Latest / Becker’s Healthcare Podcast / Sham Firdausi, Deputy Chief Financial Officer of County of Santa Clara Health System

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Sham Firdausi, Deputy Chief Financial Officer of County of Santa Clara Health System · Becker’s Healthcare Podcast

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This is Alan Condon back with another episode
0:40
of the Becker's Healthcare Podcast. And today, I'm
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delighted to be joined by Shyam Firdassy,
0:46
deputy CFO of County of Santa Clara Health
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System.
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Shyam, I know you've done a podcast sort
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of before in person at one of our
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live events. A pleasure to have you back
0:56
on the podcast today.
0:58
For those of our listeners who who might
0:59
be as well acquainted with yourself,
1:01
the County of Santa Clara Health System, I
1:04
I'd love to hand it over to you
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just to hear a little bit more about
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your background and your experience at the health
1:08
system.
1:09
Awesome. Well, thank you for having me. It's
1:10
a pleasure to be here, and then looking
1:13
forward to being there in person in April.
1:16
My name is Sean Ferdasi.
1:17
I'm the deputy CFO at the county Santa
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Clara Health System.
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Currently, you know, I oversee a team of
1:23
finance, revenue cycle, and supply chain. A little
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bit of background about me. I'm a military
1:28
veteran. I have degrees from both Brown and
1:30
Yale.
1:31
Recently was recognized by backers in both the
1:33
CFO Donoghue and the 100 healthcare,
1:36
leaders under 40.
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I think to me, the credentials that matter
1:40
most are the ones, you know, I earn
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every day working alongside my incredibly talented team
1:44
here at the public health system.
1:46
Little bit unique background. I've worked both,
1:48
on the payer side, in the health plans
1:51
and in the hospitals.
1:53
Was overseeing,
1:54
a hospital for Scion Health Watertown Regional in
1:57
Wisconsin.
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Understand how these relationships work from both side
2:00
of the perspective
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and, where we are today, especially when it
2:04
comes to better partnership and, public health,
2:07
safety where we are. Currently,
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work for the County Santa Clara Health System.
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We're one of the nation's largest public health
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systems.
2:14
We serve almost 2,000,000 residents across our four
2:17
hospitals and multiple multiple clinics,
2:19
providing comprehensive care from primary,
2:22
care to specialty services.
2:24
We are safety net, which means we serve
2:27
everyone who walks through our doors
2:29
regardless of their ability to pay.
2:31
To me, this work is very personal, and
2:33
here's why, you know, I was once myself
2:36
a recipient
2:37
of Safety Net,
2:38
care, and I know what it means to
2:40
when a system shows up for you regardless
2:42
of your ability to pay.
2:44
That's why I'm committed to this mission, and
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now I get to protect it for others.
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It drives me every day single day, and
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I'm, again, thankful and blessed to be working
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for a health system that gives everybody
2:54
the chance to be able to get health
2:56
care as needed.
2:58
Yeah. No. Absolutely. I really appreciate the the
3:00
context of backgrounds of your experience as well
3:02
and working on the health plan side, the
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provider side.
3:06
I believe a Pakistani American, if you're if
3:07
I'm not mistaken, thank you for your service.
3:09
I just received my American citizenship a couple
3:12
weeks ago as an Irish American, but, so
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I have that in common with you as
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well. Yes.
3:17
Sham, I think you kinda set it out
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very clearly there. I think,
3:21
as someone who has experienced being a patient
3:23
of a safety net system
3:26
in a different age and now being a
3:27
leader at a safety net system,
3:30
arguably in one of the most challenging periods
3:33
of, I imagine, in terms of safety net
3:34
systems today.
3:36
I'd love to kinda just hone into
3:38
one or two initiatives that you're most proud
3:40
of, most important over the last year, maybe
3:43
something that's ongoing.
3:45
Is there anything you'd like to particularly highlight
3:47
in terms of what what you what initiative
3:48
you led? What were the results? Just to
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kinda kick the conversation off here. Yes. Absolutely.
3:53
You know, I think two of the the
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big initiatives I'm I'm proud of is, you
3:57
know, my time during at Watertown Regional, you
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know, because I mentioned part of Scion Health,
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multiple hospitals across the country. But you know
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what I'm really proud of is leading a
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business within a business model.
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For me, that's important. I think, you know,
4:10
finance for a very long time has kind
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of just been in the backseat,
4:15
whereas now in the time of crisis we're
4:17
in, you know, being involved in the operations
4:19
and learning with the team is very important.
4:21
So the mindset and the models that I
4:23
led at, CyanHealth was really giving service line
4:27
leaders real time financial insights,
4:29
having a seat at the table with the
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CEO, the CNO, clinical leaders, operational leaders, where
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we all made decisions together.
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And it it wasn't really finance telling teams
4:38
what to do or dictating operations. It's us
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working together,
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not in isolation, whether it was a clinical
4:44
team or operation teams. For us, that was
4:45
success, and that drove a success. You know,
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for Scion Health, it really helped us achieve
4:50
our targets and goals when it came to
4:52
the margin side, but also won us multiple
4:54
awards when it came to quality,
4:57
and improving just overall our performance in the
4:59
system.
5:00
The other big, project I worked on really
5:02
enhanced our value analysis process. You know, as
5:05
I mentioned, collaboration was key here.
5:08
And then I developed a revenue cycle one
5:09
zero one framework.
5:11
I put together a comprehensive playbook that standardized,
5:14
you know, across the system, both our front,
5:16
middle, and back end, processes
5:19
and embedding, like, shared accountability
5:21
across the enterprise.
5:23
I was able to look into it, tell
5:25
where denials are coming from, and how to
5:26
prevent them up stream. And I think that
5:28
was key. Trying to do the same thing
5:30
here at the, County Santa Clara,
5:32
trying to bring in an operational focused finance
5:35
business partner model.
5:37
For me, the focus is really always on
5:39
my team's development, finance, revenue cycle, operation, supply
5:42
chain, and how we work on this in
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collaboration with our clinical and operational leaders and
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give them the support we need. Hoping to
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bring that success I had previously and trying
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to emulate that here again, and I'm very
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excited.
5:54
Fantastic. I think really love those kind of
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two initiatives specifically for for this the purposes
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of this podcast.
6:01
I'd love to, Sean, maybe follow-up specifically on
6:03
the the revenue cycle initiative and maybe just
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kinda get your thoughts there. We've been talking
6:08
to CFOs like yourself, revenue cycle leaders, really
6:10
across the board in terms
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of potential opportunities when we think about AI,
6:15
specifically in the revenue cycle. No doubt this
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is a big area of focus for you.
6:20
I'm kinda curious as someone who has both
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experience on the health plan side and also
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the provider side. When you see providers
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and health plans really kind of playing catch
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up in terms of using AI in the
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in the in the revenue cycle,
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How do you kind of envision this,
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quote, unquote, AI arms race, for lack of
6:39
a better term,
6:41
playing out over the next couple of years
6:43
when we see more providers
6:45
using AI? It's being more deeply embedded, more
6:47
deeply integrated in the revenue cycle. No doubt
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health plans on the other side have have
6:51
been ahead of the game in this regard
6:53
for quite some time. But any kind of
6:55
thoughts there? Maybe is there a specific use
6:57
case where where you're leveraging AI or or
6:59
have found specific results in the revenue cycle
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so far?
7:03
Yes. Yeah. I know. I can give you
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great perfect example. I think, and you are
7:06
100% correct. You know, I come from a
7:09
very large, plan. I was,
7:11
head of that P and A and strategy
7:13
for Centene's Florida health plan at $15,000,000,000. But
7:15
Centene across the country, $140,000,000,000
7:18
worth of health health plans. Right?
7:19
Focus on that. And they were already leveraging
7:21
AI technology when it comes to that. So,
7:23
yes, hospitals are playing catch up. But I
7:25
I think the future
7:27
is going to be great when it comes
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to that,
7:29
in utilizing AI to solve these complex revenue
7:32
cycle problems. A, because it's gonna give people
7:34
the time to actually focus on the areas
7:36
that matter most. Right? You know, patient care,
7:38
patient service, upfront from registration
7:41
to back end. Right? Follow-up. The other part
7:43
that's gonna be important is if we build
7:45
out certain AI models. Sorry. I'm I have
7:47
a little technology background, so I'll share with
7:48
that. If we build out I know. I
7:49
love it.
7:51
If we build out certain technology
7:53
models that can kinda resolve the issues, like
7:55
the simple ones that where denials are prevented,
7:58
what codes to add to, you know, resubmit
8:00
different claims and appeals. I think AI is
8:02
going to be very important in that. And
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as a county of Santa Clara, you know,
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we're very important. We are looking into AI.
8:08
We're we're starting to pilot, you know, in
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the ambiance side for ambient listening for clinical
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leaders. But my big focus is having, you
8:14
know, oversight over my revenue cycle team is
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where we bring in to start help us
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start, whether it comes to as we think
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about certain, you know, coding challenges,
8:22
where we look at denial management. So I
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think that's gonna be important.
8:26
I I
8:27
where I think the real partnership is gonna
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come, and that's really gonna be key for
8:31
the future of AI. Yeah. AI is gonna
8:33
make things easier,
8:35
but it's where partner it's with pairs and
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how helps us somewhere. They're gonna have to
8:39
talk and have to have that partnership.
8:41
AI can only do so much. AI is
8:43
the models you build. You know? They're gonna
8:44
be able to do what you ask them
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to do.
8:47
The complex part is gonna be how
8:49
payers and providers collaborate in the future, and
8:52
that's what I'm excited about because it's gonna
8:54
take all the noise out of the little
8:55
day to day work, and it's gonna get
8:57
those clinical leaders, those peer to peer teams
8:59
to have more open conversations. And I think
9:02
that's important, and that's what's really needed, especially
9:04
given in the health care environment that we're
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in today.
9:07
Yeah. No. I think so so well said.
9:09
I I appreciate bringing that technology
9:11
expertise and background into the equation as well.
9:13
I guess last quick follow-up specifically on this,
9:16
Sean, before we kinda jump to our next
9:17
question. Yeah. It's what you just kinda echoed
9:20
there is a sentiment that I just heard
9:22
on a recent podcast with, Cleveland Clinic CFO,
9:24
Dennis Laraway, in terms of what's really gonna
9:27
make the difference to your point is really
9:29
this collaboration with payers and providers in terms
9:32
of the AI and the revenue cycle going
9:34
forward.
9:36
No doubt the patient is, of course, in
9:37
the middle of this, push pull dynamic. But,
9:40
are you seeing maybe
9:42
any sort of willingness in your conversations with
9:44
payers recently to kind of gear towards that
9:47
more of a collaborative,
9:48
partnership as it comes to that, or is
9:50
this something that still some work to do
9:52
to get to a point to to make
9:53
some sort of head some some real progress
9:55
there?
9:56
I I think I think they're more, open
9:58
to it. And recently, I actually, you know,
10:01
read somewhere online,
10:02
Scan is a health plan. I think their
10:05
CEO is very vocal as well. So it's
10:07
not just, you know, off the on the
10:08
provider side. You are seeing a little bit
10:10
more shift. I, you know, I think,
10:13
doctor Satyan is his name, I believe, from
10:16
the scan, and he's very vocal about provider
10:18
pair collaboration and how he wants to partner
10:20
more. You know, at the end of the
10:21
day, we're all given a challenge. Right? Whether
10:23
it comes to the payer and provider, we
10:24
have a goal where we need to provide
10:26
access, provide health care to the system. Why
10:28
not partner up on that? Yeah. There's some
10:30
payers that might not be up for it
10:32
right now, but I think with technology
10:34
where things are going
10:36
forward, I think it's going to really bring
10:39
that model forward. And I think that's that's
10:41
key here. We have to partner. We have
10:43
to talk. I mean, with the rise even
10:45
in value based care, you know, being on
10:47
the pair side, I used to work very
10:48
closely with health systems in the state of
10:50
Florida, talking to them how their financials looked
10:53
and how those models worked, whether it came
10:55
to outside medical costs or whether it came
10:57
to other areas. So, yeah, I think there
10:59
is a rise in that,
11:00
and I do see a hopeful future of
11:03
better payer provider, collaboration.
11:06
Yeah. Absolutely. Certainly something to look forward to
11:08
over the next coming years as as it
11:09
no doubt does become more more embedded, more
11:11
deeply integrated across the revenue cycle. Certainly a
11:14
big opportunity there across the the landscape.
11:17
I wanted to shift gears a little bit
11:19
here, Shyam. I think
11:20
I think I know what your headwinds are
11:23
as a safety net system in California.
11:26
It's a very
11:27
arguably the most challenging time from a reimbursement
11:30
landscape I imagine, particularly for California safety net
11:32
providers like yourself.
11:34
Recently spoke with the the CEO and CFO
11:36
of Scripps Health about everything that they're facing,
11:40
in terms of ACA subsidy lapses, the medic
11:42
medical cuts coming down the pipeline and end
11:44
of this year and into next.
11:46
No doubt a very challenging landscape. But I
11:48
guess to elaborate specifically on the headwinds that
11:51
you're focused on combating this year and kinda
11:53
what your ultimate priorities are there?
11:56
Yeah. I mean, for us, again, you know,
11:58
you you already kinda hit the nail on
11:59
the head. You know, we're we're we're we're
12:01
a public health system. We're safety net. I
12:02
we're facing one of the biggest financial challenges
12:05
in the history of California. I mean, I
12:07
as far as I can remember, even in
12:09
health care, you know, HR one represents for
12:11
us almost a $1,000,000,000
12:14
shortfall by 2028.
12:16
And I'm gonna be very direct when I
12:17
say it is there's no sugarcoat. I mean,
12:19
I again, someone who has a public health
12:21
degree, I mean, studying all of this, you
12:23
know, public health care across the country, I
12:25
mean, it's under attack. It's being gutted left
12:27
and right, whether it's Medicaid, whether it's other
12:29
programs. I mean, this for us, it's an
12:31
assault on the safety net and the millions
12:34
of people that depend on the safety net.
12:37
At the end of the day, we're gonna
12:39
serve everybody who walks through the door whether
12:41
they're able to pay or not. That's just
12:42
our mission. We're not gonna turn people away.
12:45
We're gonna probably absorb even more of that
12:47
as the subsidies lapse and people become uninsured
12:50
because
12:51
prices are gonna skyrocket.
12:53
Times are tough, but I am someone who,
12:56
you know, thinks positive, who's very optimistic
12:59
even in tough times. Yeah. Maybe it's that
13:00
military background in me. Right? I think for
13:02
me, tough times
13:04
are where collaboration comes in, creativity comes in,
13:07
you know, innovation comes in. At the end
13:09
of the day, the patience are the mission,
13:11
and that's where we're gonna head. So for
13:12
us,
13:13
my big kind of priorities right now is
13:16
how can I make sure the teams that
13:18
support us in revenue cycle have the support
13:20
they need? So So really focusing on revenue
13:22
cycle transformation,
13:24
you know, my finance team, operational teams collaborating
13:27
more, really focusing on that
13:30
facility anchored business partner model, service line kind
13:33
of development areas,
13:34
targeting technology when it comes to, you know,
13:36
denial management, AR,
13:38
reduction,
13:39
and pretty much trying to capture any and
13:41
every dollar we, as a system, earn, so
13:44
trying to reduce those denials. Right?
13:47
Big focus for me is gonna be against
13:48
strategic pair of provider part partnerships. I'm hoping,
13:51
you know, with my background on the pair
13:52
side, I'm able to bring that lens forward
13:55
and, you know, kinda have a seat at
13:56
the table with the pairs and talk about
13:58
it, how we can collaborate better.
14:00
And the last part is really focusing kind
14:02
of on the technology part of it, technology
14:04
to support my teams. I think workforce investment
14:06
is very important.
14:08
But having that technology, making their lives easier,
14:10
making their jobs easier, setting them up for
14:13
success for the future is what my focus
14:15
is. And like I said, constraint breeds innovation.
14:18
And, obviously, when the traditional approaches don't work,
14:20
we're we're forced to think differently. And I
14:22
think this is where I'm kind of, yeah,
14:25
in the face.
14:26
We're facing all these challenges,
14:28
but I think for me, this is where
14:29
I feel that the breakthrough is gonna happen.
14:31
We're gonna get the innovation. We're gonna get
14:33
the technology.
14:34
We're gonna get creative because
14:36
mission doesn't stop for us as a safety
14:38
net health system.
14:40
Yeah.
14:41
I'm particularly interested in kind of what you
14:43
said in your points around,
14:45
revenue cycle transformation, leveraging technology there for your
14:48
finance teams.
14:50
We we don't we already talked quite a
14:51
bit about kinda AI and revenue cycle. But
14:54
outside of AI, do you mind, like, kind
14:56
of drilling one bit deeper into kind of
14:58
specific areas of transformation of the revenue cycle
15:00
or kinda how you're how you're using technology
15:02
and which technology to benefit your teams?
15:04
Yeah. I think my focus right now is,
15:06
thinking through technology about revenue cycle. I mean,
15:09
denial management, AR reduction. I mean, we're we're
15:11
relying heavily. Epic is our go our our
15:14
EMR system here. So we're relying heavily on
15:16
Epic, the dashboards and the tools that are
15:19
given to us to start with that to
15:21
make the lives easier. But then we're also
15:23
looking into specific technology and specific
15:25
AI partnerships when it comes to denial management.
15:28
Again, you know, AI, a lot of health
15:30
system are using it
15:32
across the country for those areas. But for
15:34
us, right now, we are taking a little
15:36
bit slow because we wanna make sure, you
15:38
know, patient safety is protected and all of
15:40
that. So for us, we are taking our
15:42
time, but we're starting to,
15:44
get the teams excited about it, make sure
15:47
we're we're thinking and talking about it. So
15:49
really focusing on the denial management area,
15:52
more of, like, real time kind of decision
15:55
making when it comes to clinical teams. The
15:57
other part that I'm doing so a little
15:59
bit, and I'm sure other health systems are
16:00
already thinking about this too, is really embedding
16:02
clinical leaders in revenue cycle matters. I think
16:05
for a long time
16:06
growing in the health system space, you know,
16:08
I've noticed that clinical leaders were not and
16:11
even finance specific leaders were not
16:14
involved in revenue cycle. Really? Revenue cycle is
16:16
its own solid function. But I'm trying to
16:18
break that barrier
16:19
because if we don't talk to our clinical
16:21
leaders, if we are not talking to our
16:22
operational leaders and we don't see what's happening
16:24
and what they're seeing, you're gonna continue to
16:26
see have those missing. You're gonna continue to
16:28
have denial. So even before I think technology
16:31
and AI comes, it's really about the process
16:33
of how we set up our teams for
16:34
success. And that's really with collaboration, open communication,
16:38
and making sure our clinical and operational leaders
16:40
are involved and working together so they have
16:43
a say on how things are done and
16:45
the different processes we're building.
16:47
Yeah. No. Absolutely. I really appreciate the kinda
16:50
level of specificity and diving deeper into kinda
16:52
some of the the key key areas you're
16:54
you're working on the revenue cycle and embedding
16:56
those clinical leaders. No doubt. So significant advantages
16:59
and benefits may come from that too.
17:02
Sham, not to get all doom and gloom,
17:04
but I think next question,
17:06
no doubt to to your point, a lot
17:08
of our conversations resolved around the HR one.
17:10
I believe you said 1,000,000,000
17:12
federal funding cliff in California this year alone.
17:15
No doubt, some hard tough decisions being made
17:17
by leaders like yourself across the board.
17:20
What do you anticipate the hardest thing you'll
17:23
have to do in the coming year will
17:24
be?
17:25
Yeah. I think it's really about resource allocation
17:27
for us. I mean, decision our our goal
17:29
is to be able to think through those
17:31
decisions,
17:32
protecting our mission and capacity to serve. I
17:34
mean, we we are just even our health
17:36
systems alone is we're heading for a billion
17:38
dollar
17:39
funding cliff. Right? I mean, it's it's really
17:41
kind of
17:43
changing the dynamics
17:44
of how we look at safety net, how
17:46
we look at, you know, public health systems.
17:48
Because right now, as I mentioned earlier, I
17:50
mean, to to us, it truly feels like
17:52
it's an attack on the public health system.
17:54
So my approach right now is transparency.
17:56
I think everything we do
17:59
needs to have the right stakeholders involved, clinical
18:02
leaders, operational partners, and always asking, how do
18:05
we preserve our ability to serve our community?
18:07
And not just today, five years from now,
18:09
ten years from now.
18:11
For me, tough decisions really come with how
18:13
we look at, a,
18:15
supporting our teams, but also making sure
18:18
we are thinking about proper resource allocation. I
18:21
think I I said that earlier, but to
18:22
me, that's that's key. We're facing unprecedented times,
18:25
and we have to navigate them strategically.
18:29
During my military service, you know, and across
18:31
health health system, I I I one thing
18:33
I I always keep that in the back
18:35
of my head is, you know, leadership isn't
18:37
about avoiding the difficult decision.
18:39
It's about making them decisively and with full
18:41
transparency
18:43
and clear rationale.
18:45
For us, it's really about the responsible thing
18:47
is we have if we have to make
18:49
tough calls, we make it with clarity and
18:50
transparency
18:51
and making sure it doesn't
18:54
impact the clinical workforce and it doesn't impact
18:57
the teams that we work with. So for
18:59
us, it's really focusing on resource allocation, but
19:02
making tough calls without make, without
19:05
hindering our ability to serve our patients. It's,
19:08
and not veering off from the mission that
19:10
we're headed towards.
19:12
Yeah. No. Absolutely. And, of course,
19:15
with with such challenging circumstances, there are, of
19:18
course, some there's some great opportunities out there.
19:21
When you think about the future of County
19:24
of Santa Clara Health System,
19:26
where do you see the biggest kind of
19:27
opportunities for organizational growth over the coming years?
19:30
Yeah. Yeah. That's a great question. I mean,
19:32
I'm very much a people person. I love
19:34
collaboration of people. So for me, I think,
19:37
yeah, I have four,
19:38
major opportunities that I see coming in the
19:40
future. One of the big things as I
19:41
mentioned, I wanna bring that model, the business
19:43
within a business model type of mentality.
19:46
You know, for me, that's cross function cross
19:48
functional operations and finance training.
19:51
That's how I learned the health system when
19:53
I started.
19:53
When I became a CFO, it it just
19:55
made me a better CFO because I got
19:57
to understand how operations
19:59
happen behind the scenes.
20:01
And
20:02
I cannot sit in my office all day
20:04
and try to think about data and financial
20:06
decisions because some decisions have to be bigger
20:08
than the the finances when it comes to
20:10
the mission.
20:11
So right now, I'm developing a training program
20:14
that embeds finance leader within operation and clinical
20:17
teams. So they develop that same operational mindsets.
20:20
I think when finance understands how clinicians,
20:23
works together, you know, with the clinical leaders
20:26
in operations,
20:27
They understand how to make smart decisions together,
20:30
and that cross functional fluency is gonna drive,
20:33
real performance.
20:34
The other areas I'm focused on is revenue
20:36
cycle excellence.
20:37
You know, I think,
20:39
we talked a lot about AI and technology,
20:40
but when you're facing a billion dollar cut
20:43
coming your way, you cannot
20:45
afford any type of preventable denials, coding gaps,
20:48
or process inefficiencies.
20:50
You know, building out the team to their
20:51
best of their capabilities, building them up, providing
20:53
them the tools that they need, and freeing
20:56
them up so they can kind of think
20:57
through, other areas of focus.
21:00
Strategic partnership across our supply chain and vendor
21:02
ecosystem.
21:03
We're one of the largest health systems in
21:05
California that public health systems California.
21:07
You know, our partners have that opportunity to
21:09
be part of the transforming community health and
21:12
be part of that mission. So my other
21:14
focus really right now is building better relationship
21:16
with these
21:17
vendors
21:18
and investing in our future success. We innovate
21:21
together and make sure we're creating value for
21:23
our patients and still aligning with our missions.
21:26
The other part is talent development. This is
21:29
our edge. People here in this county are
21:31
so mission oriented.
21:32
People have been here thirty, forty years as
21:35
I get to meet the different teams all
21:36
the way from nursing teams that have grown
21:38
up since they were, like, 18, 19, and
21:40
now in their forties, fifties, sixties, working through
21:43
the system because they believe in the mission.
21:45
So for me, I'm invested in my team's
21:47
development, whether it's finance, operations, revenue cycle, supply
21:50
chain, you name it. I wanna create career
21:52
pathways and develop the future leaders
21:54
and make sure the leaders that are here,
21:56
we are taking and learning from them because
21:58
they've done it all. They've seen it all
22:00
from when this was a one hospital system
22:02
to now four hospital systems. There are almost
22:04
16,
22:05
clinics.
22:06
All our questions are it's it's it's as
22:08
simple
22:09
as that. It's like, we have to answer.
22:11
Are we here for the mission? Let's serve
22:12
the people together.
22:14
And for us, that's our strategy, and that's
22:16
my focus for the next years to come.
22:17
Because
22:18
this right here, we're in a crunch, but
22:21
this does give me and my team, the
22:23
leadership team here, the opportunity to develop
22:25
a strong system team that focuses not just
22:29
on what's coming our way now in the
22:31
short term, but what do we do five
22:32
to ten years from now?
22:34
Yeah. I think,
22:36
shout fascinating to hear. I think that it
22:38
sounds like a challenge that no doubt you're
22:40
you're relishing, but I think is the the
22:42
largest public
22:43
safety net system in California.
22:46
You know, a shout out a real shout
22:48
out to you, the team that you work
22:49
with at at the County Santa Clara Health
22:51
System.
22:52
Real been a pleasure. I've learned a lot
22:53
from this podcast. I'm really looking forward to
22:55
to meeting you in person and have you
22:56
speak on a panel here in April and
22:59
in Chicago. And no doubt, it'll be a
23:01
little bit warmer than it is today, but,
23:03
Sham, it's been a real pleasure. Thank you
23:04
so much. I really appreciate your time. Awesome.
23:07
Thank you so much, Al. Thank you.