Latest / Daxko Fitness Forward / Dr. Gloria Winters on the Y's Role in Preventative Health and Wellbeing | Fitness Forward Ep. 05
Transcript
- speaker-1: This is Fitness Forward Conversations Shaping. speaker-0: The future of fitness speaker-1: Alright, well, welcome everyone to the next episode of Fitness Forward. ⁓ I am privileged today to have Gloria Winters with me, and ⁓ her title is quite a mouthful. ⁓ her title is ⁓ Chief Health Officer and SVP, Health Partnerships and Business Development at YMCA of the USA. So ⁓ welcome Gloria and why don't you just tell the gr the audience w what does that mean? What what what is your role ⁓ at YUSA and in the industry? speaker-0: ⁓ yeah, it's it is a mouthful. And I actually the funny thing is is I actually have to often go back to my title and my signature line to see what it actually is when I'm sharing it out with people. So ⁓ no harm, no foul there, Jeff. ⁓ so my my background, this will help, because I've been in ⁓ healthcare for over twenty-six years. ⁓ my doctorate is in orthopedic physical therapy and then switching over and I operated ⁓ managed 12 clinics across the front range in Colorado for those years, as well as treating a full load of patients. And so if you can see that shift over into the YMCA of the USA in health and wellness, not formal sick care, right, but in health and wellness and prevention, and then ⁓ the business innovation side of the house, right? So all of the partnerships that the YMCA has in the myriad of health care opportunities, ⁓ I have the the fun, pleasure, and opportunity of innovating in that space and really creating ⁓ business models that make us financially sustainable and relevant. So that's really the summary of that ⁓ mouthful. speaker-1: Yeah. No. We've had a chance to get to know each other over the la last number of years and ⁓ you know I I think your perspective and your leadership in this area is really impactful. just to take it back a little bit, you mentioned, you know, you've been in you know in healthcare for over twenty six years and initially started, you know, working in a clinic and offices and then now you've shifted, you know, into you know, working, you know, originally at Pike's Peak and then, you know, now with YUSA. ⁓ how would you characterize ⁓ kind of work you've done in the clinic and then now work you're doing ⁓ with YMCAs and and you know kind of in that, you know, out in the field. speaker-0: Yeah. what I saw as a clinician and as a business operator was that it was becoming increasingly difficult to provide good patient care. And I knew that going into the profession, I knew that healthcare was fragmented and complex, but it had a really rapid expansion in around two thousand and six, seven and eight. And so what I saw was that one I was having less time to spend with you, Jeff, as the patient, and I was just hoping you didn't notice. And two, the dictating of what I call care enablement, the health plans, dictating the care I could provide based off of certain codes. All of that really began to squeeze the ability for me to to actually enjoy what I was doing. And I had ⁓ I had a hundred practitioners that were feeling the same way and colleagues in the space that were feeling the same way. And then of course, you, the patient, were receiving the the bunt the the brunt end of that. And ⁓ that is was across not just my specialty, but across all of the specialties. And so that was my experience and I began and then I I had clinics inside YMCAs. And what I recognized with those particular clinics and then ones that were closely located, we did a really good job of creating a f referral structure to the YMCAs for Cancer survivorship and diabetes prevention and senior coffee and fall prevention and personal training and and and and they would come back to me and say, Gloria, your care was great. I got better, but when you connected me to the why, it was life changing. And when it was one patient, I went, No, okay. When it was dozens and dozens of patients, and not just my own, but my my staff, that really began to shift me from going, This, there's a secret sauce into the YMCA. And so that was really my ⁓ my thought of it and this was in the days too when it was pretty early on to talk about whole person health and now it's shifted into longevity and lifespan and h health span and these kinds of things, but it's really this whole person health thought process. And so I began to think, what what is the difference here that creates this whole person health that I'm not recognizing? And it was truly because of who and what and why ⁓ the YMCA ⁓ what they do across all of their hundred seventy five years. speaker-1: Yeah. That's amazing and yeah, I think I've heard you say in the past, you know, eighty percent of health outcomes come from happen happens in the community and twenty percent from a doctor's office. And i I d I definitely don't wanna undervalue doctors' offices and clinics and and the value that that provides. But maybe just elaborate on that a little bit. speaker-0: Yeah, well and that that comes from the CDC, right? So their definition of what affects health is twenty percent clinical care and eighty percent behavioral, physical, and socioeconomic factors. And then in addition, the World Health Organization defines health as a state of Physical, mental, and social well-being, not merely the absence of disease or infirmity. And so as I began to really look at the impact that I was having, which was significant because these people are sick, and the impact then that the YMCA has, and they're hitting behavioral, physical, socioeconomic factors, I thought we've got to really bridge this better. And there's a huge gap between the two. How might we do that? And you can't just do that by referrals alone. You actually have to build a business model in order to enable that. speaker-1: Yeah. Alright, so perfect segue. So you see the problem. ⁓ you're you're working, you know, in y in your clinics in ⁓ in YMCAs and I know you're, you know, involved at Pikes Peak and so what is the translation? So y our audience, you know, people that are in Yes day to day, in clubs day to day, ⁓ and they're trying to solve this problem too, and and sometimes it feels complicated, right, navigating all of this. So ⁓ talk a little bit about practically kind of what does this look like you know, in a Y, in a facility, ⁓ to set this type of program up. speaker-0: Yeah. The one of the first ways that I'll frame this, I think this is good for the entire audience, not just wise alone, is that what we're trying to accomplish is what I call upstream health care, right? Not formal health care. And that's a really significant differentiator because it is not within our ⁓ training or or position to do formal health care. We have really good practitioners out there. Again. Bridging the gap between the two. But upstream healthcare means getting upstream from all the sick care. And of course, ⁓ we just know that ⁓ once you end up in the sick care system, it's really hard to navigate it, it's hard to get out, it's super expensive. And so what we're really talking about is creating that clinic to community bridge. ⁓ but it does require business sophistication. It does require a business model. So again, as I said earlier, it's not just ⁓ me referring to Jeff and hoping that that exists in perpetuity. For example, when I went away from my clinics, that went away. And that was hundreds and hundreds of of people that were being connected to the the system. So what it really requires is a significant build of ⁓ admin, which is you know the oversight of compliance and contracts and standardizations. ⁓ engagement and service delivery, things like revenue management systems, client management, reporting, analytics, staff training. So you can see that list is quite lengthy. And when I came into the YMCA, this was already occurring in some capacity, but what we've tried to do is actually strengthen that. Because if you don't have those front office and back office components built in, which is a business model, front office and back office. then something's gonna fall away and you're not gonna be able to be sustainable. And what we really need in order to truly get upstream and ⁓ capture more people before they get sick is to have that really strong business model. So again back to when you asked me about my title, that's why it's ⁓ chief health officer, but it's also business, business, business, because the two together is what's gonna drive this. speaker-1: Yeah. Alright, so if you take those the the the business model, right, in in a in a business and trying to, you know, build out this structure, you have the front end, which is identifying the the people that have a need for this, right? So let's just start there. So what what are ways that you know in a while that you're prescribing ⁓ for people to identify to be in a program like this and how do they then, you know, ⁓ take that first step? speaker-0: Yeah, so the interesting piece as we go back to the definition of health, and let's just simply say it's behavioral, physical, and socioeconomic factors that we really have the ability to impact. ⁓ then if you look at that definition of health, what we're doing across the span is actually from childcare, camp, swim lessons, ⁓ youth sports, ⁓ senior pickleball, youth pickleball. ⁓ evidence-based health intervention programs, group exercise, HIIT training, weight management, person personal training, that entire span is health, right? And you could even say that ⁓ just by, you know, we don't always know what people do when they come into the Y to our facilities, but they might be having just a sit-down coffee with with Jeff for the day. That may actually be improving their health, right? Their social connectedness, their mental and behavioral well being. So if you look at that span of health, That's actually, in my opinion, the better way to back up and start these conversations. Is let's not actually just only look at a program that we could launch in. ⁓ let's actually look at how we're addressing health already. And how I how might we then create a business model behind that where we could do that better at more scale and maybe even measure that. So ⁓ that was one of the fun things of coming into the why. I'm like, we don't actually have to change all these things. We just wanna say, man, when we when we do pickleball senior, when we do pickleball for youth, we're actually improving health. How might we measure that to actually show that what we're doing is upstream health? speaker-1: Yeah. So yeah, I could not agree more, right? And yeah, I think that's encouraging, hopefully, to the audience is it's not like you have to come up with some special program. ⁓ like the programs that are being delivered are impactful now. You know, like you said, whether it be physically active or just ⁓ it it's interesting, I I own a number of ⁓ clubs and ⁓ I would say to our team we'd have ⁓ people that would come in just for coffee and sit in the lobby and chat and you know, sometimes it was like that's they need. You know, like that is actually what they need today. Or to to be known by someone when they're walking into the facility by name, right? And somewhere they can be identified, right? And so I think it's important that we don't underestimate the value of those things that might not seem so significant. speaker-0: Yeah, and that's key pieces, right? So we look at first vision, strategy, and then what are we doing well? And then yes, and then making sure that that aligns with the customer's needs. But the customer's needs may be senior coffee or maybe a ⁓ a group coffee. And and if that's the case, then how do you actually level that up and create structure around that? But unless you have, as you said, identified it and then created relationship around it. we've really lost the key component. And so that's ⁓ I love that you said that because th those are things that kind of pass us by for whatever's the latest and greatest. And there's a lot of latest and greatest out there ⁓ in things that we can do in some of the med spa components and all of the technologies that are coming out. But if we throw that against the wall as one thing, it's actually even if it's really good, it may not stick because we actually haven't created the construct around it. speaker-1: Right. So so going then to understanding the impact and the outcomes, what are what are the things, Gloria, that ⁓ you advocate measuring to to one to have a baseline and then to to show progress in improving health and wellness? speaker-0: Yeah, well, first what is required, and we talked about this with front office and back office, is really an operating system of which you can do that, right? we know that people are walking in with one, two, three wearables, but what does that information do for us? Exactly. Nothing. ⁓ we know that our machines can measure quite a few things, but what is that actually doing for us? We don't actually have population aggregate data to say When Jeff does these things, his sleep improves. When Jeff does these things, his energy improves. We don't know that. So what I would say to that is first we ought to look at creating an operating system. And within that, what I mean by that is ⁓ for example, we did create a centralized operating system where all of our Y and CAs can now participate and we're we're we have an electronic health record system so that we can capture that data together. So now we're using One system instead of, if you will, as 800 separate 501c3s, 800 different systems that could be on paper, could be on Excel, right? And and again, we're we're doing the things and we're actually making huge changes in people's lives. But what do we know about it? And we tell great stories, but but data is data, and so we need to actually have that good data. So creating that operating system allows for billing reimbursement utilization and then. Because of where technology is at today, you can actually measure pretty much whatever you want to measure. Now you may need to make sure that it's good science. And so what I often do with that is actually take that to ⁓ expert scientists to say, validate this for me, or say it's garbage. ⁓ for example, whether it's an HRV, which some of like some of the rings and ⁓ and wearables can do. ⁓ is that valid science? What do we need to do about bioimpedance, right? Which is telling you your body ⁓ composition? What do we need to do about ⁓ genomics and blood testing and things like that? So there's a lot of things out there that you can get overwhelmed with, but validate it and then determine if you want to measure it and then talk to your constituents, talk to your stakeholders and ask them what they want to measure. Interestingly, the ⁓ stakeholders, like say a health plan, They don't often know what we should measure and why is that? Because we haven't done it before. ⁓ So so it's actually something that we have the opportunity to create and do really well and bring the evidence to the table. speaker-1: Yeah, what it what what would be the things that ⁓ you would advocate for measuring? What are what are some of the key measuring, you know ⁓ and I and I would say or what are you tracking to see ⁓ what would you qualify as success? speaker-0: Yeah. ⁓ there's quite a few components out there. I would say ⁓ what we're moving towards is things like I mentioned HR V and bio impedance, which is body composition and ⁓ some of those type VO two max, some of these things that are really strong indicators of your health. And ⁓ again this moves into health span, lifespan, longevity, these types of things. ⁓ so that's one component that a that with all of the new science, how do we actually pull that together into one living space, one house, so one ecosystem? Because right now it sleep, nutrition, beauty and aging, I mean there's just all these different health categories that have some things that we could measure behind it. So that's a fairly loose ⁓ answer to your question because there's a lot out there that requires vetting. Number two In our evidence-based health interventions, which I know you're familiar with, things like cancer survivorship, fall prevention, diabetes prevention, all of those program weight management, all of those programs have, because they're evidence-based health interventions, they have pre-mid and post measures that we take in all of our YMCAs. Those those have a strong fidelity, strong compliance. So what we have needed was for those to live into one system, one electronic health record system, or I call electronic wellness record system so that we can actually extrapolate that. And we did that with fall prevent we did that one of the examples is fall prevention, right? So we ⁓ pulled that all into one system so that we could actually see we believe we are preventing falls in this country, which is ⁓ a a huge, huge it's the number one health care cost in the country. 80 ⁓ billion, 80 billion a year in healthcare costs. But But what do we actually know empirically about that, quantitatively about that? And so we were able to do that within the system. And so we just need more people to be a part of that. And that's just one example of how we've done that. speaker-1: Yeah. So you talk about data and y ⁓ I I'd be I'd be curious to understand, ⁓ you're obviously sitting in the room with ⁓ a lot of people across health and wellness, you know, government, state agencies, insurance providers, CDC, et cetera. ⁓ when you're in in these audiences, ⁓ what are the things that you're trying to convey to these groups to help them understand the importance of what you just talked about? speaker-0: Yeah, they are surprised that we have the sophisticated systems that are safe, compliant, ⁓ and have data to report from it. They're just not used to those types of structures. So it's really important that we communicate that we have those. For example, we are SOC two certified and you you of course know all the certifications, but in formal healthcare it's usually SOC two certification or high trust. ⁓ and so as soon as I say we actually have SOC 2 certification and that we can do a secure file transfer, ⁓ they're they they're blown away because they know that the why, and this is another piece to communicate, but they they know, but we communicate again that we are a trusted entity. ⁓ seventy seven percent of Americans live within ten miles of a why. ⁓ it's where people live, work, play, and learn. So restating that, because usually they have a why story, but they don't necessarily know. all of what we do and that we are impacting health from cradle to grave and in swim lessons to older adult programs and across that whole ⁓ lifespan, then we say now we actually have the infrastructure to help show that what we're doing is actually ⁓ impactful and and we could truly show that we're decreasing healthcare costs and in improving health. speaker-1: Yeah, and then s it's then taking that next step. So ⁓ you you you now can track the outcomes. How does that then translate to ⁓ reimbursements or outcome based payment from insurance providers? like and and maybe just update, you know, the audience on where are we with that? I'm I I think, you know, everyone is ⁓ bought into preventative ⁓ care and I won't say medicine 'cause I I know medicine is the wrong word, but preventative health, right? In in I think the numbers are s I think the data's staggering where it's, you know, ⁓ three times more expensive to treat illness than it is to prevent, you know, and so I think everyone's bought in on that. ⁓ yeah, what what is it like yeah, w what what is it gonna take for payers to spend more money at the Y or other facilities ⁓ In order to invest in this. speaker-0: Yeah, so that's a that's a really complicated ⁓ I the middle frame of your question was really complicated. Like what what will it take to get these people to understand? And we'll we'll put that aside for a second to say what we're what we're doing. ⁓ and I'll just say right now we do have this centralized operating system that then has allowed us to do statewide or regional wide or even nationwide contracts to contract directly with health plans. for ⁓ membership and for programs. And so that has been a key piece of being able to do that ⁓ rather than at a association to association level, meaning if there's 35 associations in one state, that health plan historically or ⁓ employer or other third party entity would have had to contract with all 30 something different associations. With our centralized operating system, now we can do one contract for that state, that region, or nationally. So that has been a bit and it's safe, secure, compliant, and as you know, as I said, you know, SOC2 certified. ⁓ so that has been a huge shift in the ability to do this well. And again, you look at these master service agreements and statements of work, and you know, they're thirty-five pages long and they have risk and legal and d indemnities and all these components that maybe a big YMCA or a large Fitness organization might be able to handle, but maybe the smaller one might not. So if we can actually help to cover that for them, now we've a really centralized the ability for all to participate. So that's one piece of what we're doing. And we're seeing, of course, that there's significant value proposition to the health plans ⁓ because of who the YMCA is and they know that it's trusted and it has high access. And so now these ⁓ the first contract that we did, the health plan said, ⁓ Gloria, ⁓ what if members call and complain about the customer experience or about this and that and the other? And five days into the contract, the health plan called me up and said, ⁓ never mind, they are calling us to thank us for providing this membership and this access. ⁓ and so and that wasn't the end of that, right? And so what we've seen is the contracts have continued to expand because it really provides for something that beforehand they they really didn't have. ⁓ So that's really a key piece to it. I think the other answer to your question about ⁓ what what we have done is again we've built a business model that has allowed this to be sustainable for YMCAs. ⁓ Sometimes we have gotten into contracts, into business for the good of the member without always looking at the full breadth of what it would require to make sure that we can stay in business. And so and and and we do that for the good of the community and the member. ⁓ and so instead of doing that to our detriment, that doesn't allow us to sustain that program. Now if we have a really strong business model behind that, we can sustain that. And so that's a really key piece that I've enjoyed working with WIS to say this is good, but if we're in the red on this and not as a nonprofit we we need to at least break even. ⁓ that's that's a really key component for us. So part of what we've looked at is swit ⁓ we have a subscription model ⁓ within our YMCAs as as everyone well knows. And oftentimes in this third party pay component, it's a what I call an access model. So really switching the language to you can't just dump them into the same bowl. You actually have to separate them out and say, This is my subscription model. This is my access model. If this access model isn't working for me, maybe I need to ax it or reconfigure it. speaker-1: Yeah. And and then I know there's a number of ⁓ technology providers that assist. I I I think, you know, Weld Health. We both, you know, ⁓ are close to Weld Health and the work they're doing. And maybe just talk about, you know, what are some of the, you know, I would say tools that people could leverage ⁓ on the payer side and and connecting that, you know, outcome base or activity, you know, at the facility, you know, to a payer. speaker-0: Yep, right. And that you're you're exactly right. So when I have talked about the electronic health record system, electronic wellness record system, we have utilized Weld Health for that. They've been extremely flexible and build things for us as as we say that we n ⁓ really need them. And that has proved out because of the number of contracts that we've been able to multiply. So when And there's there's a definitely a lot of other groups out there. Of course it's t it's technology, but really you want to spend time to understand what you can measure, as you asked earlier, and how those outcomes can be compared back to what I call the sick care data. So what we're again trying to do is bridge the gap between sick care, formal health care, and health and wellness and prevention. And in order to do that, we need to have data from both. That can actually talk to each other and show that truly what we're doing is impacting this for the good, meaning decreased sick care costs and then and improved health. That's ⁓ so when you're talking about sharing that back to the payer, again, this is a really interesting concept because in the formal health care world, me as a practitioner, that data for me treating you doesn't go anywhere. So I could do best practice, I could get you better in just a couple of visits. And that doesn't actually go anywhere to say, hey, what Glory is doing is is best practice. Now I I think it is, but it doesn't actually aggregate engineering. Even if I had all of my patients on the same health plan, let's say, I don't actually have access to that aggregate data. Who has it? The health plan does. But the health plan has to have that and then have something to compare it to. And in prevention, one of the reasons why We haven't seen this big shift over into spending more dollars in prevention, is because we haven't had a way to measure that. That's all coming because ⁓ my theory is that technology and the rapid expansion of interoperability and digital transformation is informing how all of that works in both the sick care. And in the health and wellness and prevention, which means that the consumer is now making informed decisions about their health and wellness because they actually have access to that data. Jeff, ten years ago we didn't never have access to that data as a provider or as a patient. You couldn't actually aggregate that. So now that we have that, we can actually p potentially aggregate that aggregate that information and truly show what we intend to show. speaker-1: Yeah. Okay, so ⁓ I'm I'm listening to this ⁓ podcast and I'm a Y CEO or ⁓ I run a ⁓ a group of clubs. what should I do tomorrow? Like if it's like I believe you, I hear you, but I still am not sure what to do. what should I do tomorrow to at least start down this path and this journey? speaker-0: Yeah, well hey, the fun piece is is that if you're a Y CEO, you just call me. speaker-1: Well or they can see you at the General Assembly next next week and you know. speaker-0: So easy answer there. ⁓ and I I'm I'm on my phone a little bit 20 more 24-7, maybe more than I should, but that comes from the patient care days when I was on call. ⁓ so it's just hardwired in me. ⁓ so that's really one of the the ways to do that. But I even without that, and to ⁓ the others that are watching, one, we ought to do all of this together. There's enough both sick people and unfit people, unwell people for all of us, right? And ⁓ You and I were talking previously about, you know, there's only about twenty-four per 24, 25 percent of the population that has a gym membership, and how many of those percentage actually utilize it on a regular basis? So so that's a curiosity. So we ought to do this all together. But what we need to do is really ⁓ create a a vision, a strategy, and then a business model in order to move this. And it doesn't have to be as maybe as expansive as mine is where I'm really trying to switch the future of health. You just wanna really want to pick one thing to address and maybe you're already doing it, but you haven't re-evaluated your business model underneath it. And so I I utilize Clay Christensen, I utilize Alexander Osterwalder, they're two of my favorite business guys. Clay has since passed away but he was from Harvard. But really what what they were about was looking at efficiency innovation. Sustaining innovation and transformative innovation. And most likely in sustaining and efficiency innovation, you're already doing the work like we are at the WISE with swim lessons and membership. It wasn't about creating something brand new, it was actually about really redefining explicitly, because we've been doing this implicitly for 175 years, and saying, Are we missing a component of this business model? And oftentimes we are because we have not actually designed that back out again. So That's one easy place, I would say easy place to start because you're already doing it. And then ⁓ and then go f and then there's Mike Bloomberg, ⁓ is one of my favorites just because of how radical his business life has been. But ⁓ he has a quote that he talks about ⁓ to succeed you need a vision that's affordable, practical, and fills customer needs. And you alluded to that at the beginning about filling customer needs. And then he says, then go for it. Don't worry about all the details. Yes, there's some details that we have to look at. And he says, don't second guess your creativity. He says, most importantly, don't strategize too much about the long term. Because then we get we get stuck because all we're concerned is about the end of the road, and we really just need to get started on that journey. So I would say just make a decision to do that strategically and with your team, and then just take one step at a time into really reevaluating maybe some of those. ⁓ business models and the the customer needs that you have. speaker-1: Yeah. Well it it sounds like ⁓ an another plug for Weld Health, ⁓ which is, you know, one of our partners ⁓ here at Daxco and I know you know ⁓ one of yours at ⁓ Y USA. Sounds like that would be a good starting point for people. It's like I don't understand this world, you know what I mean? And and in the Y the Y space, you've got a good playbook, ⁓ but more broadly, you know, Weld Health could be a great resource ⁓ to take this next step ⁓ for listeners. speaker-0: Yeah, that's a really good call. They really understand the formal healthcare side and the health and wellness and prevention side. So they've got a really unique position where sometimes the ⁓ technology systems didn't have ⁓ an understanding of both worlds because we really ⁓ don't want to do formal healthcare that's hardwired, fragmented. We really want to create a new pathway and ⁓ Weld has some really good ways of looking at that and and how to create that. You're absolutely right. speaker-1: Great. Well Gloria, thank thanks for ⁓ joining me today. ⁓ any final parting words you'd like to leave for our audience? speaker-0: Well I I I think we've covered a lot of things actually in a short time, Jeff. ⁓ and again, the the listeners are welcome to reach out to me, why folk or not. ⁓ we we need to do this all together. And really what I ⁓ sense in this, and you and I have had lots of good riffing conversations about this, is that we in this industry at all need to become an essential part of the health ecosystem, not a nice to have. ⁓ but we are a trusted extension of it. And so when the other stakeholders, like doctors, public health, payers, ⁓ community members, you know, government recognize that health happens every day outside of the clinic, then that's where I think together we can truly help to shift the actual ⁓ formal healthcare system and then strengthen the health of our community. So I think that would be my leaving thoughts is ⁓ It it only takes ⁓ a couple people to really ⁓ get things moving, but then it takes all of us underneath that to to leverage the strength of what we offer. speaker-1: Yeah, no, no, I I I agree and and it it I am optimistic. It feels like there is more H of a shift ⁓ i in the right direction, you know, and ⁓ we were close to, you know, getting the Fit Act passed and ⁓ I think that would have been a benefit in terms of, you know, being able to use HSA, FSA dollars, you know, for you know, ⁓ not just ⁓ a membership ⁓ but also for activities, you know, and even youth activities. so again, hopeful that we're making some momentum and and ⁓ in into the preventative side and and I would say for all the people listening, ⁓ just emphasizes the value of the work that you're doing every day, you know, in WISE and in clubs, ⁓ to really have a big impact on communities. So speaker-0: Well thank you for that. And it really does take ⁓ all of us together to get that done ⁓ because of how fragmented and hardwired that system is. But I really do see the momentum that we're carrying and that we can push that in the right direction. speaker-1: Yeah, absolutely. And Gloria, thanks for all their work you're doing ⁓ in that regard. So thank you for joining. ⁓ have a great rest of your day.