Latest / StartUp Health NOW Podcast / inHealth CEO Harry Kim on Why Lifestyle Therapeutics Are the Next Frontier in Health
Transcript
- 0:00[on-hold music] There is a certain percentage of people that will never move because you give them an app.
- 0:17They never move because you throw AI at them and it starts to send them some information. So one is, this is really built for the disengaged, uh, for the folks who really need that intervention.
- 0:32[upbeat music] Welcome to Startup Health Now, the podcast where we talk to the entrepreneurs shaping the future of health and explore the health moonshots they're working to achieve. I'm your host, Logan Plaster.
- 0:49We may not live like it, but we know deep down that how we live, how we eat, move our bodies, how we sleep, has a big impact on our health.
- 0:59If I smoke and eat fried food three times a day, my health is gonna suffer, and my risks for things like hypertension and type 2 diabetes are gonna go way up. Lifestyle isn't the only factor in health, of course.
- 1:11There are genetics, our environment, other external forces, but it's a big one, and it often gets ignored in healthcare because breaking lifestyle habits is hard. Changing how I eat and sleep is hard.
- 1:25Sometimes it's easier to send someone home with a prescription. This is the challenge that the company Inhealth has taken on, connecting specific lifestyle changes with evidence-based medical therapies.
- 1:37I sat down with Inhealth CEO Harry Kim to learn why they believe this idea of lifestyle therapeutics is the next frontier in health.
- 1:46We discuss how they've been able to make high touch, one-on-one coaching financially viable by focusing on outcomes rather than just paying for coaching services, and they're seeing impressive results.
- 1:58We'll dive right into our interview with CEO Harry Kim, giving an overview on his idea of lifestyle therapeutics and why it's so critical to the healthcare system. Hope you enjoy.
- 2:07[upbeat music] Well, Logan, one, uh, just thanks for the opportunity. I'm looking forward to help, uh, thinking about how Startup helps gets this message out for us, 'cause it's a big message. Yeah.
- 2:24Um, and I think it starts sort of a forest from the trees with this big fundamental idea.
- 2:30When you look at somebody's, um, health and what drives an individual's health, the really sad reality is only 10% of that person's health is driven by the medical care. Yeah. Right?
- 2:42So the entire industry is chasing the 10% lever, right? And they're digitizing how care is delivered, and they're investing in diagnostics, they're investings in, uh, medication.
- 2:56So the whole industry is sort of looking at this through the wrong lens in many respects. And, and I get it 'cause the other factors are really hard, um, and they're not what the healthcare industry is geared towards.
- 3:10The biggest lever that is unaddressed is lifestyle. Lifestyle is the 50% lever, right? So over half of our sort of health condition is dictated by the life and, that we choose to live.
- 3:25Now, just for context, you know, other 20% is the genes that you're born with and the environment in which you live, right? But again, only 10% is really... and that's where all of the spend in energy and focus is.
- 3:39So when you start with this very basic notion that lifestyle has become the disease, right? So the disease has a name.
- 3:47It's called hypertension, it's called diabetes, it is called obesity, but the underlying disease is fundamentally our lifestyle. Hm. Now, the very, very big idea for lifestyle therapeutics or Inhealth, right? What...
- 4:00we focus on lifestyle therapeutics, is this idea that lifestyle can be medicine. Hm. And this was an idea that has taken many years to materialize, right? And we took a very much like a clinical trials approach.
- 4:15You had to get funding, you have to do research, you have to do bl- double blinded sort of studies. You have to really demonstrate that there's clinical efficacy- Sure... of this idea of lifestyle as medicine- Sure...
- 4:29which then we'll call lifestyle therapeutics. Um, and we see an entire explosion in the industry where you've got all of these new therapeutics and you've got all of these great ideas that are happening.
- 4:43Um, but in many respects, a lot of these companies are not gonna see the light of day or see scale. Yeah. Because the other side of the equation from just clinical efficacy is can you get people to take the medicine?
- 4:57Sure. Right? It's the idea of engagement. Because of our approach, which we can talk about, uh, because of our approach, we get our patients to take this medicine, right?
- 5:09And the measurement for us is, depending on the cohort, could be up to 60% engagement at six months, right? You compare that to, uh, and I won't use names.
- 5:19So you compare it to other digital disease management companies, uh, and you will see probably a 3 to 5% engagement rate at six months, right? Got it. And fundamentally, you can only tell someone so much.
- 5:33"Don't eat french fries. Um, measure your blood glucose. Um, hey, you're hypo or hyper. Stop doing this, do more of that." And it's really much of this sort of guardrails of disease progression. Sure. Right?
- 5:48It's kind of largely what's there.
- 5:50Because we have figured out how to merge the art and the science of behavior change with a clinical lens, this is what's transformed, um, our ability to get great outcomes and great engagement.So l-let me give you an example of this.
- 6:06Yeah. I have a- Tell me, tell m- tell me about this art plus science. What does it look like? Yeah. So, um, we'll give it to you in a real example. Um, someone says, "Take this pill.
- 6:16Now you gotta take it twice a day, and you gotta take it every day, but just take the pill because I told you you need to take the pill." Mm-hmm. Someone's taking the pill and they're like, "Geez, what am I taking?
- 6:26I'm not sure I'm feeling so good. I'm not sure what it's doing for me, and my doctor keeps yelling at me to take the pill, but they said it's important for me." Okay, you have that on one side of the equation.
- 6:36The other side of the equation is, "My daughter's getting married next year, and I need to walk her down the aisle." Sure. And all of a sudden you tap onto something very, very powerful. Mm.
- 6:49This idea that they have something in their life which represents a big motivation to improve their health, because they want to do this and walk their daughter down the aisle. Okay.
- 7:02So our science and, um, uh, art here is for us to find the intrinsic motivations of individuals and how and why they need to make certain, um, behavior changes.
- 7:20Okay. So one, we find the intrinsic motivation. Um, two, we- Wait, hold on, hold on. Yes. [laughs] That, that's not as easy as just step one. How do you- That's correct... i-is that through counseling, uh, one on one?
- 7:33How do you find someone's intrinsic motivations? Correct. So number one, this is a tech-enabled service. Mm-hmm. So we have clinicians sitting on the other side. Sure.
- 7:42These clinicians, uh, we have a patented methodology. Uh, and this methodology, we look at what they call Seven Pillars. So we help explore across these seven holistic pillars, what are the weaknesses and challenges?
- 7:57And it could be spiritual. It could be, "I'm going through a divorce and I am, I'm struggling with something."
- 8:04It can be knowledge base around, what drives my disease, and the, and the relationship between nutrition and outcomes. So we span and look across these seven pillars. Mm-hmm.
- 8:16Uh, those seven pillars give us the ability to understand all of the drivers of an individual's health, and through that,
- 8:24uh, review of those seven pillars, that's where we find those intrinsic motivations, and that's where we find, you know, that second step for us is the why, right? Mm.
- 8:34That's hugely important, like why are you stuck in a certain behavior pattern? Yeah. Okay.
- 8:40So that's the art part, is a holistic methodology, finding intrinsic motivations, understanding and sort of codifying the why behind certain patterns.
- 8:51And it's tech-enabled in that I'm maybe going through some sort of surveying, uh, some sort of branching logic, but there's also a coach behind that- That is correct. So we-... bringing some humanity to it... we have a,
- 9:05a coach, uh, that's all virtual, so it's telehealth. We also embed remote patient monitoring, right? So if you're, uh, hypertensive, you get a blood pressure cuff. Mm-hmm. If you're overweight, there's a scale.
- 9:18If you're hypertensive or if you're diabetic, you may have a, um, blood glucose measurement. So there's an RPM service there. But so that's the art side.
- 9:28The science side for our clinicians is they're a little schizophrenic, right? Because in one respects they are helping... And I shouldn't say schizophrenic 'cause that's a medical term, and it means something.
- 9:37But what I mean by that is they're looking and they're engaging with their patient on a personal journey level. But we also have an eye towards clinical measurements, right? Sure.
- 9:50So our bar for progress is, how are we doing in respect to BMI? How are we doing in respect to A1C? How are we doing in respect into blood glucose or, um, blood pressure?
- 10:03So that is what our coach is sort of translating is, an eye towards clinical measurement, but supporting the patient's journey- Sure... and using their motivations and supporting them.
- 10:17Now, our clinicians have a common sort of methodology, but they have an access to an entire knowledge base.
- 10:24My patient is, is hypertensive or is, uh, diabetic and is taking metformin, but is also hypertensive and taking this medication. So we can bring to the table, um, both information about their medication.
- 10:38We can bring information around drug to drug sort of, um, uh, conflicts. We can bring in nutrition information.
- 10:46So we bring and harvest from our knowledge base all of this data, and we wrap it around the patient's experience. Sure. Um, it is a... You know, when we first start with many of our patients, it's a weekly video visit.
- 11:02Okay. Um, but daily they get, uh, updates that are tailored to them around a medication or around a nutrition or following up around an agreement that they may have made. "Did you do this?
- 11:15Did you take 15 minutes to breathe? Um, how did this thing go?" So it, it is sort of high engagement, um, but also sort of high touch. Yeah.
- 11:25Now, that sounds sort of, like business model-wise, you're like, "Oh, geez, is this really scalable? Is this really like, you know, you guys-" That was gonna be my next question. The, the tech side I understand.
- 11:36The, the nudges, the little prompts. But the, the one-on-one coaching, when I read about that and, and, and I r-read in one of your descriptions reimbursable one-on-one coaching, I think, "That sounds awfully nice."
- 11:49I love that much high touch care, like I would love a phys- you know, a, um, trainer at the gym, you know? So how do you make that high, um, that one-on-one coaching work? Yeah.
- 12:01So, you know, a couple ways to think about this. One is, um, the startup world were, was enamored with a very tech-heavy approach to sort of digital and healthcare and all of that. Yeah.
- 12:13So you see a lot of AIs, you see a lot of chatbots, you see a lot of, um, you know, intelligence embedded. Here's the problemUm, there's a certain percentage of people that will never move because you give them an app.
- 12:29They will never move because you throw AI at them, and it starts to send them some information. So one is, this is really built for the disengaged, uh, for the folks who really need that intervention.
- 12:44I think the other thing that sort of happened is, geez, is a tech-enabled service business, is that a good business? Right? Mm. Is that a good business model?
- 12:54The reality is a tech-enabled service is closer to the real outcome, right? It's closer to actually delivering health outcomes, engagement outcomes.
- 13:04When you think about American Well, Teladoc, Livongo, what are all of these companies? Are they tech-only companies? No. By and large, these are tech-enabled services. Sure. Now, we leverage technology, great.
- 13:19We use telehealth, great. We use RPM, great. We're beginning to use more and more AI and different modalities to engage, but the top of the pyramid is this social contract, is this, "I'm on this journey with you." Yeah.
- 13:34And then be- beneath that iceberg is a mountain of tech and tech-enabled sort of content and capabilities- Sure... that feed that interaction. Sure.
- 13:44I think people are going from the opposite direction, uh, in many respects.
- 13:47They're looking a lot of AI and other things, but again, it doesn't move the most, um, at risk, the most disengaged, the people who are spending and consume those costs. 5% of our population consume 50% of our spend.
- 14:05That percentage of people doesn't need a peanut butter approach as all of these other, uh, sort of, uh, services are often trying to do. What this also means for us is we're highly complementary, right?
- 14:19So we complement today providers, right? We are an extension of their care. And imagine a provider. You got 15 minutes once a month or once a quarter.
- 14:29You got seven minutes of face time, four minutes, your back's turned, typing into the EMR. Yeah. Yeah, you're frustrated. A horrible- Yeah... horrible experience.
- 14:38We are the other 99.998% of the time where we are there as an extension of the provider, helping them through their choices and their journey, but more importantly, unlocking the 5X sort of lever- Yeah...
- 14:55of using their lifestyle as medicine, and that's why it is, uh, and quite powerful. So let's say I'm a primary care physician, and I've got a regular patient who has, who's a type II diabetic. They come in.
- 15:07I am, I'm frustrated. I can't really get through to them. They're, they're not getting better. I, they're getting worse. Um, I, have I con- if I, let's say I'm a, I'm a private practice, uh, physician.
- 15:19Have I contracted with InHealth, uh, independently or as part of a group, um, through an insurer? How does that work? So both ways.
- 15:27Um, so one, today we have over 30 provider relationships, uh, and we contract directly, and they pres- and, and they prescribe our service. We activate them and enroll them. We are a direct extension of them.
- 15:42In some cases, we literally are acting on their behalf, like pick up the phone, "Hi, I'm, you know- Yeah... I'm your coach from doctor's whatever's office." Um, so that is sort of one of our primary channels.
- 15:55Um, the other one is around through health plans. So the great example there is we're in a four-year relationship with Anthem. Um, Anthem offers to their employer accounts this program called Healthy Impact.
- 16:10Healthy Impact, you know, as many health plans have, they offer lots of different programs, telehealth, and, you know, all of this stuff.
- 16:18As an extension of their telehealth service, they're now offering this Healthy Impact program.
- 16:23Now, employees go in, and they say, um, "Man, I'm really stressed," or, "I'm overweight," or, "I'm hypertensive," or, "I'm diabetic," or, "I'm a smoker."
- 16:32They can choose whatever their own personal goals and sort of challenges are. We accept those patients coming through.
- 16:42We engage with them, uh, and there's a minimum of three visits, and three visits get a $200 sort of incentive during annual enrollment, right?
- 16:52Um, now, those three visits, um, we often find individuals who have a chronic condition, and we will enroll them into a more intensive program, uh, similar to what we are doing.
- 17:05So we can go through health plans, which is great. We go direct. Um, and, the, um, the other area for us is w- partnering with sort of medical device companies, right?
- 17:17So Philips as an example, all of these medical device companies sell a piece of plastic or a piece of hardware, and it's a, it's like a s- it's like a hardware sale, right? Sure. Sell it and be done.
- 17:31Um, they're all realizing that they have to have a stake in the outcome- Yeah... of their patient's health. Yep. So Philips Respironics has taken our lifestyle therapeutics program.
- 17:42We've white labeled it, and we've wrapped it around their CPAP product. Okay.
- 17:46We're gonna be wrapping it around their COPD product, as well as so- uh, sort of other products as well, so it's a service that complements medical device companies. Gotcha. Okay.
- 17:57Um, probably a couple of other comments, one around the business of it. Um, because of the reimbursement rate, uh, we have higher than a 50% gross margin just on doing visits, right? So- Okay...
- 18:13okay, eh, it's a pretty good business, you know, gross margin. We, and we can see some expansion of that gross margin.
- 18:20Because these enterprises want to white label us and want to wrap it around their brand or their product- Yeah...
- 18:28that represents another revenue stream for us is to white label it and sort of-Put the listing on our program tied to, again, their brand or their product. That is high margin for us.
- 18:38It's an 80% plus gross margin business and then, um, Amanda mentioned earlier this accreditation.
- 18:47Uh, why this is important for us, this space is murky, and this space is noisy, and this space is hard to figure out what are truly the winners and losers in this area. Sure.
- 18:59So imagine taking our proven outcomes, our proven engagement. We spent 4,000 hours, and we created an accreditation program.
- 19:09It's been now stamped by the National Board of Health and Wellness Coaches, administered by the National Board of Medical Examiners, and what we now can do is take an entire displaced health and wellness coach workforce, think gyms, think all of this- Mm-hmm...
- 19:28offer an accreditation. They become a clinical coach that can get access to health plan reimbursement. Gotcha. So that unlocks the supply side of this sort of new breed of clinician.
- 19:41We think because of the stress in today's healthcare environment, because of the model in the healthcare environment, that unlocking the supply side, uh, will, will create a massive disruption to scaling this idea of lifestyle therapeutics.
- 19:57Has the supply side been a challenge up until now? No, it hasn't been. Is it a problem you need to solve? Not yet, um, but here's our hypothesis, right? You know, and, and this will become a new standard of care. Mm-hmm.
- 20:12So the same way if you get surgery on your hip, your shoulder, your knee, when you get discharged, they're gonna write you a script for physical therapy, right? That's a standard part of... re.
- 20:26We see a world, because this is proven and because, again, all of the outcomes, we see a world where this will be a standard part of care.
- 20:34If you see your doctor, and you have a BMI of 30 or 35, and you're hypertensive, and you're this- Mm-hmm... and you're this, and you're this, we see this as a, um, lifestyle therapeutic script being- Mm-hmm...
- 20:48as part and standard of your care. Um, because we are just beginning to open up the access to this large addressable market, we're really excited about what we're doing with Philips and Reshape and Anthem.
- 21:03Oh, this is, this is a spark that is just starting to catch fire. Yeah. We are preparing the supply side of our equation. Yeah.
- 21:12You know, just to sh- uh, shift gears slightly, uh, I know you b- came on as CEO just this year or d- in 2019, within the last year, uh, from, uh, American Well, and I just was curious just in terms of understanding your own motivations and passions, what drew you to In Health, and I guess the sort of corollary is that is what, what makes you passionate about getting up and solving these problems?
- 21:35Lo- Logan, thank you so much for the question. Um, uh, I've spent 20-plus years in this ind- and at, I s- primarily at very large, scaled-out companies.
- 21:47So even before American Well, I was at Samsung, and even before Samsung, I was at HP. So imagine, uh, uh, I'm at HP. I've got an $11 billion book of business bringing technology into health and life sciences.
- 22:00It's awesome that we are doing genetics research. It's awesome that we're building digital host- hospitals. It's awesome that we're doing a billion claims through Medicaid. Um,
- 22:12what I lacked there was truly am I making a difference? Yeah. I know I was helping enterprises. I know I was digitizing things. Yeah. But could I affect and touch the outcomes? Yeah.
- 22:23That's why I went over to Samsung, because here I am at Samsung at headquarters in South Korea, 365 million devices in people's hands, people touching it 70 times a day. Mm-hmm.
- 22:35And my job and my goal was how do I bridge health services directly to the consumer? Okay.
- 22:42And so sensors and services loaded onto your device, and wearables was all in this pursuit of unlocking the consumer side and the consumer engagement to health services.
- 22:55Now, that still wasn't enough 'cause I believe that there were certain modalities like telemedicine and remote patient monitoring, actual services that needed to be deployed. That's why my time at American Well.
- 23:11Um, for me, it all came down to, uh, an MIT, uh, workshop that I was at.
- 23:16I was talking about bio cities and work we're doing in, in the Middle East and China when I was at HP, and this is when it really struck me that the industry has been looking at the wrong end of this lens, and that- Hmm...
- 23:2990/10, right? The 10% lever, and really what are we doing in bringing technology to do the other? And I was hunting
- 23:38for my entire career to find a place where we can really drive meaningful outcomes and begin to scale that. Yeah. Um, I was introduced with it, to In Health when I was at American Well.
- 23:52Uh, I was looking for a population-based program, and this is when I got to know about In Health, and I was really intrigued, but I called bullshit, right? I was just like, "I don't get it. I, I don't buy it.
- 24:05It's such a big story. I don't believe it." Aubrey had asked me to be an advisor to the company, uh, which I agreed to do. Uh, a few months later he asked me to join the board and then to chair the board.
- 24:17Uh, so then I came aboard as sort of the chairman of the company and really as a part-time to just shape where the company is going. I spent six months kicking the tires, and I said, "Is this real? Is this scalable?
- 24:30Is this a good business model?"
- 24:32And that's when I jumped in with both feet, took on the CEO role, and went hunting for badasses like Amanda and Brittany and a handful of others that we brought aboard to bring new energy and life, to think of this as forget the proving part of what we've been doing.
- 24:47Now it's the scale part of what we've been doing. Yeah. And so that's the journey that we're...That's awesome.
- 24:54That's a good segue to what I think could be my final question, which is, you know, you have put a lot of energy into really proving this out. Uh, you've done the clinical trials. You know this works.
- 25:06Uh, you're entering that scaling phase. Um, they, they brought you both on to, to scale, to, to really do that process. Um, and yet, you know, lifestyle therapeutics is still new. You're still, you know, proving that.
- 25:20You said it was murky. When you dream really big and you think out a decade and you think, "Hey, if we can, if we can crack this nut and, and we can really convince at, the market that that digital...
- 25:33you know, that lifestyle therapeutics is the standard of care, and this takes off," how do you see being able to address some of these really seemingly intractable health issues? Like, like, where could we get to? Yeah.
- 25:47Um, the first thing you gotta think about is there's 100 million individuals in the United States that can get meaningful, transformational value from lifestyle therapeutics.
- 26:01So there's 100 million of them out there today, and they're getting worse by the moment, and the aging population and COVID and the new norm is forcing the need for a telehealth RPM personalized sort of approach around it.
- 26:17So that's one. If you really want to get scale around this, there will be a day when it will be considered malpractice to not offer lifestyle therapeutics as part of your standard of care.
- 26:31When you get to that point, because it is proven, because it is real, uh, a doctor giving you a shoulder, knee surgery without giving you physical therapy is malpractice.
- 26:44A g- seeing your health provider and seeing them and just being fed
- 26:49medications and surgery, it will be considered malpractice to not use this as the first line of defense or as a, as a therapy for recovery from certain, um, sort of conditions.
- 27:03That's where I see this going in terms of scale. Now, medicine takes a long time in this industry to get to that sort of idea of standard practice. It takes, in fact, 17 years- Yeah...
- 27:16to go from proven insight to real s- you know, standard of care. I think we are more than halfway in this journey. We've done the hard work of proving it.
- 27:28Our job is to open up the addressable opportunity through health plans and with providers and through medical device companies.
- 27:35We are all doing that in pursuit of opening up our TAM and getting as much of this 100 million in addressable population. Our job is what we call share of population.
- 27:47How fast can we activate that TAM to become users of lifestyle therapeutics? So w- if we're at 1% of our TAM, right?
- 27:56Or 2% or 5%, so we're beginning to put metrics that translate that addressable opportunity into engaged, activated patients. Mm.
- 28:06And we're spending a lot of it internally with our processes, with our technology around activation, all around measuring what we call SOP, right?
- 28:15What is the share of our patients that are using, um, uh, lifestyle therapeutics? Very interesting. Um, who are you primarily trying to partner with?
- 28:27And if someone's watching this, what's the best way for them to reach out to you? So we continue to partner with providers. We continue to scale with health plans. I think we gotta get beyond Anthem. Anthem's great.
- 28:41Um, we're going direct now to self-employed in, uh, employers or self-insured employers. Okay. We wanna get to other health plans as well. Um, there's also a whole range of, um,
- 28:54innovators in this space that need this sort of a service to complement what they're doing. Right. So we see opportunity. Think of Livongos, think of Omadas, think of American Wells and the Teladocs. They have a service.
- 29:10What does this service represent as a complement at, to a tier of their patients? Um- Is what-... we are just getting started. Is, is your- Yeah...
- 29:20complementary service the coaching side, or is it the, uh, the software, the way it interacts, uh, throughout the week and gives those little nudges? So our service can get disaggregated from our core software. Okay.
- 29:33Meaning, our service can fit within Anthem's app. Our core service can fit within American Well. Our core service can be embedded on third-party apps. So we have our own app.
- 29:44We white label our app, and our service can also be integrated into third-party brands and services. What we do not want to be, we're not a tech platform company. We're gonna allow that to play out.
- 29:57We want to be embedded. We want to be as part of their platforms. We don't wanna be a platform company technology-wise in and of itself.
- 30:06So if I'm understanding correctly, for the verticals, for the disease states that you, uh, w- work through, you're the brains that understand what are the levers that need to be pulled to really affect change for this type of individual.
- 30:19And we are the mechanism to make sure we get high engagement from those patients so that they are motivated to stay in this journey to improve their health. Got it.
- 30:31And whether it's a d- you know, and this world is full of disease-specific companies, right? Yeah. And I think that's a mistake, right? Mm-hmm. You can chase disease all you want, but disease is still progressing. Yeah.
- 30:43When we can get after their motivations, their lifestyle, we have an opportunity to change the direction of that disease, and that's why we have shown results in hypertension.
- 30:54We've shown results in diabetes, obesity, uh, cardiovascular, uh, not because we have unique programs for each of those diseases, but because the biggest contributor to change the tidal wave of their disease is to understand how to make improvements in their lifestyle and unlock their own motivations and desires to improve their health.
- 31:16That's a perfect note to end on, Harry. I think it was like you, you knew it was coming. So, uh, appreciate your time, and Amanda, really appreciate, uh, you both letting me know what In Health is working on.
- 31:29And more importantly, just thank you for your, your diligence in pursuing these, these avenues to really help people, um, heal and, uh, you know, get control of their lives. So thank you both.
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- 31:56If you wanna learn how you can join this community of entrepreneurs, or if you wanna connect with one of our 330 companies, go to startuphealth.com. Thanks for listening to StartUp Health NOW. We'll be back next week.
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