical community affiliated with Advocate Aurora Health.
Financially it’s been quite challenging for us like it has for almost every provider in the country. But our reactivation work has been successful so we’re building that backup. And 2020 we sort of have written off financially. We’ll incur a loss, but we intend to bounce back strong and ’21 and it looks like we’re on a path to do that.
Some of the major impacts that we’ve experienced, like every one of my colleagues, the acceleration and the use of virtual health has been amazing. I think we did our 700,000 virtual health visit about four days ago. We crossed that 700,000 number. Remote work is something we’d never really played with before and now it’s become part of our lingo and we think that remote work is going to stay with us. We like the idea of reducing our real estate footprint. We have surveyed our own people who have a 75% favorable response to remote work and we haven’t seen any diminution in efficiency or effectiveness so we think that’s here to stay to a certain extent.
We also understand and I have gained a greater appreciation for the need for a very flexible workforce. What I mean by that, Gary, is when you hire like team members for environmental services, that are also able and willing to do patient transport. When you hire OR nurses or recovery room nurses that are also able to work med-surg units, because we’ve had to do a lot of that during COVID. So it pointed out or identified very clearly that need and so we’re going to be acting on that for a more flexible workforce.
Who can talk about COVID and not talk about PPE, right? And I would say that prior to COVID, we were one of those that were very proud of our just-in-time inventory and we’ve realized that there is a downside to a just-in-time inventory. And so we are building up some onsite capabilities, particularly with personal protective equipment. And so we’re going to approach our supply and particularly PPE supply in a very different way as a result of our learnings. But I couldn’t be more proud of our team members and our medical community and the way we’ve responded and handled this COVID crisis. And that’s one of the reasons that we’ll see our way out of this thing. We’ve always been strong financially. We knew we could take a punch from a fiscal point of view and 2020 has dealt us a blow, without a doubt, but we’re going to put that behind us, recover, and bounce back in ’21.
Gary Bisbee 5:59
Jim, how do you think about the next three years in strategic opportunities relative to your existing plan. Are you going to have to change your strategic plan?
Jim Skogsbergh 6:09
We have spent a lot of time talking about our strategic direction and right now the current thinking is that we don’t anticipate changing our strategic direction at all. Now the pace of things might change. COVID has certainly slowed down some things. We’ve had to push pause on a number of things, but we still believe that our strategic direction is sound and appropriate because fundamentally we think the healthcare industry is still moving in the same direction. The pandemic has created quite a flurry of activity. So Gary, for us, Advocate Aurora Health, we’ve really got three main pillars to our strategy. One is what we call transform the core. The simple version of that is we really believe we’re going to have to make changes to our core business if we’re going to achieve the results that we desire – top decile health outcomes, zero serious safety events, making healthcare more affordable – all those things are going to require a transformation. And so we’re continuing to work on that. Becoming more consumer-focused, we call it a consumer-first focus and that’s getting much closer to our patients and to our consumers and providing healthcare, what they need, when they need it, where they want it, how they want it. I mean, a much more focused effort around consumer wants and needs as opposed to our own. That, hey, this schedule doesn’t work good for me, but we got to start asking the question, does it work good for our patients, for their family members, for our consumers. And then the third piece is becoming a little bit more of what we call a whole-person health company, which means moving into some health-related kinds of businesses that maybe have not really been on our radar screen before. Examples of that, we’re part of the Civica RX activity with some other health systems around the country, around pharmaceuticals. We’re going to participate in the purchase of a PPE supply company that’s domiciled here in the States. You’re going to see us making some investments in health-related businesses all designed to make us a destination health company. That you don’t look to us just for hospital services or just for doctor services or just for home care services, but look to us for all your healthcare needs. And we think that direction is still sound. The pace of change might be different, but the overall direction, I don’t think you’re going to see a significant deviation for Advocate Aurora Health.
Gary Bisbee 8:28
You spoke about investments, which brings up the balance sheet. How is the balance sheet after this hit from COVID?
Jim Skogsbergh 8:34
Well, if you talk to Dominic Nakis our chief financial officer. I’m sort of tongue in cheek here, but the funds that we’ve received from the federal government, some of which we’re going to be paying back clearly, but our cash balance probably has never been stronger right now, but it’s got to get paid back. Gary, we went into this pretty darn strong and we’ll come out of this slightly less strong, to be honest with you, but nothing of great concern. To be honest with you, we’ve been a little bit relieved with the recovery that we’ve had. Once we opened up the services, patients started coming back and they continue to come back. We’ve been at somewhere between, oh it varies between 105% and 93% of our pre-COVID targets and it continues to get better. That’s one of the reasons, Gary, that we did not make any big moves when COVID hit. I know a lot of my colleagues pulled some levers pretty quick, and I’m really talking about reducing the workforce, making staffing changes, cutting back on a number of things. With respect to our team members, we furloughed people, but we furloughed them with full pay and benefits. We enhanced our benefits, paid time off benefit where people could cash out more and we also allowed people to go negative balance on their PTO. We’ve enhanced our benefit around family care, mostly daycare. We provided benefits for lodging for those folks that didn’t want to go home and possibly expose their family to the virus. We provided a merit increase in 2020. We kept our 401k match in 2020. Because we could, we did everything we could to continue to be great employer. And I don’t say that with any criticism about others, because we all do what we gotta do, right? And there are some folks that absolutely needed to pull some levers and make some changes.
I got to tell you, we really wanted to let the dust settle. I never wanted to solve for June and then have to come back again and solve for July. I wanted to let the dust settle and then see if our businesses fundamentally changed and then make the changes that are going to be required. So we may still make some adjustments, but when we do, we’ll be careful and thoughtful about them and they’ll make a lot of sense, ultimately.
Gary Bisbee 10:43
So Jim, in terms of supply chain, you laid out some steps about a more reliable supply chain for Advocate Aurora Health, and producing PPE in the US may be more expensive under the plans you’re talking about. Will payers such as governments, employers, and consumers be willing to pay more because it’s going to cost you more?
Jim Skogsbergh 11:03
You’re right, we’re kind of anxious about that. We certainly hope all of those groups you talked about will see that our efforts translate into value through quality and safe care. We’re currently working with FEMA and others to recoup some of the costs incurred during the first wave of COVID. And we certainly elected as an organization to spend the necessary dollars to secure critical inventories and I believe we’ve done that. So we never ever ran out and we just kept building and building and building. The reimbursement is a big piece of the next body of work to be done about having these folks recognize the importance. So I think all of us are anxious to find out how the payers and the government are going to look at this. Nobody would argue with the importance of having those supplies on hand, that’s been made very, very clear. But then the test becomes, are you willing to pay for it? And we shall see.
Gary Bisbee 11:55
Part of the followup on that one is the role of the federal government, GPOs, and health systems regarding PPE stockpiles, for example. How do you cut through that one, Jim?
Jim Skogsbergh 12:06
Well, I think we all have a role to play in preparing and executing during times of crisis, right? Everybody’s got a role to play. Our role is to always provide our communities with quality care and a safe environment. And that’s safe for our patients and for our team members. So we leveraged GPO to extend our influence across the entire supplier community and make connections with suppliers that we previously had never done business with. And the federal government helped clear the path for imported goods from overseas and coordinated a disbursement of national stockpiles, potentially some cost-sharing through FEMA. We plan to be ready with our own appropriate levels of stockpiling to fulfill that promise, but yeah, absolutely, we’ve all got a role to play and preparing and executing during times of crisis, and government and GPOs, and health systems all have their special role.
Gary Bisbee: [00:12:55]
So here’s another question. It seems like COVID has accelerated the timeline for decision making for many of our health systems – pharma, suppliers. Will the increased pace of decision-making continue, do you think, or ease back to pre-COVID levels?
Jim Skogsbergh 13:10
I don’t see any of that going back. I don’t think you can put that genie back in the bottle. I mean, increased speed of decision making is probably here to stay. And even if it wasn’t COVID, it’d been something else that would have caused us to recognize that the marketplace is unforgiving, right? And so I do think there is value to these kinds of crises, narrowing our priorities. It forces us to be crystal clear about what’s important. I think there’s some beauty in that, this notion of clarity around what’s important, what’s a priority, what do you value most highly? And so there’s some good stuff that can come out of that, but the notion of decision making, accelerated timeline for decision making, I think is here to stay.
I also want to say this, Gary, that I don’t think accelerated time frames for decision-making means so fast that you crash and burn. Accelerated does not mean out of control, and we’ve never felt that way. You always sort of feel like you’re a little bit under the gun, but you also know that you need to be thoughtful and careful in your decision making. And so speeding that up is not a bad thing, but you can still be thoughtful and careful even though you, you speed it up. So that’s what we’re trying to do. We’re trying to thread that needle here at Advocate Aurora.
Gary Bisbee 14:26
So you spoke about personalization, virtualization. Telehealth usage at Advocate Aurora I’m sure exploded like it did at many other health systems. How do you see your medical staff and the consumers accepting that on a go-forward basis?
Jim Skogsbergh 14:42
Again, it’s an overused term, but I don’t, I think that’s another genie that you’re not going to put back in the bottle. So I do think that the use of telehealth and virtual visits is here to stay. We know our patients have responded very well to it. But Gary, as you and I both know, there are some things that absolutely lend themselves to, if you will, a virtual visit. There are other things you must be in front of a physician, right? You, you must be in person. And that’s just good quality care. So we think it’s that balance of finding out how people want to interact with our delivery system. What do they prefer? What’s their preferred mode or method? And then meeting their needs, meeting them where they are.
So you’re going to see us continue to do virtual visits and we’ll continue to have face-to-face interactions as well. I don’t think it’s going to go back to pre-COVID, but I also don’t think it’s necessarily going to stay at the height that it was during the time, because that was a rather forced environment. If you’re going to interact with your physician, you will do it this way. And now you’ve got a choice to come back.
Gary Bisbee 15:46
What do you think about insurance companies and paying for virtual visits or televisits?
Jim Skogsbergh 15:53
This is a question that we’re asking ourselves all the time. I am hopeful that the payers will recognize the value of these virtual visits and see benefit from these virtual visits. But I will share with you, Gary, that I’m concerned that some of them will not. And then we find ourselves in that age-old struggle between the payers and the providers of what’s in the best interest of the patient and how you provide that care in a manner that’s economically feasible for the provider and the patient and the insurer. And these are struggles that we’ve had in this industry forever. And I see this as one more arena where there may have to be some additional struggle. I wish that wasn’t the case. I wish everybody would just embrace the value of these virtual visits, the ability to improve access, get them the care they need as soon as possible, and that there’s value in that. But I suspect not everybody will see it.
Gary Bisbee 16:53
Yup. For sure. Well, do you think that virtual visits will open a door to more competition for health systems?
Jim Skogsbergh 17:02
I do see that as, and I think we’re already beginning to see it, where other companies are giving 800 numbers or allowing people to dial in. And I do believe that there’ll be greater competition through this venue than just those of us that have traditionally been in the business. So you’d better get sharp, you’d better do it right. You’re proving your value every single day. And if you fail to, I think there’ll be lots of others that would like to step in and say, “Hey, if these folks didn’t meet your needs, try us because we will.” So I see increased competition for sure.
Gary Bisbee 17:35
Well, you’ve been a proponent turning to consolidation now of Advocate Aurora Health continuing to grow. How do your colleagues across the country view it? Do you think that we’ll see more focus on consolidation over the next several years?
Jim Skogsbergh 17:49
I think without a doubt we’re going to continue to see consolidation. I just think that’s a road that everybody’s going to walk down at some point in time. When they see the writing on the wall in a similar fashion that we do. I think there are so many positives that are associated with, the keyword here is, effectively executing scale. I think the COVID crisis brought that out. Put it this way, Gary, the way I’ve described this to some folks is, I said, “Does anybody believe that we could have done the things that we did during COVID if we were just Advocate Health Care or just Aurora Health Care?” There’s no way we could have done that. There’s no way we would have furloughed everybody at full pay and benefits. We would not have been able to do that, right? So I just think when you’re talking about risk mitigation or you’re talking about enhanced access to capital and liquidity, you’re talking about reducing costs, whether that be supply chain or back-office functions, you talk about political advocacy, you talk about talent acquisition. I mean, I just scale, scale, scale, scale. All those things have to result in improved performance. It’s not just getting big for bigness sake. If you can’t execute around the scale then it does you no good and in some cases might be an anchor that you gotta be careful of. But we are proponents of the scale argument. I have long believed in this industry we spend way too much time fighting among ourselves. We should be working together. There are other people that we could be competing with rather than ourselves. I’m a big believer in stronger together.
Gary Bisbee 19:24
Thinking about the role of the government, it seems like the COVID crisis is going to accelerate the government’s role as payer. I think we’re up to 75 or 80 million Medicaid recipients now, for example. Do you think that Medicaid will in effect become the new floor for health coverage?
Jim Skogsbergh 19:42
I wouldn’t be betting no. We’ve all talked about Medicare reimbursement. And when you refer to reimbursement as X percent of Medicare it kind of tells you what the basis is, right? What the denominator is. And you’re asking, is the same thing going to happen with Medicaid as more and more people enter into that payer group. We’re already challenged financially as a nation. I think this will only add to the challenges. So it’s very conceivable that at a minimum Medicare becomes the baseline, but Medicaid could also become the baseline as well.
Gary Bisbee 20:14
When you think about it now, I think the average across our largest health systems is roughly 55% of their revenue now comes from governments, which is primarily Medicare and Medicaid. Yeah, half the baby boomers aren’t even 65 yet. We’re seeing this huge spike of people on Medicaid. So you could think that 55% might be 65 or 70% by the end of the decade. What do you think that means to our health systems in terms of challenges or opportunities?
Jim Skogsbergh 20:44
Well, tremendous challenges financially. I mean if there’s a case to be made for transformation, I think there it is right there because this is sort of a math exercise. We all can do the math and we’re all going to see how many people qualify, the aging of America, the trend in the growth of Medicaid. So you can make some projections out there and model it and you’re going to realize, wow, we have got to change our cost structure, without a doubt. So tremendous challenges. Now, the aging of America is also an opportunity. Opportunities for us to better meet needs, better serve, to deliver care in venues we’ve never done before or never considered before. So I think we will see both opportunities and challenges. I think the biggest challenge of course is financial. And the biggest opportunity is to serve the needs of a growing number of Americans.
Gary Bisbee 21:35
Let’s think about integrating healthcare delivery and financing. What’s been Advocate Aurora’s experience working with health plans, health insurers?
Jim Skogsbergh 21:45
We’re big proponents of partnerships. I do believe the financing mechanism is an important part of our future. We’d like to do that with our existing partners. But you know, you’ve got to structure win-win circumstances, can’t be a win-lose. And so we’re very hopeful that we can take risks, accept risk, but doing it in a partnership with the insurers and the payers. I think we’re all going to be called to provide that capability. If you want to meet people where they are or meet people’s needs, I think that’s gotta be one of the arrows in your quiver, right? You’re going to have to have that ability. And so we want to create it and we already have, in some situations, we’ve got a variety of those. But I think you’re going to see us continue to push for those kinds of partnerships so that we can provide both the financing and the delivery capability.
Gary Bisbee 22:34
It’s now evident that public health is part of the national security. How do you think about that, Jim?
Jim Skogsbergh 22:40
Gary, I gotta tell ya. I’m kind of still thinking about it. I think we’re all trying to figure out. Where does CDC come in and some of these other key federal agencies, Food and Drug Administration, National Institutes of Health? It’s awfully easy to sit back and poke holes in how this country has responded, right? But on some days I would simply say, let Dr. Fauci become the czar and whatever he says, let’s go do. I kind of lean, lean in that direction. But let’s acknowledge it is a very complex, very complicated. If we’re not funding these agencies properly, we’re going to get caught some time. So it requires consistent funding. It requires consistent support. I do believe that you mentioned national security, right? So I do believe that battles are fought on the internet now. We know that. And I think battles are going to be fought with agents, whether they be viruses or whatever. So I do think it’s a matter of national security. And it, what will be really interesting is how tolerant, how tolerant we are as a nation with some of the infringements that might come into our daily lives. Well, what do you mean you’re tracking me because I tested positive for COVID, but what do you mean you’re tracking me? I mean, those kinds of questions. And it’s a question of, I think, greater good versus personal freedom. You’ve got to thread that needle because both arguments make a lot of sense, but it’ll be fascinating to see how we solve or resolve those issues. And I, for one, I’m not sure how.
Gary Bisbee 24:14
Well, it’s tough. It’d be good if everybody would wear a mask, that we can move on from there.
Jim Skogsbergh 24:20
Case in point, people that just refuse to wear a mask, like there are still people that think this was a hoax. It’s like, really? You sort of want to ask, “What planet are you on?” This is a worldwide pandemic and it’s frustrating for you to have to wear a mask? Gee, I’m sorry. So yeah, don’t get me started, Gary. I’m, I’m not very tolerant with some of that stuff.
Gary Bisbee 24:41
What about social determinants of health over the last, I guess about five years, we’ve been spending more and more time thinking about that, figuring out how we can deal with that as a health system. Where’s your thinking on that one, Jim?
Jim Skogsbergh 24:56
Again, if you’re trying to make lemonade out of lemons, COVID-19 has certainly exposed some very harsh realities for many of our communities around social determinants of health. And with that, I mean, this has been front and center and it’s pretty hard to argue that they don’t have health disparities. So we think that health care has a significant role to play in achieving health equity. Now, health organizations alone do not have the power to improve all the multiple determinants of health, that’s for sure. But we do have the power to address inequities directly at the point of care. And to impact many of the determinants that create the gaps. So for instance, in Chicagoland, I think we’ve got a recent study that says about 24% of our African American community receive a flu vaccine, forget COVID for a minute, receive a flu vaccine. So for the first time ever, we’re getting in mobile vans. We’re going to get in mobile vans and we’re going out in these communities and we’re providing flu vaccinations, right? Now, will that alone solve the problem? No, but like we talked about earlier, if everybody has a part to play and everybody steps up, we think we have the ability to put a dent in some of these gaps. And that’s exactly what we intend to do. So we’ve made health equity a strategic priority. I guarantee you, Gary, it is the topic of conversation at our board meetings, THE topic of conversation at our board meetings. So it occupies a lot of time and energy and we are putting resources and time, energy around it and frankly, some structure and a process. We’re big on trying to address those social determinants of health. You’re going to hear a lot more about it from us in ’21 and beyond.
Gary Bisbee 26:37
Jim, this has been a terrific interview, as expected by the way. If I could, I’d like to ask a couple of questions about leadership. One being, what are the most important characteristics of a leader during a crisis?
Jim Skogsbergh 26:49
Communication, communication, communication. We have a phrase here. I stole it and it’s caught on like wildfire. “Calm over chaos, faith over fear.” And we use it all the time. And I do think that part of the role of a leader is to model and conduct him or herself in a way that sends a message that we’re going to be fine. We’re going to be fine. Yeah, this is very challenging, very difficult it’s not without its pain and suffering, but we’re going to see our way through this, and here’s the plan to see it through. I’ve spent most of my time simply in communication throughout the organization, reinforcing messages, talking about the pivots that we’re making, and why we’re making them, explaining the challenges that we have. Our big focus is why. Make sure you’re nailing the why. I believe that this COVID crisis has heightened the importance of clear, concise, frequent communication, and that’s something we’ve been working on. And then Gary, my gosh, the list goes on and on. I mean, man, if you’re not developing talent, you don’t have a talented team to do the work you’re in a world of hurt, right? So talent development and teamwork, making sure that everybody’s weighing in and utilizing people, sort of what we call at the top of their license, right? And I don’t mean just clinical folks. I’m talking about everybody sort of at the top of their license. Two heads are better than one, three heads are better than two. So we focused a lot on that and it’s been fascinating to see how some people step up and then also on occasion discover that not everybody was cut out for these kinds of stressful or challenging times because this stuff is revealing, right? It does reveal character and substance and courage and all those things that you want from your leaders, which is one of the reasons I’ve been so encouraged about our 75,000. We’ve got folks who run to the fire, not run away but run to it.
Gary Bisbee 28:38
Final question, Jim. How’s the COVID crisis changed you as a leader and a family member?
Jim Skogsbergh 28:44
I don’t think you can look at this kind of pandemic and see the many, many sad stories of death and not appreciate how blessed you are, right? So I think it’s in me, it’s sorta, uh, allowed me to develop even a, a larger heart of gratitude or greater repository of gratitude and acknowledging how very, very fortunate I am and members of my family how blessed we are. And just acknowledging the blessing, right? I think that’s a little more mindful about that. A little more aware of that. As a leader, we’ve kind of chatted about those things, the importance of communication, making yourself, if you will, more vulnerable, allowing yourself to become more vulnerable, to share with people this is what you think and this is why you think it, and this is the direction you believe we should go, this is why you think we should go in this direction. Acknowledging the deficiencies in the organization, when you identify, now I’m moving on from sort of COVID to racism that’s so obvious in our nation. We’ve, I’ve early on, talked about the fact that we have not one pandemic, but two. You know, we’re fighting a COVID pandemic. We’re also fighting the pandemic of racism. One’s existed about six months and one’s existed since this nation was born and we’re fighting both. And I would argue that we haven’t fought very hard on the one for a long, long, long time. And now we have more and more people sort of joining the fight. And I think that’s a good thing. It’s very painful, very difficult, but I think we’re moving in the right direction. At least we’re trying hard to do that at Advocate Aurora Health. We’re just trying to make our corner of the world a little bit better and by so doing, perhaps making our neighborhoods and our communities a little bit better as well. Those are some thoughts. That’s a great question, Gary, deserves a more thoughtful response.
Gary Bisbee 30:26
I thought it was quite thoughtful and well said. Well done. Jim, we appreciate your role as a leader for the whole healthcare field, so well done.
Jim Skogsbergh 30:35
Gary Bisbee 30:36
This episode of Fireside Chat is produced by Strafire. Please subscribe to Fireside Chat on Apple Podcasts or wherever you’re listening right now. Be sure to rate and review Fireside Chat so we can continue to explore key issues with innovative and dynamic healthcare leaders. In addition to subscribing and rating, we have found that podcasts are known through word of mouth. We appreciate your spreading the word to friends or those who might be interested. Fireside Chat is brought to you from our nation’s capital in Washington, DC where we explore the intersection of healthcare politics, financing, and delivery. For additional perspectives on health policy and leadership read my weekly blog Bisbee’s Brief. For questions and suggestions about Fireside Chat contact me through our website firesidechatpodcast.com or firstname.lastname@example.org. Thanks for listening.