Public Policy with Mari Savickis and Leslie Krigstein at the CHIME Fall Forum 2019

Bill Russell: 00:04 Welcome to this week in health it events where we amplify great ideas with interviews from the floor. My name is bill Russell healthcare CIO, coach and creator of this week in health it a set of podcasts and videos dedicated to developing the next generation of health leaders. We want to thank our founding channel sponsors who make this content possible, health lyrics and VMware. If you want to be a part of our mission to develop health leaders, go to this week, health.com/sponsor for more information. This episode is sponsored by health lyrics. When I became a CIO, I was really overwhelmed at first and one of the first things I did was to sign a CIO coach to walk with me through the journey. This was someone who had wisdom that can only be gained through years of experience. It was invaluable to my success in the role and I now coached CIOs through health lyrics.

Bill Russell: 00:57 If you want to learn more, visit health lyrics.com or drop me a note at [email protected] over the next three weeks we have a real treat for you. We just got back from the chime fall forum in Scottsdale, which was a fantastic event and we caught up with 12 active CIOs from various sized health systems and asked them to take a look back at 2019 and I look forward at 2020 you’re going to hear what they’re excited to have accomplished and what they are looking forward to accomplishing in the next year. I asked each of them the same eight questions and I think you’re going to be as fascinated as I was to hear the similarities and the differences from CIO’s. Each of these interviews is around 10 minutes long so you can really listen to them quickly, especially if you listen to them at one and a half times speed as I know some of you do and we’re going to publish one a day with a few news day episodes sprinkled in through the end of November.

Bill Russell: 01:50 So check back every day for the next episode and look back to see if he missed any. That is all going to start on Monday. Today we have an interview from the floor with Leslie Krigstein and, Mari Savickis, the chime, congressional and federal affairs liaisons on Capitol Hill. Uh, they are working on so many things. It’s really amazing. We hit, uh, we hit on a 2120 first century cures cybersecurity national patient ID in this brief interview. Uh, I hope to have them all more frequently to share the great work that they are doing. Have a listen and I hope you enjoy,

Bill Russell: 02:25 we’re doing another session from chime fall forum in 2019 and we are going to talk public policy. I’m really excited to be joined by the two of you, uh, Leslie and Mari and actually why don’t you give you roles cause you’re congreational and you’re more in a different area. But introduce yourself to.

Leslie Krigstei: 02:47 Yea so, Leslie Krigstein. I’m Chime’s vice president of congressional affairs and I am responsible for trying to stay on top of all of the dysfunction going on on Capitol Hill for the Chime membership. So, um, it keeps me busy. Uh, there’s lots of excitement these days and uh, lots of challenges cutting through the noise. So really just disfunction. We, you know, are hoping to just keep the government funded through Thanksgiving. Um, let alone, uh, tackle some of the bigger policy issues like surprise billing and drug costs and um, as we sit and wait for some of the forthcoming health it rules and see where we may need to have Congress engaged there. So, um, there’s some big policy conversations happening along with some of the headline news that you’re seeing, uh, each and every night.

Bill Russell: 03:39 So you are federal affairs. So can you introduce yourself?

Mari Savickis: 03:43 Hi, I’m Mari Savickis. I’m Chime’s vice president for federal affairs and I have the flip side of the coin with Leslie where I basically read and digest the thousands of pages of government regulation on any given day and try to translate into what that means for practical realities for our members. And there’s no day off for the agencies. They don’t take recesses. There’s always something coming out on any given days. So it’s just trying to keep pace with what’s happening. And that’s really fun reading. It’s very, I mean it takes a certain kind of individual to want to read government regulation and I happen to be that crazy person.

Bill Russell: 04:18 We’re going to talk about a lot of, we’re going to try to get really pragmatic here. You guys sent out a great membership. So I’m not, I’m actually just going to walk through this cause there’s, there’s so much here. Um, so stark anti, uh, anti-kickback, uh, where are we at on that? What is that about? Where are we at?

Leslie Krigstei: 04:38 And it’s a big deal to open up stark and kickback roll. So these are issues that govern, uh, the healthcare sector of our particular interest to our members as providers. You don’t want to be inducing referrals and appropriately. And so one of the things that we’ve been advocating for the past several years, knowing that there’s only a few ways to really insent financially good cyber hygiene through government incentives, is to look at ways that we can leverage existing revenue streams. And one of the ways that we went about doing this was looking at start getting into kickback. So we finally saw in the proposed rule and the ability for a provider who say a better resource to donate to a cyber security technology and services to a lesser resource provider. And it’s not mandatory, it’s voluntary. So we know that there are some of our members who would have a strong desire to take care of to take advantage of this and others that have no desire, but nonetheless every course. Um, it’s not final. So this is proposed. We’ll be commenting and engaging our members for feedback and input because the comments are due the end of the year.

Bill Russell: 05:41 This is huge because the stark laws allowed us to, to digitize a lot of these physician practices, individual physician practice that were out there. Um, but we didn’t really do much after that. And without cybersecurity cybersecurity’s changing on a daily basis.

Leslie Krigstei: 05:56 Absolutely. We’ve been, we’ve been busy trying to hit reboot on the sector collectively and many of our members are actively engaged with an industry wide effort to try and improve the cyber posture of the healthcare sector. So it’s a volunteer effort. It’s free. We, we do a lot of work with them and we’re very engaged. The other thing I would have mentioned about the stark and Kickback rules is that it extends the, again, if adopted and finalized the EHR donation a way that you can donate an EHR to a, again, a lesser resource provider that was set to sunset in 2021, but this under these rules that would be extended. And then there’s also a series of changes that they’ve made that would promote value and care coordination.

Bill Russell: 06:40 Lots to Unpackaged yeah. I want to talk 21st century cures. So which one of you is like the extra 21st century?

Leslie Krigstei: 06:48 It depends what way it’s coming through. So I mean this was landmark legislation for the entire healthcare industry, right? It had a number of, um, efforts to speed biomedical research and bring cures to patients. Um, but then there were about 40 pages of health it, uh, statute that really will dictate our industry moving forward. And, um, it came on the heels of years of hearings and stakeholder round tables and meetings. And, um, one of the things that was kind of became the buzz phrase was information blocking. And so, uh, the rule dictated to ONC that they need to start promulgating rules on how to spur interoperability, how to create this network of networks, but also how to stop information blocking. And so, you know, Congress to the extent that, uh, health it as getting attention has kind of taken a step back because we do have the rules that are currently pending. So I think we will see congressional action kind of once we’ve seen those rules and see if they’re actually going to mimic, uh, what congressional intent was for the various provisions, uh, that call for action. But that’s really, you know, where my side of the house is right now in limbo.

Bill Russell: 08:08 21st century cures was the last administration do you see movement in healthcare, across administrations.

Leslie Krigstei: 08:15 Um, and the broadest sense. No, of course not. Um, but, and, and the health it space, I think, you know, naturally, even as national coordinators changed and as frankly, um, leadership on Capitol Hill change, you saw folks prioritizing different it, um, issues or opportunities? So I think there has been a commitment to interoperability. We had the interoperability roadmap that dated back years. So the last administration that really took off on the Hill and where folks became very passionate about all of the different things that we could do to spur inter-operability. Um, but you’re right that, that’s the reality of our democracy is it may have been by the last administration under a few congresses ago, but now it’s up to this administration to carry out. So I don’t know if you want to pick up on that,

Mari Savickis: 09:03 you know, so cures act was signed into, um, into law in 2016 and now this is like, there’s several year lag time and so to Leslie’s point, the rules are now coming out and they’re going to be operationalized very shortly. We’re waiting on the final wall for CMS and ONC concerning the interoperability role as a dual companion rules that will govern what I’ve been calling the next decade of our industry. So we’re of course on pins and needles waiting for that to happen. Um, until Leslie’s point there is like a bit of, they’ve been the ball carrying forward from the last administration, I would say the name of the game and the next era is going to be the consumer. And so it’s all about engaging the consumer and making sure that the consumer has access to their data as quickly and as securely as possible.

Bill Russell: 09:43 Well, I mean too, so we’ve uh, at HIMSS last year we had a Aneesh Chopra on the, on the show and he talked about how this in healthcare it’s been relatively consistent drive towards interoperability towards, uh, transparency, data sharing, uh, in the best interest of the patient because almost it doesn’t matter what your political background, do we want to do what’s in the best interest of the patient? Yes. Do we want to share the data with the patient? Yes. And so there’s been consistency. And I also have Don Rucker on the show recently and we were talking about this, but one of the things that’s probably more for that feels like it’s more pronounced in this administration is Don just came out and said we want to make healthcare a market in every market. It’s you know, transparency of price so you don’t have surprise bills. It’s a choice and it’s access to data around business services that quality of services you’re going to receive. And then I recently as at the health conference I heard Semma Verma talk and then she just drove that home. Seems to be, that seems to be the whole push right now. Is that what you’re feeling?

Mari Savickis: 10:52 I think that is, and there’s a counterweight to this. So on the one hand this is all like moving in the right direction. Patients should be engaged consumers, there should be transparency about cost and like, and they should have access to their data. But on the flip side of this, one issue that’s been emerging is making sure that their data is not used in a way that they didn’t intend it to be used, such as the commoditization and do the aggregation of it. And so there needs to be some protections that are put into place around how say a healthcare data is married with like other consumer data. So there’s two different regulatory schematics that govern these spaces. There’s HIPAA that governs the providers and pairs and then there’s the FTC that governs third party apps. So we’ve been trying to rustle that dragon down and try to figure out how best to ensure that patients are informed about how their information could be used while at the same time facilitating quick and seamless access.

Leslie Krigstei: 11:45 And that also marries while with the broader conversations happening on Capitol Hill with you’re seeing tech giant after tech giant brought up, set a congressional committee and the Dawn of what is privacy? I’m with CCPA and GDPR. I think there’s, um, a call to action for a national privacy standard law. Same with a breach. Uh, but there still remains some significant issues to be resolved. And so how healthcare fits into that. Um, and to what extent non-covered entities kind of end up under other jurisdictions. And, um, you know, how we can better empower patients from the outset I think is something that we’re tracking closely and a few bills have been introduced. And I expect that to continue, um, to be of interest to folks on better focused on healthcare.

Bill Russell: 12:34 Let’s talk cyber security. It’s interesting when I was CIO. I would have to sit in front of a board and I’d say, look, if a nation state attack or a health system, you’re getting our data. And that’s seems so defeatist to me. And the, the analogy cyber security CEO gave me, here’s the deal. Some of these nations States have set up attacks directly on your health system. They’ve essentially put aircraft carriers on the coast of California and they’re attacking and we’re asking each individual hospital to defend their turf against that kind of attack he goes, until the federal government steps in and starts to supply some help. You’re defenseless is what he essentially said to me. But it seems kind of defeatists is the federal government is Congress looking at this and saying, Hey, we’ve got to start to help.

Leslie Krigstei: 13:26 Yeah, I think there was a recognition with the passage of the cybersecurity act back in 2015 you know broadly that we could do a better job of at least sharing information and bringing the government in and setting forth exactly what a recording structure would look like to make sure that at least you can share what you’re seeing and how it may be impacting your health system versus another. But in there there was also a specific section looking at health care. So that was the first time that law makers, you know, put a stake in the ground and said healthcare is probably behind where everybody else is and is nowhere near where the industry should be. So we’re still seeing a, I would say like reaping the benefits of that statute and that legislation. In the sense that It created a task force, the task force created recommendations and then from the recommendations best practices and then it’s changes to the stark law. And um, so now that those things, you know, that cycle is running the cycle of policymaking. We are seeing, um, from a tech leaders on Capitol Hill interest in going back to the drawing board to say we need to specifically help those that are small, rural, under-resourced, and what does that look like? We know the money trees have kind of shriveled up and gone away. It’s not like we’re going to get another meaningful use for cybersecurity unfortunately, even though that might be what it takes or you know, one of the suggestions in the task force report, um, for relative to medical device security was like a cash for clunkers program for outdated medical devices. You know, again, if we had another stimulus that might be a great opportunity to, uh, to change things. But being realistic about our current budget situation, that’s probably not possible. But I do think there is renewed interest. I think there’s commitment and I, I think there’s also a recognition that, um, providers aren’t actively saying come take my data. Right? One of the CIOs I was talking to you last night equated a cyber attack to, you know, if someone came in and stabbed a patient in the ed, the hospital’s not going to be liable for that action. You’re going to charge the person who committed the crime. How was that different than if someone came in and held your system ransom? Why is the health system being the victim? And so one of the things that we were really encouraged about in the broader healthcare cost conversation, um, there is a provision that would direct OCR, right? The, the agency that every healthcare entity fears because there’s usually fines associated that if OCR is following up on a potential breach or is considering an audit that they should take into account. Um, if a health system is following publicly available resources like the new cybersecurity framework or the practices outlined in, um, the healthcare industry, cyber security practices, the hiccup guidance, which was created out of, uh, the cybersecurity after 2015. So see it’s, you know, I live in Washington, yeah. Block off 15 minutes of my day everyday to make sure that I have alphabet soup under control.

Leslie Krigstei: 16:24 So there has been a lot of progress. I think, um, there’s been progress in terms of education of lawmakers. Um, but I think, you know, we’re also, you know, trying to do the work of educating the provider community, right. Um, it’s challenging, it’s new and um, you know, it’s scary. Uh, we know resources are finite, you know, the decision between investing in it and it security and finding the qualified professionals to be able to do that. This is a very complex conversation that unfortunately right now doesn’t present with a lot of easy answers.

Mari Savickis: 16:59 And we’ve been also collaborating a lot with the sector and also the federal government and that that’s, I mean, that’s part of the reboot on our sector to try and hit refresh. How are we going to work more cohesively so that we can improve this out or posture overall. And so that’s been, I mean, many of our members are involved in the health sector coordinating council and the joint effort on cyber security. We just did a podcast with HHS where we, it was, you know, locked arms and talked about with the products that we’ve made and the things that we have to look forward to. And we’re still, we’re still, we’ve got a long ways to go, but we’ve also made a lot of progress. We’ve seen a lot of good developments from the FDA. A lot of those recommendations that Leslie referenced in the industry report on cyber security are now coming to fruition. Just like the stark kickback, which was recommended by that, that group. And so there’s work that’s being done to improve the posture. So I think that, you know, it’s nice to acknowledge like how far we’ve come, but we still have a ways to go. Yeah.

Bill Russell: 17:53 So I want to talk to tele-health, national patient ID. I also want to talk about the work that you’re doing and, and, um, I mean we are seeing CIOs go to Capitol Hill. I have conversations. We’re also seeing state engagement in those kind of things. Um, but two more, two more policy things. So telehealth, on a, uh, from a Medicare standpoint, from a CMS standpoint, they’re trying to do something pretty progressive with telehealth and can give us a little bit,

Mari Savickis: 18:21 I mean, a lot of this, I mean, I’ll let Leslie talk. There’s been actually a lot, a fair amount of activity on Capitol Hill to actually move the ball forward. But still we have a lot of challenges with, with again, like this is very wonky, but they call it 1834 M of this social security statute. It’s that area of the law that says that, you know, you can only do certain things with telehealth. And so we’ve been busy, you know, trying to push the needle forward on this, both from a regulatory and a statutory side. And so for example, the recent, the current administration has actually moved the needle forward. They now pay for, um, certain, you know, remote monitoring, uh, visits and um, or eConsults like with a physician, a physician, or if a patient needs to check in with their clinician. So between, you know, between that there’s actually been a fair amount of progress and CMS each year usually adds a few extra services to their list of tele-health, but we still need a lot more action and that’s where we go to the Hill where we need to remove those statutory barriers. And that work is really underway.

Leslie Krigstei: 19:19 Yeah, there was a fairly comprehensive tele-health, uh, uh, proposal introduced last week, uh, by cameral bi-partisan from, uh, the tele-health caucus membership. And it really does, uh, look to at least expand CMSs capabilities to reimburse. Right? So, um, there’s a lot that folks are doing, uh, with private payers, right? Better thinking, more creative. All you’re seeing new entrance into the marketplace that are offerings kinds of services. But unfortunately, Medicare is far behind. And so, um, and a hearing before the energy and commerce committee in the house a few weeks back, uh, administrator Verma was asked a few questions about telehealth. And asked about, um, you know, what’s the value, what can we do to, to improve the outlook? And she said it’s, it’s critical and especially as they’re looking at rural health and, and addressing some of the access challenges. Uh, but unfortunately Medicare is bound by some very archaic, uh, statutory guidelines that, and this political nonsense, it’s really difficult to change something like 1834.

Leslie Krigstei: 20:26 And because the congressional budget office, which is something in Washington you get infinitely familiar with because every time a legislative proposal comes for a vote, the CBO will give it a score. And if it costs too much, then Congress says, no way we don’t have the money unless you’re coming with a pay for. And so CPO is convinced annually that increasing telehealth services will result not in cost savings, but additional costs because I think it’s going to result in duplicate of services and over utilization. And so we continuously work with our members to try to paint the picture of, you know, how can we be more proactive? How can we be more preventative? How can we look at keeping folks out of, you know, the high cost environments. And unfortunately, CPO has been very, very slow to acknowledge, but we’ve seen progress in opioid and mental health.

Leslie Krigstei: 21:15 Um, I mean there’s so much. Uh, so you know, they’ve taken a very, um, uh, kind of stepwise approach and looking at different disease States or different geographic locations to like slowly start adding more reimbursement opportunities. But we still have a long way to go.

Mari Savickis: 21:31 And speaking of costs, I mean that’s one of the things that while we have several members who are early adopters and first movers, the vast majority of our members can’t afford to do telehealth because they need the spigot to be turned on by the government so they can get reimbursement or by the commercial payers so that they can start funding the actual infrastructure associated with that. So until those two, um, I guess planets online, it’s very, very hard to keep moving this forward. And so that’s why we work on, it’s a little bit of the reimbursement piece that has to be changed in order for that to really like kind of take off.

Leslie Krigstei: 22:07 And I think the other thing that we’ve really tried to drive home with lawmakers is it won’t always be tele-health. It’s just going to be delivery of health care and whether it’s, you know, the traditional brick and mortar touch and feel and care experience, or if it’s going to be delivered via a virtual platform that’s just going to be healthcare in the future. And so let’s make sure that we’re not hampering that evolution and meeting folks who like me very much like my ability to do a telehealth visit at home. People who don’t live in your world.

Bill Russell: 22:38 That’s crazy. Telehealth, first of all, that patient satisfaction is through the roof. We have, we have the numbers to show access is through the roof and cost is reduced significantly.

Mari Savickis: 22:55 The wheels, the wheels that change in Washington are very slow. It’s a lot of hurry up and wait. I mean, it is just, I like changing public policy to rolling a Boulder up a mountain sometimes. It just takes a long time.

Bill Russell: 23:09 A lot of conversations.

Leslie Krigstei: 23:10 Yeah. I mean it’s telling the stories. It’s having folks share the data. Um, you know, CBO likes particular sources of data. I mean it’s been a great source of frustration for I think folks in the health it space because, you know, just to do what every CIO can probably attest to the value that it would bring to their organization and frankly to patients. Um, but.

Mari Savickis: 23:34 Medicare too, they feel like they have to be very good stewards of taxpayer dollars. So there is this underlying current of whether or not if you increase the reimbursement and the number of services that are allowed to be paid under tele-health rules, that there could be program integrity issues. And so there’s, there’s that sort of in the, in the low line in the background and try to overcome that. It’s been a little challenging.

New Speaker: 23:57 They have to constanly be cognizant of fraud.

Mari Savickis: 23:57 , exactly. and there was fraud, but I mean, yeah, there was a big opportunity to that. So it’s, it’s a balancing act honestly, yeah,

Bill Russell: 24:10 we can talk about a national patient ID pushback.

Leslie Krigstei: 24:15 We are and we aren’t. I mean, for this being an issue that’s over two decades old. And you know, when I started at Chime about five years ago, we were still very much afraid of the folks wearing the tinfoil hats and you know, to see a bipartisan vote and the house of representatives in favor of repealing the ban. Um, it wasn’t something that just got tucked into.

Bill Russell: 24:38 Is that national funding, research for national.

Leslie Krigstei: 24:40 Correct. And so, um, you know, what the industry, and I think a way that we really haven’t seen over the last 20 years is, you know, there are 50 plus organizations that we’re working with that are all saying in unison. We’ve got to address this once and for all folks are generally solution agnostic. So, you know, if the government wants to go down the route of an identifier, they want to go down the route of expanding the Medicare beneficiary identifier. If they want to look at biometrics or you know, I think folks are open. It’s just a matter of the time has come. And if we really do believe that we need to be interoperable, which we all do, until we address this foundational element of data exchange, we’re not going to accomplish the goals that high tech set out, that cure set out.

Leslie Krigstei: 25:22 And that, you know, we hear administrator Verma and folks in the administration saying is, you know, a top priority for them. So yes, we know where Senator Paul stands. He’s very much carrying forth, um, where his father is and, and we did see some opposition from the ACLU. Um, but I’m optimistic given the industry support, um, given the fact that, you know, a new day has dawned also in privacy and patient expectations that I think we’ll see some level of progress. Unfortunately, we’ve been victim of the broader political chaos and the fact that the government isn’t even even funded for fiscal year 20, 20. So, um, hopefully that will get rectified. Probably not in the near future, but maybe into early next year. Uh, but I still have optimism about getting some kind of significant policy change on this.

Bill Russell: 26:22 Will an election year make it more challenging.

Leslie Krigstei: 26:24 I think, you know, on Capitol Hill, we’re already starting to see kind of the political gamesmanship with, um, of course the house is moving forward with impeachment and the, the leadership of the house is saying, we’ve got to kind of show our worth. So let’s look at some of these other healthcare packages cause they heard voters loud and clear in the last election. The healthcare is a big priority. So you’re seeing a lot of those like messaging bills. So that sort of thing we’ll pick up. Um, but, and then you’ll start to see like, we can’t give that candidate a win or we can’t let the president get a win. So, you know, things will come to a halt on the congressional front. Um, but after the election and lame duck, I think it’s going to be a complete free for all with an immense amount of opportunity. So it’s definitely, you know, the tension is going to be ramping up. Um, you know, I don’t anticipate a lot of productive conversation, but, and my world health, it has been bipartisan. Um, Republicans, Democrats have commitments for different reasons about, you know, recognizing the need to do better with our federal investment. So from that vantage point, we’ve been able to stay out of the fray. There’s just a lot of noise that we’re coming through.

Bill Russell: 27:35 But the great thing about an election year after an election year, everyone’s trying to move the needle quickly in that first year, especially the first hundred days. Right? This is really setting the foundation.

Leslie Krigstei: 27:49 I mean, you asked about telehealth, I think, you know, five or six of the democratic candidates have included some kind of reference to tele-health and their healthcare platform. So I think tracking what that looks like and kind of seeing what the president might unveil and healthcare space as well will be, you know, worth watching.

Mari Savickis: 28:08 on the regular slide too. As you lead up to an election, what they’re going to do is they’re just going to start pushing things out very quickly because they have to get that out the door before the election. And so we’re already seeing pressure on the administration to get the ONC roll out as CMS rule. And then you know, there’s a HIPAA that is going to be calming. They just got the stark and kickback. It’s going to be just like a steady stream. And then probably the closer you get to the election, things will start to Peter off. And as people really focus in on that,

Bill Russell: 28:37 You guys have already stayed longer, is there anything that you want to get out to people who are listening in terms of the work you’re doing, how they could participate, what role members areplaying?

Leslie Krigstei: 28:45 You know, there’s really countless ways that you can engage on policy. Um, whether it’s working with us directly or responding to comments and those sorts of formal opportunities. We also get members with a lot of questions. You know, I saw this in a bill, what does that mean for my health system or I don’t understand this measure and we’re happy to kind of do those one-on-one, um, you know, office hour kind of things. Um, but we also, the last two years who’ve done advocacy summits in D C and have been able to bring lawmakers and policymakers to have those one-on-one conversations.

Leslie Krigstei: 29:21 And we took about 30 members up to Capitol Hill to do Hill visits. So you know, I think our opportunities for engagement are growing. There’s always opportunities to engage lawmakers at home when often our members are the biggest employers in the district. We’ve got a story to tell, so it’s really a choose your own adventure kind of interaction with policy. And you know the more the merrier,

Mari Savickis: 29:41 we also have a Phantom email box which. We both staff but it’s [email protected] and we are happy to talk to both members and industry. We and you know we routinely do both and so the Leslie’s point, there’s really like a lot of different ways to interact with us so we would certainly encourage anyone to reach out to us.

Bill Russell: 30:04 Thank you for your time. You guys are always welcome on the show.

Mari Savickis: 30:04 Okay. Thanks very much.

Bill Russell: 30:05 I hope you enjoy the conversation. Remember to check back often as we are going to drop an episode a day for most of November of 2019 following that, please come back every Friday for more great interviews with influencers. And don’t forget every Tuesday we take a look at the news, which impacts health it if you want to support the fastest growing podcast and the health it space. Here’s a few ways that you can do that. The first share it with a peer, share it with a friend. Share it with somebody who’s working right there next to you. Number two, sign up for insights and staff meetings. These are services designed to help you in your career. Number three, interact with our social media content on Twitter and LinkedIn. Number four, post or repost our content. And number five, always send me feedback. [email protected] your insights continue to shape the channel. This show is a production of this week in health it for more great content. You can check out our website at this week, health.com or our YouTube channel. Special thanks to our sponsors, VM-ware and health, Eric’s for choosing to invest in developing the next generation of health leaders. Thanks for listening. That’s all for now.