Latest / Becker’s Healthcare Podcast / Financial Turnarounds, AI, and Leading Care New England with Dr. Michael Wagner

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Financial Turnarounds, AI, and Leading Care New England with Dr. Michael Wagner · Becker’s Healthcare Podcast

• 0:02
  - There's a small circle of people who truly
• 0:04
  - understand what it takes to lead a health
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  - system right now. The decisions are enormous.
• 0:08
  - The variables are constantly shifting, and the stakes
• 0:11
  - of getting a call wrong don't stay contained.
• 0:14
  - That's not a complaint. It's a structural reality.
• 0:17
  - And it's why the most effective c suite
• 0:19
  - leaders are deliberate about where they go to
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  - pressure test their thinking.
• 0:22
  - Becker's fourteenth annual CEO and CFO roundtable
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  - brings together more than 1,500
• 0:28
  - executive level attendees
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  - and nearly 400 speakers for four days built
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  - around growth, financial sustainability,
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  - workforce strategy, and the leadership questions that don't
• 0:38
  - have easy answers.
• 0:39
  - Join us November second through the fifth in
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  - Chicago.
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  - For the agenda and event details,
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  - visit beckershospitalreview.com
• 0:47
  - and click on the events tab in the
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  - upper right.
• 0:50
  - This is Scott Becker with the Becker's Healthcare
• 0:53
  - Podcast.
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  - I'm thrilled today to be visiting with a
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  - brilliant
• 0:58
  - physician
• 0:59
  - leader.
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  - We're joined today by doctor Michael Wagner.
• 1:03
  - And doctor Michael Wagner is the president and
• 1:06
  - CEO of Care New England.
• 1:08
  - He is somewhat of a unicorn in people
• 1:11
  - that we've talked about to and we've talked
• 1:13
  - with, And we'll talk about that in a
• 1:15
  - little bit. He he spent a lot a
• 1:17
  - lot of his career in the Boston area,
• 1:19
  - presidency of Tufts Medical Center, chief assistant executive
• 1:23
  - at Tufts, and a lot more. Doctor Wagner,
• 1:26
  - can you take a moment and introduce yourself
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  - and and tell us a little bit about
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  - your career, your background,
• 1:32
  - and about Care New England?
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  - Sure. Well, Scott, it's great to be on,
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  - and thank you for the invitation. So I'm
• 1:38
  - Mike Wagner. I'm a,
• 1:39
  - president and CEO, as you said, at Care
• 1:41
  - New England. I'm an internist by background, and,
• 1:43
  - and, clinically, I was active up until I
• 1:45
  - came to Care New England about four years
• 1:47
  - ago.
• 1:48
  - Primary care and then mostly hospital based medicine.
• 1:51
  - Care New England is comprised of three hospitals,
• 1:54
  - Butler Hospital,
• 1:55
  - Women and Infants, and, Kent Hospital.
• 1:58
  - Butler is a freestanding
• 2:00
  - psychiatric hospital,
• 2:01
  - providing the majority of inpatient behavioral health care
• 2:04
  - for the state of Rhode Island. And Women
• 2:06
  - and Infants,
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  - does about eighty one percent of all the
• 2:08
  - deliveries in the state, 8,500
• 2:10
  - deliveries per year.
• 2:12
  - And every complicated mom and baby is ultimately
• 2:15
  - transferred to women and infants if they need
• 2:17
  - higher level care. And Kent sits about 10
• 2:19
  - miles south of Providence.
• 2:21
  - And the goal of Kent is to progressively
• 2:23
  - increase the complexity of care so that Rhode
• 2:26
  - Islanders from the that part of the state,
• 2:28
  - the southern tier of the state, no don't
• 2:30
  - need to go to Providence or Boston for
• 2:32
  - higher level care. So really,
• 2:34
  - an amazing organization that provides essential services
• 2:38
  - in the state of Rhode Island, and we're
• 2:40
  - one of the two systems
• 2:42
  - that exist in this state.
• 2:44
  - Phenomenal. And and take a moment, doctor Wagner,
• 2:47
  - because you've got this fascinating background.
• 2:50
  - Both a
• 2:51
  - brilliant physician,
• 2:53
  - brilliant
• 2:53
  - medical education,
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  - in in in then on top of that,
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  - you know, looking at your background,
• 3:01
  - you are perhaps I mean, Georgetown University School
• 3:04
  - of Medicine,
• 3:05
  - Dartmouth Medical School. I mean, just a brilliant
• 3:08
  - career.
• 3:09
  - But but I wanna ask you about something.
• 3:11
  - If you are the first
• 3:13
  - physician leader CEO
• 3:15
  - that I think I've ever talked to
• 3:18
  - who got a bachelor of arts
• 3:20
  - in botany, phi beta kappa,
• 3:23
  - by all means.
• 3:24
  - But but talk about the career path that
• 3:26
  - led you from
• 3:28
  - botanist,
• 3:29
  - taking a few years off before going back
• 3:31
  - to medical school, and deciding
• 3:34
  - I wanna apply my skills, my brain to
• 3:36
  - everything,
• 3:37
  - not to plants, but to people. What was
• 3:40
  - that evolution? It's almost like talking to Charles
• 3:43
  - Darwin. How did you end up in this
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  - evolution from botanist
• 3:47
  - to
• 3:47
  - to being
• 3:49
  - physician leader to now CEO in a in
• 3:51
  - a brilliant career at Tufts as well? Yeah.
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  - Well, thank you, Scott. You're too generous. I,
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  - I went to Connecticut College and majored in
• 3:59
  - botany.
• 4:00
  - And,
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  - at Connecticut College at the time, there wasn't
• 4:03
  - the option of biology as a major. It
• 4:05
  - was either botany or zoology.
• 4:07
  - And frankly, I I I, thought of myself
• 4:10
  - more of the mindset of the botany majors
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  - who are kinda earthy crunchy people and the
• 4:14
  - zoology people are all pre med.
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  - So So it tells you a little bit
• 4:17
  - about the people I like to hang around
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  - with, which are, you know, nice kind people,
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  - not to say that pre med people aren't.
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  - But what it did though is I took
• 4:25
  - all those requisite courses and in in college,
• 4:29
  - made the decision to go to medical school.
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  - My brother, older brother,
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  - was a physician and, you know, he encouraged
• 4:35
  - me. We weren't from a medical family, but
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  - he encouraged me to really think about medicine
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  - as a career.
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  - And so I ended up applying to Georgetown.
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  - I I didn't get in the first time
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  - around, so I'm not as brilliant as the
• 4:46
  - way you're portraying me. I'm very, honored that
• 4:48
  - you talked about me that way. But it
• 4:50
  - did give me an an opportunity to work
• 4:52
  - for a year,
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  - for a navy contractor, and I did naval
• 4:55
  - underwater warfare simulation or submarine war games. And
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  - I was the grunt programmer back in the
• 5:00
  - days
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  - before personal computers.
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  - And that really got me interested in computational
• 5:06
  - aspects of health care. So when I went
• 5:09
  - to medical school,
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  - I became very fascinated with a whole emerging
• 5:13
  - field of medicine called clinical decision analysis. It
• 5:16
  - was basically using
• 5:18
  - mathematical models
• 5:20
  - to make medical decisions, and it was based
• 5:22
  - on,
• 5:23
  - work done in, this business decision analysis about
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  - how to make,
• 5:28
  - sound business decisions based on mathematics of likely
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  - outcomes
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  - and probabilities and costs.
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  - So,
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  - I had the opportunity to train at Dartmouth,
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  - which would let me to go from Georgetown
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  - to Dartmouth because Dartmouth was one of the
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  - few
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  - medical organizations in the country that was actually
• 5:45
  - had experts in this field, and I had
• 5:47
  - the opportunity to work with some really
• 5:49
  - renowned researchers in this area. And that got
• 5:52
  - me started in terms of using
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  - math quantitative methodologies,
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  - not only for medical decision making, but ultimately
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  - also from a medical economics perspective, and that
• 6:01
  - really shaped my career.
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  - Really remarkable. And and talk a bit about
• 6:07
  - the pride you're taking Care New England today.
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  - Give us a sense of a few things
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  - that you're really proud of with respect to
• 6:13
  - Care New England.
• 6:15
  - So Care when I came on board in
• 6:17
  - 2022,
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  - and you know this because Becker has reported
• 6:20
  - on this pretty extensively, is Care New England
• 6:22
  - had been in merger discussions
• 6:24
  - for at least ten years with somebody.
• 6:27
  - And I won't name all the organizations, but
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  - literally it was revolving door of multiple different
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  - organizations. And there was a belief that Care
• 6:34
  - New England had to merge with somebody else
• 6:36
  - in order to be sustainable.
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  - And when I was hired,
• 6:40
  - the the prior CEO was stepping down and
• 6:41
  - retiring.
• 6:43
  - The board chair and I,
• 6:44
  - chatted and he goes, here's the deal.
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  - We're interested in you, but we we're not
• 6:50
  - interested in reengaging in merger discussions. And I
• 6:52
  - said, that's fine. I think this organization is
• 6:55
  - very sustainable,
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  - but it needs discipline. It needs focus. And
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  - so I'll come on board, and let's get
• 7:01
  - this organization back on track. So probably a
• 7:03
  - bit from a macro perspective,
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  - the thing I'm most proud about is that
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  - we've demonstrated not only to the market, to
• 7:10
  - the Rhode Islanders, the legislature, the leaders, but
• 7:12
  - also to our own organization that we're a
• 7:14
  - sustainable organization.
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  - And we've gone from in '20 f y
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  - twenty two of losing about $55,000,000
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  - to getting back to profitability. And in our
• 7:24
  - last quarter, we actually made money, which is,
• 7:27
  - which is important.
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  - We actually had a two year period of,
• 7:30
  - eight consecutive quarters of making money. Last year
• 7:33
  - was a bit of a challenge.
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  - The first six months of this fiscal year
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  - from October
• 7:38
  - through March were challenging, but we're back on
• 7:40
  - track with a modest margin 1% margin, essentially.
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  - So I'm most proud of that. The the
• 7:46
  - other is that we've gotten a lot accomplished.
• 7:50
  - The financial sustainability
• 7:51
  - was very important for three important strategic
• 7:55
  - objectives. One was getting Epic across the board,
• 7:58
  - which we did, in October of last year.
• 8:01
  - We had Epic on the physician side. We
• 8:03
  - got all of our three hospitals up on
• 8:05
  - Epic. In October of last year, we had
• 8:08
  - no revenue drop. We seamlessly moved cut over
• 8:11
  - from a clinical perspective from Cerner to Epic,
• 8:15
  - and that
• 8:16
  - go live has been successful. The second thing
• 8:18
  - we did is that in working with the
• 8:20
  - board, we
• 8:21
  - we we
• 8:22
  - reimagine the strategy of Care New England with
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  - these different organizations
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  - to be Rhode Islanders'
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  - partner in their life's health care journey. That
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  - strategic
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  - focus
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  - is the, work of the board and senior
• 8:35
  - leadership.
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  - The representation of that was refreshing our brand
• 8:39
  - that came out in January of this past
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  - year of this year, and we were able
• 8:43
  - to, go from a house of brands to
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  - a branded house. And so now we have
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  - a shared master brand structure with a reimagined
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  - positive,
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  - logo that we now have across all of
• 8:56
  - our organizations.
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  - And the third piece was that we had
• 8:59
  - a very antiquated capital and debt structure,
• 9:03
  - that was,
• 9:04
  - challenging. We had about a $125,000,000
• 9:06
  - of outstanding debt, and we had a bullet
• 9:08
  - payment of about $21,000,000
• 9:10
  - that was due in '26,
• 9:12
  - which was a challenge for us.
• 9:14
  - By getting back to financial,
• 9:16
  - stability and profitability,
• 9:19
  - we actually refinanced our debt. You know, it
• 9:21
  - took down,
• 9:23
  - retired the 120,000,000,
• 9:24
  - took down an additional $100,000,000.
• 9:27
  - And, we have a much more modernized debt
• 9:30
  - structure,
• 9:31
  - good cost of capital, and also a covenant
• 9:34
  - that basically says we have to make a
• 9:36
  - 1% margin.
• 9:37
  - And so we're in a much better position.
• 9:40
  - That $100,000,000
• 9:41
  - that we've taken down has enabled us to
• 9:43
  - have,
• 9:45
  - shovels in the ground at Kent Hospital with
• 9:47
  - a new ambulatory pavilion.
• 9:49
  - We have renovations in the emergency room adding
• 9:52
  - a cath lab, and we have renovations at
• 9:54
  - women and infants hospital that will be part
• 9:56
  - of that $100,000,000
• 9:57
  - capital investment. We've,
• 9:59
  - reinvigorated the organization. We've invested hundreds of millions
• 10:03
  - of dollars over the last four years, and
• 10:05
  - we're just getting started.
• 10:08
  - I mean, that's truly remarkable.
• 10:10
  - And talk about when you look at the
• 10:12
  - next year coming up,
• 10:14
  - doctor Wagner, what are you most focused on
• 10:17
  - and excited about? So I think there's two
• 10:19
  - pieces, and it's a tale of almost two,
• 10:21
  - two cities or two stories. One is on
• 10:24
  - the positive side.
• 10:25
  - AI has had a dramatic positive
• 10:29
  - impact for our clinicians. We went live with
• 10:31
  - Ambient AI in October two years ago, October
• 10:35
  - 24,
• 10:36
  - with a very small pilot of about 16
• 10:38
  - docs. We had adoption rates in the 80
• 10:41
  - to 90% rate immediately with that subset of
• 10:44
  - docs. Now granted, they were, you know, a
• 10:46
  - bit of a early, you know, adopter cohort.
• 10:49
  - But when you see voluntary adoption rates of
• 10:52
  - using a technology like Ambien AI
• 10:55
  - of the 85 to 95%
• 10:57
  - range without ever telling the docs, you know,
• 10:59
  - you're gonna get paid more money or you're
• 11:01
  - gonna there's some incentive or requirement,
• 11:04
  - you realize you have something that's really valuable.
• 11:06
  - And and for the first time, technology was
• 11:09
  - moving from being a burden
• 11:10
  - to something that docs were now saying, you
• 11:13
  - know what? I was thinking about retirement every
• 11:15
  - day because I I wasn't sure how I
• 11:16
  - was gonna keep this up. I'm not thinking
• 11:19
  - about retirement anymore. I'm really enjoying practicing medicine.
• 11:22
  - I mean, the number of docs that have
• 11:23
  - said this in board meetings or in spontaneously
• 11:26
  - has been phenomenal. Now we just rolled out
• 11:29
  - we just had a enterprise license. So we
• 11:31
  - were now rolling out Ambien AI to any
• 11:33
  - physician
• 11:34
  - at Care New England that wants to use
• 11:35
  - it. So that's really a great positive story,
• 11:38
  - and we're looking to lean further into AI
• 11:40
  - and AI adoption, especially to reduce friction at
• 11:43
  - the clinical moment. On the flip side, the
• 11:46
  - other thing we're spending time on is obviously
• 11:48
  - HR one. The worry regarding
• 11:50
  - Medicaid redetermination
• 11:52
  - and keeping the Medicaid population covered.
• 11:55
  - The,
• 11:56
  - exchange and patients losing coverage on the commercial
• 11:59
  - side. These two things worry us greatly. We're
• 12:01
  - worried we're gonna go from very low single
• 12:03
  - digit uninsured rate in Rhode Island to
• 12:06
  - a rate that's in the
• 12:08
  - could be as high as nine, ten percent,
• 12:10
  - which would take us back to really, you
• 12:12
  - know, many, many years ago in terms of
• 12:14
  - the uninsured rate. What's interesting about Rhode Island
• 12:16
  - in in a lot of ways, it's a
• 12:18
  - microcosm
• 12:19
  - or it's a representation
• 12:20
  - or ticket as the canary in the coal
• 12:22
  - mine of what's happening in regions all over
• 12:24
  - the country, whether it's Rochester, New York or
• 12:27
  - Worcester, Massachusetts
• 12:28
  - or Hartford, Connecticut.
• 12:29
  - Our middle market, like Providence,
• 12:32
  - where we have a high,
• 12:34
  - a high penetration of Medicaid,
• 12:36
  - essential hospitals,
• 12:38
  - and low margin,
• 12:39
  - Rhode Island is really emblematic of what's gonna
• 12:41
  - happen nationally, and so we're spending a lot
• 12:44
  - of time on mitigating the impact of HR
• 12:46
  - one.
• 12:48
  - Thank you. I'm gonna ask you a couple
• 12:49
  - other questions. You've had this great leadership career.
• 12:53
  - Any advice or thoughts for emerging leaders?
• 12:56
  - And don't have to be particularly for emerging
• 12:59
  - physician leaders, don't wanna be in leadership, but
• 13:01
  - for emerging leaders,
• 13:02
  - and having an impactful
• 13:04
  - and successful journey
• 13:05
  - into leadership.
• 13:07
  - Yeah. So it's a great question. I the
• 13:10
  - first is, you know, when I was a
• 13:12
  - a emerging leader back in Rochester, New York
• 13:15
  - thirty years ago, the chair of the board
• 13:18
  - of trustees at Saint Mary's Hospital, which is
• 13:20
  - part of the daughters of charity,
• 13:22
  - health system spoke to the resident resident physicians,
• 13:25
  - and and her opening comments were
• 13:28
  - no margin, no mission. And I'm I'm thinking,
• 13:31
  - alright. Here's a nun
• 13:33
  - who's the chair of a not for profit
• 13:35
  - Catholic health care system and a hospital, and
• 13:38
  - she's making it clear to the my residents
• 13:41
  - at the time that,
• 13:43
  - look, you know, if we don't deliver financial
• 13:45
  - results, we won't continue to be able to
• 13:48
  - live to our mission. And so I've taken
• 13:51
  - that advice
• 13:52
  - to heart, and so I'm very focused on
• 13:54
  - results.
• 13:55
  - I don't think in this world that losing
• 13:57
  - money on operations is acceptable. And so the
• 14:00
  - first bit of advice is focus on results.
• 14:03
  - No margin, no mission.
• 14:04
  - The second piece is that this this conundrum
• 14:07
  - we have in American health care with which
• 14:09
  - is that we spend a tremendous amount of
• 14:11
  - money
• 14:12
  - on, health care, you know, whatever the current
• 14:15
  - GDP is. You know, 19%
• 14:17
  - of our gross domestic product is spent on
• 14:19
  - health care. Literally 5,000,000,000,000 plus a year. Yeah.
• 14:22
  - So it's just crazy amount of money. But
• 14:24
  - yet, we have hospitals that can't make a
• 14:26
  - margin. So you have this juxtaposition
• 14:28
  - of we're spending a lot of money in
• 14:30
  - health care, but yet, we have hospital and
• 14:32
  - health care systems that are scraping by and
• 14:35
  - having very low margins, especially true in the
• 14:37
  - Northeast. So
• 14:39
  - some
• 14:40
  - the leaders have to be thinking, how do
• 14:42
  - I how do I thread that needle? How
• 14:44
  - do I as a leader from a health
• 14:46
  - from a regional perspective or a state level,
• 14:48
  - how do I engage from a policy perspective
• 14:51
  - on how to
• 14:53
  - bend the cost curve? And at the same
• 14:55
  - time, think about how I'm gonna help drive
• 14:58
  - margin results, because that's my first goal is
• 15:00
  - how do I drive margin results? And I
• 15:02
  - think that requires a very special
• 15:05
  - talent and political savviness of how to engage
• 15:08
  - with the political leadership. And certainly in Rhode
• 15:10
  - Island, being a very small state and very
• 15:13
  - close,
• 15:14
  - we are looking from moving from crisis language
• 15:17
  - to solution language.
• 15:19
  - How do we work with the state? How
• 15:21
  - do we work with the payers? How do
• 15:22
  - we work with employers
• 15:23
  - in creating solutions that help to do these
• 15:26
  - things simultaneously?
• 15:28
  - The third is probably one that, again, born
• 15:30
  - from me being a physician,
• 15:32
  - is that I keep coming back to this
• 15:34
  - concept of staying connected to the clinical moment,
• 15:36
  - the moment between
• 15:38
  - a patient and their caregiver.
• 15:40
  - And as a doctor, having lived in this
• 15:42
  - world for many, many years and been not
• 15:45
  - only
• 15:45
  - in the clinic and then going, you know,
• 15:47
  - to a boardroom for a boardroom conversation, I
• 15:50
  - keep coming back to how do we as
• 15:52
  - leaders create that moments that magic happens between
• 15:55
  - the patient and their clinician?
• 15:57
  - How do we support them? That's why MB
• 15:58
  - and AI to me is such an important
• 16:00
  - innovation.
• 16:01
  - It allows, as it was with my case
• 16:03
  - when I went and saw my doctor for
• 16:05
  - my annual visit, we just sat and talked
• 16:07
  - to each other
• 16:08
  - for my visit, and
• 16:10
  - I knew he didn't have to worry about
• 16:12
  - the burden of taking down a bunch of
• 16:14
  - details
• 16:15
  - because it was all gonna be collected in
• 16:17
  - the Ambien AI listening tool. So to me,
• 16:20
  - we have to come back to this concept
• 16:22
  - of the clinical moment and how do we
• 16:24
  - support
• 16:25
  - clinicians and patients at that moment.
• 16:29
  - Thank you, doctor Wagner. And amazing. Right? The
• 16:31
  - the how these certain piece of advice, like
• 16:33
  - no marginal mission, sticks with you throughout your
• 16:36
  - entire career, literally fascinating.
• 16:38
  - I'm gonna ask you the next question, and
• 16:40
  - bear with me on this. I'm gonna a
• 16:42
  - couple different questions.
• 16:44
  - One,
• 16:45
  - are you a Boston sports fan or or
• 16:47
  - a New York sports fan or or a
• 16:49
  - Providence College fan or none of the above?
• 16:51
  - Oh my god. And second,
• 16:53
  - tell us a little bit about the experience
• 16:55
  - at Dartmouth and Georgetown,
• 16:56
  - what you loved more or less, thoughts at
• 16:59
  - all.
• 17:00
  - Yeah. So,
• 17:02
  - boy, my ancestral,
• 17:04
  - origins are from the New York City area.
• 17:06
  - So I have to be very careful living
• 17:08
  - up in the Boston area.
• 17:10
  - And,
• 17:10
  - so but I will say that I have
• 17:12
  - grown an affection for the Boston teams, Red
• 17:14
  - Sox, Patriots, etcetera.
• 17:16
  - And so,
• 17:17
  - you know, I'm I'm more of a Boston
• 17:19
  - fan. In Providence,
• 17:21
  - a great degree of pride around, Providence College,
• 17:24
  - their basketball team. I did go to a
• 17:26
  - Georgetown Providence College game in which, Ewing was
• 17:29
  - coaching at the time. So it was I
• 17:31
  - was on campus at Georgetown when you Patrick
• 17:33
  - Ewing was playing for Georgetown. It was great
• 17:36
  - to see him as coach even though they
• 17:37
  - did lose that game and he ultimately,
• 17:40
  - left coaching at Georgetown.
• 17:42
  - I you know, at Georgetown
• 17:44
  - at Dartmouth, Georgetown, Tufts,
• 17:47
  - amazing and great academic organizations.
• 17:50
  - And for each one of them, you know,
• 17:52
  - Georgetown, the cath the the deep roots,
• 17:55
  - Catholic mission connected to the community,
• 17:59
  - it led when I worked for a Catholic
• 18:00
  - hospital in Rochester, New York, I felt very
• 18:02
  - comfortable with the mission oriented,
• 18:06
  - approach that, not only the Jesuits at Georgetown,
• 18:08
  - but also the Daughters of Charity up in
• 18:10
  - Rochester, New York deeply connected to the community
• 18:14
  - and deeply connected to health equity,
• 18:16
  - and doing the right thing for patients.
• 18:19
  - Dartmouth,
• 18:20
  - it's one of the most unique academic environments.
• 18:23
  - You're up in the woods of New Hampshire.
• 18:25
  - And I will say part of the reason
• 18:26
  - I picked Dartmouth is because I was missing
• 18:28
  - skiing in the wintertime,
• 18:30
  - and I went from Washington DC to Dartmouth.
• 18:32
  - So, one, I could go to a great
• 18:34
  - organization like Dartmouth Hitchcock Medical Center and Dartmouth
• 18:37
  - College,
• 18:38
  - but also the opportunity to get back to
• 18:40
  - doing a little bit of skiing in the
• 18:41
  - wintertime.
• 18:42
  - Dartmouth,
• 18:43
  - for me,
• 18:44
  - was
• 18:45
  - the computational
• 18:47
  - analytical approach
• 18:48
  - and the commitment they had to,
• 18:51
  - that mathematical approach, was, has shaped my career
• 18:55
  - very much,
• 18:57
  - over the last, you know, three decades.
• 19:00
  - Fantastic.
• 19:01
  - And do you still ski? Do you still
• 19:03
  - get out some? And have you moved to
• 19:06
  - blue,
• 19:06
  - you know, sort of runs versus black? Or
• 19:09
  - can you still do the blacks? Where you
• 19:11
  - at on the ski game? Yeah. No. My
• 19:12
  - hey. Listen. When my son started passing me
• 19:14
  - at the age of 14 on the ski
• 19:16
  - slopes, I realized that I probably should stick
• 19:18
  - with the blue more than the black. I
• 19:21
  - yeah. I got out last year with my
• 19:22
  - son, and so I try to get out,
• 19:25
  - a couple of times a year, mostly in
• 19:27
  - the North,
• 19:28
  - almost
• 19:29
  - exclusively in the Northeast. And as you know,
• 19:31
  - Northeast skiing is like skiing on ice as
• 19:33
  - opposed to powder. So,
• 19:35
  - you know, I'm very careful. I'm more careful
• 19:37
  - today than I was thirty years ago.
• 19:41
  - Totally understood. I I I wanna thank you
• 19:43
  - for for joining us today
• 19:45
  - on the Becker's Healthcare podcast. What a pleasure
• 19:48
  - to visit with you, and what a magnificent
• 19:50
  - career. And you are a unicorn. The first
• 19:52
  - botanist turned CEO towards physician executive,
• 19:55
  - Georgetown, Dartmouth, and all of it, and what
• 19:57
  - magnificent work at Care New England that you
• 19:59
  - are doing and your team is doing. So
• 20:01
  - thank you so much for, joining us. Thank
• 20:03
  - you. Thank you, Scott. Appreciate it.