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      Transforming Coverage to Meet Healthcare Needs with SCAN Health Plan

      Healthcare Rethink - Episode 18

      John Petito, SVP of Transformation at SCAN Health Plan, joins the podcast to share his story and how his work is helping enable new types of healthcare coverage for diverse populations. Join us to hear how health plans are beginning to evolve their approach to addressing the needs of older adults and the LGBTQ+ community with personalized healthcare coverage.

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      Healthcare Rethink: Hear From Leading Changemakers

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      Brian Urban: [00:00:30]
      Yes, this is the Healthcare Rethink Podcast. I'm your host, Brian Urban, and today we're talking Medicare Advantage. So we brought in one of the head honchos from the SCAN Group and Health Plan, the corporate Vice President of Transformation, John Petito. Now, if you don't know about SCAN Health Plan, they are big and growing in a dynamic way. They're a not-for-profit Medicare Advantage plan, but they offer more than just coverage. They're based out of Long Beach, California, and have been growing since the 1970s and they've grown, actually, in through California, Arizona, and now Nevada. So without further ado, John, welcome to the show.

      John Petito:
      Brian, thanks for having me.

      Brian Urban: [00:01:30]
      This is going to be fun, man. We've gotten to know each other a little bit before we've come to this recording here, but we always want to get our guest familiar with our audience and vice versa, so before we get into who SCAN is and some of the great projects you're doing, I want to understand a little bit about your path to being the corporate Vice President of Transformation at SCAN Group and Health Plan. So take me a little bit through your background, where you've come from, what you've done, and how you've come to be a leader here at SCAN.

      John Petito: [00:02:00]
      Yeah, sure. Happy to. I think my background is maybe a little bit atraditional. I spent a good part of my early career as a consultant to a lot of large healthcare organizations, most of the clients on the health plan side so have seen a lot of change, a lot of activity for the last 17 or so years. I've worked with a number of the blues, some of the nationals. Most recently was working with Oliver Wyman with a Blue Plan and I think it was maybe six or so months, maybe three to six months into his tenure, our CEO, Dr. Sachin Jain started to put out, he's very active on social media, started to put out some sort of view around what the strategy was for the organization. One video, then another video, and became very clear there was a lot of speed, a lot of purpose and focus with which he was, effectively, driving the organization in a very different direction than, I think, historically, it had been focused. Taking the organization from a regional focused MAPD organization to something much larger and that really was exciting and was inspiring.

       I think one of the challenges that most healthcare organizations and anyone certainly trying to sell into the healthcare industry is that they moved rather slow. There's some degree of bureaucracy and what I saw at SCAN was none of that, it was moving fast, was moving quick with a lot of deliberation. Years ago, I had connected with Sachin and actually applied for a job at the previous organization he was running, CareMore, and much to my chagrin at the time, he did not hire me, he hired a peer at my firm. And so I licked my wounds and went back to consulting. And during my last sort of stint when he and I reconnected, it was a bit of serendipity. He asked what I was doing and I said, "I like what you're doing." And think it was maybe within a matter of weeks I had made the decision to join SCAN. I came in as his chief of staff. I've worn a number of different hats between when I started in 2020 and today and my focus today is really on transformation.

       So really, how do we help ensure that the dollars we spend enable our strategy and really our best spent towards improving the care for our members, both the ones we have today in our current markets, but also those that we want to serve going forward as we continue to grow.

      Brian Urban: [00:04:30]
       I love that little story and I know you're just full of little stories that we're going to get more into. What a nice, really almost like a meet cute, if you will, into leadership. So that's so great. And Sachin, great shout out to him as well, what an influential leader. Not just thought leader, he's a doer. That guy does things. So I think he shared a lot of that in terms of investing into health equity and how are you really helping your members progress in health and addressing barriers they have in their lives so I love that background. And that brings us to today. So you were hinting at SCAN's growth, obviously. I want to talk a little bit about your strategy. So you're really growing in a purposeful way to do more to serve older adults. So we talked about Medicare Advantage Plans being one of the biggest solutions and products you offer in the space, but I wanted to talk a little bit about your mission focus that's also helping really go in concert with your growth and offering MA plans in other states.

       So one thing comes to mind, is your Healthcare In Action team. What a beautiful design team to help the homeless populations in LA County and probably even broader as well. I want to get a little bit more information for our viewers on this. Can you tell us what the Healthcare In Action team is?

      John Petito: [00:06:00]
      Yeah, absolutely. And to set context for why Healthcare In Action before what Healthcare In Action. You know, you had alluded to it. SCAN has been around for over 45 years. We were founded by a diverse group of seniors, older adults that effectively looked around and said aging in America's hard and there's got to be a better way and created this mission to keep seniors healthy and independent. And I think that mission stays true today, as far as guiding everything that we do. And one of the things that became very apparent is, as an MAPD plan, as a Medicare Advantage Health Plan, there is only so much you can do to keep seniors healthy and independent. The types of issues that they face go far beyond medical care. And when we, as a team, and I think one of the, probably, the greatest things about being at this organization is that when we step back and say, "What do we want to do?" The question is not, "Well, how big are we? How much profit? How much membership?" The question is, which societal issues do we want to tackle? And there are big ones.

      And so, that sort of sets the context that when we looked around we said people experiencing homelessness, that is a major impediment, that is a huge barrier. We also saw that there was frankly a gap. There are a lot of things that SCAN has historically done through our independence at home organization with rental assistance, housing placement, et cetera, but actually taking care of those folks who are on the street and actually needing care. And so that started down the path of building this healthcare delivery organization, Healthcare In Action. The CEO is this incredible doctor, Dr. Michael Hockman. That's effectively going out into the streets, into the hard places where people are living and taking care of them. It's addressing all of the needs that they have, identifying other concerns. And one of the goals of it is not just to provide medical care to them where they are and help with behavioral health issues, et cetera, but also to place them into housing. And that's actually one of the metrics that we use for measuring success is how many of the folks that we've interacted with and touched have been able to place.

      And so, I think it's just one example of how we've looked at the market, we've looked at our customers and the demographics and some of the challenges they face and said, "What are things we can do because there are gaps in serving them against our mission of keeping them healthy and independent." And Healthcare In Action is just one example of us sort of closing that gap and investing in something that can meaningfully improve the experience and lives of our customers.

      Brian Urban:
      Yeah.

      John Petito: [00:09:00]
      Well maybe, Brian, I'll just keep going to say Healthcare In Action is just one example. It's us looking at the issue of the homelessness crisis in America and looking at it through the lens of healthcare. But that's just one. We've actually launched four different medical groups over the same period of time. Healthcare In Action is focused specifically on the issue and helping to resolve and address the homeless challenge.

      Brian Urban: [00:09:30]
      And that's a great walkthrough and thank you for setting the context for our audience as well because it speaks to purpose-based growth. It's not just how many members can you get into your health plan that helps revenue overall, year to year, and you just keep growing until you get so big that you're just a big box store and that's not your approach. It's, how are you actually seeding positive change in the communities and the lives that you serve? So that is extremely helpful and it speaks a lot to the new delivery organizations that you're building. And another one I wanted to get into was Welcome Health. So this, again, is focused on older adults and addressing the needs that they have in a home setting. So John, this is a really exciting venture for you all and how you're deploying, not only, coverage, but also health services along with that. And this has such a big economic impact in a good way. So can you tell us a little bit more about Welcome Health?

      John Petito: [00:10:30]
      Yeah. Welcome Health is a fantastic organization. This one has personal resonance for me, but is a medical group that's focused on providing home-based, geriatric focused and specialized primary care. The goal is to meet people where they are, whether they need to receive care in the home, whether they want to come in to a clinic to get care, whether they want to do telemedicine, it's about applying the philosophy of geriatrics to the healthcare that's provided. So specifically tailoring it to the unique needs of older adults and prioritizing the things that matter to them most. I think one of the things that is really critical to that organization, including... We've got a fantastic CEO, Emily Cook, is really taking advantage of that unique value proposition that, candidly, there is a significant shortage of in this country, of people that are trained specifically in the science of geriatric medicine, but then putting that on a platform like Welcome Health, where we can bring it into the home, we can do it telemedicine, we've got the in site clinics as well.

      My view is there's a very large gap in that primary care space, specifically for the population of older adults, and this is SCAN's response to it. And for me, in my own family, the personal resonance comes through. The amount of time it took for my family, I would say, well equipped to go and parse through and do research, no constraints, fortunately, from a financial perspective, to go find the right kind of care, it simply just did not exist. And my family's on the east coast in New Jersey, but it took between three to six months of work, calling around, trying to find a primary care practice that was focused on geriatric medicine, that could come and deliver care in the home, but would also enable telemedicine as well. It's interesting to think that we're focused on Los Angeles at the moment and our current markets, this is actually something that cuts far across geographic boundaries. Same thing as people experiencing homelessness.

      These are issues that we're trying to close gaps in the system, that if we can get the model, which I think we have, we should bring these things everywhere because these are problems that face America as a whole, not just Southern California, Arizona, Nevada, and Texas. And I think the other piece to this is actually having the right people that are focused on this. Dina Goldwater is only one of a handful of cardiologists in the country, double board certified in geriatrics and cardiology, and when you have people like that, that are applying that kind of focus specialization to deliver a model of care, I think you've got something really special. So I'm very excited about Welcome Health as well as Healthcare In Action.

      Brian Urban: 
      Wow, that's so amazing John. And I think it's interesting in where SCAN Group is going in designing new services, new types of plans for coverage that's unique to individuals of a unique population like LGBTQ plus population. Not only are they seniors in our society, but they have different needs and specializing a plan to those needs is really important. So how do you take this approach? Can you walk me through it a little bit more?

      John Petito: [00:14:30]
      Yeah, I think it starts with an acknowledgement that the needs of older adults, I'd say people in general, but older adults in particular, are different based on their needs, where they come from, the unique challenges and disparities that exist and designing services and benefits that address those specific needs, and the acknowledgement that healthcare isn't a one size fits all industry or service and it is very personal. And so, we looked around and realized that there was a significant gap in the way the healthcare, I will call it, industry was serving or healthcare community was serving LGBTQ plus individuals, and we said we should do something about this. So we built a product specifically based on their unique needs and considerations. The product Affirm is the first of its kind in the industry. In fact, we exceeded expectations. We did not know exactly what to expect as far as how members would respond and whether we'd have a lot of enrollees into it, but it kind of blew away our expectations.

      And in fact, we now are in a position where we see other organizations looking to effectively imitate what we've done. And so I'm really excited about that. I actually think some of the things we're doing, the previous comment I made around challenges and opportunities in healthcare cutting across geographic boundaries, I think part of the great thing about SCAN is that it actually is setting the bar that's pushing the industry to do better, and I think Affirm is one example of this where we launched a product that was effectively focused on helping that specific community, or set of individuals, get better access to healthcare in a way that was concordant with their needs and preferences. It's just a start. We'll look at other communities, other diverse populations and how we can serve them better, not just through medical groups or products, but the entire ecosystem combined. And so my hope is that we've sort of set out, effectively, a challenge of sorts to the industry to do better in this regard.

      Brian Urban: [00:16:30]
      Absolutely love that because it's going to influence innovation, others imitating this model. I guess, if you go back 10, maybe 20 years, would you ever have thought there was going to be a custom fit health plan designed for the LGBTQ plus community? And in my head, no, because traditional health plans, the larger national payers, not thought in that way. And a lot of things, I think, even through the pandemic, have highlighted a lot of needs that are specific for populations at the individual level and this is speaking to that. You all are paying attention and you're putting something out there and I'm just so excited to see that continue to grow, John.

      John Petito: [00:17:30]
      Yeah, Brian, I mean I think it starts with the facts. I mean, LGBTQ plus older adults, they're less likely than their heterosexual peers to reach out to providers, senior centers, meal programs, et cetera, because there's a fear of sexual orientation or gender-based discrimination and harassment and that's just the data. And so, it's looking at some of these gaps, these disparities, these challenges that, frankly, I think that the healthcare industry as a whole has a moral obligation to address and close. And I think if there is one silver lining of the COVID pandemic is that it exposed the real gaps that exist in how we serve Americans from a healthcare perspective. And so I think it, hopefully, shined a light on some of these issues. And my hope is that things like Affirm, products like Affirm, things that SCAN is doing to really challenge the status quo and create products and services that address the needs of different individuals, that it effectively pushes the industry to do better in this regard.

      Brian Urban: [00:18:30]
      So really, in thinking about changing industry and really motivating other health plans to innovate in the way you're doing by creating a very specific service and plan design for a unique population is the outcome here. I think that's amazing. That needs to happen. I hope you're influential in that way. And what's great is, you've kind of done an innovative approach to another service you've come out with called Venture and it's nothing new. I believe it's an HMO construct, but there are a few nuances to it. So wanted to hear from you, John, on the development of that health plan coverage type and what it's affording to its members.

      John Petito: [00:19:30]
      Yeah. Venture, I will say, it was not an industry first product. It is not the first of its kind. The unique characteristic of venture is the fact that it had a very significant Part B rebate attached to it. Part B rebate being the dollars given back to individuals that sign up for the plan via their social security. It was $125. It was, at the time, at least on par with what had previously been in the market. There are now higher rebates that exist in our Southern California market, which is a very competitive market for Medicare Advantage plans. What really stood out to us was just how far past our expectations this plan performed, to a certain extent, and how much people needed it or wanted it. And at the time, and still true today, inflation was at record highs, 40 year highs, people were under a lot of financial string, the Part B premium had actually been increased at that sort of exact same time.

      And so, there was an acknowledgement that as part of what SCAN can do with our mission to keep seniors healthy and independent, if financial constraint and challenges, which we know, from the data, is a significant concern for older adults, especially in a time when the cost of milk, the cost of gas is going up significantly faster than it has previously, that putting dollars back in their pockets is critical, is a really important way that we can help keep them independent, keep individuals healthy and independent. And so I think that's a large part of what drove the results. I think it was something like 50,000 additional members signed up over the course of one enrollment period, specifically because of that product. But I will say, like I mentioned at the onset, it was not the only one of its kind. What I think really resonated was the fact that those types of benefits coupled with the SCAN service model and...

      One of the critical pillars of SCAN strategy is having leading customer service and creating, effectively, a very high-end, I wouldn't use the word high-end, I'd say an exceptional service experience for our individuals trying to really help make healthcare easy and simple when we all know that it's anything but. So it's the combination of having leading benefits without having to give up or compromise the service experience that really resonated in the market.

      Brian Urban: [00:22:00]
       And thank you for separating it in terms of, "Hey, it's an HMO model, nothing's really different, but what is different is still trying to keep the affordability in place." And I also am just amazed at Medicare Advantage. The growth that it's seen, I think we're going on 8% year over year since 2010. Now in 2023, it's going to keep growing. Obviously for a huge part of the population aging into eligibility, but also the choice of having more valuable coverage on top of what you pay into and not just getting supplementary insurance like Medigap, things like that. But I think it's so interesting that you all are seeing this growth and I'm curious on your growth, and I want to talk about the states that you're expanding into as well, but did you see this type of growth coming from '22 to '23? I mean, you have your growth projections with your memberships, but did you know it was going to grow, I think the stat I saw was about 10% more. That's pretty amazing. And then I want to get into where you're expanding, but did you see that growth coming? I mean that's pretty amazing.

      John Petito: [00:23:30]
      Yeah, it was actually 60,000 members. I will say it was more than we had projected and I think had anyone told us that it would be 60,000, I think we would've probably looked at them funny. I think it was really kind of a pleasant surprise, in a lot of ways, just how much interest there was in that product and how well it was received. I think one of the things that has stood out to us and is important is the fact that as you're launching these different types of products and services, it is hard to forecast because when you're effectively at the cutting edge and you're doing things that other plans haven't, you don't have really good reference points and models to understand how they're going to resonate. And you can do the market research and the testing, and we do all of that, of course, but when the rubber hits the road and you're in market, you do your best to forecast but 60,000, we would not have predicted. It was a little bit higher than what we had thought, put it that way.

      Brian Urban: [00:24:30]

      Definitely a good problem to have in all regards. But I mean, it's just amazing that you kind of see that growth. Not many organizations across the industry see that type of growth, John. I want to get into a couple things here. I want to talk about where you're expanding, and I actually forgot you're going into Texas. You've pushed yourselves into a great place in Arizona and Nevada and then now Texas as well. So can you help me understand a little bit more about those populations? I mean, they're relative to California, but every population and every culture of health is different, so needs are different. Can you tell me a little bit about some of the new learnings that you've seen from expanding into these new markets?

      John Petito: [00:25:00]
      Yeah. I mean, you kind of hit it right there. I mean, every market is different, the needs are different. SCAN has started with the principle,[inaudible 00:25:02] it's our CEO, Dr. Jain said, "If you've got a good thing going, you should not keep it a secret, bring it to more people." Yeah, I think said differently is, why should geography define what kind of healthcare you have access to? And I think that's the underlying premise. If someone is born in Texas or Nevada or Arizona or New Jersey, they should have access to SCAN. And we believe SCAN is a wonderful healthcare organization that delivers incredible care to its members, and so we should bring that to as many places as we can. It's the right thing to do. With regards to Arizona, Nevada, and Texas, I think we've learned that every market is different. As we move outside of Southern California, obviously the partners that you have, so the medical groups, the healthcare system operates differently. And so, building the muscle in order to partner with those organizations as we grow is what we're focused on to sustain growth as we go forward.

      I think the other piece to it is, we've grown with our partners that we've worked with in the Southern California market to bring our model to more places. So Arizona, Nevada, and Texas is a starting point. I would sort of venture to say we will likely do more. It's just the starting point. So we're early in this journey, a couple years in, but as we learn and grow, we'll continue to do more, but hopefully we'll get sharper as we continue to do it.

      Brian Urban:
      There's so many complexities going into a different department of insurance in each state and going into different markets and how you talk about who you are and how do you understand these different communities and some communities. It's so commendable onto itself just going into new places to help serve more lives, so I love that, John. But as we all know, Medicare Advantage is not this beautiful, utopic place, it's a challenge. It has a lot of scrutiny on the model. A lot of regulatory changes have come into '23, especially on rate sheets as well, for those providing care to Medicare Lives. So it's on all sides of the ecosystem that there's a lot of eyeballing on Medicare Advantage and Medicare Reimbursement, so I wanted to get a little perspective from you on what you've been facing, some of the headwinds in the Medicare Advantage space today and how you're hoping to address some of those things through this year and beyond.

      John Petito: [00:28:00]
      Yeah. I think you hit on some of the big points. As I think about my perspective on what the headwinds are, the first that comes to mind is what I call or refer to as the spotlight effects. Medicare Advantage has proven to be incredibly popular. Now serving more than 30 million older adults, and for good reason. We provide comprehensive benefits, a lot of value add services that traditional Medicare doesn't, and these are real needs that support real people in real life. And so there's good reason that it's popular, but when you're 50% of the Medicare population and [inaudible 00:28:26] base, people look at the model more closely. I think there's been a lot of coverage, a lot of criticism, especially about certain practices like risk adjustment of Medicare Advantage plans and the industry as a whole.

       My perspective is, there are probably bad practices in a lot of industries, almost every industry. And I think the focus should be on correcting and innovating the model, but not inadvertently harming those organizations that are actually good actors and doing the right things. And that's my hope is that we can continue to refine Medicare Advantage as a model. Our CEO, Dr. Jain, has written quite a bit calling to action for the industry to help innovate the model, improve it, not abandon it, and move towards something else, which I think would be a shame for the older adults that are really benefiting from the program. Coupled with the scrutiny, this year in particular, there have been a lot of regulatory changes and further proposed changes from the Biden administration that are going to create some significant financial pressures for the industry, potentially. As a whole, I think we've been in a rising rate environment for quite some time. I think that has translated into very generous benefits.

      There's been a lot of outside investment from both large organizations, but also the private equity, venture capital entities looking to enter the space, seeing how attractive it is to members. And I think a lot of that has resulted in generous benefits, a lot of innovation, maybe some over-exuberance in certain areas. And I think the shift towards an environment where we're no longer seeing rising rates and financial pressure may force players like SCAN and others to look critically around what we're offering and what we can afford to offer. My hope is that we don't have to, as an industry, reduce benefits that are truly value add to members because I think there's a lot of things that we're offering that are critically needed, especially in the environment that we're in today where economic forces are shrinking the nest egg of older adults quite rapidly. Prices are still rising. So my hope is that we can change the model, we can last through the financial pressures and do so in a way that preserves the benefits that members have come to rely on.

      Brian Urban: [00:31:30]
      Well, that's a great member-centric approach that you're having with your population and I think it's true. What can you cut out and what can you change with your model that won't negatively impact the business, but it's going to have a positive result on the experience and services and value that a member would see?

      John Petito: [00:32:00]

       Yeah, that's absolutely right. The last thing that I think about, and I don't know if I would call it a headwind, so much as an inevitable fact, which is that healthcare, historically, at least as long as I've been in it, has always been behind almost every other industry when it comes to technology. In a world where you can take a photo of a check and deposit into your bank account, where you can split the tip and send money back and forth over your smartphone... To me, I look at healthcare and I look at some of the practices, I think we, oftentimes, compare ourselves to each other. So we look at Kaiser or United or Cigna or Humana and say, "Well, that's the bar." And I think the answer is not that that's the bar, the answer is that that is a bar, but we should be comparing ourselves, from a member perspective, to the other experiences they have, the other brands and their lives and experiences that they have in different industries. That should be our bar.

      And that's been part of the philosophy at SCAN for where we invest in order to create that better experience. And I think the challenge that comes from this, especially for an organization like SCAN, is, doing these things cost money. We need to invest in creating a better experience in the technology that supports that, and we need to do that in order to scale, in order to create the same SCAN experience that results in a 91 plus percent member satisfaction. We've had four and a half stars for six years in a row. Increasing the stars measures are focused on and weighting member experience and doing that requires us to invest in tools and capabilities that will scale as we get larger. I also think there's probably simple things we can do, though, that are complex. They don't require a lot of investment, they require thoughtful redesign of our processes and looking critically at what we do today, things like prior authorizations, which make it hard for people to access care.

      Are there other ways we can have the same comfort that we're not doing too much, we're not creating overburden, we're spending on things that people don't or really don't need to have without putting up the barriers to the members themselves. As an industry, we should look to other countries and where we can learn from them about ways we can improve our system here in the US.

      Brian Urban: 
      That's awesome, John. So let's transition into a little bit of the future. Let's get out our crystal ball here. What is going to be SCAN Group's biggest impact to the lives you serve looking over the next few years? Is it going to be on services or through new partnerships? What can you tell us that's going to happen in the future that's going to be a big deal in helping the lives you serve?

      John Petito: [00:35:00] 
      Where to begin? Well, I'll start with... I hope you saw that in December, we announced that we had filed to combine with Care Oregon and formed the Health-Right group. I'm incredibly excited about the prospects of two incredible mission-driven organizations coming together with very similar philosophies around how to solve big, thorny, societal issues and bringing different ways of doing that together so the experience and the scale of two organizations coming together, not-for-profit organizations coming to together to create an alternatives to the rest of the industry, I think, will create a lot of opportunity for us to address issues like homelessness, food insecurity, loneliness, financial insecurity. I think the scale of the organizations coming together, but also the experience of organizations, SCAN and Care Oregon, having tried different things in our respective geographies to solve problems that, I think, like I mentioned earlier, are not defined or constrained by geographical boundaries. They're not constrained by age or other perceived lines in the sand that we draw. 65 is a number that the government set around what it means to be Medicare eligible.

      Does that mean that you turn 65 and all of a sudden you are a different person and have a different set of issues? No. And today's issues, from a healthcare perspective, they're lifelong issues that are lifestyle related and start well before. And so I think having the two organizations come together in this manner is really going to help us to do more, to continue down the path of shining a light for what can be done, to improve the health of Americans, not just older adults, but of Americans in general. The other thing I'm really excited about, that SCAN has been doing, and I believe it was in the HBR, Harvard Business Review, there was an article about the work we did around medication adherence and closing the disparity in medication adherence. We're doubling down on health equity initiatives like that. We're, in fact, this year, starting a multi-year effort to eliminate disparities in care in three key areas among Hispanic and black members, so flu, A1C and statin adherence, and we're putting our money where our mouth is. We're actually tying bonuses to the results of this work. We're actually closing gaps.

      I'm incredibly excited about that and I think it really is a testament to the kind of opportunity and the diligent and focus that can result in potentially some really incredible outcomes. And I'll just add, I mean, the original goal was to close the gap by 25%, we actually closed it by 35%. So I think it just goes to show, when you put your money where your mouth is and you really put the challenge, it is possible to do these things. And I love that we're undertaking this work because I think it does sort of shine a light on what is possible, the art of the possible, when you really just set out to accomplish these things one at a time.

      Pick specific issues or areas where there is a challenge, a gap or something that needs to be fixed and put people to work on solving it and that's, I think, what we saw and that's why we're doubling down on it. And it was the whole entire organization that really sort of got behind driving that, and I think that's exactly what is going to help us to do more going forward, and that's why the Care Oregon deal with Health-Right Group is exciting as well. I mean, we'll have more people, a larger organization with more experience to do these kinds of bold initiatives.

      Brian Urban: [00:38:30]
      Those are bold initiatives and I can't wait to see the future impact that SCAN Group is going to have along the West Coast because now you've entered in a few other states that we've mentioned. It's just so amazing to have your leadership and, really, your doing capacity on our show, John. We don't like to just talk to thought leaders here, the doers that are actually out there pushing and creating change is what we love to hear, so that is absolutely something you embody and what SCAN Group is all about as well. So thank you for joining our little show, John. And for more exciting insights and excerpts, please visit us at finthrive.com.

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