Whether you were in Boston at #HLTH2021 or you’re wishing you’d been able to eavesdrop on what was being said by your colleagues in the halls between sessions, this is one episode you won’t want to miss!

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In this episode you’ll discover:

• Why Medicare is banking on 100% beneficiary participation in value-based care models by 2030

• How the government is turning “payer-agnostic” on value-based care models by partnering with commercial payers and Medicaid

• Why you’ll be glad this White House is reinvigorating CMS’s Health Care Payment Learning and Action Network (LAN)

• Why providers and tech companies are embracing Full Risk Contracts and Payment Models

• Why “Virtual Care is replacing “telemedicine” as the new umbrella term—and how it helps companies meet patients where they are

• Why failure to adopt value-based care models could be an existential threat

• What everyone is saying about RPM, RTM and care management

Learn more from Carrie and Rebecca: 

Healthcare insights (monthly email) | Telehealth/Virtual Care Mgmt Update (biweekly LinkedIn update)

Website | Carrie on LinkedIn | Rebecca on LinkedIn | NGL on LinkedIn

Read the transcript here:

Rebecca Gwilt (00:00):

Failure to adopt value-based care models. Failure to adopt technology, failure to orient yourself toward the patient is actually an existential threat. We heard that from one of the panelists while we are here,

Speaker 2 (00:13):

You're listening to Decoding Healthcare Innovation with Carrie Nixon and Rebecca Gwilt, A podcast for novel and disruptive business leaders seeking to transform how we receive and experience healthcare.

Carrie Nixon (00:26):

Hi everyone. It's Carrie and Rebecca coming to you from HLTH 2021, and we are here to give you some of our hot takes from the conference. Rebecca, have you had a good time so far?

Rebecca Gwilt (00:36):

I've had an amazing time so far, Carrie. This is a bananas conference. You can tell there's a lot of pent up energy. Everybody's so excited to get back in person and see each other at the same time. They've done a tremendous job here, making sure everybody feels safe, making sure that we are fed and watered and all the things that humans need. I'm super glad to be here and I'm glad to be here with you personally, live, Carrie. We rarely sit next to each other for these podcasts.

Carrie Nixon (01:06):

It's very exciting. It's very exciting. But no, I will join you in giving kudos to the team at HLTH. They have really rocked this conference. It's spectacular. It's fun. It's well organized and best of all, they had puppies a check-in.

Rebecca Gwilt (01:22):

They did have puppies.

Carrie Nixon (01:22):

To make everyone happy while they were waiting for their covid testing.

Rebecca Gwilt (01:26):

I was really surprised. They also have a salon here,

Carrie Nixon (01:30):

A salon.

Rebecca Gwilt (01:31):

You can get your haired,

Carrie Nixon (01:33):

You can get

Rebecca Gwilt (01:35):

Your face put on.

Carrie Nixon (01:37):

We have not done that, hence, you are not seeing us on video today,

Rebecca Gwilt (01:41):

Right? That's right. That's right. We're here for business folks. All business. All right. The other thing, wait a minute. One more thing I would like to say in kudos to the health folks is this is the most female friendly conference that I have ever been to. Absolutely. It's been tremendous, the effort and intentionality of making sure that the panels are balanced, making sure that there are events connecting senior female leaders in the space with other folks providing encouragement and fellowship. And it has been, I have have enjoyed all of the events here, but in particular have been struck by again, the intentionality with which they designed things for supporting women in tech, women in the life sciences. It, it's just been tremendous

Carrie Nixon (02:30):

Diverse voices and faces across all panels. Very much appreciated and much needed. Yeah. All right. So let's get to our hot take.

Rebecca Gwilt (02:40):

Let's do it.

Carrie Nixon (02:41):

We're going to start with value-based care. Liz Fowler from the Center for Medicare and Medicaid Innovation made a few announcements at the conference today, and in particular, she announced the goal of 100% of Medicare beneficiaries participating in a value-based care model by 2030. It's a pretty audacious goal. Sure. We've made good progress though thus far since the value-based care and delivery models first started. I think we're at 30 some percent now of beneficiaries.

Rebecca Gwilt (03:17):

Yeah. I think 30 percent's the right number, and what's exciting is we haven't seen probably all of the APMs or alternative payment models that are going to come out. Carrie and I actually started the firm back in the old days of the MSSP ACO program and certainly there have been innovative models coming out of CMMI since then, but it really sounded from what Liz was saying, that they were going to really be putting energy behind this and creating new models that maybe even will improve upon the models that exist today.

Carrie Nixon (03:45):

Yeah, they mentioned the next Gen ACOs as kind of a favorite and one that has done really well. One thing that struck me was that she specifically referenced partnering with commercial payers and with Medicaid on these value-based models so that they are basically payer agnostic, and that means that providers don't have to worry as much about who is the payer for this particular patient. Right. If they are more collaborative and the models are payer agnostic, that's going to be better for providers and it's going to be better for patients. She mentioned sort of reinvigorating the HCP land. I forget what that acronym,

Rebecca Gwilt (04:29):

Learning and Action Network.

Carrie Nixon (04:29):

It's the Learning and Action Network. I think. Oh, don't Healthcare Providers Learning and Action Network, but it's really a public-private partnership that does at least an annual conference. They may have even started out doing twice a year, and I found it to actually be one of the most substantive conferences on value-based care models hearing directly from the folks at cms, CMS listening directly to some of the stakeholders in the spaces. It died off a bit during the last administration but I was really pleased to hear the announcement that they're going to reinvigorate that because bringing those players to the table is going to be really important if they're going to create partnerships with payers across the spectrum.

Rebecca Gwilt (05:12):

Yeah. I think in general, one of the coolest things that I've heard while was I've been here is Micky Tripathi, who is the current national coordinator and Dan Brillman, who's the CEO of Unite Us. Talking about, again, with intentionality, the importance of the partnership between the federal government and industry as they try to regulate around really complex technologies and payment models across the spectrum of a ton of different kinds of providers that this concept that it is not only better for industry to be engaged with government so they know what's coming down the pike so that they can stay out of trouble maybe even influence things to their benefit, to their business benefit. But to hear somebody in government, and again, Micky spent 20 years in the private sector, so I think he gets this, but to hear somebody in government say, Hey, actually the way to make our policies smart to make our policies actionable by industry so that they actually create the kind of change we're trying to create. We need private industry at the table and it's a thread that I'm starting to see that honestly, when I was in government, I didn't really see private industry was sort of the people knocking at the door interfering with our jobs. I, I'm really seeing that start to change which is really exciting actually.

Carrie Nixon (06:36):

Hugely important. Hugely important. Full risk contracts. Full risk models.

Rebecca Gwilt (06:42):

Yeah. I mean, we've seen this is true alignment in value-based care, right? Yeah. This is your patient population, take care of them for X amount of money, and if you can take care of them for less and maintain quality, that is a great upside for you. The surprising thing that I am learning here at the conference is the breadth of providers who are willing to engage in these full risk contracts.

Carrie Nixon (07:10):

A hundred percent. I have not heard ever before anyone saying, yes, let's go full risk. Yes, let's do these capitated models. Yes. It's a huge sea change,

Rebecca Gwilt (07:20):

And not just folks that are sort of used to managing patient populations across the care spectrum. We're seeing tech companies, tech companies who have developed their own primary care offering saying, Hey, Aetna I am really good at this. Give me your sickest patients. Give me your patients that have this disease state. Give me your patients that need this elevated level of care and pay me a flat rate. I'm going to take on the risk. I'm going to do a great job because I have educated myself and I'm using these tools, and I understand the data mean. These are companies that you guys would know in the marketplace as direct to consumer brands that are saying, actually, we've figured out because of all the data we've collected, going direct to consumer, that we understand better than some of the more established providers in the country how to take full risk and were ready to do it.

Carrie Nixon (08:21):

Well, and not only that, but I literally heard Roy Schoenberg of Amwell saying that full risk contracts, global payments are the means of removing the shackles of innovation in healthcare, which I thought was super powerful, was really striking. Very, very powerful. So I think that what we're observing is a real recognition that digital health and virtual care are going to be key to value-based care and delivery models to making them a success.

Rebecca Gwilt (08:53):

Yeah, absolutely.

Carrie Nixon (08:56):

So let's turn to virtual care specifically for moment

Rebecca Gwilt (08:59):

Virtual care. I don't know anything,

Carrie Nixon (09:01):

Haha, nothing about virtual care. Yeah, so it's actually wondering whether we're just going to start using that term as the broad umbrella. It used to be telehealth was the umbrella for this type of thing. That was the term that everyone used, but now I think it's really more virtual care. Telehealth is absolutely a component of that

Rebecca Gwilt (09:22):

Or virtual first. We're hearing virtual first a lot about hybrid models but all these hybrid meaning partially brick and mortar, telemedicine, traditional, or sorry, brick and mortar healthcare delivery in person and telemedicine, but all of the hybrid hybrid companies that we're seeing all have virtual front doors. Absolutely. So this is sort of absolutely a virtual first model, and over the last couple of months including while we're at this conference, that has been what we're hearing over and over.

Carrie Nixon (09:52):

Yeah, absolutely. And someone on a panel today talked about three categories of care in-office care as we have typically experienced. Synchronous virtual care, synchronous telehealth generally, and then asynchronous care that are all going to play incredibly important roles just in the delivery of healthcare overall. That is going to be the definition of the delivery of healthcare, those three things. It's no longer just in-person care.

Rebecca Gwilt (10:23):

Well, and the exciting thing for all of us as individual humans and not companies, is that the reason why this is happening is that everyone is taking in an intensely patient centered approach to this. There is a broad recognition that patients want their care when they want it, how they want it in what manner they want it in, what location they want it. And all of these companies are saying, okay, well how do we do this? Let's forget about how we have traditionally caused people to walk in our doors and say, maybe they need to come in, but maybe they need a telehealth visit, or maybe we need to send a mobile phlebotomist to their house. Right?

Carrie Nixon (11:04):

Yeah. It's much more the attitude of let's meet the patient where they are.

Rebecca Gwilt (11:07):

Exactly. Exactly.

Carrie Nixon (11:08):

Which I think is really neat. It's really neat

Rebecca Gwilt (11:11):

Here for it.

Carrie Nixon (11:11):

Yeah. So Roy, again, Shoenberg, the CEO of Amwell, said, we were talking about parody in one of these sessions, payment parody, and he said, in actuality, here's the deal. If you are a provider or some kind of a healthcare delivery system and you are not offering telehealth, you're going to be marginalized. You're going to be marginalized. So that's a huge sea change as well. And I, listen, I'm a big proponent of payment parody for sure, but it was an interesting way to look at things. There are perhaps going to be other incentives and other drivers at force for the adoption of adoption of telehealth rather than just sort of payment parody.

Rebecca Gwilt (11:55):

And I'm hearing the same message from I'm seeing the same message from the major VCs in the space. In their opinion failure to adopt value-based care models, failure to adopt technology, failure to orient yourself toward the patient is actually an existential threat. We heard that from one of the panelists while we are here which is

Carrie Nixon (12:19):

I love that language. I love that language.

Rebecca Gwilt (12:22):

It's pretty stark. It's pretty stark.

Carrie Nixon (12:24):

Yeah, for sure. I mean, we've talked about healthcare before on this podcast as an issue of national security, and I think that language that says it all, this is an existential threat. Absolutely. And frankly, I agree. So turning to another component of virtual care, we have heard a lot of buzz about remote monitoring and, but not just RPM

Rebecca Gwilt (12:50):

RTM,

Carrie Nixon (12:50):

as well. For sure. So we've got remote patient monitoring, which has been around for a number of years now or several years now. And now we've got remote therapeutic monitoring where we're actually able to take into account therapy adherence and sort of unphysiologic metrics that are very, very important to the patient care, but are not necessarily captured by a separate peripheral device. And I think the recognition of these therapeutic components as a really critical part of providing care for the patient is a huge step forward. I was really glad to see CCMS propose these new codes in the fee schedule we will see come November, whether how they shake out and how they're finalized, finally adopted. But again, we keep hearing the drumbeat here that this type of virtual care is actually going to be the driver for the shift to value-based care. Absolutely. So it's no longer all about the physician fee schedule and how much on a fee for service basis something is reimbursed. Sort of a bigger picture.

Rebecca Gwilt (14:08):

And it, along with what we heard from was it might have been the CEO of CVS that was speaking who said that home was going to become the mainstream site of care. Yes. If home is the mainstream site of care, then remote monitoring of patients is the primary care delivery mechanism, right? Wouldn't you say?

Carrie Nixon (14:29):

Yeah. Yeah. Absolutely. So I was in a session with Warner Thomas Ochsner Health System, and he said, listen, we are moving to a system where we are actually never discharging a patient. We're never discharging a patient. We're simply changing the care setting and the care itself is going to be continuous care. I mean, that's a pretty amazing concept.

Rebecca Gwilt (14:54):

Yeah we heard that also from the CEO of Mayo Clinic. He said that in the future healthcare hospitals and healthcare systems have, where they're going to be moving from a pipeline model to a platform model where the health system is actually a single platform from which the patients get all of their care in all different ways. It's no longer the case that you have to get somebody to walk in the front door of your hospital in order for your hospital to make good money and manage patient care.

Carrie Nixon (15:26):

Yeah. It's kind of like an aggregator of the different types of services available, virtual in person, urgent, all of that.

Rebecca Gwilt (15:32):

Yeah. I mean, we're going to see, I, I'm excited to see sort of hospital white-labeled solutions.

Carrie Nixon (15:39):

IYes. Yeah. I think that's a direction that we're going to see happening. For sure.

Rebecca Gwilt (15:42):

Well, and they're big enough to take on the risk, right? Yeah. I mean, we are absolutely seeing bold vision from companies who are smaller who are saying, we believe we can take on risk, but the healthcare system has a ton of folks that are not here at HLTH and not plugged into this conversation. And I think very large hospitals and health systems are really going to be drivers of the value-based delivery of healthcare.

Carrie Nixon (16:07):

Totally agree. And Warner from Ochsner again said, think about this notion of care as being a continuous thing that happens throughout, no matter where you are, is going to lead to better care for more patients at a fraction of the cost. And this is going to help address the shortage of healthcare workers and the labor force. It really has ripple effects. Pretty interesting.

Rebecca Gwilt (16:33):

Yes, absolutely. I'm feeling a sense of urgency to move toward what I'm really excited to talk about next.

Carrie Nixon (16:39):

Cool. Do it,

Rebecca Gwilt (16:40):

Which is totally related. This is the fact that hospitals and urgent care companies, they're all talking about how we're going to bring, not just sort of zooming into your home via video, but the actual delivery of hospital level care in the home, right. Digitally enabled home care models that include people walking in the front air of your home to tell you how to use your remote patient monitoring tools mobile phlebotomy and mobile scanning. We heard that dispatch health actually, who I thought was just a mobile ed company or a mobile urgent care rather company, that is not what they are anymore. They're actually, I think they said they're the nation's largest mobile scanning provider. They're acquiring companies that can do full x-rays in the home

Carrie Nixon (17:34):

And basically mobile. What, what's going to turn into mobile ED, right?

Rebecca Gwilt (17:38):

Absolutely. Absolutely. Right. Yeah. And you think, wow, that's super expensive. How do you do that? And there's a couple of ways that we're seeing that people are ideating around that the first is driven by, certainly by the COVID19 crisis which is the government's hospital at home program that 90 different hospitals across the country signed up for that created a waiver that essentially the way I understand it is they essentially pay the same rate that they would pay for the care in the hospital if that care is delivered in the home. And of course, things are very expensive in the hospital setting, high acuity so that makes sense financially. But outside of that waiver model where you're getting part A payments like hospital level part A payments for care in the home, how do you make that make sense?

Carrie Nixon (18:28):

Right? Yeah. That's the question.

Rebecca Gwilt (18:29):

That's the question. And it loops back to value-based care, of course. Right? But it's incredible when you stop thinking about things on a unit by unit basis. Sending a doctor to someone's home is very expensive on a fee for service basis, super expensive. But what if sending somebody into the home prevents a readmission that costs a hundred thousand dollars? Well, maybe it's much cheaper to send nurses into homes. And we're starting to see payers really, really open up around this,

Carrie Nixon (19:01):

Taking the long-term view a much a hundred percent more longitudinal model of care. Absolutely. Let's see, what else do we want to talk about? Pharmacy. You had some great sessions on digital pharmacy. I did, et cetera, et cetera.

Rebecca Gwilt (19:18):

I did one company that knocked my socks off while I was here was Ro.

Carrie Nixon (19:26):

Oh, yeah.

Rebecca Gwilt (19:26):

Melinda Barnes, who I got to meet is lovely and also incredibly smart and a visionary, really. She talked to the audience about how Ro which we know as a direct to consumer sort of med delivery business that they were becoming a patient-centered healthcare system, which I think dropped jaws in the room. I think a lot of people in the industry have been not taking them very seriously, thinking of them as a Instagram direct to consumer small time player, right? Big money, but small time player in the

Carrie Nixon (20:16):

Not really small,

Rebecca Gwilt (20:25):

But when you look at sort of the big problems we're managing across the healthcare system, big costs, very sick people, chronic conditions the percentage of GDP that healthcare is taking up in this country, nobody's thinking like, well, rose probably thinking about that actually. I think they are. Yeah. They've been acquiring companies in the home diagnostic space, in the home health space. They already have their own pharmacy that's delivering generics in many cases, completely outside of the PBM insurance market at lower rates according to Melinda Barnes at lower rates for folks for generics than their local pharmacy can do. And they're doing it delivering to the home, right? They are talking about a true vertically integrated healthcare system that starts virtual first, but they're acquiring physical workers who are going into homes. This is what we're talking about now. It's absolutely incredible. And they're in the pharmacy space. We thought of them as pharmacy.

Carrie Nixon (21:31):

Well, and on that note CVS, Walgreens, Walmart, they are really obviously continuing their push into whole delivery, integrated delivery of care, and really pharmacy first, it's, that's where it coming in. And then not just pharmacy first, but telepharmacy. Very interesting.

Rebecca Gwilt (21:54):

Yeah. I, if you think about which player in the healthcare system you and I see more than anyone else, it's definitely our pharmacist.

Carrie Nixon (22:02):

Sure.

Rebecca Gwilt (22:03):

And if you have multiple chronic conditions and a whole list of medications, your pharmacist plays a fairly significant role in your life. And they know the scope of what many of us think about a pharmacist is much more narrow than what they're actually trained and capable of doing. There are pharmacy companies that are, certainly, Walgreens is certainly partnering with provider organizations. They have Village MD and then CVS has Minute Clinic, but actually the pharmacists are playing a very central role in those companies. And I think, again, payers are starting to realize that those pharmacists have a touchpoint through which they can engage patients. And patient engagement is the holy grail, right? Totally. If you can engage patients to manage their own care, to understand what they can do to keep themselves healthy, you win.

Carrie Nixon (22:57):

Right? And this kind of brings us to another point, right? About data. So it's data not only for payers and not only for providers. It's data for patients that does allow them to actively engage in their care. I think as a general matter, we are seeing a move from a much more reactive approach to healthcare, to a much more proactive approach to healthcare when we have actionable data. And I kept hearing that term actionable. The data has to be actionable. When we have that, it allows us to be proactive. It allows us to be predictive. Super interesting.

Rebecca Gwilt (23:40):

Yeah. I mean, we are certainly seeing a number of payers and providers and tech companies talk about how important risk stratification is to value-based care, right? So in a fee for service system, of course everybody should get rpm, right? Because we make more money the more RPM we do, and is an argument to be made that the more RPM you do, the better the outcomes later on. But does every single person need it? No. We know. Probably not. That's not true. Probably not. So you have to be able to risk stratify your patient population to insert resources where they are needed, where the patient can most benefit from them to the end goal of not just reducing costs, but keeping them better. Yeah. The sicker they are, the more expensive they are for the system. So from a data perspective, the only way you can do that is you have to have good data.

(24:38):

You have to be able to make sense of the data, and you have to be able to present the data in a way that makes sense to the decision makers. And that's where we get to the actionable part. And there are all sorts of ways to screw that up. All <laugh> along the way, bad inputs wrong inputs inconsistent inputs and then a platform that Carrie and I used to go around to these conferences like six or seven years ago, and everybody knew that they were the answer for data analytics. And we would get into these conversations with these companies and realize they've got great, they've got a ton of data. What does it mean? And no one knows, right? This is what to do. This dashboard has the best color scheme. Yeah. Ever. For sure. It was definitely about the color scheme, but what does it mean if I'm a family physician or I'm running an ED, or I'm running an entire hospital system, how do I use this data to make decisions?

(25:32):

Super, super interesting stuff. The other thing I want to bring up is a lot of talk here around the <laugh>, the V1 of interoperability, right? Micky Tripathi said, ingest, we're done. We did it. We did interoperability. Yay. Check. Yeah. Yeah. But actually very thoughtfully said, we are learning new things all of the time. We are focusing on the goal of making sure that data for patients is accessible, and then between providers, because we still do have a siloed healthcare system, and by the way, we need lots of different providers. We need comp competition. We need probably more competition than we have, and we have to have those providers be able to send information back and forth between each other. It's, I don't think the answer is one centralized place where every piece of information is, and that's where everybody has to go but a lot about in about operability the work that has to be done.

(26:31):

Mickyy Tripathi announced a new initiative with CDC and the ONC working on more making the standard measures that they have more robust more useful. And for any of you out there that are in the data management, data enhancement, data harmonization business, these are initiatives that allow private industry to absolutely help set priorities with the government in partnership so that they can hasten whatever their priority project is, but also so that when the government releases these standards, you're not, industry isn't scrambling around going, this makes no sense to me. Why is it this way? We have to rewrite everything.

Carrie Nixon (27:22):

Then we also heard about data as a way of means of achieving another goal that Liz Fowler talked about, which is health equity.

Rebecca Gwilt (27:32):

I love hearing that over and over again.

Carrie Nixon (27:34):

We have heard that a lot during this conference.

Rebecca Gwilt (27:36):

She said, equity is central in every aspect of our work. It was so striking that I wrote it down word for word.

Carrie Nixon (27:42):

Yeah. Yeah, absolutely. And so data obviously has a role to play in that. Decentralized clinical trials, I think also has a role to play in that health equity aspect.

Rebecca Gwilt (27:52):

Yes. Yes. We are so excited about DCT. I mean, it makes a lot of sense. Frankly, I didn't come from a clinical trial background. There are extremely smart people that work with me that have begun to educate me on this, but absolutely. Well, it has to exist. I mean, now that we have the capability of identifying through data, through our data projects, identifying patients who are the best position to serve in clinical trials, to advance our medical knowledge, especially people who are generally not included in clinical trials, right?

Carrie Nixon (28:34):

Right. Absolutely.

Rebecca Gwilt (28:35):

We want diverse groups of participants. We have to have that data to make our solutions more robust. If they live in Cleveland and the trial is going on in LA, why shouldn't they be able to participate?

Carrie Nixon (28:50):

No reason why.

Rebecca Gwilt (28:51):

We have heard stories from individuals in our lives where they said, well, we've had to pack up. We moved.

Carrie Nixon (28:57):

Yeah, we participate in this trial.

Rebecca Gwilt (28:59):

We had to move as a family to participate, to participate in this trial. It's crazy to me. It's crazy. To me, the other thing that's very cool and a little bit futurey, right? Carrie and I spent a lot of time talking about what's the next thing on the horizon? But we don't do a ton of talking about what's 20 and 30 years down the line. I'm going to make that my 2022 resolution. I'm going to, I'm the future. Yes. Okay. Really long term. But one of the things that they were talking about as we were having this conversation about decentralized clinical trials is the digital twin. They didn't use this term but it's what they were talking about. We have a couple of clients who are working on digital twin technology, but essentially this is taking someone from the physical world and making a digital representation of them. And when you're talking about sort of spooky, I know, I know. But when you're talking about clinical trials in particular, what these folks on the stage were saying is at some point, we're going to get such good data about you, Carrie Nixon, about your genetics, about your history, about your makeup, about people you have had similar experiences and have similar makeup that we're going to be able to move through clinical trials without you, Carrie Nixon participating in that trial.

Carrie Nixon (30:08):

Well I'm all for that. Yeah, <laugh> all for that,

Rebecca Gwilt (30:12):

Which I think is really from a safety perspective, I mean, I don't know enough about it to be as scared as I probably should be about that in the near term term. But in the long term, why can't we do that? Why can't we do that?

Carrie Nixon (30:24):

Sounds like we're going that direction.

Rebecca Gwilt (30:26):

Well, we are headed there. Yeah. We are headed there. And very, very smart people and people committed to advancing our medical knowledge and really improving our lives. That's the, we're going to stop talking about substance substantive things right now, and it's very late in the day.

Carrie Nixon (30:43):

I know.

Rebecca Gwilt (30:43):

But I wanted to bring it back to the fact that all of everyone that I've met, at least here, and I'd love to hear your perspective about that as well, Carrie, they're here because they believe in the mission of the companies that are here, right? This is a corporate event. People are selling things. We are selling things, but why are we here?

Carrie Nixon (31:05):

Because we care.

Rebecca Gwilt (31:05):

Yeah. I mean, this is what being a famous podcast host,

Carrie Nixon (31:12):

<laugh> almost famous,

Rebecca Gwilt (31:13):

Is not the most fulfilling thing. <laugh> come on in our lives.

Carrie Nixon (31:19):

But everyone here is trying to better healthcare make healthcare better, and people, and make people better. So it's a super cool thing.

Rebecca Gwilt (31:26):

Yeah. You should come next year

Carrie Nixon (31:28):

That everyone should come next year. You should come. We'll invite you on the podcast. Yeah, so we've talked forever. You can probably hear the enthusiasm and the excitement in our voices. We're practically talking over each other. It also is very late in our third day of conference, and so we're a little giddy. Shall we sign anything else?

Rebecca Gwilt (31:49):

Well, Carrie, what was your favorite part of this? I know you're dying to talk about your favorite part of this, the puppies.

Carrie Nixon (31:57):

It was otally the puppies.

Rebecca Gwilt (31:58):

Yeah. Sorry, we didn't frame it that way, but this was Carrie Nixon's absolute favorite part.

Carrie Nixon (32:02):

I got to love the puppies.

Rebecca Gwilt (32:03):

They do also have, they do also have what is that called? Air hockey? It's air. They have air hockey.

Carrie Nixon (32:11):

Yeah, they're games.

Rebecca Gwilt (32:13):

Like car video game things, air video games. I'm a very serious person, as you can tell, so I wouldn't be caught doing something like that.

Carrie Nixon (32:19):

No

Rebecca Gwilt (32:19):

But it's

Carrie Nixon (32:21):

They need karaoke.

Rebecca Gwilt (32:21):

It's such a good environment. I mean, this is a brutal pace, especially if you haven't been to a conference in two years. Two years. Yeah. It's a brutal pace. So like stop and pet the puppies. It was a great idea. Anyway, I'm done. I'm done.

Carrie Nixon (32:35):

All right. Thanks everyone. We'll talk to you on our next episode.

Rebecca Gwilt (32:39):

Tune in. Bye.