Latest / Becker’s Healthcare - Clinical Leadership Podcast / Matt Boles, MD, MHA, MSc, Chief Medical Officer at Salem Health Hospitals and Clinics

Transcript

Matt Boles, MD, MHA, MSc, Chief Medical Officer at Salem Health Hospitals and Clinics · Becker’s Healthcare - Clinical Leadership Podcast

0:02
The most important health care decisions don't happen
0:05
in isolation.
0:06
They happen when leaders come together.
0:08
Becker's sixteenth annual meeting brings together more than
0:11
3,500
0:12
hospital and health system executives this April in
0:15
Chicago.
0:16
With 800 speakers from Ascension,
0:18
Cleveland Clinic, CommonSpirit and more, the conversations get
0:22
real. Leaders will share how their scenario planning
0:24
for policy shifts, breaking through value based care
0:27
barriers, and building clinical teams that translate
0:46
This is Laura Dierda with the Becker's Healthcare
0:48
podcast. I'm thrilled today to be joined by
0:50
doctor Matt Boles, chief medical officer at Salem
0:53
Health Hospitals and Clinics. Doctor Boles, it's a
0:55
pleasure to have you on the podcast today.
0:57
Great. Thanks, Laura, for having me. Absolutely. Now
1:00
I'm excited for our conversation because I know
1:03
health care is changing so much right now.
1:04
And so I'm looking forward to learning more
1:06
about what you're doing at Salem Health and
1:08
how you've been successful over the last couple
1:10
years and how you're thinking about the future
1:12
too. But before we dive in, can you
1:13
tell me a little bit more about yourself
1:15
and Salem Health?
1:17
Sure. Absolutely. So,
1:19
I'm an anesthesiologist,
1:20
and I'm also the chief medical officer
1:23
at Salem Health hospitals and clinics. And so
1:26
I've been in my executive
1:28
leadership role since about 2018,
1:31
but recently stepped into that CMO role when
1:34
my dear friend,
1:35
doctor Ralph Yates retired.
1:38
But fun fact, I've actually been at Salem
1:40
Health for thirty five years. Started my career
1:42
here when I was 18,
1:45
only leaving for medical school and residency. So
1:47
it truly is an honor and a privilege
1:50
to serve in this role.
1:51
A little bit about Salem Health.
1:54
We, a lot of people don't know this.
1:56
You know, we're in the capital city of
1:57
Oregon, but we're actually the largest acute care
1:59
hospital
2:01
in the state.
2:02
And Salem Health is a level two trauma
2:04
center. We have over 600
2:07
licensed beds, almost 650.
2:10
A really large catchment area. We go all
2:12
the way to the coast to the west
2:13
of us, up the canyon towards
2:16
the middle of Oregon,
2:17
to our East. So maybe about half a
2:19
million or so in our catchment area.
2:22
And I've been told that we're one of
2:23
the largest cities in The US with only
2:26
one health system.
2:27
And another fun fact about Salem Health is
2:29
that we have one of the busiest EDs
2:33
on the West Coast.
2:35
We saw over a 115,000
2:37
patients last year,
2:38
and so a very, very busy level two
2:41
trauma center. We do have a small critical
2:44
access hospital to our west about 20 miles.
2:48
And then also,
2:49
I think it's important to point out that
2:50
we are not
2:52
a teaching hospital. So we have no residents
2:54
or fellows,
2:55
at our at our in our health system.
3:00
That's helpful to understand. You know, great context.
3:02
I mean, I think it's just so,
3:05
impressive to see how many different folks that,
3:08
you
3:09
you you do serve within,
3:11
your community and then too, like, to to
3:13
hear how your career has evolved, you know,
3:15
from stopping in the hospital in in when
3:18
you're 18 and now being a physician and
3:20
then chief medical officer is, truly, truly an
3:23
amazing journey I can imagine.
3:25
Yeah. No. Like I said, it's I never
3:28
thought in a million years I would be
3:29
in the role I am.
3:31
I still practice one day a week, so
3:33
it's great to be on the front lines
3:35
with,
3:36
you know, with all our caregivers caring for
3:39
patients. So but, no, it is. It's It's
3:40
great to be in the community I was
3:42
born and raised in. I was born in
3:44
this hospital system.
3:45
Both my kids were. So, no. It is
3:48
an honor and a privilege.
3:50
Fantastic. And, you know, when you look at
3:52
the last year or so, what was the
3:54
most important initiative initiative
3:56
you led?
3:57
What did you do, and what were the
3:58
results? Yeah. No. I think that's a that's
4:00
a great question. And so let me begin
4:02
by saying I have an amazing
4:03
executive team
4:05
that I work with. And so we
4:07
we often co lead these initiatives,
4:10
together, and I would not be successful without
4:12
them.
4:13
And, so,
4:15
looking back on this past year, I I
4:18
I probably would would,
4:20
like to reflect on the work we did
4:23
to employ
4:24
our anesthesia group. Right? And so when I
4:27
started my executive journey, I was part of
4:29
an independent
4:31
anesthesia group, but I also worked for the
4:33
hospital in my executive role.
4:36
And I'd say back in 2022,
4:38
that's when this work started of moving,
4:41
our anesthesia group to the employed model.
4:45
Just to give you some context,
4:48
the the group I worked for was out
4:49
of Portland. Great group.
4:51
Amazing group. One of the largest in the
4:53
country. But, again, they were struggling just like
4:56
everyone else's with recruitment
4:58
and,
4:59
trying to keep up with the demands of
5:01
the contract that they had with our health
5:03
system. And so
5:05
they let us know, OAG,
5:07
Oregon Anesthesiology Group, let us know that they
5:09
were no longer able to honor the contract.
5:11
And so I was led,
5:14
to bring our employed
5:16
excuse me, our our our private group to
5:18
the employed model.
5:20
And that was a three year three year
5:22
journey that just concluded
5:24
this last, this last fall. And so I
5:27
learned so much culturally,
5:29
professionally, personally,
5:32
just to bring all of them from this,
5:34
you know, fiercely independent,
5:36
autonomous model. And what does it look like
5:39
to be employed in a large health system?
5:41
And so this was vital, right, to the,
5:45
just for the care that we provide for
5:47
our patients. We could not, we meaning Salem
5:49
Health, could not lose this vital service line.
5:52
And so it was an honor and a
5:54
privilege to to bring them over. And as
5:56
far as results,
5:58
I think it really speaks well to our
6:00
culture and to just what we've really,
6:03
grown here at Salem Health. We had pretty
6:06
much had everyone except for two of my
6:08
partners decide to stay.
6:11
That just really showcases their commitment to our
6:14
community, to our health system.
6:16
And also this work just really showcases that,
6:19
yes, we have metrics, we have goals, we
6:21
have targets.
6:23
But this took a lot of
6:25
those soft skills of, you know, talking
6:28
these,
6:29
providers
6:30
through that journey of becoming employed.
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So there was hours spent on the on
6:36
the, you know, the back end
6:38
of, reassuring them about, what does it look
6:41
like to be employed.
6:43
Yes. You you are losing
6:45
some of those,
6:46
factors that were in an independent practice, but
6:49
you're gaining so much more.
6:51
And so, again, that was probably one of
6:53
the most,
6:55
professionally and personal fulfilling,
6:58
projects that I've led over this past year,
7:00
which concluded,
7:02
basically this last summer.
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And then if I could just talk about
7:06
one more,
7:07
strategic initiative that I helped lead or co
7:10
lead with other executives,
7:12
was all about procedural capacity. And so,
7:16
let me give you a little more context.
7:18
We we have had surgeons over the last
7:21
several years and other proceduralists say, hey. I
7:23
cannot get more OR time. I can't get
7:26
my patients into the OR.
7:28
And so we did some research and data,
7:31
and, you know, our baseline data did show
7:34
that we probably had a backlog of several
7:37
thousand patients waiting for their surgery.
7:39
And so,
7:41
when we first approached this problem, you know,
7:43
the the easy solution or the solution that
7:46
we thought was the right answer was just
7:48
to build
7:49
more ORs. And as we all know in
7:51
the financial
7:53
landscape that we're in, that's hugely expensive.
7:56
And so,
7:58
we're a lean organization,
8:00
and so we use data to drive our
8:02
problem solving.
8:03
And so we were able to show that
8:06
we are actually underutilizing
8:08
all of our procedural space across the health
8:10
system.
8:11
So that started us on a journey of
8:14
reimagining how we use this procedural space.
8:18
And so for years,
8:20
I'd say problem solving in the surgical space
8:23
really centered on the day of surgery. Meaning,
8:26
what can we do for, on time starts,
8:28
turnover times,
8:30
maximizing our sterile processing or prep, recovery areas,
8:34
etcetera.
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But we really just stretched that value stream
8:39
out for the patient, meaning we went upstream
8:43
all the way to where that patient was
8:44
referred into the clinics.
8:47
And so because we have the luxury of
8:50
having a lot of our surgical clinics,
8:52
being employed,
8:53
we were able to take that problem solving
8:55
up way upstream,
8:57
work with,
8:59
our clinics,
9:00
and to just really
9:02
maximize the flow of that patient
9:04
to our ORs.
9:06
And here's where we leaned into technology.
9:09
Epic traditionally had some great metrics around on
9:12
time starts, turnover times, etcetera, just like I
9:15
mentioned.
9:16
But we were able to basically build a
9:19
procedural
9:20
traffic control system in Epic.
9:23
And so we could see wherever that patient
9:25
was on that value stream, meaning all the
9:27
way back up in the clinic,
9:29
the time they were waiting to see the
9:31
specialist,
9:33
the time that was needed to optimize the
9:35
patient for surgery, the time that was needed,
9:38
for authorizations and referrals. And so we were
9:42
able to, look at data, how many patients
9:44
were in each of those buckets,
9:47
and, also, that helped focus our problem solving.
9:50
And so we've had some really good results.
9:53
We haven't built any more ORs. I think
9:55
that's the that's the number one result to
9:58
really celebrate because, like I said, they're so
9:59
expensive.
10:01
But we've maximized
10:02
our,
10:03
block time with these surgeons.
10:06
We've been able to create a new system
10:08
called,
10:09
patient case classification window. We call it CCW.
10:13
So we put targets on all of our
10:15
electively
10:16
scheduled patients.
10:18
And so,
10:19
we had an ambitious goal. We we we
10:22
wanted all of our
10:24
patients seen in the clinic to be scheduled
10:26
in surgery in forty five days or less.
10:29
And there were there, I won't get into
10:30
all the details, but there are many classifications
10:33
we can use under that.
10:34
So globally,
10:36
we are at about 67, 68%
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of meeting that target,
10:40
which is a huge improvement from when we
10:42
started this work.
10:44
And, again, we are now starting to see
10:46
that backlog that I spoke about,
10:49
being addressed. And so those patients are getting
10:52
the care that they need,
10:54
in our procedural system. So, again, those are
10:57
just a couple of,
10:58
projects that I can recall, again, that I
11:01
had the honor and privilege to to leave
11:03
with my co executives.
11:06
I love that. I think all of those
11:07
things you mentioned are are so critical, especially,
11:10
being able to improve that efficiency, reimagine the
11:13
way that you're looking at the space, some
11:15
processes, procedures,
11:17
and then the data and having the information
11:19
that can inform whether you're making improvements and
11:22
and how it impacts quality and outcomes and
11:24
everything else,
11:25
you know, is so critical. I'm curious as
11:28
you were making this transformation
11:30
and putting all of this in place and
11:31
integrating it into the the daily functioning at
11:34
the hospitals,
11:36
how did you, at the same time, go
11:38
through the cultural transformation for folks to really,
11:41
embrace all of these things and then make
11:43
sure that, you're getting the outcomes that you
11:46
wanted.
11:47
Yeah. No. That's great. Right? It's part of
11:49
that change curve. Right? When we had some
11:52
you know, surgeons can be,
11:55
let's say,
11:57
you know, very,
11:59
emotional and passionate
12:00
about, their patients. And so we had to
12:02
bring them along and it took some time.
12:04
Absolutely.
12:05
Like I said, we use our lean management
12:08
system. And so everything is visible either electronically
12:12
or,
12:13
in our what we call our war rooms.
12:15
And so we would bring our surgeons right
12:18
along, and they would see,
12:20
all the problem solving.
12:21
And,
12:23
and and also an important element is that
12:25
we would include them in on the problem
12:28
solving.
12:29
And so, again, using our lean fundamentals
12:32
of taking the work to our frontline,
12:34
asking them to be a part of
12:36
the problem solving, helping us set up targets,
12:40
our process and outcome metrics. I think that
12:42
was key.
12:44
And,
12:45
having several identified
12:47
anesthesiologists
12:48
and surgeons
12:49
kinda champion this work. So it wasn't so
12:51
much the executive team selling it. It really
12:54
was the those that are impacted by this
12:57
work.
12:58
And so, again, that that to me really
13:00
helped,
13:02
you know, help help make this change easier
13:05
and and also showing them results. Right?
13:08
Showing them that, yes, you're getting this case
13:10
in or we heard you. So we opened
13:12
up this service line. We had a a
13:14
big bottleneck in robotics, and so we had
13:17
to, reimagine
13:19
where we were going to do those surgeries.
13:21
And so we put put the robot in
13:23
a in a room, in an OR that
13:25
may not have been,
13:27
everyone's first choice, but we did simulations.
13:30
We did mock ups. And so when we
13:32
did all those,
13:35
test of change, we included our surgeons in
13:37
on that so that they could own it.
13:39
They could give their feedback,
13:40
and then they could also turn around and
13:42
sell it to their section members and practice
13:45
partners. So
13:47
it just was critical to get them involved,
13:49
early on.
13:52
That's so helpful to understand. Thank you for
13:54
sharing, and talking through that. Now looking ahead,
13:57
what are some of your big priorities and
13:59
headwinds for 2026?
14:01
Gosh.
14:02
Where do I begin? Lots of headwinds.
14:05
I'd say, you know, we're not alone. I
14:08
think everywhere and everywhere is struggling with the
14:10
payer mix and reimbursements,
14:13
and those issues that are coming, especially from
14:15
our,
14:16
government,
14:17
programs such as Medicaid.
14:19
And so, you know, it's it's just, the
14:22
shrinking dollar. Right? Especially from the,
14:27
the Medicaid program. And I know that in
14:29
our community,
14:31
you know, we're just not seeing those rates,
14:34
increase year over year,
14:36
like they need to to match inflation and
14:39
match labor, to match all the other costs
14:42
that are,
14:44
you know, not just the hospital.
14:46
You know, we're so big. We can kind
14:48
of weather some of this a little bit
14:50
better,
14:50
but our private group's in town. And so,
14:54
it is really impacting our private practices. And
14:57
so to give you a little bit of
14:59
perspective,
15:00
we have had several large practices over the
15:03
last couple of years
15:05
that simply
15:06
couldn't make,
15:08
their books balance,
15:09
so to speak, and and their businesses were
15:11
failing.
15:12
And so despite, you know, very smart people
15:15
that were running these businesses, they could not
15:18
keep up with all of those factors I
15:20
just mentioned, like inflation and especially labor. That
15:23
has been a huge
15:24
huge,
15:26
driver of cost for these practices.
15:29
And when you couple that with, shrinking reimbursements,
15:33
it really just made it almost impossible to
15:36
function. And so we've had,
15:38
a couple of large groups in our community
15:41
come to us for employment. And again, that's
15:44
not Salem Health strategy is to compete in
15:47
these service lines.
15:49
But our strategy
15:50
absolutely
15:51
is to make sure
15:53
that
15:54
these service lines are available to our patients,
15:56
if that makes sense. We know we need
15:58
orthopedics
16:00
in our community. And so when that group
16:02
approached us for employment, we absolutely worked with
16:04
them, brought them in board.
16:06
And, but the, I guess the concerning or
16:09
the big challenges we're we're seeing more and
16:11
more groups do this too. We just did
16:13
this with our urology group.
16:15
And so, it's not going away, but we're
16:18
here to, you know, to help the best
16:20
we can,
16:22
to, you know, bolster these headwinds like you
16:24
described in the question. But I really think
16:26
that's that's our big challenge,
16:29
facing all of us in our community.
16:32
I think that's such an excellent point. And,
16:34
you know, especially looking at how,
16:37
physicians and physician shortages are impacting
16:40
communities and hospitals and systems across the country
16:42
in, you know, bringing
16:44
those physician groups into employment. I know it's
16:46
no small task and and then, you know,
16:50
integrating
16:51
them financially,
16:52
culturally, everything else. And so when you're looking
16:55
at, you know, how you've been able to
16:57
do this successfully now a couple of different
16:59
times,
17:00
you know,
17:01
what are your kind of, like, business considerations
17:04
for your your,
17:05
deciding to do that? And how do you,
17:08
make sure that, you know, you have everything
17:10
in place? Or what lessons have you learned,
17:11
I guess, in,
17:12
bringing in those types of groups and and
17:14
making them employed to make sure things go
17:16
as smoothly as possible?
17:18
Yeah. No. We've learned a lot. Right? I
17:20
talked about the anesthesia,
17:22
model that became employed,
17:24
several years ago. And so,
17:26
again, we learn through,
17:28
all of our problem solving. Like I said,
17:30
we're a lean organization.
17:33
But, yes, assimilating into our culture,
17:36
You know, again, I just wanna make sure,
17:38
you know, our strategy is not to compete
17:40
or go after these groups, but we really
17:42
try to put the patient in the middle
17:44
of all this.
17:45
What services do our patients need in our
17:48
community?
17:49
And so that's that's really been our approach.
17:52
They need urology.
17:53
They absolutely need orthopedics.
17:56
And so when we take that approach, it
17:58
makes that work, you know, focused on a
18:01
a solitary mission or vision.
18:04
But getting them culturally,
18:06
you know,
18:07
into our health system, that's been a challenge.
18:10
But again, it just takes lots of,
18:13
conversation,
18:14
lots of time. Sometimes you have to slow
18:16
down to go fast.
18:18
And, just walking through these,
18:21
numbers, sometimes it's just individually with all of
18:23
them, keeping everything visible, good communication, follow through,
18:27
etcetera.
18:28
Like I said, a lot of those soft
18:29
skills that you may not have learned so
18:31
much in in medical school, but,
18:34
it's just it speaks to that relational side
18:36
of leadership.
18:39
Absolutely. Easier said than done, I know, in
18:41
many ways, but, seems like something that comes
18:44
naturally to you, or did you have to
18:45
to acquire skills there too?
18:48
Oh, I'm always learning. Absolutely.
18:50
Asking for feedback.
18:52
But, yes, you know, there there really is
18:54
there there there are people. There are humans,
18:58
behind all of these,
19:00
decisions that we make. And so again,
19:03
I keep talking about lean. One of our
19:05
fundamental pillars is respect for people. And so
19:08
we really do honor that in all that
19:10
we do.
19:11
And walking, these people through these changes is
19:14
is not easy, but it's essential to get
19:17
them to where they need to be.
19:19
Absolutely. I I I definitely agree.
19:22
Now, when you're looking ahead to, what do
19:24
you think the hardest thing you'll have to
19:25
do in the coming year will be?
19:27
Great. Well, I don't wanna be doom and
19:29
gloom. I do think a lot of health
19:31
care is is really hard right now.
19:34
So, you know, there's there's pressures and challenges
19:36
on all fronts. So I'd say,
19:40
maybe the hardest thing that we we have
19:42
in front of us is just to make
19:43
sure that we stay true to our mission
19:45
and serving patients
19:47
and really,
19:49
kinda getting back to,
19:51
why we're why we are all doing this.
19:54
And so,
19:55
for instance, I love when,
19:58
young people come and shadow me, in the
20:00
OR or ask me about my profession. It
20:03
kinda reminds me of why I even stepped
20:05
into all of this. So,
20:07
so I just you know, I think our
20:08
challenge is, you know, how do we keep
20:11
this fresh? How do we make this,
20:13
rewarding?
20:14
How do we just remind ourselves that our
20:17
patients are benefiting from what we do?
20:20
Just earlier today, I was at the nephrology
20:23
section meeting.
20:25
And so they're such a great amazing group
20:27
of individuals. And so it was refreshing
20:30
to see,
20:31
them not jaded by all of those challenges
20:33
I just mentioned. And they were,
20:36
excited to share with me some innovative and
20:39
creative ideas they had about
20:41
certain barriers and problems that they were experiencing.
20:44
So,
20:45
so I guess, you know, some of the
20:47
challenges that I think that we face as
20:49
leaders is,
20:51
let's not lose sight of,
20:53
you know, why we're doing this, and it's
20:55
for the patient.
20:56
And so if we kinda keep that in
20:58
mind, then I think all those other things
21:00
will follow. And so, you know, how do
21:02
we care for those who care for the
21:04
patient? And so it just kind of expands
21:07
from there.
21:08
So that that's a challenge. We do get
21:10
kind of focused on our problems.
21:12
So how can we keep that,
21:14
that true north, that positive,
21:16
mission statement of caring for our our patients?
21:20
That is such a helpful reminder and especially,
21:23
you know, today in thinking about all the
21:25
different pressures and, things that are going on
21:27
for health care providers,
21:30
being able to really craft that type of
21:32
environment, atmosphere, atmosphere, and culture where they feel
21:35
supported,
21:36
can be so critical. And I I think
21:38
when you're looking at, you know,
21:41
some of those innovations that you've been hearing
21:43
about, creative ideas and other ways to problem
21:46
solve, Does anything,
21:47
rise to the top or come to mind
21:49
as something that was a particularly unique way
21:51
that you've been tackling
21:53
some of these, you know, more physician bonus
21:56
or or clinician,
21:57
you know, resilience issues?
22:00
We are actually learning a lot. And if
22:03
you wanna talk about innovation and creativity, we're
22:05
learning so much about virtual
22:07
care.
22:09
I know we we did round one of
22:11
that, right, with COVID.
22:13
I'd say round two is kinda reimagining
22:16
virtual care in a new way. And so
22:18
we launched,
22:19
I think it was about a year ago,
22:21
maybe a little longer than that, virtual nursing.
22:25
And so we have actually seen a lot
22:27
of success there.
22:29
Our nurses like it. Our patients like it.
22:32
Our patient experience scores have grown.
22:35
And so,
22:37
I would say from a provider perspective,
22:40
we are taking a deep lean into that
22:43
work, and we're looking at what our nurses
22:45
did to make that successful.
22:47
And so we're,
22:49
just scratching the surface on how can we
22:51
apply that to,
22:53
provider practices. You know, what does virtual care
22:55
look like? And
22:57
again, not necessarily in the way we saw
22:59
it during COVID, but how do we do
23:01
it in the acute care setting?
23:03
So, I'm really excited for that. I think
23:06
there's some great potential
23:08
which will,
23:10
perhaps
23:11
make care better, more efficient.
23:13
It might address the financial questions.
23:15
And so it could be, you know, the
23:17
triple or quadruple aim type of
23:20
innovation that we're looking for. So, yeah, more
23:22
to come on that. I'm really excited about
23:24
virtual care.
23:28
I love it. I I think there's so
23:29
many opportunities there, and, really, it just seems
23:32
like amazing way to expand access to care
23:34
and and get you, in the system, you
23:36
know, into the position it wants to be.
23:39
Before we wrap up here, are there any
23:40
other areas that you see as being really
23:42
primed for organizational growth?
23:45
I'd say,
23:46
you know, this is a very small subset
23:48
of our organization, but an important one is
23:50
our medical executive committee.
23:52
And we had a retreat this last fall.
23:55
It was great to get us all together
23:57
to have some time off-site,
23:59
to really have some protected,
24:02
conversation
24:03
about the challenges that our medical executive committee,
24:07
kinda kinda is seeing or experiencing.
24:10
You know, we talked a lot about APPs,
24:13
just how grateful we are for them, but
24:15
also,
24:17
just recognizing that their presence here in Oregon
24:19
has exploded. It really has over the last
24:22
several years and even here at Salem Health.
24:25
So how can we honor them? How can
24:27
we support them?
24:28
How do we balance that independence
24:30
versus where they fit in the healthcare,
24:33
continuum?
24:35
How do we help support them with quality
24:37
of care, etcetera. So that's been exciting.
24:39
And then, it was great to hear from
24:42
my MEC leaders about how
24:45
they can impact
24:47
quality, not so much in the
24:50
traditional sense of, you know, problem solving, all
24:53
those,
24:54
you know, important measures such as CAUTIs and
24:57
CLABSIs, etcetera. But to hear from that that
24:59
they want to drive the culture
25:02
of quality. How do they improve that
25:05
among our medical staff and care team? That
25:07
was really exciting. So that was refreshing.
25:10
It was great to have that, opportunity with
25:13
them. And and so our next step now
25:15
is just trying to apply that to some
25:17
tactical,
25:19
strategy to execute those those goals.
25:24
I love that. Thank you so much, doctor
25:26
Boles, for your time today. This has been
25:28
such a fascinating interview. I think you've shared
25:30
so many,
25:31
different ideas
25:32
in creative ways that you're problem solving today.
25:34
It's just been very inspiring, and I look
25:37
forward to seeing you as well at our
25:38
annual meeting in April. I know you'll be
25:40
speaking on a panel and covering a lot
25:42
of these same same themes, and so it'll
25:43
be great to continue the conversation.
25:46
Great. Thanks, Laura. Well, like I said, it's
25:48
an honor and privilege to be here. I'm
25:50
very grateful.