Latest / Becker’s Healthcare Podcast / George Stein, Vice President of Digital at Montefiore Einstein, and Dr. Shivani Agarwal, Senior Director of Community Healthcare Improvement & Strategy at Montefiore Einstein

Transcript

George Stein, Vice President of Digital at Montefiore Einstein, and Dr. Shivani Agarwal, Senior Director of Community Healthcare Improvement & Strategy at Montefiore Einstein · Becker’s Healthcare Podcast

• 0:02
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• 1:02
  - This is Laura Dierda with the Becker's Healthcare
• 1:05
  - Podcast.
• 1:06
  - I'm thrilled today to be joined by doctor
• 1:07
  - Shivani Agarwal,
• 1:09
  - who is the senior director of community healthcare
• 1:11
  - improvement and strategy at Montefiore Einstein, and George
• 1:14
  - Stein, vice president of digital at Montefiore Einstein.
• 1:18
  - Doctor Agarwal, George, thank you so much for
• 1:19
  - joining on the me on the podcast today.
• 1:23
  - Thanks for having us, Laura.
• 1:24
  - Thank you for having us.
• 1:26
  - Absolutely. Now I'm excited to dig into our
• 1:28
  - conversation because I know we're gonna be talking
• 1:31
  - a lot about what you're doing at the
• 1:32
  - Montefiore Einstein Comprehensive Cancer Center, some of the
• 1:35
  - successes that you've had, with cancer screenings and
• 1:38
  - just really bringing,
• 1:40
  - great care to the community. But before we
• 1:42
  - dive in, I was wondering if you could
• 1:44
  - both introduce yourselves and just tell us a
• 1:46
  - little bit about your roles at Montefiore. So,
• 1:49
  - Doctor. Agarwal, let's start with you.
• 1:52
  - Sure. So,
• 1:53
  - I am the senior director of community healthcare
• 1:55
  - improvement and strategy. I'm also a practicing physician
• 1:58
  - and have a background in public health and
• 1:59
  - healthcare redesign.
• 2:01
  - In my role, I help the system identify
• 2:04
  - gaps and outcomes and work with clinical, operational,
• 2:07
  - and digital,
• 2:08
  - IT leaders to implement new models of care,
• 2:11
  - into real world practice, and we use this
• 2:13
  - population health data driven approach. We implement codesign
• 2:17
  - with patients and frontline providers.
• 2:19
  - We integrate digital strategies, and we apply quality
• 2:22
  - improvement and implement implementation
• 2:24
  - science to kind of scale sustainably.
• 2:26
  - That's my role.
• 2:28
  - That's amazing to hear. And you cover so
• 2:30
  - much ground. That's fantastic. And, George, can you
• 2:33
  - tell us a little bit about,
• 2:34
  - your role in how you're approaching these projects?
• 2:37
  - Yes. I'm the VP for digital for the
• 2:40
  - health system, and my scope includes
• 2:43
  - the enterprise digital transformation.
• 2:45
  - My team's focus on addressing end user needs
• 2:48
  - wherever they are, but particularly for patients.
• 2:51
  - And we do that with a lot of
• 2:52
  - different technology solutions. And we also spend a
• 2:55
  - lot of time making sure that we're really
• 2:57
  - integrated with operations
• 2:59
  - and data to make sure that what someone
• 3:02
  - is seeing is really seamless.
• 3:05
  - That's fantastic. And, you know, so important, especially
• 3:07
  - right now, is the patient experience is,
• 3:10
  - really key in order to bring the services
• 3:12
  - that are needed into the community. And to
• 3:14
  - that point, I know you've been able to
• 3:16
  - launch a more resource efficient screening outreach strategy
• 3:19
  - that combines those digital tools with human navigation
• 3:22
  - and AI assistance and more as you're looking
• 3:25
  - to approach screening for breast cancer and beyond.
• 3:28
  - So I wanted to learn a little bit
• 3:30
  - more about that. Doctor. Agarwal,
• 3:32
  - your screening rates have beat the national average,
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  - yet still we see around twenty eight percent
• 3:37
  - of patients who are overdue. Can you talk
• 3:39
  - a little bit about the program that you've
• 3:40
  - designed and and what's still missing?
• 3:43
  - Sure. So, let me take a step back
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  - and talk a little bit about Montefiore Health
• 3:46
  - System first. So it's a a premier academic
• 3:49
  - health system, serves about 3,000,000 patients across the
• 3:52
  - Bronx, Westchester, and Hudson Valley.
• 3:54
  - We have,
• 3:55
  - 10 hospitals, 200 plus ambulatory sites. So it's
• 3:58
  - a really large system. It includes the Albert
• 4:01
  - Einstein College of Medicine,
• 4:03
  - and notably related to the discussion today, Montefiore
• 4:06
  - Medical Center is this large safety net medical
• 4:08
  - center with several hospitals across the Bronx and,
• 4:11
  - Mount Vernon serving those communities.
• 4:14
  - We also have the Montphere Einstein Comprehensive Cancer
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  - Center, which is an NCI designated comprehensive center
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  - and a national leader in cancer center and
• 4:22
  - research. And so we really have,
• 4:24
  - I I think, the milieu to be able
• 4:26
  - to,
• 4:28
  - think through kind of population health
• 4:30
  - at the point of care. Right? How do
• 4:31
  - we improve patient experience and access for our
• 4:34
  - entire population?
• 4:36
  - So,
• 4:38
  - related to your question, we have a pretty
• 4:41
  - strong a very strong primary care network with
• 4:43
  - a with a really amazing infrastructure with centralized
• 4:46
  - leadership analytics and outreach. And so we were
• 4:49
  - able that primary care network was able to
• 4:51
  - achieve those excellent rates, but we still knew
• 4:53
  - that patients still face some barriers to scheduling
• 4:56
  - and screening.
• 4:57
  - And so through,
• 4:59
  - a lot of work, we found gaps at
• 5:01
  - multiple levels, and I always think for the
• 5:02
  - pop health lens. Right? What what does the
• 5:04
  - system
• 5:05
  - need and where are the barriers at the
• 5:07
  - system level, the provider level, and the patient
• 5:09
  - level?
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  - And so
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  - at the system level, we did a real
• 5:13
  - really big kinda data dive and tried to
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  - understand
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  - what at the system level was happening. So
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  - there was a lot of variation across the
• 5:20
  - primary network sites. We have about 18 to
• 5:23
  - 20 sites across our network across The Bronx
• 5:25
  - and Mount Vernon.
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  - And so that at least signaled to us
• 5:28
  - that we have an opportunity. We had an
• 5:30
  - opportunity for targeted resourcing and standardization
• 5:32
  - across that network. Network. So that was first.
• 5:35
  - The second was understanding the provider kind of
• 5:38
  - experience. Right? So,
• 5:41
  - unfortunately,
• 5:41
  - missed visits
• 5:43
  - really limited access to screening. Right? Those orders,
• 5:46
  - those conversations for screening happen at the PCP
• 5:50
  - visits. And so when those visits don't happen,
• 5:52
  - you somewhat lose that opportunity to get that
• 5:55
  - screening,
• 5:57
  - cascade started. Right? And so was there a
• 6:00
  - kind of a there was a need to
• 6:01
  - decouple screening from our primary care practice appointments?
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  - The the third and really importantly was the
• 6:09
  - patient level. And so this is where I
• 6:11
  - wanna overemphasize
• 6:12
  - how important it is to talk to patients
• 6:15
  - and communities because they're at the front lines
• 6:17
  - of that care.
• 6:18
  - And so,
• 6:19
  - quantitatively,
• 6:20
  - we found that there was an overrepresentation
• 6:22
  - of that those people that were overdue among
• 6:25
  - our Medicaid insured patients, those with transportation needs.
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  - And interestingly,
• 6:29
  - among our adults that were 40 45 years
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  - old. Right? So that kind of reflects maybe
• 6:34
  - newer guidelines weren't getting integrated,
• 6:36
  - as seamlessly as we had hoped. But qualitatively,
• 6:39
  - when we talked to community, we listened to
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  - countless stories,
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  - at our community advisory boards, out in the
• 6:44
  - community.
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  - And what we heard was that fear was
• 6:49
  - a very big barrier
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  - to scheduling appointments, keeping those appointments, and getting
• 6:53
  - screened, fear of the results,
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  - fear of the test itself is not that
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  - comfortable,
• 7:00
  - if anyone has had those mammograms, I myself
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  - included,
• 7:03
  - and then scheduling. Right? Our communities have this
• 7:06
  - desire to make it easier to take care
• 7:07
  - of their health in a proactive way while
• 7:09
  - also being really busy and on the go.
• 7:12
  - And so,
• 7:13
  - the sentiment that life happens, sometimes you miss
• 7:16
  - your appointments, you need an extra nudge to
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  - come back in, that was really important.
• 7:20
  - And so that's kind of how we discovered
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  - who that twenty eight percent were. Right? What
• 7:24
  - were their needs? How could we redesign what
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  - we needed to do in order to meet
• 7:28
  - all of those kind of levels of needs?
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  - It's fascinating to hear about it. And thank
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  - you so much for giving us the overview
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  - of how you, you know, discovered that need
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  - and and designed the program. We're thinking through,
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  - you know, what really can make a difference
• 7:45
  - for patients and and how you can meet
• 7:47
  - them where where they're at, which I know
• 7:48
  - is so critical.
• 7:50
  - I I'm curious, as you've gone through this
• 7:52
  - process, what have you found does and does
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  - not work to make sure, that that different
• 7:57
  - people are scheduling and attending their screenings?
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  - What have you learned, and how are you,
• 8:03
  - navigating and solutioning around it?
• 8:06
  - Yeah. I'm I'm very excited to to present
• 8:08
  - this work. So based on all of our,
• 8:10
  - you know, data discovery and conversations, we built
• 8:13
  - this plan to address those opportunities at all
• 8:15
  - of those levels. Right? System provider and patient.
• 8:18
  - In the first year in 2025, we wanted
• 8:20
  - to test these potential strategies to see what
• 8:22
  - was most effective and acceptable before we built
• 8:25
  - for scale.
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  - Right? And so
• 8:27
  - what we tested was this multilevel approach, and
• 8:29
  - and we learned a lot along the way.
• 8:32
  - So first off, navigation is kind of key
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  - to all preventative cancer screening. We have patients
• 8:38
  - that need extra navigation, and that's really important.
• 8:41
  - And so we had our, radiology,
• 8:44
  - leadership also felt it was important and, hired
• 8:47
  - a navigator
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  - with scheduling access. And we trained them to
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  - address transportation,
• 8:53
  - assessments and needs,
• 8:55
  - assess for fear of that screening,
• 8:58
  - and then coordination.
• 9:00
  - And so what we did with them first
• 9:02
  - was
• 9:03
  - we gave them lists of patients that were
• 9:05
  - overdue at the sites where we knew that,
• 9:08
  - we had opportunities to kind of boost their
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  - average rates.
• 9:12
  - And so,
• 9:14
  - at the same time, we had our navigator
• 9:15
  - learn from our cancer center behavioral health specialist
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  - how to help assess for that screening hesitation,
• 9:21
  - and then refer to our amazing Bronx Oncology
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  - Living Daily program, our BOLD program, where we
• 9:26
  - have peer support for people who are,
• 9:29
  - living with a cancer diagnosis or who have
• 9:31
  - screening hesitation.
• 9:33
  - And so we kind of put into place
• 9:34
  - a lot of these navigation aspects, but it
• 9:37
  - wasn't only navigation to scheduling. Right? It was
• 9:39
  - navigation of the whole person
• 9:41
  - to improve that patient experience. And what we
• 9:43
  - learned
• 9:44
  - was,
• 9:46
  - that that works, number one, really important.
• 9:50
  - And number two, you know, we have one
• 9:52
  - person who can't get to everyone, and not
• 9:55
  - everyone needed the same thing. And so then
• 9:57
  - we thought through, well, how do we kind
• 9:59
  - of also digitize this approach? How do we
• 10:01
  - get to people in various different ways with
• 10:03
  - various different needs?
• 10:05
  - And so we also,
• 10:07
  - put into place centralized ordering. We kind of
• 10:10
  - removed the primary care provider from that visit
• 10:12
  - dependency because we heard from them. We know
• 10:15
  - these screenings are important. We want our patients
• 10:16
  - to get our screenings.
• 10:18
  - We we just know they can't always get
• 10:20
  - access to us when they need that order.
• 10:22
  - So we centralized that approach. We also, I'm
• 10:24
  - really excited about this, enabled self scheduling via
• 10:27
  - text
• 10:29
  - so that we make that scheduling experience frictionless.
• 10:31
  - Right?
• 10:32
  - Patient gets an order for that mammogram.
• 10:35
  - They get a text on their phone saying
• 10:37
  - it's time for your scheduled mammogram.
• 10:39
  - Here's an appointment. If you don't like this
• 10:41
  - appointment, here's the next appointment. It's, like, colocated
• 10:44
  - to their geographic location, and it's beautiful. I
• 10:47
  - myself have tried it. It's life changing.
• 10:50
  - And for our patients, we've heard because we
• 10:52
  - co designed this with them. They were asking
• 10:54
  - for this, and we were able to give
• 10:55
  - this to them. They love it. Right?
• 10:59
  - Another thing that we kind of co designed
• 11:01
  - with our patients and providers was agentic AI
• 11:03
  - outreach.
• 11:05
  - So,
• 11:06
  - again, this life happens moment. Right? Oops. I
• 11:09
  - missed my appointment. I thought I was gonna
• 11:10
  - be there, and I couldn't get there.
• 11:12
  - We have this Agentic AI proactively
• 11:15
  - outreach to patients,
• 11:17
  - within a few days of that missed appointment
• 11:19
  - if the patient hasn't rescheduled
• 11:21
  - to, again, kind of transfer them to the
• 11:24
  - call center or to,
• 11:26
  - our text options to reschedule their appointment if
• 11:28
  - they want. Or, again, if fear is was
• 11:31
  - an issue, they will be re referred to
• 11:33
  - our BOLD program, etcetera etcetera, our our navigator.
• 11:36
  - So we're trying to create this kind of,
• 11:38
  - like, these wrap around services while also integrating
• 11:41
  - both our patient needs and our operational needs
• 11:44
  - together
• 11:45
  - in a digital solution.
• 11:49
  - That's amazing. If I can if I can
• 11:52
  - add to that, I think there from a
• 11:54
  - a tech perspective,
• 11:56
  - not only do we involve the patients, I
• 11:57
  - think there's a really important point that doctor
• 11:59
  - Agarwal made, which is that we changed our
• 12:01
  - operations
• 12:02
  - for the future state. We didn't just put
• 12:04
  - tech on top of something that worked today.
• 12:07
  - We did both together.
• 12:08
  - And then I think we translated that into
• 12:12
  - technology based on what care teams needed and
• 12:15
  - what patients needed
• 12:17
  - overall and end to end, not just a
• 12:18
  - particular
• 12:19
  - moment. We didn't just send a text that
• 12:21
  - said you
• 12:23
  - are eligible or there's screening available. We then
• 12:26
  - connected it to the actually scheduling interface so
• 12:29
  - someone can just click and schedule. And then
• 12:31
  - we anticipated the needs. Well, if the initial
• 12:33
  - time doesn't work, show me other times and
• 12:36
  - made that as easy as possible working backwards
• 12:38
  - from from from what folks
• 12:40
  - really needed. And we also did a lot
• 12:42
  - of proactive outreach. We are have gotten very
• 12:44
  - good at
• 12:46
  - response rates and making sure that our messages
• 12:49
  - meet patients the way they'd like to interpret
• 12:51
  - them and read them. And so the right
• 12:53
  - channel at the right time is really, really
• 12:55
  - important.
• 12:56
  - We allow patients to say what their preferences
• 12:59
  - are, and that's really helpful to make sure
• 13:01
  - that we communicate them with them in a
• 13:03
  - way that really resonates for them.
• 13:07
  - That's amazing to hear, you know, truly to
• 13:09
  - have that type of partnership with between,
• 13:12
  - the clinical side, the technology, and then the
• 13:15
  - patients too. Seems like you've been able to
• 13:17
  - produce something that's beneficial and meaningful in,
• 13:20
  - bringing that type of, you know, return that
• 13:22
  - you're looking for. I think, George, across the
• 13:25
  - navigator, self scheduling, AI outreach, where do you
• 13:28
  - see some of the digital strategy continuing to
• 13:30
  - play a role in enabling these programs to
• 13:32
  - scale across the system?
• 13:35
  - I think digital is going to take a
• 13:37
  - very important role for us access and
• 13:41
  - time back to our care teams so they
• 13:43
  - can focus more on care are two really
• 13:45
  - big parts of our strategy, and this fits
• 13:47
  - very squarely
• 13:48
  - within that. And so as we think about
• 13:51
  - this, we're going to continue to take a
• 13:53
  - comprehensive approach, all those steps for patients
• 13:56
  - and for members of the care team. We
• 13:58
  - wanna look at them together, not just in
• 14:00
  - isolated incidents,
• 14:02
  - so that we can then solve for what
• 14:04
  - is what is the right building block and
• 14:06
  - puzzle piece of technology to make things
• 14:08
  - work. And as we also build this, we
• 14:11
  - wanna continue to keep in mind the overall
• 14:13
  - goal, which is improving the health of the
• 14:16
  - community.
• 14:17
  - Understanding that upfront,
• 14:19
  - I think, has made this very easy to
• 14:21
  - scale. We've been able to build this in
• 14:23
  - a way that allows us to think, okay.
• 14:25
  - If we apply this for not just breast
• 14:27
  - cancer screening, but colorectal screening, lung cancer screening,
• 14:31
  - other types of screening and population,
• 14:33
  - health needs, we can then work backward and
• 14:36
  - say, we're not creating this thing to only
• 14:38
  - solve for breast cancer screening. We are building
• 14:42
  - our technology, our digital solutions for something that
• 14:44
  - we know is not going to just be
• 14:46
  - a pilot. It's gonna be a big, big
• 14:48
  - program.
• 14:49
  - And I'll take one very tangible example of
• 14:52
  - that. We knew scheduling was gonna be important.
• 14:54
  - So we didn't just create scheduling
• 14:57
  - in that interface for breast cancer screening. We
• 14:59
  - actually had our scheduling interface. What do we
• 15:01
  - want scheduling to look like? How is that
• 15:03
  - gonna be really seamless? And then we said,
• 15:05
  - what are the specific components that are going
• 15:08
  - to be applicable for breast cancer screening? So
• 15:10
  - that way we could always make sure that
• 15:12
  - we were doing things in a way that
• 15:13
  - is really, really scalable for all the different
• 15:15
  - patient populations
• 15:16
  - as well as for all of the different
• 15:18
  - types of screening.
• 15:21
  - That makes a lot of sense. You know?
• 15:23
  - And it is really cool to hear you
• 15:24
  - have that type of planning and foresight to
• 15:26
  - not only think of the small pilot that
• 15:28
  - you were doing, but actually look at the
• 15:30
  - bigger picture and see the potential for the
• 15:32
  - whole organization.
• 15:34
  - Now I know the results, again, have been
• 15:36
  - very impressive looking at, looking at, you know,
• 15:38
  - adding 5,000
• 15:39
  - plus screens from people who were overdue to
• 15:42
  - be screened in about nine months without adding
• 15:44
  - any new radiologists as well, which is really
• 15:46
  - impressive. So how do you replicate this if
• 15:49
  - you're one of the hospitals or systems listening
• 15:51
  - to the podcast today? What advice do you
• 15:53
  - have, and where do you see some of
• 15:55
  - the areas that, you know, other organizations could
• 15:58
  - learn from you?
• 16:00
  - I'll take the baton first. So,
• 16:03
  - I wanna echo what George said. The partnerships
• 16:06
  - are really important. So our kind of clinical
• 16:08
  - and operational partnership
• 16:10
  - with the digital team has been pivotal
• 16:13
  - to creating products and workflows that can scale.
• 16:17
  - So I'll say that first. And, you know,
• 16:19
  - I I didn't know what was possible until
• 16:21
  - until our our digital team kind of told
• 16:23
  - us, you know, this is possible. You tell
• 16:25
  - us
• 16:26
  - your vision and your wish list, and we'll
• 16:29
  - try to make that happen. And so we
• 16:31
  - were able to kind of unlock all of
• 16:33
  - these ways that the EMR systems and digital
• 16:35
  - strategies could work for our on the ground
• 16:37
  - needs that I did not really recognize until
• 16:40
  - our partnership.
• 16:41
  - So,
• 16:42
  - I think what is also really important is
• 16:45
  - that this project was not about adding capacity.
• 16:49
  - Right? It was about redesigning how patients access
• 16:52
  - high quality care.
• 16:53
  - And so that really was the foundation of
• 16:57
  - rebuilding workflows around patient and provider needs,
• 17:00
  - integrating our existing resources more effectively together,
• 17:04
  - aligning, you know, again, that system, clinical, those
• 17:07
  - operational teams.
• 17:09
  - And the other thing I'll say really is
• 17:10
  - that,
• 17:11
  - we've had strong executive leadership endorsement of this
• 17:14
  - work from the get go, and that goes
• 17:16
  - a really long way. So I'm very thankful
• 17:18
  - that our leadership at Montefiore
• 17:20
  - values and underscores the importance of preventative health
• 17:23
  - for our communities and our patients.
• 17:26
  - And so that's really helped, I think, elevate
• 17:28
  - the work and and have us, you know,
• 17:30
  - open new lines of conversation,
• 17:32
  - that enable this work to scale and replicate.
• 17:39
  - I will highlight the upfront
• 17:41
  - buy in I'll highlight the partnership, and I
• 17:43
  - think there's a big mindset
• 17:45
  - as well. It wasn't about one piece of
• 17:48
  - technology or another piece of technology.
• 17:50
  - It was just, doctor Agarwal said, here's the
• 17:53
  - problem we want to solve, and so what
• 17:55
  - is the art of the possible?
• 17:57
  - I think that coupled with a lot of
• 17:58
  - cross functional sessions upfront,
• 18:01
  - some capabilities that we have to best utilize
• 18:04
  - that,
• 18:05
  - and then the feedback
• 18:07
  - from patients from from other individuals
• 18:09
  - who are involved in this process was really,
• 18:11
  - really pivotal.
• 18:12
  - I think one thing that also really helped
• 18:14
  - our success was that from the very beginning
• 18:17
  - and then throughout, we had operational clinical
• 18:20
  - leaders in the team
• 18:22
  - so they could see what was happening, comment
• 18:24
  - on this
• 18:25
  - piece of tech doesn't work, or that piece
• 18:27
  - of tech really does resonate.
• 18:29
  - And I think that helped us build the
• 18:30
  - right thing first time around. It also really
• 18:33
  - helped us prepare for the hard part, which
• 18:35
  - was change management.
• 18:37
  - So if we're going to have people looking
• 18:39
  - internally at
• 18:41
  - a tool or something that helps to figure
• 18:43
  - out who are the right people to contact,
• 18:45
  - knowing what that's going to feel like for
• 18:47
  - them upfront really helps us get ahead of
• 18:50
  - of the change management to make this feel
• 18:52
  - really, really natural. And then I think from
• 18:55
  - the technology perspective as I highlighted,
• 18:58
  - we did
• 18:59
  - design this upfront in a way that we
• 19:01
  - knew would be really reusable so that we
• 19:03
  - could add on to that foundation and make
• 19:05
  - sure this is applicable across many different types
• 19:08
  - of screenings and,
• 19:10
  - different populations.
• 19:11
  - So I think that there's a lot that
• 19:13
  - other organizations can do. It wasn't really about
• 19:16
  - necessarily what
• 19:17
  - specific thing that we built, but I think
• 19:19
  - really how we organized and our approach to
• 19:21
  - making sure that we had success
• 19:24
  - layered in from start to finish.
• 19:27
  - Yeah. And I'll I'll add to that even
• 19:29
  - more too. I mean, what we created, right,
• 19:31
  - was this kind of population health care at
• 19:33
  - the point of care. So that was the
• 19:34
  - vision. Right? How do we create a place
• 19:36
  - where we can empanel every person who may
• 19:39
  - be due for their cancer screening
• 19:41
  - and follow them from their eligibility point all
• 19:44
  - the way through
• 19:45
  - to the time that they, are screened and
• 19:48
  - pass that if they need it. Right?
• 19:50
  - And so
• 19:51
  - building that kind of product within, we call
• 19:54
  - it the action list. I said, you know,
• 19:56
  - we're done with our dashboards. We don't just
• 19:58
  - wanna visualize the data. We wanna act on
• 20:00
  - it. Right? And so how can we combine
• 20:02
  - this data into a way where we can
• 20:04
  - act at the point of care? Right? So
• 20:07
  - we know which patients in our 57,000
• 20:10
  - women or,
• 20:11
  - eligible women
• 20:13
  - who are overdue, who are up to date,
• 20:15
  - who may be due in a month. Right?
• 20:17
  - We know if they have orders. If they
• 20:19
  - don't have an order, we can bulk order
• 20:20
  - for those women and,
• 20:23
  - ensure that the PCP is getting those results
• 20:25
  - as they need. We can then understand have
• 20:28
  - they scheduled. If not, we can send out
• 20:30
  - self scheduling links. Right? We can have our
• 20:31
  - navigators call. And so it's a really lovely
• 20:34
  - creation of how our partners can coordinate in
• 20:37
  - one center source of truth and make sure
• 20:39
  - that we're looking out for our entire population.
• 20:42
  - So that's really exciting to me.
• 20:48
  - That's amazing to hear. I mean, it really,
• 20:50
  - really is such a great example of meeting
• 20:51
  - the patients where they're at and identifying what's
• 20:53
  - gonna be most important.
• 20:55
  - George, doctor Agarwal, thank you so much for
• 20:57
  - joining us on the podcast today. This has
• 20:59
  - been such a fun conversation. I've learned a
• 21:01
  - ton, and I look forward to connecting with
• 21:02
  - you again soon.
• 21:04
  - Thank you.
• 21:06
  - Thank you.