Hello and welcome to today's webinar, Beyond Point Solutions, Chronic Condition Support for Total Cost of Care. Before we get started, I'd like to review a few housekeeping details. Today's webinar is being recorded and an online archive of today's event will be available within one to two business days. If you have trouble seeing the slides at any time during the presentation, please press F5 to refresh your screen on a PC or Command-R if you're using a Mac. You may ask a question at any time during the presentation by typing your question into the Q&A box located on the right side of your screen and pressing enter. And finally, I'd like to remind you of AHIP's antitrust statement located in the link just below the slide viewer. We will, as always, comply with that statement. Among other things, the antitrust statement prohibits us from discussing competitively sensitive information. We're very fortunate to have with us today Melissa Salucci, National Vice President of Payer Growth and Dr. Thomas Tsang, Chief Medical Officer both with Omada Health along with Dr. Sachin Jain, CEO of Scan Group and Health Plan. At this time, I'd like to turn the floor over to our speakers. Welcome. Thank you, Lisa. Good afternoon and thank you all for joining us. We're so grateful for your participation today. I'm Melissa Salucci with Omada Health, and I'll be your moderator. Today's conversation is about a challenge that is becoming increasingly central for health plans, how to manage total cost of care for members whose needs do not fall neatly into a single diagnosis, benefit, or program. We will focus on the overlap across cardiometabolic conditions and the growing role of GLP-1 therapies and what it takes to move from a collection of point solutions to a more coordinated care strategy. Before we move into the plan for today's conversations, I want to acknowledge that we have two perspectives at this virtual table that are especially well-suited. Dr. Such and Jane leads SCAN Group and SCAN Health Plan, bringing the perspective of a leader accountable for serving Medicare Advantage members and navigating the realities of a health plan. Dr. Thomas Tsang is Omada's chief medical officer. He brings clinical and care delivery perspective. Both have led health plans, served in government, and as practicing physicians. So I hear you have a bit of history while making history. Sachin, tell me, how did you meet? so i i've known uh dr sang since we were both uh in the early days of the obama administration both of us um had different roles at the office of the national coordinator for health it and subsequently um cms and tom and i uh got to know each other very well we subsequently worked together at merck where we led the company's global health information and innovation efforts and have now had a long collaboration, now leading into Omada, where I'm a board member, and I'm just really excited for the conversation today. I think Tom's got a lot of great perspectives on chronic disease management, chronic care. I know this has been a passion of his ever since he was involved in the Million Hearts campaign at HHS, and I am looking forward to an engaged conversation today with Tom, with you, as well as with the audience. Thank you. Thank you, I love how well you both know each other and know this industry, which brings me to something Sachin, you wrote recently. You said that health care needs more embedded critics, people who care enough about their institutions to challenge them. That's a call for honest self examination. What are we too comfortable accepting as normal in health care? Love to hear that. Look, I think when you're part of the health care industry, it becomes very normal to see the part of the industry that you're a part of as being virtuous and everything outside of your part of the industry as the problem. I'll give you some examples. You know, when you work as a doctor, it's very popular to kind of blame insurance companies. When you work in insurance companies, it's Very popular to blame pharmaceutical manufacturers. When you're in the pharmaceutical industry, it's very easy to blame government regulation. And I think one of the big missing opportunities for us is to look within ourselves, to look within our own sectors and acknowledge the problems that we create for patients. And, you know, the truth is, is that patients everywhere recognize that the healthcare industry is in a state of crisis. And those of us who work in healthcare primarily just go to conferences and talk about, you know, how broken everything is, as opposed to doing anything about it. And I think one of the opportunities we all have is to be a bit more self-reflective and recognize the part we play in actually creating the dysfunction that exists in U.S. health care. Tom, have you experienced it the same way, similarly? Oh, absolutely. I mean, I had the fortune to work with Sachin, both in government, from the executive side, as well from the legislative side, and then at Merck Pharmaceuticals. um so i think we we we've had sort of like the breadth of experience from many verticals and many sectors and each sector has its own issues but also has its own naivete and uh sort of constrained lenses in in how they view the world and the problems um and and i and i guess this is you know sort of self-perpetuating and really reason why we're in this situation and in this in kind of like this uh dilemma that we're in yeah couldn't agree more which brings us to these four pressures that plans are feeling today we all know that these pressures are real and urgent and interconnected so the question being whether the operating model helps them respond or just adds fragmentation so um plans have always managed complexity we know that what's different now is that all of these pressures are hitting at the same time first affordability commercial group medical cost trend is projected at nine percent for 2027 second specialty farming pharmacy nglp ones somebody's playing with my slides here let's get us back to where we were um the question is no longer just can we cover it it's can we show more durable outcomes and defend the spend third is medicare advantage which could be its whole own webinar in itself plans are managing so many things while protecting quality benefits and member experience. And fourth is modernizing care operations, because coordination and better data without adding another layer of vendors, contracts, and handoffs. So when this operating model is already so stretched, the answer can't be just one more point solution. The question isn't whether we need more support, it's whether we can make the care more coordinated, outcomes more durable, and the total cost of care more manageable. We want to move over to a poll and bring our audience into this conversation and ask, what is the greatest barrier to a sustainable cardiometabolic total cost-of-care strategy in your organization? Thank you so much. Now, in order to view the poll, it will be appearing on right hand side of your screen just make sure you're not in full screen mode and again that question is what is the greatest barrier to a sustainable cardiometabolic total cost of care strategy in your organization and there are four choices is it lack of internal alignment on a path forward is it duplicative in house care management models or is it employer or market demands and external pressures or is balancing near-term roi with long-term clinical value so i'll take just a moment while you go ahead and select the best answer that represents your situation and then i will turn it back to melissa to continue thank you so much okay we can see those answers coming in i'm seeing balancing near-term roi with long-term clinical value as a high winner i'll give it another second I think that makes a lot of sense given the pressures everyone is under today. I honestly would have anticipated lack of internal alignment on a path forward to be the number one answer. What do you think, Tom? Are you aligned with these answers? I do. I think there is a misalignment in equating hard ROI generically with long-term clinical value, meaning on the surface, I think a lot of decision makers and either health plans or employers equate this hard value in a very broad population rather than focusing and say, hey, who are the 10% of the population or employees who drive 60% or 50% of the cost? And what can we do about that 10% in at least the next 12 months and 24 months? And understand the relative differences in ROI impact amongst members or employees with mild conditions versus moderate conditions versus severe conditions. And so likewise, I think a holistic solution or a platform like us, we need to articulate that value proposition relative to the segments or to the risk level of that population, rather than generically say, hey, we're going to give you one to one or two to one, or three to one in 12 months. We need to like drill down. And I think we have to help the industry understand these subtle differences. Yeah, very interesting. Anything pop out here for you, Sachin, related to? Yeah, unsurprisingly, Tom and I are in violent agreement about this. I think oftentimes there is a misapplication of models to a broad population that would be better deployed to a smaller group of people and better positioned to actually generate a true ROI. I would say that there is kind of a missing answer possibility, which is I would says many organizations don't even know what a cardiometabolic total cost of care strategy really is. I think that many organizations are in this kind of pre-contemplative stage around what that actually is. You know, I think they understand the words, but I don't know that there's enough experience with these types of models to really know what it would look like in the real world. And so I think there's a hesitance around introducing a new benefit that has a different model, a different approach to kind of traditional benefits. benefits. And so I think a lot of health benefits purchasers end up, you know, getting stuck on not necessarily knowing what it would actually look like to have a cardiometabolic total cost of care strategy. For all the conversation we've had over the last two decades about the rising cost of employer-sponsored health insurance, I would say we've been very slow to adopt innovations that actually drive total cost of care improvement. And again, I think what Tom said is really, really important, is that to manage population health, you actually really need to take a hyper-segmented approach to it and really thinly slice your population and get to a clear view of what are the real drivers of costs for different buckets of people, and then have highly targeted, highly impactful solutions for that sub-segment. And again, I think that that is a relatively new approach, if not in theory, definitely in practice. And I think most organizations don't have a lot of experience with thinly slicing populations in that way. I think they mostly think that they're going to buy benefits, people are going to use those benefits as they are needed. But I think the mindset is really shifting right now to how do we actually get upstream of the utilization and better manage chronic disease and reduce the overall need for high-acuity services long-term? That's a strategy that we've used for years in the Medicare space, but I think in the commercial space, it feels a little bit harder to execute on because there's less familiarity, less comfort on the health plan member side. Makes a lot of sense. Okay, so go ahead. Melissa, I would also add that, you know, and I sound like a broken record on this, but I would say the industry itself needs to really move the needle in value-based and outcomes payment models as opposed to a time-based fee-for-service model, especially, you know, in the health plan payer world where it's just not encouraging for care delivery models to be targeted on impacting outcomes. And I know, you knows, ScanHealth has been tremendously innovative in the value-based model paradigm. And I think we kind of, all of us as an industry, need to move closer to that sort of holy grail. But Tom, I'll just say, I think value- based care is a lot like cardiometabolic cost of care. It's one of those things that you kind of understand in theory, but it's hard to actually implement in practice and hard to really understand what it's going to look like in practice. And i think, you know, one of the kind of key issues is frankly a little bit of change aversion. And so I think people are afraid of introducing new paradigms because they're afraid of what's going to come on the other side of those paradigmas. But I think it's important for us to kind of recognize that you can't change without changing. And we all have to kindof take some risks. You know, we're at a point where health expenses are through the roof, and we need to start to try new approaches to try to bend the cost curve and bring down total cost of care for employers and for all payers. And so I think it's a time of where we should be experimenting more boldly and trying new approaches because, you know, what got us here is just going to take us to, you know, similar places going forward. We need to change the paradigm a bit. Yeah, absolutely. And I'll just say anecdotally, within a matter of 12 months, I've had two neighbors with major, major heart attacks who, one, had a strong family history and also abnormal dyslipidemias that could have been addressed but wasn't. and and and the other just did not go for any screening tests whatsoever and needed cpr and resuscitation i mean these unfortunate tragic events happened where we know in the industry right now and document well documented that 80 percent of the population with high cholesterol is going and walking around um uncontrolled and not being treated uh to the max and similarly uh blood pressures not being controlled so we know that but tom we should we should but tom we should reflect on why that happens i mean people have insurance but they don't have access and i think part of what needs to happen is we need to create new nodes of access um you know i know you live in connecticut i love and live in southern california i can tell you i have to to schedule my primary care visits six to nine months in advance. I don't know what the wait time is in Connecticut right now. I think part of what we need to do is create new, you know, clinical models wherein people can actually get care much, much more easily. And, you know, I think the traditional health care system is breaking at the seams. And I think employers need to acknowledge that reality and create differential access. I don't think, you know, these folks are not getting their lipids managed because they don't know that they need to be managed. It's because they just don't even have access to care and any kind of continuous relationship with the healthcare system. I think that's the root of so many people's problems. I totally agree with that. But at the same time, I think, you know—I think we ourselves need to hold everyone accountable, and that means like health plans putting and pushing the needle on value and and clinical outcome impact as opposed to asking for cpt coding yeah i think you're getting at these three topics that um we're teeing up for this conversation which is the economic reality the evolving operating model and partner not vendor and And, you know, the fact is we're there's a lot of work to do right in health care right now. But if we start with this economic reality. Tom, I understand you're a serious pickleball player. I think we all know that we know it's a really simple game until someone explains the kitchen to bounce rule and the scoring and health care is just like that. We have simple goals. We want to keep everyone well. We want to get people well, but the operating model is so complicated. What are the most important pressures shaping plan strategy today? There's this whole strategy paradigm that you're all trying to manage, but we all know it's pretty complicated. What are those pressures? Look, I live in the Medicare Advantage world. The pressure comes from all sides right now. In my world, the pressure is coming from declining government reimbursement, changing coding paradigms, a changing star rating system. I think it's also coming from the provider community that increasingly wants to move away from serving Medicare Advantage patients and would be much happier to just serve commercial patients. So I think that there is a I think there the pressure comes from all sides. I think the reality is, is that the way you create ROI in health care has to change. And I think Tom alluded to it. I think it historically was like we just provide more services and that that has resulted in massive health care inflation in this country. But I would say value-based care, I mean, Tom, I'm going to push back a little bit because I think you've overplayed the value-base care hand in this. It's kind of been a failed experiment the last 15 years, because I mean many organizations kind of pursued it through the lens of just contracting and or coding, but didn't do the hard work to actually improve health outcomes. outcomes, the stuff we're talking about is actually really hard because it requires that you change the clinical model, you changethe clinical paradigm, that you stop thinking about care just in terms of primary care visits and specialty visits and hospital admissions, and you start thinking about being continuously connected to patients and really managing health outcomes. And I think that's, I would say, Omada and companies like Omada have kind of taken a of step in that direction. But even you all are kind of early in this journey. But I think the idea of kind of continuously engaging with members to improve outcomes, continuously engaging with people, patients to improve outcome is something people talk. People like you, Tom, no offense, talk about a lot, but actually we don't do a lot of. It's very easy to talk about it. It is very easy be like, oh, we need to pay for outcomes. At the end of the day, the real issue is that there's a little bit of a lack of courage in the system to actually make the change and to create the change people just want to do business as usual and that's why even though we know we've been in a healthcare affordability crisis for 30 plus years you know um onwards things look more more similar to what they did you know then then than different um maybe we have high deductible health plans which is a problem in itself i i think the issue we have to really confront is we have to build new clinical models that actually get upstream of total health, total cost of care, and reduce overutilization in acute settings or avoidable utilization in acute settings. What do you have to say for that, Tom? I totally agree with you. Look, you're preaching to the choir here we we we are the in-between visit company and uh what we've done this year is is uh added another stack of tools which is prescribing medications where we can impact um you know the journey almost i would say let's just if you had to put a number we would say, like, we're impacting almost 80% of the continuum of care. So we're hoping to actually move the needle on impact and outcomes. So I totally agree with you. I'm having an issue with wrapping my head around, like how do we continue with what you've said, but not change the reimbursement paradigm. But that's not really, I mean, that is the economic reality and that the industry is not going to change overnight on that piece. So I don't know exactly what the solution is, but I totally agree with you. Like, you know, when you and I practice as an internist, we sell diabetics four times a year, 15 minutes a visit. And the delusion that we have that we are going to change someone's hba1c from 9.0 to more like 6.5 um we're we're crazy to think that that we're going to impact that that type 2 diabetic or type 1 diabetic with just four 15 minute visits we can't that's it's impossible it's kind of like trying to you know change a wayward employee with like three feedback conversations. It doesn't really work, right? So I think the reality is we need to take a much more realistic view of healthcare behavioral change and provide a more intensive approach for the patients that need it. But the truth is that what we need is mass customization in healthcare. We need like lots of little micro models and microsystems for different segments of patients. And the truth is, is that the large healthcare systems largely treat all patients the same because we have this egalitarian ideal that's actually quite misplaced, as opposed to saying different patients will need different things and they may need different benefits. And we need to create a menu of benefit options that actually serves a variety of patients differently. I'm in the business right now of actually procuring health benefits for our employees at SCAN. We're a Medicare plan, so we have to work with commercial insurers. And I can tell you, like, it's way easier for us to just think about people as like, think about our employee base as 3,000 employees, as opposed to thinking about it as, you know, like maybe 100 or 200 different healthcare journeys that we can map to those 3,000 employees. But that's what we have to do to actually effectively move costs and move care. But I think all too often we just hit the easy button. We're just like, oh, let's just get the lowest cost benefits that check most of the boxes that we need. And I think what we have to be doing is be much more innovative in our approaches and much more thoughtful about a sub-segmented approach. I think that's the message for today is like really thinking in terms of sub-segments, and then, you know, working with a variety of solutions providers that actually attack those sub- segments, but doing so in a, not a check-the-box way, but in a way where we're using the best clinical evidence to actually, you Know, implement evidence-based solutions to serve the variety of different populations that are in any employee population. Do you think part of the issue is the thinking of the clinical model as being separate from the benefits model so that evolutionarily before virtual care became a thing, all of care was managed under the care arm at a health plan and things like virtual products were managed under the benefits arm or a different area in the organization. Do you think that plays in at all? Tom, do you want to? Why don't you go first? Yeah, I mean, look, I think it's that, but I also think, you know, what's really needed is a much more clinical design-oriented approach to benefits as opposed to a, like, as an approach where, you know, and again, I think we're guilty of this, too, as we're procuring health benefits for our employees. You know, you have a few months to do this. You're working with a benefits consultant who you think knows the market way better than you do. And so you're kind of taking the guidance that you're given and you're just kind of trying to move things through. But I think you have to start asking really interesting questions of your employee base. Like, number one, like, do we have a geographic density that we could use to create differential relationship with provider groups? So, or to provide a different kind of on-site or near-site, you know, clinical experience for folks. I think you then have to also look at the underlying epidemiology of disease in your population. And I don't think health benefits consultants are used to providing that. That should be the first page of every slide deck when you actually look at, you know, proposal around health benefits, like what percentage of your members have diabetes? Which percentage of Your members have cardiometabolic disease? which percentage of your members have cancer. And then you can use those data to then drive some decisions around what kinds of solutions that you're going to build. The truth is that we live in an era of a lot of snake oil. I hate to say it. Lots of digital health companies, lots of employer health companies are selling like nonsense to companies like mine in order to check boxes as opposed to actually change care. And we platform these companies. We platform these countries at conferences. We give them a lot of airtime, but they don't actually change anything. It's moving the deck chairs around the Titanic. So I think it's a lot of the work of health benefits purchasers is to make sure that we're actually buying the things that make a difference as opposedto just like checking a box and making ourselves think we're making a difference. And I think that we have to hold ourselves accountable to go back to the embedded critics comment. We've enabled a lot of kind of a really broken healthcare ecosystem. We've created this ecosystem. We have allowed a thousand weeds to bloom as opposed to a thousand flowers to bloom. And we have let those weeds grow out of control. And, I think, that that's a huge problem in our industry. AndI think we need to be much more selective purchasers. and you know the journey begins when we purchase something not not it doesn't end when we purchase something and i think we have to hold our vendors accountable hold our solutions providers way more accountable um and really take a hard look at whether there's true outcomes improvement otherwise we're just we'rejust padding you know company bottom lines and and you know making venture investors happy but not moving anything and i i you know and i think unfortunately we've gone through a pretty dark snake oily period within you know u.s health care and i think it's up to all of us to get out of that i i think melissa the only thing i would add to that um would be um before companies hit many big icebergs um that they they really do in addition to the segmentation piece is to really take a hard look at the bundled nature of how diseases present themselves right and so are you going to have five point solutions are you to have one or two sort of multi-condition solutions who can comprehensively provide support for for all of um the disease conditions that make up you know what what we perceive and what we know is the number one killer in the country which is that you know cardiovascular conditions are still the number one cause of mortality um and so i i think that would be one strong recommendation out of all of this is is in addition to segmentation is looking at looking at multi-condition um capabilities yeah that makes a lot of sense and that probably is a good segue to going into that operating model decision. You know, obviously when, what, the question for you, Tom, here is what do plans get wrong when they build these capabilities themselves? You know obviously there's care management programs, there's different ways of addressing the same kinds of diseases that we're talking about that plans have invested a lot of money into building out. Should they be building these should they be choosing separate single condition vendors should they be thinking more holistically like you just said about multiple conditions at once um i i would i probably have three caveats and one is um choose a partner not a vendor um i think my uh collaborations in the last 30 years the best partnerships are really collaborating on that customization piece and really thinking about you know what what are the problems that the partner is trying to solve and we work at it together who is the really the comprehensive nature and having a true understanding and not just you know checking the box on on really like hey let's have an msk solution in one bucket let's have a mental health solution in the second bucket let'S have a cholesterol solution in the third bucket um but let's let's think about what the greatest challenges are for your population whether that's members or employees um and then the third piece is really thinking ahead you know what what is the partner wanted to two years three years four years five years down the line how can we grow together and and creating that n equals one type of personalization as opposed to like really just selling something off the shelf yeah yeah yes i mean the other thing i'll just say is like i think we have to get a little bit out you know i know that the number one barrier that people articulated was the um the in-year roi issue which is certainly like a real issue um but there's also kind of like the right and wrong issue, which is like, you know, no, no employer should ever be comfortable with the fact, you Know, that you have, you have any number of members or patients or employees who have a one C's that are, you over 10. And yet, we kind of let that go on. And I so I think we have to kind of bring more of a moral voice to our benefits and clinical care decisions. Um, and that's a voice that I think has been beat out of these kinds of conversations for like multiple, for the last few decades, we've gotten lost with, you know, kind of charge rhetoric, like no margin, no mission, or, you Know, you, you get overly focused on affordability, um, to the exclusion of like what I call radical common sense and, you know, radical common Sense is that like, we don't want sick employees, sick employees take more sick days. Sick employees have more downstream costs. But we've kind of been penny wise and pound foolish in lots of ways. And I think employers have, you know, a lot of times just kind of gotten into the rinse and repeat cycle as opposed to like really thinking hard about like what a population has and what it actually needs. And so and then actually taking on some moral stances around like just right and wrong. And and I think that there's like a lot of value in, you know, kind of reinjecting language of ethics and right and wrong into our conversations like this. I know lots of corporate environments don't allow it, but when it comes to issues like employee health that affect all of us, I think there's opportunity to kind of bring more of a right versus wrong view of things. And, you Know, right is we want a healthy employee population period full stop yeah i love that i love that okay um how about if we move into the partner not vendor discussion um tom i'm curious here when omada partners with a plan what's actually different day to day compared with vendor relationships how do you think about that I think it starts with pre-contracting alignment on what is the overarching mission goal of the collaboration. It's certainly not purely a financial one, and I hope there would be a combination of what I see as sort of like the triple aims of health care, which is, yes, there's cost savings and cost efficiency, but two is also the quality of care. and you know that there's an alignment on what defines quality and it's not purely a dollar sign but there are standardized outcomes that we should all align on and also looking and making sure that the partner has the right accreditations you know are they ncqa credentialed are they credentialed by standard um quality standard setting bodies like cdc for a diabetes prevention program um and then lastly is this focus on patient experience or employee experience or member experience but it's really that sort of that um truly uh subjective piece um maybe it's the uh customer satisfaction score um or maybe it's testimonials but it's it's really you know that that that sort of um piece of it that's talking about no friction and just making that experience as optimal as possible and as delightful as possible to to make sure that healthcare is engaging for the member yeah sachem what do you think when when these solution companies and you mentioned those that are snake oil when when they're walking into scan pitching to you all what are some questions that your team i think that i mean i just want to pause and say i think most of the snake oil companies don't even know that they're snake oil companies because i think people because i think people uncritically accept the claims that their companies make um and just kind of go out and sell and do the work and aren't really, and I'll say, you know, I've been involved in companies like that, either as an advisor, a board member, as a customer, because you just kind of, most of us want to believe. But I think the stakes are too important for us to just take on faith or believe. And there's oftentimes like the I know a guy mindset. I mean, that's how most of healthcare is done. They're like, I know, a guy or a gal like I know Tom. So sure, if Tom's selling me something, I'll buy it because I know Tom. Sadly, that's how most healthcare purchasing decision decisions are made, is that there's a lot of just relationships. And it's not necessarily like the hard evidence-based view of like what's actually making a difference or not. And so, you know, again, I think the work that we need to do more of is build more rigorous process around evaluating effect size. And look, there's a normal pattern that exists in this whole vendor space, which is like year one, do a pilot, year two, argue about the results, year three, terminate the pilot and move on to the next vendor. I mean, you guys are laughing and smiling because you've seen that so many times over the course of your careers. We have to get out of that, right? And I also think we have to get into the mindset, to your point about partnership, If you approach it with the right humility and say, look, we may not get it right out the gate, but we're going to iterate over time to make sure we get it right, that we're gonna pick the right population, we're to take an initial guess, the initial guess may be wrong, but let's keep working at it, you know, over the long haul, then I think we're getting be successful. But I think where it falls apart is where we approach these things like vendor relationships where there isn't the co-creation, the co development, and the drive towards outcomes together. And, and again, I think if it's a, if it'S an arm's length relationship where we're not invested in each other's success, then, you know, at the end of the year or two, we say, oh, it hasn't really been as successful as we wanted it to be or thought it would be. And then we, we all go in our own direction. That's, that's a problem. That'S a problem, so I, I do believe that how we partner and how we vendor is completely broken in U.S. healthcare. It's completely broken. There's too much I know a guy or I know gal behavior. There's too much pilot mania. I mean, like, please, let's eliminate the word pilot from our vocabulary. Let's actually pick an outcome we want to drive towards and actually commit and work together to actually create results together. And also wrecking accomplish in two or three. And so I think we have to kind of get the time horizon right. And there's nothing magical about 365 days. So, like, let's stop fetishizing that and let's get to a place where we start thinking about long-term impact, long- term investment, co-creation, iteration, and actually driving towards results together. I love that. I love it. I'm going to stop here. I have one more question before going to some of audience questions and there's quite a few popped in here so um anyone out there that's holding back please go ahead and drop them in um i'll i'll post this and whichever one jumps in if a plan could make one change in the next 12 months to reduce this fragmentation what should it be Tom, at least you're smiling. I'm going to go to you. You know, I think, I've been in healthcare for 30 years and I've never seen, never seen the American people suffering um as they are now in this day and age um on one is the access problem that Sachin was talking about we are so so understaffed in terms of PCPs you know folks are waiting six months for an appointment or in New York City, you can't find a PCP that accepts health insurance. But I think that's one is really working on the access issue. And two is, I think the average American has affordability issues. Not even the average, I think all Americans have affordability issues. I don't have an answer on the second one. You know, on the first one, I think we at Omada is trying to help alleviate that access point. On the second, well, I, I think on the second one, we are also trying to help with that with a with a more affordable solution on that and options. But it's going to take, you know, more than just one player and it's gonna take a village to work on these two, two issues. And I sound again, I said, it sounds very cliche. But I do think we are, you now really, really at the height of these two problems, access and affordability. Yeah, let me rephrase this one just a little bit. You know, thinking about how plans could prioritize with this operational modernization that they need, there's just so many places to focus. And, you know, there is front office, middle office, back office. There is AI coming into the picture that can help them get there faster. Do you have thoughts on sort of that low-hanging fruit and how this type of conversation can build in, whether it's build, buy, partner, vendor, trying to figure out how to help get there? So I think it's simpler goals. Look, I think if you're a big, and I think picking some bold goals, but also some simple goals. If you're a big, if you're a big employer, you know, with a lot of employees, you know you could pick a clinical outcome and say there's going to be a single person in our employee population who has lipids that are out of range or an A1C that's, you know, over eight. You know, if you're smaller employee population, you know, something that we're actively focused on for our 470,000 members at SCAN is making sure that every member has a primary care visit scheduled at all times. It's a very basic thing, but in our business, we know that that will improve star ratings. We know it'll improve risk adjustment. We want every member to know when their next primary care appointment is. Most employers are not engaged at that level with their employees. So I would say, and most health plans aren't thinking that simply about the outcomes that they're driving. And I think we've kind of been overrun by the quality improvement industrial complex and the quality measurement industrial complex in U.S. healthcare. And I blame Tom for that. Tom is on the board of NCQA. He also was part of setting quality measures during the Affordable Care Act, and I think you overdid it, Tom. I think you're continuing to overdo it. And I think we have to simplify things, and we haveto encourage health care purchasers to simplify things to two or three things that they can change in any given year, as opposed to a basket of 700 measures that are completely meaningless. I'm sorry, but I thinkyou got this completely wrong. So I think that's part of the work here. I'll let you respond there, Tom, I'll hand you I'm not going to respond and dignify that comment. That's because there's no dignity in your position, Tom. Anyway. Okay. I'm going to go to some of our audience questions. I'm gonna start with this one. We serve different populations across multiple lines of business. how much should we expect a partner to adapt and where does customization start to create too much complexity who would like to take that pickleball um i'm happy to take it i i think that there's the problem that happens in the vendor space particularly across lines of business is that everyone is in sales mode so everyone's trying to oversell capabilities that may or may not exist. And so I think the temptation is to try to simplify your procurement exercise to the exclusion of really looking at whether capabilities are going to be effective across all lines of business. And I think, you know, this is going to be an unpopular answer, but like the work is managing the complexity. So I don't, I think and I think oftentimes we take shortcuts to our own detriment. So I think a lot of the work is trying to navigate and drive the customization. And I think that the work sometimes is going to be to customize, not to try to peanut butter the same thing across all people. So that's my perspective about it. Tom, any thoughts? Well, I think it goes back to some of the points that I've made that part of that due diligence is really examining and scrutinizing the claims that one would make. I think, yes, if there's a capacity to do customization, but does that customization produce reproducible outcomes and results that are validated by scientific rigor invalid validated by external third-party standard-setting agencies so again it's it's not the trust me because i'm tom your friend but it's trust the data and trust the science and trust, the rigor that we present. Yeah. Yeah. I'm going to add my two cents into that one. And that is, you know, I think there's different places to focus on customization and some are easy and some hard. And I think the easy way to customize is perhaps outreach campaigns or other ways of going after different populations as opposed to the back end like core of the program the care delivery of the program which is a lot harder to customize um and i think there's quite a few solutions out there that can deliver the core across multiple lines of business and multiple conditions without having to customize each interaction um one other question uh please speak about point solution aggregators your perspective is appreciated the good and the bad when i hear point solution aggregators i'm not going to name names but it's more of the sort of front end um technology solutions that can bring multiple point solutions on a front door platform that i know a lot of health plans are looking at to kind of reduce their own you know technology front load thoughts on those i i would say it's it's sort of like a shortcut to a process that requires execution executional excellence meaning how would the solution be embedded into your current workflow schema and how do we also do the post-implementation analytics to give you the insights and to prove out the outcomes that we're committing to, right? And I don't see short-cutting that process of the hard work of implementation execution excellence when you have an aggregator do this or working with potentially 25 point solutions any thoughts on that suchin yeah i'm i'm i don't engage as much with these point solution aggregators so i i'll defer the question okay Okay. Yeah, I will. I'll jump in there too and agree with you, Tom. And I do think there is certainly value to that digital front door. And plans are constantly looking for the best front door to put forced in their members. and i think something that you both said earlier is there's not always going to be one answer because members are going to need what members are gonna need and the care delivery system needs multiple solutions to um to some really hard problems there's areas of you know uh care deserts and they may need more virtual solutions than downtown new york city so um yeah Yeah. Okay. I am at the end of the questions. We have six minutes left, and I think we shall give everyone a little bit of time back. And I want to thank you all, audience. Thank you for all the wonderful questions. I want thank you, Sachin and Tom. To recap, fewer point solutions, more coordinated care, more durable outcomes, and more manageable total cost of care. We will be sending out a follow-up to all of the audience participants. We're including a recent study that OMADA has run, and we look forward to any follow-ups conversations you'd like to have with any of us. Thank you so much. Thank you, Melissa, and a heartfelt thanks to Sachin Jain. Thank you. It was great to join you both. Thank you for that great presentation and for sharing your thoughts. And thank you to the audience for participating in today's webinar. This concludes today's presentation and thank you again. Enjoy the rest of your day. Thank you!