Latest / Becker’s Healthcare -- Pediatric Leadership Podcast / Building the Future of Pediatric Care Through Access, Partnerships and Innovation

Transcript

Building the Future of Pediatric Care Through Access, Partnerships and Innovation · Becker’s Healthcare -- Pediatric Leadership Podcast

• 0:00
  - Hello, everyone. This is Erica Spicer Mason with
• 0:02
  - Becker's Healthcare.
• 0:04
  - Thank you so much for tuning in to
• 0:05
  - the Becker's Healthcare podcast series.
• 0:08
  - Today, we're going to talk about growing the
• 0:10
  - pediatric footprint.
• 0:11
  - We'll cover strategy, access, sustainability.
• 0:15
  - And joining me for this conversation are two
• 0:17
  - leaders. We have Phil Dabruzzi,
• 0:20
  - principal at Forvis Mazars,
• 0:22
  - and Ryan Nagy, president and COO at Boston
• 0:25
  - Children's Hospital.
• 0:27
  - Phil, Ryan, welcome to the podcast. Great to
• 0:29
  - have you with us today. It's great to
• 0:31
  - be here.
• 0:32
  - Well, great to hear from you both today
• 0:34
  - on
• 0:35
  - the pediatric care landscape, and that's really where
• 0:38
  - I want to start our conversation today.
• 0:41
  - And, Ryan, I'll I'll kick this first question
• 0:43
  - over to you, especially given your role at
• 0:45
  - Boston Children's.
• 0:47
  - We're seeing in pediatrics,
• 0:49
  - there's certainly a fundamentally different,
• 0:52
  - way of caring for pediatric patients, of course,
• 0:55
  - but then we're also seeing differences with payer
• 0:57
  - mix, workforce dynamics,
• 0:59
  - demand for behavioral health services, and specialty care.
• 1:02
  - So I'd love to know from you, Ryan,
• 1:03
  - what you see as the biggest forces right
• 1:06
  - now that are reshaping
• 1:08
  - pediatric care delivery, and how are those forces
• 1:10
  - changing the strategic priorities for children's hospitals, whether
• 1:14
  - broadly or at Boston?
• 1:17
  - Oh, I appreciate that, question, Erica. And, again,
• 1:19
  - it's great, to be with you today.
• 1:22
  - Number one where I'd start is the, clinical
• 1:25
  - talent,
• 1:25
  - the ability to attract talent,
• 1:28
  - particularly subspecialists,
• 1:30
  - and retain that. That's going to be a
• 1:32
  - headwind for pediatrics
• 1:34
  - for
• 1:35
  - many, many years to come.
• 1:37
  - Some of us are positioned a little bit
• 1:39
  - better than others, but even,
• 1:41
  - those of us that have large
• 1:44
  - clinical practices and the ability to
• 1:48
  - grow our own, so to speak, with residency
• 1:50
  - and fellowship programs.
• 1:52
  - The ability to meet the demand,
• 1:54
  - of clinical care is
• 1:56
  - compounding
• 1:57
  - by the year.
• 1:59
  - Another element is just the aspect of community
• 2:02
  - hospitals throughout the entire nation
• 2:06
  - declining or shedding pediatric inpatient capacity. That's that's
• 2:10
  - causing a situation where
• 2:12
  - the children's hospitals or the medical centers are
• 2:15
  - becoming more and more concentrated with high acuity
• 2:18
  - care
• 2:19
  - and needing to distribute
• 2:21
  - a network of care broader and broader. So
• 2:24
  - if,
• 2:25
  - the top two, I'd place as clinical
• 2:27
  - talent
• 2:28
  - as well as growing a network development that
• 2:31
  - allows a full continuum of care that,
• 2:35
  - patients, their families expect and,
• 2:38
  - quite frankly, demand. And,
• 2:41
  - any question like this, I I have to,
• 2:43
  - finish, though, with behavioral health.
• 2:47
  - It is without question unprecedented. The ED boarding,
• 2:51
  - inpatient site bed
• 2:52
  - capacity,
• 2:54
  - the demand is far outstripping the supply.
• 2:57
  - At Boston Children's, we're making,
• 2:59
  - enormous investments both in, behavioral health as well
• 3:02
  - as our capacity in ambulatory networks in order
• 3:05
  - to meet this demand, but I see the
• 3:08
  - these shifts impacting,
• 3:11
  - every provider in children's health for several years,
• 3:14
  - if not the at least the next ten,
• 3:16
  - twenty years combined.
• 3:18
  - Yeah. Ryan, appreciate you shedding some additional light
• 3:20
  - on on the behavioral health crisis as well.
• 3:24
  - And and really everything that you've covered too
• 3:26
  - really does signal the capacity needs in pediatric
• 3:29
  - care right now.
• 3:30
  - Just wanna check-in with you, Phil. Is there
• 3:32
  - anything that you'd add to what Ryan has
• 3:34
  - laid out?
• 3:35
  - Yeah. I would expand a little bit. I
• 3:38
  - think, he touched on some great points. I
• 3:40
  - guess from my lens,
• 3:41
  - our health care consulting practice, you know, we're
• 3:44
  - focused on strategy, facility capital planning, kind of
• 3:47
  - the financial reimbursement
• 3:48
  - side. So
• 3:50
  - that's the lens I kind of,
• 3:52
  - you know, view things from. And I think
• 3:54
  - there are two
• 3:55
  - two ads there. I think the demographic
• 3:57
  - trends for children's versus you have compared to
• 4:00
  - adults versus adults
• 4:02
  - quite different. It's been happening over a decade
• 4:04
  - and a half. It's a big structural shift.
• 4:07
  - Our birth rates have been declining.
• 4:09
  - Fertility rates are record low at one point
• 4:12
  - seven per,
• 4:13
  - you know, and that's leading to an inpatient,
• 4:16
  - you know, a peak in inpatient discharges
• 4:19
  - for children's organizations across the country. So I
• 4:22
  - think
• 4:22
  - that that relates to the point that Ryan
• 4:25
  - made about
• 4:27
  - rural community hospitals, not as much pediatric
• 4:30
  - capacity that's shifting to more urban environments in
• 4:33
  - the larger centers.
• 4:34
  - So with that increased acuity as
• 4:37
  - well, we're seeing in those patients that are
• 4:39
  - still getting into the hospital
• 4:41
  - higher acuity,
• 4:43
  - as Ryan mentioned. So
• 4:45
  - the other piece I would say is we
• 4:47
  - do a
• 4:48
  - survey of health care executives across the country
• 4:50
  - every year. It's called the mindset survey.
• 4:52
  - And and Ryan touched on the number one
• 4:54
  - concern
• 4:55
  - most organizations have, which is around workforce and
• 4:58
  - and physicians. The second is reimbursement. So
• 5:02
  - the elephant in the room is is the
• 5:03
  - Medicaid cuts on the horizon.
• 5:05
  - You know, largest cuts in history
• 5:08
  - trillion over a decade
• 5:10
  - is pretty significant for for children's organizations. And
• 5:13
  - so I think we'll see
• 5:15
  - that continue to put
• 5:17
  - pressure on organizations. They'll have more of an
• 5:19
  - eye towards the return on investment
• 5:21
  - when they're making decisions. And I think
• 5:24
  - further,
• 5:25
  - you know, really help organizations focus and understand
• 5:28
  - what their role and their brand is in
• 5:30
  - the market in serving children's.
• 5:33
  - Yeah. Phil, appreciate you sharing a little bit
• 5:35
  - more about
• 5:36
  - where your role factors into this when we're
• 5:38
  - talking about
• 5:40
  - you know, fascinating to learn those results of
• 5:41
  - the mindset survey. Workforce and physicians reimbursement being
• 5:44
  - top concerns, not necessarily
• 5:46
  - surprising, but it's it's helpful to know that
• 5:48
  - that is what's on leaders' minds, especially as
• 5:52
  - it relates to pediatric care.
• 5:54
  - And when you were speaking about reimbursement,
• 5:57
  - it reminded me that I also wanted to
• 5:58
  - ensure that we covered growth strategies too because
• 6:01
  - I I know we're focused a lot here
• 6:03
  - on the challenges that pediatric providers are facing.
• 6:08
  - And and growth in pediatrics can mean more
• 6:10
  - than just building more in inpatient capacity. You
• 6:13
  - know, we're seeing health systems do this through
• 6:15
  - ambulatory expansion, partnerships,
• 6:18
  - digital innovation.
• 6:20
  - So
• 6:20
  - I'll hand this over to Ryan first to
• 6:23
  - to kick us off. But, Ryan, when Boston
• 6:25
  - Children's evaluates
• 6:26
  - where to invest in growth,
• 6:29
  - what framework or criteria
• 6:31
  - matter most right now, and how are you
• 6:33
  - balancing
• 6:34
  - the mission of your organization against margin? You
• 6:36
  - know, that common refrain we tend to hear.
• 6:39
  - I'm gonna structure my answer a bit
• 6:42
  - on pediatrics in general, but, I'll start first
• 6:44
  - with how,
• 6:46
  - we at Boston Children's,
• 6:48
  - frame this, and every institution's gonna be different,
• 6:51
  - depending on the situation they're in.
• 6:53
  - But, for us, our our margin absolutely funds
• 6:57
  - our mission. And where we
• 7:00
  - first start is where our value differentiation,
• 7:03
  - begins,
• 7:04
  - and that's in a
• 7:06
  - deeply,
• 7:07
  - committed academic research innovative platform.
• 7:11
  - We are never coming off that. That is
• 7:13
  - where we add value, not just to the
• 7:15
  - Boston, New England area, but to the nation
• 7:17
  - and the world.
• 7:18
  - And
• 7:19
  - that in its initial investment,
• 7:22
  - does not have a
• 7:24
  - terribly,
• 7:25
  - positive margin, but it
• 7:28
  - has so many great downstream effects both for
• 7:31
  - our organization and, quite frankly, it it's our
• 7:33
  - culture. So we are,
• 7:35
  - completely committed to the research and educational mission
• 7:38
  - of academics, and
• 7:40
  - and we build from that. And when we're
• 7:43
  - looking at that,
• 7:44
  - back to my, statement about margin funding mission,
• 7:47
  - we have to be very deliberate about the
• 7:49
  - investments we make and which side of the
• 7:52
  - the ledger it fits.
• 7:53
  - Quite frankly,
• 7:54
  - contribution positive activities,
• 7:56
  - that cross subsidize those that, just are by
• 7:59
  - the nature of our health care,
• 8:03
  - structure in this this country are structurally unprofitable.
• 8:06
  - And
• 8:08
  - where
• 8:08
  - we are focusing
• 8:10
  - considerably right now. We've made investments both in
• 8:13
  - behavioral health as well as furthering our research
• 8:15
  - mission. But,
• 8:17
  - in addition,
• 8:18
  - focusing,
• 8:19
  - heavily in access,
• 8:21
  - how do we push
• 8:23
  - the value we provide
• 8:25
  - further outside
• 8:26
  - this,
• 8:27
  - medical center,
• 8:29
  - tertiary, coronary core into ambulatory platforms
• 8:32
  - using partnerships
• 8:34
  - more deliberately
• 8:35
  - and actively,
• 8:37
  - building digital channels,
• 8:39
  - as well as,
• 8:40
  - asking a very, very important question that all
• 8:43
  - organizations,
• 8:45
  - ask. And if you're not asking,
• 8:47
  - I would highly recommend it is, quite frankly,
• 8:49
  - feasibility and capital.
• 8:50
  - Can you actually staff it?
• 8:52
  - That's usually the first gating feature,
• 8:55
  - for us is,
• 8:57
  - can we staff it and can we provide
• 8:59
  - the care that we're known in providing?
• 9:02
  - Is this the brand of Boston Children's? And
• 9:04
  - if it's not, we're not gonna do it.
• 9:06
  - And can we do a capital light? Is
• 9:08
  - it reversible?
• 9:09
  - I'm in complete agreement that the future is
• 9:12
  - not more bed towers.
• 9:13
  - Yes.
• 9:15
  - Beds and bed capacity will expand in certain
• 9:18
  - spots,
• 9:19
  - But having a capital light platform,
• 9:23
  - investing in the development of the relationships and
• 9:26
  - partnerships, and making it much easier
• 9:29
  - for patients and families to interact with us
• 9:31
  - is the way forward for Boston Children's while
• 9:34
  - being completely committed to our research mission, which
• 9:37
  - we feel, adds value not just to our
• 9:40
  - organization, but to, our peer groups,
• 9:43
  - as well as health care in general.
• 9:46
  - Mhmm.
• 9:47
  - Ryan, thanks so much for sharing. And it
• 9:49
  - really sounds
• 9:50
  - like margin and mission aren't competing. They're enabling
• 9:54
  - one another at your organization.
• 9:56
  - And it's it also sounds like quite a
• 9:58
  - holistic approach that you've outlined here, you know,
• 10:00
  - being deliberate about the investments you're making,
• 10:02
  - focusing heavily on access at the same time,
• 10:05
  - and then also balancing that with what's feasible,
• 10:08
  - what's on brand for Boston Children's,
• 10:11
  - what's doable in terms of capital.
• 10:14
  - So so thank you again for sharing.
• 10:16
  - And, Phil, I know you work with pediatric
• 10:18
  - organizations
• 10:19
  - across the country on growth strategies
• 10:22
  - just like this, but I'm sure it looks
• 10:24
  - different in every organization.
• 10:26
  - Despite that, I'd love to know, from your
• 10:28
  - point of view, what separates organizations that are
• 10:30
  - approaching growth most effectively right now from those
• 10:33
  - that may struggle to evolve or to see
• 10:35
  - that growth?
• 10:37
  - Yeah. It's a it's a good question. I
• 10:38
  - think,
• 10:39
  - I I would look at it from from
• 10:41
  - two perspectives.
• 10:42
  - The the framework piece that that Ryan touched
• 10:45
  - on and and holistic planning would be the
• 10:47
  - second
• 10:49
  - item. So a framework for decision making,
• 10:53
  - is critically important.
• 10:54
  - It's an opportunity to revisit the mission and
• 10:57
  - the role of the organization in the community,
• 10:59
  - you know, and serving children.
• 11:01
  - It also
• 11:03
  - eliminates
• 11:04
  - confusion down the line about growth and opportunity.
• 11:07
  - And so you really
• 11:09
  - anchor
• 11:10
  - and align the organization
• 11:12
  - around where the growth
• 11:15
  - should be, where the investments should be.
• 11:17
  - I ran into an organization where we were
• 11:19
  - hired to do, some facility
• 11:22
  - planning. And, you know, ultimately,
• 11:25
  - their growth strategy was quite,
• 11:27
  - quite ambitious and everything was growing. And once
• 11:30
  - you start to put
• 11:31
  - capital,
• 11:33
  - not only staffing, but capital to that,
• 11:36
  - it becomes
• 11:38
  - infeasible.
• 11:39
  - So
• 11:40
  - certainly being focused and having that decision making
• 11:43
  - framework,
• 11:44
  - is important. And then the holistic planning element,
• 11:49
  - of it is
• 11:51
  - really
• 11:52
  - understanding,
• 11:54
  - you know, the the financial implications of that
• 11:56
  - that growth opportunity, what the operational assumptions are
• 12:00
  - and the model
• 12:02
  - around
• 12:03
  - that growth.
• 12:05
  - You know, when Brian's talking about beds,
• 12:08
  - you know, an ambulatory network and other sites
• 12:11
  - of care, it's important to understand,
• 12:13
  - the staffing models for that. The operating assumptions
• 12:17
  - may be different in the future than they
• 12:19
  - are today. So you can't just use what
• 12:21
  - you have what you are experiencing today.
• 12:23
  - And ultimately,
• 12:24
  - taking that down to understand the space, the
• 12:28
  - capital
• 12:29
  - reimbursement assumptions in that
• 12:32
  - broader financial plan, is it sustainable?
• 12:35
  - Do we have the philanthropy and the financial
• 12:37
  - resources to to support that? So I think
• 12:39
  - those are the the two pieces.
• 12:42
  - Mhmm.
• 12:43
  - Yeah. Really helpful, Phil. And I'm curious.
• 12:46
  - It might be hard to narrow it down
• 12:47
  - to just one, but is there one common
• 12:49
  - denominator
• 12:50
  - or mistake that you see consistently,
• 12:53
  - that systems may be getting wrong or an
• 12:56
  - an assumption that they may have that you'd
• 12:57
  - wanna correct around this growth strategy arena?
• 13:01
  - Yep. Brian, anything to to add from your
• 13:03
  - perspective?
• 13:05
  - Yes, sir. Real quick
• 13:08
  - is simply confusing
• 13:10
  - volume with a strategy. I
• 13:13
  - volume for volume's sake,
• 13:16
  - without knowing
• 13:18
  - how it's adding value and doing it blindly
• 13:21
  - without, taking into the very real impacts,
• 13:24
  - to what we talked about earlier, margin and
• 13:27
  - access, but also
• 13:28
  - shifting it to sites of care that, make
• 13:31
  - more sense for, patients and their families. Simply
• 13:34
  - building volume in in an inpatient capacity or
• 13:37
  - bed tower
• 13:38
  - may not be the right answer. The right
• 13:40
  - answer may be a an outpatient facility where
• 13:43
  - you can, avoid an inpatient stay. So where
• 13:46
  - I'm very critical in strategy is,
• 13:49
  - when a presentation is handed to me and
• 13:52
  - it starts with volume
• 13:53
  - and it cannot
• 13:55
  - state explicitly where this solves a different problem
• 13:59
  - other than just volume.
• 14:00
  - To put that in perspective, Erica, really quickly,
• 14:03
  - to build an outpatient,
• 14:05
  - something that's designed or meant to be in
• 14:07
  - an outpatient environment in the hospital is three
• 14:09
  - to four times more expensive.
• 14:11
  - So so having that financial discipline in that
• 14:14
  - in that focus, I think, is critical.
• 14:17
  - Yeah. A great example, Phil. Thanks for that
• 14:19
  - hook on.
• 14:21
  - And I know that we've also several times
• 14:23
  - throughout this conversation, we've touched on workforce concerns,
• 14:27
  - whether we're talking about the the results of
• 14:29
  - that mindset survey you mentioned, Phil, or Ryan,
• 14:31
  - in your introductory remarks, remarks, noting that clinical
• 14:34
  - talent and retaining subspecialists was so top of
• 14:36
  - mind.
• 14:37
  - This is certainly not something that's, limited to
• 14:40
  - just Boston Children's, that we're seeing this across
• 14:42
  - the pediatric landscape.
• 14:44
  - So, Ryan, I'd love to know how your
• 14:45
  - organization is thinking about workforce as a strategic
• 14:49
  - growth enabler rather than simply just a cost
• 14:52
  - center, and where are you investing differently as
• 14:54
  - a result of that mindset?
• 14:57
  - Excellent point, and,
• 14:59
  - restate a few things and then build upon
• 15:01
  - it from the start of our discussion. But
• 15:05
  - particularly in pediatrics,
• 15:07
  - when you think through your
• 15:10
  - areas of risk,
• 15:11
  - people, not beds or capital are the are
• 15:14
  - the true binding constraint. So
• 15:16
  - treating clinical
• 15:18
  - workforce as a cost to minimize,
• 15:21
  - you really start to strangle your ability for
• 15:23
  - growth. Now you you you need to be
• 15:25
  - prudent, but,
• 15:27
  - it take it's such a long life cycle
• 15:30
  - to get somebody
• 15:31
  - very well trained at a high level in
• 15:33
  - pediatrics.
• 15:34
  - That is the most important thing is having,
• 15:37
  - the pediatric workforce,
• 15:39
  - to not just grow, but
• 15:41
  - to continue and evolve in your care.
• 15:44
  - Second,
• 15:45
  - if you're if you have the ability, we're
• 15:47
  - an organization
• 15:48
  - that does is, grow your own as much
• 15:50
  - as possible. It's incredibly hard to recruit subspecialists,
• 15:55
  - and particularly subspecialists that don't exist. So,
• 15:58
  - you have to make them. You have to
• 16:00
  - train them. Our our deep, deep relationship with
• 16:03
  - Harvard Medical School goes back,
• 16:06
  - many, many, many decades,
• 16:08
  - and having the fellowships and the residency programs
• 16:11
  - that,
• 16:13
  - really enable our growth is,
• 16:15
  - extremely, extremely important. And, again, that's not viewed
• 16:18
  - as a as a cost center.
• 16:21
  - Making sure your clinical team is at the
• 16:23
  - top of their license as best they can.
• 16:25
  - That's a that's a phrase used over and
• 16:28
  - over again, but is more relevant today than
• 16:30
  - ever.
• 16:31
  - And then finally,
• 16:34
  - retention is actually growth.
• 16:36
  - So
• 16:38
  - every departure,
• 16:39
  - I'd put at a minimum, is twelve to
• 16:41
  - eighteen months of capacity
• 16:44
  - that you may not refill. So,
• 16:47
  - retain retain the best that you have and,
• 16:50
  - continue to work on
• 16:52
  - stripping any administrative burden using,
• 16:55
  - AI, and that's the first time I've used
• 16:57
  - the phrase AI. We're fifteen minutes into it,
• 16:59
  - so I think that's a record for any
• 17:00
  - type of podcast right now,
• 17:02
  - than any talk.
• 17:04
  - But, stripping administrative burden using, some AI ambient
• 17:08
  - documentation,
• 17:09
  - you gotta give the clinicians their time back
• 17:11
  - to be with patients.
• 17:13
  - So, it is a key enabler. People are
• 17:15
  - more than ever in in clinical medicine, particularly
• 17:19
  - pediatrics,
• 17:20
  - the key part of any successful organization or
• 17:23
  - strategy.
• 17:24
  - Yeah.
• 17:25
  - Yeah.
• 17:26
  - Appreciate that, Ryan. And, hey, we made this
• 17:28
  - fifteen minute mark without me impressed.
• 17:33
  - But I truly appreciate what you've shared here.
• 17:35
  - You know, the growing your growing from within
• 17:38
  - the system, growing your own, you know, fostering
• 17:41
  - that deep relationship with your academic partner,
• 17:44
  - and then also seeing retention as growth. I
• 17:47
  - that really stood out to me as a
• 17:49
  - really nice sound bite,
• 17:50
  - but one that I think will will probably
• 17:52
  - land with our listeners. Phil, is there anything
• 17:54
  - that you'd add here, you know, whether that
• 17:56
  - be creative staffing or operating models you're seeing
• 17:59
  - organizations adopt or or anything else that comes
• 18:01
  - up for you?
• 18:03
  - Yeah. I I think the, piggybacking on the
• 18:06
  - multiplying the the reach,
• 18:08
  - extending
• 18:09
  - the subspecialists as much as possible from the
• 18:11
  - hub to satellite sites of care,
• 18:13
  - is certainly,
• 18:15
  - something,
• 18:16
  - organizations continue to to expand
• 18:19
  - on and, you
• 18:21
  - know, just simply access to your fixed capacity,
• 18:23
  - just just looking for opportunities to
• 18:26
  - open up
• 18:28
  - that operating room
• 18:29
  - for another case or two and
• 18:32
  - the ED to see more patients.
• 18:34
  - Just unlocking that that fixed capacity is is
• 18:37
  - something organizations
• 18:39
  - spend a lot of time on.
• 18:41
  - Fantastic.
• 18:41
  - Well,
• 18:43
  - it it has been such a great conversation
• 18:45
  - with you both. I wanna make sure that
• 18:47
  - we close out on looking ahead just a
• 18:49
  - few years.
• 18:50
  - You know, as you consider what might be
• 18:53
  - the reality, the landscape five years from now,
• 18:56
  - what do you think will define successful pediatric
• 18:59
  - growth, and what do you think leaders should
• 19:01
  - be doing right now to position their organizations
• 19:04
  - for that future?
• 19:06
  - My comments are,
• 19:07
  - pediatrics in general, obviously biased by our experience
• 19:11
  - here in Boston, but, I have three main
• 19:13
  - areas that I would recommend focusing on. One,
• 19:16
  - being capital efficient, partnerships,
• 19:18
  - and lead time. So in capital efficient,
• 19:21
  - again, success is
• 19:23
  - absolutely growth decoupled from bed building.
• 19:26
  - And,
• 19:27
  - frankly, the winners are gonna be those that
• 19:29
  - grow acuity and reach,
• 19:31
  - with the least amount of fixed capital. They
• 19:34
  - deploy and execute on ambulatory
• 19:37
  - digital and some partnership led, distribution,
• 19:40
  - again, around
• 19:42
  - many of us having a a highly concentrate
• 19:44
  - a high acuity concentrated
• 19:46
  - core or the the main campus or medical
• 19:48
  - center where we're at.
• 19:51
  - Highlighting partnerships,
• 19:53
  - partnerships
• 19:54
  - for many will likely be the primary growth
• 19:56
  - vehicle.
• 19:57
  - Community hospitals, you know, they the coverage, the
• 20:00
  - transfers, co management, value based arrangements for complex
• 20:04
  - kids with payers.
• 20:06
  - And for those of us that are in
• 20:07
  - research,
• 20:08
  - biotech pharma,
• 20:09
  - partnerships for rare disease research to therapeutics speeding
• 20:12
  - that up.
• 20:14
  - And and finally,
• 20:16
  - continued great collaboration with,
• 20:18
  - PEER Children's Hospital and sharing data and, frankly,
• 20:21
  - services,
• 20:22
  - are gonna be important. And finally,
• 20:25
  - just the reality of how long this takes.
• 20:27
  - The lead times are immense. They're brutal. They're
• 20:30
  - long. Building an ambulatory digital network and partnerships
• 20:33
  - take years, so you gotta get them started
• 20:36
  - now. Don't try don't wait for perfect. Build
• 20:38
  - the relationships.
• 20:40
  - Lay the data and AI foundations. We're all
• 20:43
  - talking about it right now. There's so many
• 20:45
  - different options. At least what we're doing here
• 20:48
  - is,
• 20:49
  - leveraging some of our pilot programs,
• 20:51
  - scaling in some areas, and just learning. Again,
• 20:54
  - not trying to be perfect, but continue to
• 20:57
  - learn. And then finally,
• 20:58
  - as best you can, you know, you keep
• 21:00
  - a strong balance sheet so you can invest,
• 21:02
  - countercyclically
• 21:03
  - through,
• 21:04
  - the many headwinds we all know we'll face
• 21:07
  - and that are never gonna go away. But,
• 21:09
  - I'll close my comments,
• 21:11
  - Erica, with I truly believe that, health care
• 21:15
  - life sciences are in a golden age right
• 21:17
  - now, with the data processing power and our
• 21:20
  - ability to really harness
• 21:22
  - networks. And, there's never been a better time
• 21:25
  - to be in medicine and pediatrics, so I
• 21:27
  - really appreciate the opportunity
• 21:29
  - to chime in.
• 21:31
  - Great strategies,
• 21:32
  - best practices, Ryan, and appreciate the outlook you've
• 21:35
  - shared. Phil, Phil, I know it's hard to
• 21:36
  - follow that one up, but anything else that
• 21:38
  - we want to add? Yeah. You can agree
• 21:41
  - more. I think that the modeling of financialities
• 21:44
  - is is critical critically important in being focused
• 21:46
  - and where you're making those investments because there's
• 21:49
  - there's financial
• 21:51
  - health to support just general growth, but there's
• 21:53
  - also
• 21:54
  - additional financial health needed to support
• 21:57
  - major capital investments and and technology. So
• 22:01
  - Fabulous. Phil, thanks for rounding us out. Again,
• 22:04
  - it's been a great conversation with you both.
• 22:05
  - I wanna thank you for making the time
• 22:07
  - for Becker's today, sharing all of your wisdom
• 22:10
  - with our listeners.
• 22:11
  - And, of course, we'd also like to thank
• 22:13
  - the podcast sponsor for today, Forvis Mazars.
• 22:16
  - Listeners, be sure to tune in to more
• 22:18
  - podcasts from Becker's by visiting our podcast page
• 22:20
  - at beckershospitalreview.com.