Latest / Becker’s Healthcare -- Pediatric Leadership Podcast / Healthcare Upside/Down: Futureproofing Children's Health Systems: Strategies for Success

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Healthcare Upside/Down: Futureproofing Children's Health Systems: Strategies for Success · Becker’s Healthcare -- Pediatric Leadership Podcast

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  - Welcome to Healthcare Upside Down, a podcast
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  by Becker's Healthcare and ECG management consultants in
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  which we'll explore the upsides and downsides of healthcare
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  and the industry's most current trends.
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  I'm Molly Gamble, and today I'm joined by three guests,
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  Peggy Troy, president, and CEO of Children's, Wisconsin.
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  Dr. Jeff Speering, CEO of Seattle Children's Hospital,
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  and Evan Lynch, throne principal
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  of ECG Management consultants.
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  Peggy, Jeff and Evan, welcome to the podcast.
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  Thank you so much for joining us.
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  - Absolutely. Thank you. - Thank you.
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  - Well, to get us started,
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  can you please introduce yourselves
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  and share a bit more about your roles and organization?
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  Peggy, can I turn to you first?
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  - Sure. Hi.
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  As I said, I'm Peggy Troy, uh, president
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  and CEO of Children's Wisconsin in the Milwaukee area.
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  And I have been at Children's, Wisconsin
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  for the last 15 years.
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  So, um, a little bit about children's.
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  Uh, we have nearly 60 locations
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  across the state of Wisconsin.
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  So we have a hospital in Milwaukee.
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  And then we have a hospital within a hospital up in the Fox
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  Valley, which is a couple hours north of our organization.
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  Our primary site, we have a surgery center.
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  We have 22 primary care clinics, five urgent care clinics,
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  and then several specialty clinics.
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  Uh, we also have a robust community-based program
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  that support and strengthen family.
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  So we have child advocacy centers, school nurses,
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  and community health navigators, safety
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  and injury prevention.
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  And then we also have the largest foster care
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  and adoption, uh, program in the state of Wisconsin.
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  We foster care case manage about 3000 kids.
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  We also have a health plan,
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  and we, uh, it's a Medicaid health plan plus a marketplace.
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  And we insure about 150,000 members.
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  It's a at full at risk program, uh, first dollar.
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  We have more than 6.5 million connections
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  with kids across the year.
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  And, uh, so we have a big responsibility in terms of, uh,
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  serving the kids of the state of Wisconsin.
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  'cause we are the only independent freestanding
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  children's hospital in the state.
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  - Mm-Hmm. an important note.
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  You ended on there, Peggy. Thank you
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  for the introduction and overview.
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  Dr. Speering, can we hear from you next?
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  - Sure, absolutely. So, um,
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  I'm Jeff sparing the CEO at Seattle Children's,
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  have been here for, uh, eight years now.
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  And so Seattle Children's, again,
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  also an independent freestanding children's hospital with,
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  uh, main hospital campus in Seattle.
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  Um, but we have the incredible privilege of taking care
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  of kids, uh, every day from four states, Montana, Idaho,
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  Washington State, and Alaska.
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  Our main hospital campus is, is obviously in Seattle.
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  Um, but we have 43 different outreach sites throughout those
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  other four states, bringing specialty care, hopefully closer
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  to home and patients and families and, and where they live.
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  We're also one of the five largest pediatric,
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  uh, research institutes in the country.
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  So every day, our team, um,
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  not only thinking about cares today,
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  but obviously looking for cures for tomorrow
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  and how we continue to bring the best
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  and most innovative treatments to kids in clinical trials.
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  So we make sure that, uh, we're finding more cures
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  for kids in doing that.
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  And then an incredible foundation, uh,
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  that really helps support our mission through philanthropy.
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  And so like Peggy, all the way from primary care
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  to the highest level of specialty care.
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  But thinking about this
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  and how we really center our work in our communities
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  and improve children's health broadly.
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  - All. - Thanks, Dr. Speering.
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  And, and Evan, let's, let's hear from you.
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  - Thanks. I'm Evan Lynch, throne of principal of ECG,
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  which is a full service healthcare only consulting firm.
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  It's been around for over 50 years.
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  I'm part of our academic healthcare division,
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  and I lead our firm's, uh, children's service line,
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  which is a multidisciplinary group of consultants, uh,
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  with focused experience working on the issues
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  that pediatric organizations face.
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  So I spend a lot of my time working
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  with children's health systems on clinical
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  and academic partnerships and affiliations
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  and redesigning organizational structures
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  to enhance the relationship between the children's hospital
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  and the faculty practice.
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  - Thanks Evan. Well, on, on the note
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  of organizational structures, you know, let,
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  let's talk about m and a and consolidation.
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  We've seen hospital and health system consolidation.
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  It's expected to continue its upward
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  trajectory this coming year.
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  And I'm curious, when we talk to leaders
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  of independent freestanding children's
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  hospitals like you, Peggy, and Dr.
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  Spearing, how do you anticipate this trend will affect
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  children's health systems, including your own?
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  Peggy, can I turn to you first for your thoughts?
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  - Well, that's a great question, Molly,
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  and something that we ponder frequently within our own
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  organization because we are watching, uh, carefully these
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  mergers and consolidations of healthcare systems.
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  We strongly believe as an organization, along with our board
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  of trustees, that the best way to do the work that Jeff
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  and myself do, both in not only the clinical care
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  but the academics, the research,
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  et cetera, is to stay independent.
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  Because when you become absorbed within a large adult
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  system, which Jeff
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  and I have both been in that situation,
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  you become a service line.
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  So the allocation of resources is very competitive,
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  and there are many ways in which we need
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  to fund our missions, uh, in order to do it correctly.
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  And so that independence allows you to do that.
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  You know, and when we think about it,
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  you've gotta have a very strong leadership team.
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  You have to have a board of trustees
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  that believes that as well.
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  Uh, a strong strategic plan looking forward, knowing
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  that independence is the goal, most importantly,
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  a solid balance sheet in today's world.
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  And the economy of healthcare is becoming very challenged,
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  very differently than I think we've experienced in the past.
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  So keeping a strong balance sheet
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  and a positive margin is a way for us to,
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  to remain independent, a strong academic partner
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  with true integration.
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  So you're operationally, financially
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  and strategically integrated is another very important way.
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  And then I think also having
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  partnerships with adult systems.
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  Pediatrics is becoming more
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  and more constrained within adult systems.
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  I think it's an opportunity for us to look for partners
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  to help manage their pediatric service lines
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  and provide some of the expertise
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  that we experience in our institution so
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  that we can serve more kids.
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  - So Peggy, what I, what I'm hearing is it's really
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  important that agility is important.
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  You can move closer to the adult systems
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  and to other systems systems,
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  but being a free stand independent organization is
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  so important when it comes to allocation
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  of resources, like you said,
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  - And talent - And talent.
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  Jeff, what would you add? Do you see things any differently
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  from Peggy or, or would you add a a different
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  perspective to the conversation?
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  - Yeah, no, completely agree with
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  how you were certainly seeing, you know,
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  continue obviously consolidation broadly across healthcare.
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  And I think, you know, with that, the reality
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  that doing pediatric care is actually is,
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  is getting harder all the time.
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  Um, and you know, everything from the complexity
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  and acuity of, of pediatric patients
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  to the financial constraints
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  and pressures to, as Peggy mentioned, really, you know,
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  some significant shortages in workforce.
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  And so what's interesting to all of us is watching
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  as adult systems consolidate,
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  making the choices on their priorities
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  and, you know, understanding that pediatrics and,
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  and we're obviously also seeing this in, in women's health
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  and obstetrics may not be one of those priorities.
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  And so, you know, seeing community-based hospitals
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  as they're coming into systems, dropping some
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  of their pediatric services
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  or some of their women's services,
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  and as Peggy said, that's our, that's all we do.
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  That is our priority.
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  And so I think for us then looking at how can we help kind
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  of fill that gap, or as Peggy said, I completely agree.
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  How can we be the best partner to some
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  of these adult systems, if, you know, for them pediatrics,
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  you know, isn't something that they want
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  to try to continue to do.
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  How can we be that best partner to fill
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  that need, you know, within the community?
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  - Mm-Hmm. , - Well, Evan Perspectives out
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  of the Milwaukee metro area and then Washington
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  and its four state area.
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  What, what, what are you seeing Evan, uh, in terms
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  of what's unfolding across the industry when it comes
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  to consolidation in children's hospitals?
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  - Well, I think what Peggy
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  and Jeff described is really
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  what we're seeing across the country right now.
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  And, uh, a lot of these smaller community-based pediatric
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  programs are just facing tremendous challenges,
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  remaining viable, but operationally and financially
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  because it takes a certain level of volume
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  and the access to pediatric specialists to really be able
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  to deliver that care.
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  And many are considering, whether they close altogether
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  or, um, what we've seen more of, which is, you know,
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  discussions on creative partnerships
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  with children's hospitals, uh, to figure out ways
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  to continue to provide those services in the community.
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  And then I think even, uh, recently in the last few weeks,
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  we've seen a pretty notable announcement of a, a merger
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  between two freestanding children's
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  hospitals, which is pretty uncommon.
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  - Mm-Hmm, . - Well, when we talk, I think Dr.
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  Spearing, you said, doing pediatric care is
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  getting harder all the time.
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  And one big headline under that umbrella
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  of a statement is the mental health needs of children
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  and how they've just been surging in recent years.
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  I know your hospitals have been responding,
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  both Seattle Children's
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  and Children's Wisconsin have made some major investments
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  to address the pediatric mental
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  and behavioral health crisis.
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  Peggy, can, can you describe for us
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  what strategies you've put to use
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  to deliver highly specialized in these needed services
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  and what you've learned from the past couple
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  of years in those investments?
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  - Well, first and foremost, the need is
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  just growing every single day.
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  So a couple things we did, we have, uh,
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  pediatricians 120 pediatricians in 22 locations.
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  And at the time we did this evaluation,
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  there were enough psych beds in our community for the kids.
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  So we really felt we should take advantage
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  of the touch points we have with, uh, primary care
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  and really start way back with the kids
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  because you can diagnose anxiety
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  and depression in kids as early as two or younger.
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  And so what if we had mental health workers working
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  alongside of our pediatrician so
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  that parents had immediate access to a resource so
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  that they could begin the journey towards how
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  to prevent catastrophic things from happening down the road.
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  Uh, many complexities came into that, uh, in terms
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  of the workforce and just, uh, in the state of Wisconsin,
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  you have to sign a separate consent
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  for mental health services, et cetera.
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  But we've overcome a lot of that,
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  and we're starting to see a real change in
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  how parents perceive the need for mental health services
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  and are willing to access it right there
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  at the pediatric visit.
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  The other thing we've opened up is five, uh, a couple
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  of urgent care centers, uh, just for mental health so
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  that the kids, the families can access that care immediately
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  and not have to wait six months to get an appointment
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  with a psychologist or psychiatrist.
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  So we really believe that backing that up
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  is really important in terms of changing the trajectory
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  and making sure that we're helping kids grow up
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  to be resilient, productive, and fulfill in their lives.
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  - Thanks, Peggy. And, and Dr.
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  spearing, can you describe Seattle Children's approach?
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  I, I'm curious too, how you see Children's Health systems
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  responding effectively
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  and sustainably to the overwhelming community
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  needs that have unfolded.
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  - Yeah, no, it's a great question, ma.
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  And to your point, the sustainability piece
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  is such a key part of that.
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  And obviously, you know, as members
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  of Children's Hospital Association, you know,
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  it is the number one thing that we're hearing from all
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  of our Children's Hospital colleagues around the country.
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  So this is not unique to any one of us.
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  Um, and as you know, as, as Peggy said exactly right,
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  I mean, the, the numbers are staggering.
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  We were seeing the trend obviously developing even
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  before the pandemic.
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  Um, you know, we had doubled the number
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  of inpatient psychiatry beds, you know, even before that.
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  And in 2018, I kind of called
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  for a moonshot in Seattle Children's
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  around mental behavioral health.
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  And I, I don't think any of us were even then prepared for
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  what happened during the pandemic
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  and kind of the, uh, kind of, you know, just amazing, uh,
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  increase in not only just the volume,
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  but the acuity of kids coming in, in crisis.
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  And so I think the challenge that we've had
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  as children's hospitals, as Peggy said, is we,
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  we are always kind of that place of, you know,
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  the highest level of care and crisis,
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  and we're seen as kind of, you know,
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  people that find solutions.
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  And so we're seeing more and more kids
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  and families coming to us kind of in that level of crisis,
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  and we wanna be able to be there and,
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  and have a level of access for that.
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  But as Peggy described, what we'd all really love
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  to do is move further upstream.
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  And so we find ourselves kind of in this dual reality
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  of having to navigate, you know,
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  crisis care right now at levels that we've never seen.
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  But then trying to think about how do we move resources,
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  you know, to where we can intervene in schools,
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  in primary care, find other things so that we can get
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  to kids before they get to that level of crisis.
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  And so for us, you know,
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  we are expanding our intensive outpatient programs,
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  partial hospitalization programs,
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  embedding mental health in our specialty clinics,
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  embedding them in primary care,
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  and then really thinking about school-based clinics
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  and how can we again, kind of move further upstream.
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  So even while we're dealing with crisis now, trying to kind
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  of, in some ways hopefully prevent kind
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  of the next wave from coming.
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  And obviously the, the long-term implications for that.
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  - Couple other things, um, that, that are important
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  to also recognize is we need more research.
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  We need to understand if the interventions
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  that we're all working towards is really developing
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  a positive outcome for the kids.
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  The other thing is, is we can't solve this by ourselves,
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  as Jeff said, by the time the kids are coming
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  to our urgent care or our emergency departments, you know,
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  they're already in crisis.
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  So how do we work with schools and communities
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  and all these other resources that are available
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  and try to knit together a comprehensive system of care
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  so there's no wrong door, whether it's in the schools,
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  in the boys and girls clubs, wherever it happened to be.
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  And then I think the other thing
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  to consider is the financial picture.
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  'cause right now the reimbursement
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  for mental health services is not, does not have parody
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  with other types of things we treat kids for.
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  So we need to make sure that our insurance companies,
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  Medicaid and others understand
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  because unresolved mental health issues lead to cancer
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  and heart disease and some of these other things
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  that are catastrophic for our kids.
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  Uh, and again, if we can back it up and get to it
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  before it becomes a crisis, I think we'll have a better
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  stable of kids growing up
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  and doing all the things
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  that we hope they can accomplish. Mm-Hmm, ,
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  - Thanks Peggy.
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  And I think underpinning your remarks
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  is the point of access.
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  And I, I understand care access is such a
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  cornerstone of health equity.
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  Many leaders like yourselves are working hard
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  to expand access with renewed
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  and heightened focus on health equity strategies
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  for historically underserved populations.
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  Uh, Dr. Spear, if I can go to you first here,
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  how is Seattle Children's meeting the evolving needs
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  of patients, families and providers within its facilities?
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  And then what strategies do you use
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  to deliver specialized care across a, a really significant
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  and and large geographic region, like you highlighted
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  for us in your opening remarks?
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  - Yeah, it's, it's one of the great challenges and,
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  and really cool opportunities that we have to,
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  to think about how do we change kind of our delivery models
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  and, and kind of break down traditional systems
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  that we know have led to kind of disparities in access
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  or not being able to actually move our care
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  where we really want it to do.
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  So. Ma to your point, I mean, we're spending a lot
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  of focus thinking, again, you know,
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  we're historically children's hospitals where a lot
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  of like have everybody come to us, you know,
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  how can we actually move our care closer to families
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  and patients where they're at?
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  How do we center our communities in that care?
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  And I think that comes with everything from, you know,
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  where are we putting our specialty clinics, you know,
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  where are we putting our primary care offices?
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  Are we thinking about our brick
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  and mortar strategy in a way
• 15:30
  that really has an equity lens to it?
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  And we're thinking about making sure
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  that we we're addressing where those, some
• 15:35
  of those access deserts have been.
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  And I know like Peggy has done, you know,
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  we've opened up our community health clinics in areas where,
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  again, historically they might not have had that same access
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  and actually moved specialty care into those in a way that,
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  again, they don't have to come to the main hospital, uh,
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  to Seattle to be able to do.
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  And then to your point,
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  because of the, the large geography in some
• 15:54
  of those distances, how do we use digital and
• 15:56
  and technology to make sure that we're bringing access again
• 15:59
  to communities that historically would've had to do,
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  you know, multiple hours drives to be able to get to
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  that our, our patients and families in Alaska
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  who are incredibly resilient
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  and creative around how they can access care.
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  So not only, you know, our clinics in Anchorage,
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  but how do we do more travel and outreach or use digital
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  and technology to be able
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  to move care closer to where they are?
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  And so we really to exactly to your point, it's,
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  it's really making sure that there is an equitable access
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  for kids and families, you know, where they need it.
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  And a lot of kind of getting out of our centric around
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  where our hospital is based
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  and how do we actually think about it more like an ecosystem
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  of care that's really out in our communities.
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  - Mm-Hmm. , - Peggy, different market for you,
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  but I imagine some similar challenges and goals.
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  Can you, can you talk to us a little bit about
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  what Children's Wisconsin is doing,
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  and then too, you mentioned research before.
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  Um, can you talk too about
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  how you see leaders better meeting not only care delivery,
• 16:52
  but also training and research needs?
• 16:55
  - So, a couple of things. First of all, I agree 100%
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  with Jeff is that we've got
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  to get ourselves out in those communities to understand.
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  I think one really important aspect
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  of this is also understanding
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  what the community needs and values.
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  And I'll give you a couple examples of that.
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  But when we think about what drives overall health, we know
• 17:14
  that healthcare delivery is only a small part of it,
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  but it's, you know, that your genetics, the choices you make
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  and where you live, and when you start
• 17:21
  to think about those aspects of overall health, you know, we
• 17:25
  term it in whole child health, uh,
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  because we think about physical, mental, dental, social,
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  and you know, for instance, kids need food,
• 17:35
  they need housing, they need transportation.
• 17:39
  Uh, all these things play into how you can,
• 17:41
  again, have healthy kids.
• 17:43
  So we've gotta think more broadly about how we can, not
• 17:47
  by ourselves, but solve for some of these issues
• 17:49
  and partnering organizations.
• 17:51
  We, uh, do food stability evaluation on all kids that come
• 17:55
  through our specialty clinics and emergency room.
• 17:57
  And we, it's amazing
• 17:58
  how many families we find are actually hungry today.
• 18:02
  Well, we can't be the food bank for all kids,
• 18:04
  but we sure can find those resources in our community
• 18:07
  and connect families, transportation, housing,
• 18:10
  all these other aspects.
• 18:11
  So really important
• 18:13
  to think about it a little differently than how Jeff
• 18:15
  and I were raised to think about pediatric healthcare.
• 18:17
  Um, because we, we know
• 18:20
  that we can only affect a very certain part of it.
• 18:23
  Um, so I think that, you know, hospitals systems, I think
• 18:28
  that insurance companies
• 18:29
  and others are starting to take a more holistic view.
• 18:32
  And I do think research is a very important part of it.
• 18:35
  We know that we've got major gaps in health equity
• 18:38
  and we know that what we do in one community
• 18:40
  isn't gonna work in the other.
• 18:42
  But the only way we could substantiate that is
• 18:44
  by doing careful evaluation, understanding
• 18:47
  what the community values,
• 18:49
  and then doing the research to see did this work.
• 18:53
  And it doesn't have to be basic science research,
• 18:56
  it can be just research by gathering some data,
• 18:59
  looking at outcomes
• 19:00
  and doing A-P-D-S-A-P-D-S-A cycle so that you can change
• 19:05
  the way you're doing things.
• 19:09
  - Uh, let me turn to you here.
• 19:10
  We just heard from Peggy and Dr.
• 19:12
  Spearing a number of innovations tools
• 19:14
  and how they're really thinking about this work when it
• 19:16
  comes to access and equity.
• 19:17
  What else would you add in terms
• 19:18
  of things you're seeing other health systems leverage?
• 19:22
  - Well, I think, um, just as a framing too, you know,
• 19:26
  children's hospitals, the last two years probably have been
• 19:29
  some of the hardest financial
• 19:30
  and operational years for even the strongest organizations
• 19:35
  with the healthiest balance sheets.
• 19:36
  And I think that has led to a willingness maybe
• 19:41
  to reconsider traditional approaches and,
• 19:44
  and an openness to, we really do have to think about
• 19:47
  how we restructure everything we do to meet the needs
• 19:50
  of the community and our patients.
• 19:52
  There's not one solution on this.
• 19:54
  I, I think you have to do a lot of everything to try
• 19:56
  and meet this because there's fewer
• 19:58
  and fewer providers all the time.
• 19:59
  And so much of this falls back on the freestanding
• 20:02
  children's hospitals to, to be the safety net for, you know,
• 20:06
  sometimes whole states or regions.
• 20:08
  But I think, um, new bricks
• 20:10
  and mortar access, um, so that to Jeff's point,
• 20:14
  you don't have to drive downtown
• 20:16
  for everything that has to happen.
• 20:18
  Um, more virtual, uh, wherever it can be done,
• 20:22
  a closer working relationship between the hospital
• 20:25
  and the physicians, um, in their organization
• 20:28
  and out in with community pediatricians to say,
• 20:31
  how do we create more access?
• 20:33
  How do we make it easier for patients
• 20:35
  and families to get in to schedule their own appointments,
• 20:39
  um, to make sure that we're, we're freeing up the time.
• 20:42
  And, and then also how do we work across our specialists
• 20:46
  to really deliver effective multidisciplinary care too?
• 20:50
  So it's, um, you know, we can combine visits and, and,
• 20:53
  and make sure that you're getting holistic care if patients
• 20:56
  do have to travel, because we know, you know, in a lot
• 20:59
  of markets and in a lot of rural areas, sometimes
• 21:02
  if it's you have to get in the car and drive three
• 21:05
  or four hours to go get care,
• 21:06
  sometimes those kids just don't ever get seen to begin with.
• 21:10
  - Well, Evan, Peggy, Dr.
• 21:11
  Spearing, I wanna thank each of you.
• 21:13
  I mean, this has been a real great opportunity
• 21:15
  to get some high level thoughts
• 21:16
  and observations from you about m
• 21:18
  and a behavioral health access from the vantage point
• 21:21
  of independent freestanding children's hospitals like yours.
• 21:25
  Is there anything else that you weren't able to share yet
• 21:27
  that you wanna make sure our listeners hear from you?
• 21:32
  - Well, just a couple of things to reiterate.
• 21:34
  You know, healthcare has changed tremendously over the last
• 21:36
  several years, and especially since Covid.
• 21:39
  I think that we've learned a lot to that.
• 21:41
  I think our scope in children's hospitals is
• 21:44
  so much larger than what the traditional concept
• 21:47
  of a hospital was, uh,
• 21:48
  because we have to move beyond our own walls
• 21:51
  to really address kids' needs and,
• 21:53
  and how we need to think about providing those services.
• 21:57
  I think you have to diversify your portfolio
• 21:58
  because we're seeing competition in new places.
• 22:01
  You know, there's others entrance into healthcare that think
• 22:05
  that they can do it better than we can.
• 22:06
  And so making sure that we're staying on top of those,
• 22:09
  but not overreacting to some
• 22:11
  of the things that are out there.
• 22:13
  Um, again, I can't emphasize enough of having a,
• 22:16
  a strong balance sheet and making sure that you're able
• 22:18
  to face the financial headwinds.
• 22:20
  You know, when you think about the population
• 22:22
  of kids we serve most of the children's hospitals, over half
• 22:25
  of our patient base is on Medicaid and Medicaid.
• 22:29
  Well, it's a, a great program to cover kids.
• 22:32
  It only pays you a certain percentage of your cost.
• 22:34
  So you've gotta be able to accommodate that
• 22:36
  and then think about how else you're gonna balance out
• 22:39
  that portfolio to make sure that you don't have to be
• 22:42
  absorbed by a adult system.
• 22:44
  And, you know, being very active in public
• 22:46
  policy, kids don't vote.
• 22:48
  And so we need to be that really strong voice to make sure
• 22:51
  that our policy makers understand the needs and of kids
• 22:55
  and how we can better work with them together to ensure
• 22:58
  that these kids have everything they need from us.
• 23:01
  - Yeah, and I mean, I would just add to what Peggy said.
• 23:03
  I mean, we're always gonna take the opportunity
• 23:05
  to be shameless advocates for kids and kids' health.
• 23:07
  And to her point, you know,
• 23:08
  children's hospitals have historically always been there
• 23:11
  to take care of kids with the highest level
• 23:12
  of acuity needs and most severe things.
• 23:14
  But we really do wanna make sure that we're addressing
• 23:16
  children's health broadly.
• 23:18
  And it's, we care about it
• 23:19
  because it's obviously something that we see every day.
• 23:21
  But obviously as society,
• 23:22
  we just always wanna remind everyone in healthcare
• 23:24
  to not forget about the kids
• 23:26
  because obviously, you know,
• 23:27
  children's health issues today become adult health issues,
• 23:30
  um, later and are much more expensive if we're not kind
• 23:33
  of moving upstream in, in dealing with that.
• 23:34
  And so, again, for all of us really trying to, to advocate
• 23:37
  and make sure that we're thinking about
• 23:39
  how do we put resources into improving the health
• 23:41
  of our kids so that we all kind of have a healthier future
• 23:44
  and a healthier tomorrow because of
• 23:46
  that investment that we're making today.
• 23:49
  - I just wanted to add that, um, I, I think these,
• 23:51
  these children's hospitals are, um, tremendous assets
• 23:55
  for the community and no one is as committed
• 23:59
  to the mission like these organizations are.
• 24:01
  So I think everything that Peggy
• 24:04
  and Jeff highlighted about how you continue
• 24:06
  to do this sustainably
• 24:07
  and ensure that they, uh, continue to remain, um,
• 24:11
  independent and vibrant,
• 24:12
  I think is in the everybody's best interest.
• 24:16
  - Thank you so much, Peggy, Dr.
• 24:17
  spearing, Evan, for your time
• 24:19
  and for this great discussion today.
• 24:20
  We also wanna thank our podcast sponsor for this episode,
• 24:23
  e EEC g Management consultants.
• 24:25
  You can tune into more podcasts from Becker's Healthcare
• 24:28
  by visiting our podcast page at becker's podcast.com.
• 24:31
  Thank you.