Changing the Posture of Medicine Through Whole Health

Healthcare Rethink - Episode 70

The latest segment of the “Rethink Healthcare” podcast by Finthrive explored the insights and experiences of Dr. Christopher King. Host Brian Urban delved into the work and career of Dr. King, Dean at Georgetown University with a conversation on the challenges and opportunities of integrating social determinants of health into healthcare education and practice.

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Dr. Christopher:

Thanks a lot, Brian. It's a pleasure to be with you this morning.

Brian Urban:

It's so much fun because we've attempted our recording several times, but now we finally landed a good place and it's actually working and we're here in our virtual studio, so I love your patience for that as well. I was actually thinking about how to introduce you. I wanted to say Dr. King. You're not the Dr. King, you are a Dr. King, but obviously influenced by a lot of the great leaders that have come before you. I'm just so excited to talk about who you are and before we get into your work at Georgetown University and a lot of things that you've been published with just recently as well, I want to get to know Dr. King before the PhD. I know that you are a Maryland by background as well. You did a lot of academic adventures there, but let's go back even before that time. How did you find yourself becoming a dean and why did you want to get into this space pursuing social justice and structural racism, and how did your studies start to evolve maybe from your younger years? Take us through it. Dr. King.

Dr. Christopher:

Wow. I'll tell you. Well, first of all, again, it's a pleasure to be with you and I always loved the opportunity to talk about my journey, hoping that it will inspire some person in some way, shape or form. I had always been interested in health. I remember as a child just learning about the human body and what does it take [inaudible 00:02:09], and I remember loved ones dying prematurely. People in my community dying from conditions that could have been prevented, right? And so I decided to pursue a degree in community health in undergraduate school at East Carolina University, and that helped me understand the importance of community and the role that community plays in shaping health and health outcomes and moved up to teach in Prince, George's County Maryland. I was a high school health educator at Parkdale High School. That was a great moment for me to see how kids' health is shaped by their home environments.

Had an opportunity to work for Prince George's Hospital Center, which was a safety net hospital right outside the district of Columbia, and that was truly an eye-opener for me. That was when I realized the importance of safety net hospitals and the expertise that exists in those hospitals. It typically goes under recognized, and I'm happy to talk a little bit about that as well. And then I worked for an FQHC, a federally qualified health center in southern Maryland called Greater Bay Medical Services. That is when I started understanding social determinants of health and why excellent clinical care to the most vulnerable individuals in the state of Maryland, but we weren't seeing significant improvements in their health outcomes. We were providing evidence-based clinical care, but we weren't seeing significant improvements, and it was because of the community in which people were living in did not have the infrastructure for healthy living.

So that was great. Then I had an opportunity to work for MedStar Washington Hospital Center, and I realized I had, even when I worked for the FQHC, I did a lot of grant writing and I was pretty successful in really helping donors see the importance of their contribution to making sure that all people have access to high quality care regardless of income, race, gender, and so forth. So I would write compelling arguments and proposals that would motivate donors and was so successful in that work that I ended up at the hospital center as the director of community, was it the Corporate and Foundation relations. That was my title. And then in 2010, we know what happened in 2010, the Affordable Care Act, legislation passed and hospitals across the country were thinking about how do we do these community health needs assessments because now hospitals have to do a community health needs assessment once every three years, not for-profit hospitals, but we didn't have folks with a public health or a community health background and executive leadership as part of the C-suite, right?

We didn't see a lot of that. And so that was my opportunity to introduce a large healthcare system, the largest healthcare system in the mid-Atlantic to social determinants of health and think about the Affordable Care Act and what does population health management look like and how do we do better in engaging communities and co-creating interventions and measuring impact over time? So that was wonderful work. I did that for about six years, and then in 2015, Brian, that was when I said, "Okay, it's time for me to do something different," because I was ready to go deeper. I was ready to go beyond health disparities. I was ready to talk about the root causes of disparities, particularly around black and brown people and black and brown communities. And at that time, the industry was not ready for that conversation, the industry in general. Folks were not ready, and I needed to be liberated and I needed to be in some type of environment where I could be intellectually free to explore these issues. And the Georgetown opportunity came and I became an assistant professor and did some great work I'm very proud of over the years. And the university decided to launch a school a couple of years ago, brand new school, School of Health, which I am so honored to serve as the inaugural D.

Brian Urban:

Very humble with what you took us through as a journey there because there's a lot of great accolades in between and a lot of impact that you've had on young lives, educating in your research and now back in a leadership education position as well. And it's so funny that you said a couple of the comments. I'll take us back to the Affordable Care Act, a milestone in the healthcare ecosystem in the United States, and then going forward, we've had some milestones as well, the push to get back from volume to value payment reimbursement methodologies, which is still an ongoing challenge in the US getting to more pay for performance oriented models for healthcare providers and working with health plans. But then the other comment that you made was so interesting. There aren't a lot of leaders, even today there are, it's becoming more common, that have some sort of public health background at an executive level, at the C-suite level.

There are chief public health officers I've seen, a lot of chief health equity officers now by a mandate in California for a lot of health plans to have in their organization. But it doesn't seem like maybe it's being adopted in the most authentic way. And from the academic standpoint and the minds that you're shaping now, is that one of the biggest challenges you see is those that are putting their whole lives into a health discipline that might be going up against a brick wall when they look at industry and how industry is adopting everything from public health to diversity, equity, inclusion, and belonging. It seems we're maybe at the next peak evolution for things to be authentically adopted and really see the value that it can have inside industry and for private organizations as well. Are you seeing that as the biggest challenge, as a motivator for the lives that you're shaping right now? The young minds?

Dr. Christopher:

I tell you, it was a challenge when I entered this space in 2010 because hospital leaders just did not have that orientation. They had been in an environment that was focused on sick care, keeping, how you treat the sick. And I remember one of my colleagues said to me when I was talking about social determinants and the environment, "Oh, that's not our responsibility. We're a hospital. We're a healthcare system. We're here to treat the sick and make sure that when we discharge a patient, that patient is in a better condition then he or she was when they entered our institute, our hospital," and I was blown away by that because I was thinking about the future and where we're going around value-based care. We're going around, the new incentives around keeping people out of the hospital. What a different skill set, right? Totally different skill set.

We need people who have training and know how to do that. That's what we're doing at the School of Health. We hope to lead the change that needs to happen. We hope to reconceptualize patient's healthcare experiences because our system is so medically postured, right? It's very medically postured. We don't have systems, generally speaking, systems that have the capacity to meet patients biopsychosocial needs. That is an opportunity for us, and that is what we think about each and every day at the School of Health. How do we reconceptualize patients' healthcare delivery, healthcare experiences so that they have much more meaningful engagements with their providers? How do we create systems where providers have the time to really get to know and connect with patient populations because we know that's key. I do community health needs assessments, and I'm always listening to the community and what people say about their healthcare experiences. Many say they feel like they're a number being pushed through. Their provider spent seven, 10 minutes with them, they didn't get to know them. Those types of conditions help us and our efforts to have more meaningful interactions with patients. And when it comes to building trust, patients need time with their providers and providers need to work in a system that supports that. So yeah, I can go on and on Brian, with it.

Brian Urban:

I want you to, and that's actually where I was going to go, is take us through the curriculum, through the Model of Learning and Impact, and I do want to get back to your federally qualified health center days. I do want to touch upon a really cool piece that you did in Health Affairs that looked at the historical policy related impacts to black residents in and around the Washington DC era. That was a really cool graphic that I had seen in there. There's so many things I want to talk to you about, but let's get into the curriculum and the model that you're deploying right now and what you think that's going to lead toward in terms of impact for the students that you have coming through your program. So let's get into the depth there a little bit more.

Dr. Christopher:

So our school, we currently have three departments, a Department of Global Health, Department of Health Management and Policy, and the Department of Human Science, and we have a master's degree in health systems administration. Our school will grow. We're just two years old but we have about 425 students.

We have core competencies around health equity with a focus on history, and we want to be sure that our students, as they go through their experience at Georgetown, understand the history of the country or the world, when we think about vulnerability and vulnerable populations and how conditions impact their health, and how they access healthcare services, that has been void of curriculum for so long. Well, it hasn't been a part of how we teach. We believe that it's important for our students to know the history of policies and practices that help us explain disparities that we see today. Our students need to understand the root causes of disparities, and that begs us to think about inequities and how inequities show up in the environment in which we live, learn, eat, and play. So when we do that, I think what we're doing is we're first, helping our future health professionals be more compassionate and understanding around why a patient is noncompliant. By the way we teach, our students, "Don't use that language." We don't refer to patients as non-compliant. We're better than that. There's a reason-

Brian Urban:

Too, Dr. King, is the term that just bothers me so much is at-risk populations or high-need populations. These are humans we're talking about. I can't stand when we say at-risk in that kind of context, but I didn't want to get off track. But yes, I'm glad that the words you're using are critically important to your curriculum.

Dr. Christopher:

And that's part of what we're doing. We're critically auditing language and the language that we've used and how that language perpetuates what we're trying to address, right? Minorities is another term that we're ridding ourselves of. Because of the message that it sends, right? You're a minority, you're less than. So it's really critically looking at how we teach case studies to be sure that we're careful with how we're using race and how we're operationalizing race because we know that race is a social construct. And so we didn't see the devastating outcomes around black and brown people dying from COVID because solely of a biological racial category. It was because of the environment in which those populations live, learn, or eat and played, right? And so we're looking at where we have caused harm and how we talk about race and predisposition to disease. We're challenging our students to call us out, our faculty out when that happens. And that's for, not just at the School of Health, but in our School of Nursing as well as our School of Medicine. Like all of the health professions at Georgetown are going through this critical audit because our system is again, biomedically postured, and it is a white male normative evolution, the way our system has been designed. So we need to just step back and look at everything and do better and make sure that we think about intersectionality, that's important.

How does that show up in how we interact with patients and do we respect that? So it's a lot of work that we have to do. I'm not saying we've cracked the code, but I'm really proud of the work that we're doing and the accomplishments that we've made.

Brian Urban:

And only in a few short years there's such a long shot view to the impact and to the work that you have at Georgetown University and the School of Health. The other thing I was thinking about too is we've come to this very big awakening of all these buzz terms and how they're adopted from a marketing sense and from a leadership talk track sense is not always boiled down to how things are integrated into a workflow or into services that are being deployed at a hospital or tech company or health plans, et cetera. The one thing that is constantly in our face coming into '24 is whole person care and what you were talking about earlier where it is a biomedical posture, that it is clinical, sick care oriented, we treat you in acute or urgent hospitalization, that kind of point of service. But looking outside of the four walls of a physician's purview is really where you can start to address a whole person.

So I am curious with your work back in federally qualified health centers and looking at now everyone's saying, "Whole person, whole person," and really not living up to it yet. Bits and pieces here, some programs here and there, but not a standard cut of how do we integrate into a workflow? What's kind of your perspective that your time in federally qualified health centers, which you're probably doing whole person care just off the cuff to now, everyone's screaming, "We need Whole Person Care," but not really putting anything in place. What's your take on having been there and looking at what the industry is saying now?

Dr. Christopher:

Well, I'll tell you, I remember, because I worked for the FQHC before the Affordable Care Act legislation passed, and I would be in the rooms with members of the C-suite, helping them think about population health and how do we do value-based care and all that. And I would consistently say, "Get to know your local FQHC." That's what I said one time at the ACHC, the American College of Healthcare Executives. I remember standing up and telling these hospital CEOs, "Partner with your local FQHC, they have been doing this work for a long time. It's part of their DNA. We can learn from FQHCs because they have to do this by mandate." And so it's fascinating, Brian, to see the healthcare delivery system evolve to that biopsychosocial lens. I do think that AI is going to also help us get there, but caution with AI, and I'm excited about AI. Really every day I try and find time to take about 30 minutes to learn something new about AI because I'm thinking about how do we integrate AI and pedagogy and how can we use AI to address many of the root causes of inequities that we see within the walls of healthcare and within communities?

But as we think about AI, and this is one area that we're going to be training our students in, is how do you vet these algorithms with an equity lens? Because a lot these algorithms are pulling data from systems that have been biased, inherently biased. We need to be careful. We need to be careful with how we are using these algorithms. And so as Georgetown, I'm thinking about, because we're always thinking about the common good and justice and just being sure that the populations are not left behind. As these machine learning and all these wonderful digital technologies are becoming more and more normalized, we need to make sure that we don't leave population behind and we need to prioritize. I believe that if we can prioritize and focus on the most vulnerable populations or the communities that have the most need, if we can go to where the harm is, where the pain is, where the hurt is, where the disparities are the worst, and we fix those systems, then everybody else will improve. So I'm always telling my students, "Go to where the pain is. Go to where we see the worst disparities. Let's fix that, and then we will learn from that and then we'll just trickle out and everyone will benefit when it's all said and done."

Brian Urban:

That is a very thoughtful approach, but also strategic in the same way. Not just heart led, but also how you can make the right impact and replicate it. It's interesting, Dr. King, hearing the things that you say, it's obviously beyond your years. It really is. Now I know your age just because you had a birthday recently, and it's just amazing to hear you say these things as a very wise person. So we talked to a lot of MDs on the show, Dr. Gordon Chen, Omar Latif. The list can go on and on across the country, and they're standing up kind of a different philosophy in their approach, and they're more of the creative risk-takers. You align to that type of thinking, but outside of the medical world to influence that. And I'm curious, knowing some of these leaders out there and you know a lot of them from the conferences you speak at and some of the publications that you're involved with as well, but seeing some of these elite leaders that are a notch above others, and they're not just saying it, but they're actually putting things into motion.

Are you thinking that the next generation of impact makers from your cohort is looking to those people as, "Hey, I want to go into impact healthcare in this way," because I'm looking at these leaders talking about these things. Or do they want to go in and say, "I want to recreate and rebuild an entire system and structure in a community hospital that's rural based," or is it all over the map? I'm curious if your students have a particular aim based on an influence outside or they're all just their own kind of entrepreneurial leaders themselves. I'm curious of the cohort.

Dr. Christopher:

It runs the gamut. We have students that want to go into traditional systems and make change happen. We have some who are more radical and just want to blow it up and start all over again, and someone will start their own healthcare startups. Some go into consulting because that's in [inaudible 00:23:04]. Many of our students, particularly those in our human science degree, go into med school.

Brian Urban:

So there's the good impact. I guess you're already lined up with health sciences, so you're directly impacting the medical school.

Dr. Christopher:

Exactly. But what we focus on in our program, because the world is constantly changing, we teach our students that we recognize that, and what I teach you today may be obsolete tomorrow. We recognize that. What's stable though? The ability to critically think, to look at everything as a system, knowing that things are connected. We teach them the importance of interdisciplinary practice. We can't advance health by just talking to other people who are in the health profession. We have to think about all different disciplines and sectors and the role that they play. These are concepts that are immutable, right? They're immutable. And while the world is changing, the ability to critically think, to bring all types of folks together, to make sure that we're creating services that meet the needs of all people, that never changes. The importance of being humble and being open and learning from our patients and learning from the community. That never changes. The importance of co-creating interventions that are sustainable, that never changes. So there's core competencies that will remain the same regardless of how crazy our world gets or how much technology actually gives us opportunity to situations and ways that are making a big difference in people's lives. It's just important that we focus on the human side and what's necessary for us to thrive as individuals.

They're all over the place, our students, and we're so proud of the work that they do.

Brian Urban:

I was glad you took us there because I think it's so interesting. All these different master's programs and hybrid PhD programs always tout the next type of thing they're focused on and what they're delivering as a part of the model that you're learning. But the things that are of core competencies that are stable will always be there. I'm glad that you mentioned that because that's never really talked about across a lot of other higher education institutions. So that was very refreshing to hear, Dr. King. I want to change directions for a second here. Race Place and Structural Racism. This was a piece that you'd worked on, put into Health Affairs now three years ago or so, about '21 I think. And the graphic that I have up aside here on my screen, I love this. It is a tremendous amount of detail that takes a reader through a almost, it's kind of like an anthropological view almost of impacts from society to policy to a particular population that are black residents of Washington, DC.

And you took us through taxation without representation, American slavery, and then segregation, and you have it slowing down in the mid-seventies, really continued and spurred off in different ways all the way to current time. But now in 2020, is kind of where you left off when this was published, and that took us up to a lot of different impacts from healthcare to local sense, hospitals closing. And that's still a continuing theme throughout the U.S, a lot of community-based hospitals closing, and it's the affordability side. I think there's a lot on the payer side that's not being addressed, and there's a lot from the government side that needs to be stepped in as well. But with this beautiful graphic, what stands out to you as a milestone that you would point out to someone who just doesn't have this purview that needs to understand it, and that can take away insights to make an impact in their own corner of the healthcare ecosystem?

Dr. Christopher:

So we went back, like you said, to 1790, right? The beginning of the District of Columbia and identify that these milestones that help us to understand why we see the data that we see today in 2024, right? Those of us who do disparities and equity research in D.C, we're always talking about these disparities. We're always talking about communities in the District of Columbia that have the most need, but we didn't have a publication that helped us understand, and that's what we did. And we also assert in that publication that we think it's an exercise that every community needs to do.

96% of D.C residents have health insurance. DC has been recognized as the most fit city by the American Fitness Index for a few years. But when you stratify data by race and ethnicity it's a very, very different story to be told. And when you look at how segregated we are as a city on a map, it's very clear. And so the redlining hit hard, not just in D.C, but all over the country. You can go just out into any city or small town. And when you cross Main Street, there's a different side, north than south. It's pretty consistent across the country. So it helps us understand, and this is what we want our students to learn as they go through their health professions education degree programs because they will become much more compassionate, understanding individuals, and they'll use their lives to stimulate policy and practices that can help undo that damage, right?

Atonement is what I call it. What does atonement look like? With the health line question I think you were asking me about a particular area. It's all of it. I mean all of those, if you look at the actual graphic from hospitals closing to taxation without representation to St. Elizabeth's Psychiatric Institution, which when it was built, it was the nation's premier psychiatric institution and out of that came a lot of research that supported the concept of eugenics, right? And biological fallacies in black and brown people. And that work actually, it impacted psychology and the field throughout the world and country. So it was harmful. And so we wonder, why is it that black and brown people do not access or are less likely than their white counterparts to access mental health services? And there's a lot of different reasons for that, but that is certainly one of them.

The distrust, the distrust of the system because of the history. So just helping our students understand that I think is what's been missing. And I think just teaching the truth about American history in plain language. We can not use any of the buzzwords that have been used to weaponize and make this a political issue. In plain language, just talk about policies and practices that have hurt people in communities. And after you think about that and have that conversation, what can we do different? How do we fix that? What does atonement look like for the sake of health for all of us? Because if we continue to go down this trajectory that we're in, we're a little over $4 trillion a year we're spending on medical care and our life expectancy is among the lowest when we're compared to other industrial. That's a problem. That's a scary problem. And how can you be a global leader when you have a sick citizenry? How can you be a global leader? So we really need to think about what we're doing and also recognizing that we're becoming much more racially and ethnically diverse. That is something that we really need to get on top of this and we have to do better.

Brian Urban:

Yeah, you're so right, especially with your last comment. There's such a cry for clinical excellence and innovation that we have in the U.S, but we're so backwards. The outcomes don't fit with everything that we have available to us, the United States in terms of life expectancy, quality of life as well. And you look at other countries as well, and in particular a lot of Asian countries, a lot of also Scandinavian countries as well in terms of life expectancy. There's just humongous gaps. And then you drill down to the community level like you're talking about, and you see the direct impacts of activities that happened in the early 30s, late 20s red lining, and how that's now even trickled out into rural geographies as well when you think about fracking as well. And that's a completely different issue, but there's just so many challenges that have always been there.

And I just love the graphic representation, Dr. King, and it also makes me think about socio-economic data, credit bureau data, a lot of the stuff that I study in and outside of FinThrive, a lot of that data, it's raw and it's put into scores. And those scores, they are inherently not only racist, but they take the whole cut of a lower socio-economic group and make it damn near impossible for them to improve something like a credit score when there's thousands of different algorithms that companies could buy for loans and scores and things like that. We're measuring people in the wrong way, and I think all these big organizations that have the responsibility to judge and collect data should have the responsibility to help people as well. So all of that is what I was feeling and thinking looking at your piece recently that was in Health Affairs a few years ago. In fact, we'll put that publication in the link here on the podcast so folks can actually look at what we're talking about too as they listen.

Dr. Christopher:

Again, we did that because it was important for us in the District of Columbia, but we provide a template for other communities to do the same type of work. So now med students read that piece. Health students in all of our health professions, they're reading that piece and going back into the classroom and having a conversation around, "Okay, so what does this mean for us and how we move about the world, how we advocate because we have to be advocates in our community, how we advocate for patients in a different kind of way? How do we challenge our organizations to do better and think more holistically around whole person care? And how do we make sure that we have an experience that respects intersectionality, that respects their lived experiences? And how do we make sure that when patients come into our organizations, they are truly heard and appreciated for their diversity and the beauty that comes with that and the lessons that we can learn simply because of their diversity? So that's what we want.

Brian Urban:

Well, the template that you're building through your experiences and into a curriculum and into the love and curiosity that you share with your students, obviously it comes off the microphone a thousand percent from you today, and I'm so excited to see what the cohort that you have now and in the future starts to make an impact in the real world. So let's take a look ahead a little bit here, Dr. King. So there's been so many different great things that have happened in the last couple of years from a policy perspective too. So section 1115 waivers that are of SDOH program, investment nature from federal government. It's been a great highlight. The White House came out with a health equity framework as well. And then you also think about the Medicare Advantage supplement space. Now including transportation, food, affordability type services being rolled into what a health plan and employer can contribute cost toward.

It seems like everyone is starting to adopt these new policies. Things are changing. We have some really interesting things, but we still have a ton of gaps. And when you think about the unrolling of the public health emergency, a lot of Medicaid enrollees fell off their eligibility and possibly re-enrolling because of administrative errors. They didn't have the right phone numbers from a health plan perspective. Little obvious things. It's we're there, but we're not there yet. NCQA is doing great work with their social needs screening and then referral connection sometime in '25. With all these fun things happening, what do you see coming in the next two plus years that's really going to move the needle for improving health equity across the country, really addressing a lot of the inequities that we've had historically at the community level all the way up to the national level? What is anything exciting you or anything that you see is going to happen to move the needle coming up?

Dr. Christopher:

Well, I'll tell you, I'm really pleased with the playbook that was released on social determinants of health by the White House. That made those of us who've been doing this work for so long so happy to see that this conversation is now occurring at the White House and there's a playbook around that. So I think that is going to incentivize all different actors in the healthcare ecosystem in ways that haven't before. I'm excited about technology and the role that technology can play. Again, we have to just approach how we do this with caution and be sure that we're not doing more harm and that we are using technology and deploying technological resources in ways that reach populations that have been under-heard, unheard, under-recognized, underappreciated. That, and that's what I'm committed to making sure our students are thinking about as they go through their health profession, through their programs.

So yeah, so the technology, that's helpful. There are things that also concern me about the future. Climate change, what's happening with social media and folks being isolated and not having meaningful connections with people. Well-being is a core area of our work at the School of Health. So our mission is to advance health and wellbeing. So how do we make sure that we're addressing wellbeing? And we have scholars that are doing interesting work. We believe that, what if there was a paradigm shift and we focus on wellbeing? Might we see differences in health outcomes if we just focus on we take time, think about wellbeing, what it means, joyful and life, right? Gratitude and how might that impact people's behavior in ways, have favorable outcomes? So I think that's an opportunity for us, I think as a result of COVID and when we have pandemics, as devastating as they can be, on the other side of that is innovation. There's innovation on the other side of that, and that's what we're seeing.

So think about with the virtual medical visits now, that's probably normalized. Mental health and acknowledging our mental health is becoming much more talked about and socialized in different spaces across the world. It's being amplified in ways that it's never been amplified before. So I'm excited about that. That is a big part of what we're doing at the School of Health, again, to advance physical health or just health and wellbeing. And if you come to our space, you'll see that we have created an environment that does foster physically, like the environment at the School of Health really does foster wellbeing and seeing you as an individual and respecting you for your own lived experience and being thankful for being in a space where we can learn from you and see you. So I think that's an opportunity. I'm really excited about that. And again, I think AI, and there's technology that can help us in that space as well around wellbeing.

Brian Urban:

Well, I will say among anything, if there are going to be more deans of health or deans of public health sciences like yourself, that's also going to be one of the biggest impacts over the next five plus years as well. And I hope that continues to happen across higher education. You are leading an amazing group of young leaders that are going to emerge into the industry and make a good impact for the world and our society here in the US. So I'm just so excited to see the rest of your journey on Full Dr. King. I'm sure I'll run into you literally at another conference here or there. And I'm so excited that you could join our show for a little bit here today. I definitely feel a follow-up coming on. So thank you so much. Dr. Christopher King, Dean of the School of Health at Georgetown University.

Dr. Christopher:

Thank you so much. Thank you. Pleasure to talk.

Brian Urban:

And for more exciting excerpts and insights, please visit us at finthrive.com.

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