Futurist Prediction for Healthcare…The Rise of the Bionic Doctor!

Brian Urban:

Yes, this is the Healthcare Rethink podcast. I'm your host, Brian Urban, and today, man, we have a good one. We're looking across healthcare and how we can improve it from a performance standpoint and then also from a futurist standpoint as well. And who else to direct us in this conversation. Then the SVP of Data and digital at Vizient, John Becker. John, thanks for joining our little show here today.

John Becker:

Well, thanks for having me. A great introduction. I like that.

Brian Urban:

You are a futurist in a lot of ways. I'm so happy to have you on the show. We've gotten to know each other a little bit beforehand and we'll get to know each other a lot more here. And for our audience, our listenership, love to have them understand who you are, a little bit more behind the big fancy title you have at Vizient and all of the years of expertise that you bring along with that. So, let's talk about that. Who is John Becker, the person. Bring us up to date of how you got into healthcare, digital and data in particular now and where it all started?

John Becker:

Yeah, it's interesting whenever you try to do timelines, if you go history to current, you look at it and say, how did that actually happen? But if you go backwards, it all makes sense. I'm going to go all the way back. I'm one of those, probably like many of us, who work in hospitals, healthcare system, healthcare consulting. I wanted to be a doctor at one point, coming out of undergrad. Did not have the optimal application strategy, it turned out. So, ended up taking a little bit of a detour and was in a PhD program for organic chemistry. There aren't many people who go into a PhD program for organic chemistry. After about two years, I figured out why. Left with a master's, went to business school and coming out of business school, knew I wanted to apply the background that was science and interest in medicine and clinical care along with business.

So, started my career in healthcare in pharmaceuticals at Merck and Company. After, I don't know, a little under a decade of that, wanted to get a new challenge and wanted to understand better the provider side and do strategy work. So, I joined a small company called Sg2. It does data analytics and consulting for hospitals and healthcare, mainly, a little bit of suppliers, pharma device med tech as well. Built up an account management team. A lot of my history has been in sales and service management, and intelligence or key trends, futurist views of healthcare. That was what Sg2 did. Two acquisitions later, and I'm now at Vizient and as of the beginning of this year, I have a responsibility for a new business area, part of the responsibility for a new business area of Vizient, called Data and Digital. So, we have put together all of the subscription products that do clinical benchmarking, that do operational benchmarking, and that also do market sizing, along with some other capabilities into what is a thriving business to help hospitals, healthcare systems and suppliers better understand current performance and improve performance. So, that's me in a nutshell right there.

Brian Urban:

And there's more to John Becker that we're going to get into in, especially-

John Becker:

Yeah, keep coming.

Brian Urban:

... Especially on the data side of your brain and your purview, and your role now too. But I love that because when I think a lot of our audience thinks about healthcare today and the challenges, we think about rural healthcare, fairly qualified health centers, having been hit as a large part of the recent cyber attack earlier this year. And then you think about consolidation, you think about integrated delivery networks. It's such a complicated landscape that you oversee and it's just crazy to think that you've led all these different teams and now your breadth is expanding even more so. And John, I want to get your take on something that I found quite interesting over the last few months, and I'm sure you've been out on the road the last few years as the pandemic has come to more of a close and we've had less incidents in terms of public health challenges. And we're in these conferences now.

I see so many different healthcare tech players, healthcare IT, and it's just this ocean of different vendors that are coming at healthcare systems. I would imagine for you, working with a lot of your customers in healthcare, it's probably quite confusing. It's probably complex and there's so many niche healthcare tech vendors now. It's like almost how do you sort through what a yes and no decision path could be, when looking at different partnerships? I would imagine a lot of your customers are just wildly overwhelmed with how many vendors are in the landscape now. I want to get your take on that and maybe what it's been for some of your conversations with your customers?

John Becker:

Yeah, so it's a really good question. When you think about proliferation of new digital plays, new entrants to the markets, disruptors, whatever you want to call them, is this good in terms of more solutions or is this increased complexity bad? A consultant answer would be yes. It's both, right? Because it is a little bit of both. It's interesting. Behind me, there's a picture, when we got locked down in the pandemic, the Vizient, the Sg2 strategy work of Vizient, we evangelize the system of the care continuum. It's really about knitting together. You mentioned IDNs, integrated delivery networks. It's knitting together the care sites from pre-acute to acute, to post-acute to help hospitals and healthcare systems deliver better care, right. Here's my worry, here's our worry. There's a lot of point solutions right now and point solutions are all about optimizing a subsystem. You've probably heard some of this work in lean process, optimizing a subsystem, sub-optimizes the overall system.

So, the worry is when you have really good point solutions for diabetes management or for now weight management, and they're not integrated into the workflow, that is the clinical care delivery of the hospital or the healthcare system, the physician group, you're solving part of the problem. You're not solving the bigger problem. So, these new solutions are great. New technologies are wonderful, new digital tools. We track them. We advocate careful and proper adoption of those technologies. The real key is to make sure that they are integrated into that system of care, so that the patient benefits and the community benefits. I'll add one other. I like the optimized subsystem versus sub-optimized, the system. The other is sometimes we have a solution in search of a problem. Hey, here's a new technology. The technology seems pretty cool at this healthcare system. I'm going to find a problem to apply it to. In reality, we should be having problems searching for solutions. And I think that's the other thing to think about and we need to flip it on its head a little bit to make a more strategic decision.

Brian Urban:

I love that, John. It's so fascinating that you shared those two pillars of advice and consultative guidance in terms of healthcare. We had, not too long ago, the chief medical officer of Tennessee Blue Cross Blue Shield. So from the health plan, part of our ecosystem, say something very similar to what you just said. There are a lot of point solutions out there that are just coming out of blue and trying to solve a problem that may or may not exist for some or all parts of the healthcare system. So, it's money getting thrown out there to see if it sticks, which is a very, I think, dangerous part of some of the VC mentalities that we have across the U.S. and getting into healthcare. And then optimizing the subsystem, I love that comment because we need to have more follow-through solutions and less point to your earlier point there. So, it's just fascinating that you're seeing this. Do you think you're going to continue to see even more vendors flood the space or do you think we'll see some get weeded out with, I guess, the ultimate failure cliff that is probably coming if they don't build their business?

John Becker:

Yeah, it may have already been here. I think you're seeing a little more sorting out of what the real solutions are versus those that might've been fly by night. You're going to start to see platform plays, where some of these roll up into a larger offering, that can be a more holistic solution for a provider. I think the important thing, whether it's PE, VC, novel, entrepreneurial digital or technology startups, what they're pointing at for hospitals and healthcare systems is friction in the system or gaps in the system. So, they really are offering solutions, which I think is important. The key is how we adopt those solutions into the system versus the individual part. And maybe as a healthcare system, which is our primary customer base, our members, realizing that those entrants are there for a reason. It's because we as patients or payers or other funders, are saying something's wrong about the value in care, the cost of care, the access, the connectivity, et cetera. So, view this if you're a hospital or a healthcare system, as a call to think carefully about are you meeting the needs in the market. Because if you aren't, someone else will. And some of these new entrants are doing that, probably in not the best way from a full care continuum standpoint.

Brian Urban:

I love this, John, because I usually wrap these conversations with strategic advice or thoughts to the industry, but you've already peppered in four or five things for our audience to be able to take back to their own organization or their own work to apply in immediate fashion. So, I love the way your brain works already, so let's-

John Becker:

Well, thank you. I like this. This is a fun podcast.

Brian Urban:

... Yeah. It already is a fun podcast and we're only halfway through, I think here. So John, let's get to the data side of your brain. So, another huge trend in the industry that does not have strong regulations but has strong frameworks from the federal government and also from not-profit industry like NCQA. So, it's adopting alternative data sets that aren't in clinical nature. So, those of socioeconomic, those of race, ethnicity, gender, language data. We have some regulation in the state of California and regarding health plans requiring to capture and maintain these data, but we don't have healthcare in terms of in industry, taking a big leap in adopting this and really having it into the system of putting it in front of a physician via EHR. That's not a survey or not captured at a point in time. I'm curious, are you seeing a big hunger at the healthcare part of our ecosystem wanting this non-clinical data or we're still starting to figure it out programmatically and vendors are helping? Where's the state of the state here from your perspective?

John Becker:

Yeah, I'm going to try to take two branches here, and if I only do one branch, bring me back to the other branch because sometimes I forget to do the second things. The first, if we just think about health equity, social determinants, there weren't many things that came out of the pandemic that were positive. I think one of the positive things was raising, elevating the importance of community needs and social determinants around disease progression to the C-suite. We work with CQOs, chief quality officers, chief clinical officers, chief executive officers, chief strategy officers, and Perry, and then post-pandemic. All of a sudden this became a really important strategic C-level consideration, which I think is really important, okay. So, the needs are there and those data sets don't require because they're often not about clinical care or delivery, they're about the environment and what is impacting wellness of the population of the people.

Actually Vizient, through the pandemic, developed something called the Vizient Vulnerability Index, it's hard to say, but that VBI, Vizient, Vulnerability Index, is all about identifying social needs and obstacles to care in neighborhoods that may influence a person's overall health. And this is data that's collected publicly but rolled together. It's available to everyone on the Vizient website. Nine domains. I don't want to go into the domains, but here are the data sets or data pieces, elements that are brought in. Air pollution, food deserts, provider shortages, school enrollment, gun violence, there's a number of different things. The point is there's an understanding that in delivering clinical care, often a lot of the things causing the clinical exacerbation don't involve clinical care. They involve something else. So, we as healthcare systems, how do we take a step back and understand those drivers so that we can begin to make the investments, especially as not-for-profits, you should be investing in the communities, how do we make investments to raise the tide, right?

So, that's one angle which is data outside of clinical pure data being ported into the electronic record or being considered in strategic or even clinical decision making is increasing around health equity. Another one, and this is maybe the opposite, but not, would be how do you use consumer behavior data? So, we are all consumers in healthcare. It's just that historically, we've spent other people's money, our employers or the governments, right? The funder. And because we weren't spending our own money, we were probably not shopping the way we should. Well, the rise of high deductible health plans, cost sharing has forced many of us to make different decisions and start to shop for care. Healthcare systems need to understand if we're shopping for care, they need to start meeting different needs. Not just engaging clinicians who are engaging patients, but engaging me directly. So, there's a big push to understand shopping behavior overall or consumer behavior and how it relates to clinical care. But those are ICD-9 and CPT codes. Yeah, those are different.

Brian Urban:

Yeah. I love that you went that direction, John, because a large part of all of those different domains that you were mentioning in your variance index there, is affecting how people trust, access healthcare, understand healthcare and their own health on a daily basis. But then the behavior part of it in terms of transaction, like consumer marketing data, that is highly influential in terms of a decision pathway for an individual to outreach care and what modality. So, these are worlds colliding now. It's no longer just healthcare individually, it's a healthcare ecosystem and digital is a huge push to that. I love that you went that direction. That's the brain, the side of your brain I want to tap into. That was perfect, John.

John Becker:

Maybe a quick comment, if you don't mind. Even social determinants, we're all in healthcare for different reasons, and I didn't touch on this in how I got into what I did. Because it was more of an academic answer, but we all want to do good work. You want to do work that's meaningful and hopefully you apply your skills. I've got analytical skills, I've got a science background. I went to business school, so I wanted to apply those skills where I knew I could be, hopefully, more likely to be successful. But at the end of the day, we all want to do work that matters that impacts people. And this is an area with social determinants, where whether you're a clinician or not a clinician, we can make a difference because it's not hard stuff, it's just stuff we didn't necessarily tie to healthcare delivery and there were no incentives to tie it to healthcare delivery.

Brian Urban:

Right, right. Yeah. And it's so funny, John, I think this is how we connect on a personal level. I've never been a good business person because I've always wanted to try and help someone first and then figure out how and if, and when we get paid for that. And I think now we've come to a point in time where if you don't have that front and center, you are not differentiated between any other of your competitors in the ecosystem. If you're not truly trying to make a helpful play that's a meaningful impact to a person, a household, a community, a population, then you're just the same thing as a lot of other companies. But you might just be a different price point. I love that you said that.

John Becker:

Yeah. I would agree with you and I'd push. I actually think doing the right thing is good business. I think we're increasingly seeing that. I mean, Vizient's a member-owned organization, so hospitals and healthcare systems, ultimately they make up our board. Our job is to do the right thing. But I think in any business really, especially long-term, you do the right thing, you get returns. And by the way, especially for hospitals and healthcare systems, whether they're for-profit or not, or clinicians, if they do the right thing over time, they're going to be more successful. It might not just show up in quarterly earnings, which many of us don't have to deal with. Yeah.

Brian Urban:

Yeah. And I think that's probably the most challenging thing for a lot of traditional CFOs or CIOs or CEOs, is it's not a quarter by quarter balance sheet investment that you can see for diving into how do we address social determinants of health. It's addressing the human condition, the underlying causes of why our society has so many big fissures. So, you're not going to see it as a turnkey ROI. It's a strategic investment, but there's ways to measure it. Yeah.

John Becker:

A quick story on that and I think it speaks to the generational investments that need to be made. This is 10 or 15 years ago, but it was one of the more impactful conversations I had with the CEO, a small community hospital CEO, who had been CEO for 20, 25 years up in the northeast. And he was talking about some of the investments they're making in grade schools. Putting nurses in grade schools and ensuring that food needs are met in the grade schools. And I said, why are you doing that, thinking financially? Why would you make that investment in a grade school? And his point was, a lot of the violence in the community, a lot of the ED visits and the homelessness can be taken all the way back to whether or not they stay in school. So, they were looking at this especially as a community hospital provider that's going to be there. It is the institution, and he is a full career CEO. He wanted his legacy to be making the investments necessary to improve the outcomes, and they did that by keeping kids in school. That's very different for a hospital or a healthcare system leadership team or CEO to be thinking, but that's the early intervention you need to make to move a vulnerability index.

Brian Urban:

Yeah. I love that story that you just shared. It gave me chills of excitement and enthusiasm because we need-

John Becker:

Doing the right thing. Yeah.

Brian Urban:

... Thinking that way now. And if you didn't say northeast, I would've guessed maybe it was someone near your hometown in the Chicago area. Dr. Omar Latif has been actually, in a lot of these shows.

John Becker:

Very similar.

Brian Urban:

I would've guessed maybe him, but you said northeast, so it's not him. But I love these stories that you're bringing to the forefront, John. But speaking of reports, aside from the index that you were referencing, which is a really cool tool that I'm going to look up once we disconnect off the podcast here, the 2024 trends report. You have an annual trends report. I looked through it. I thought there was some really great pillars of advice. The one thing I saw, which was really cool was the big bets in 24 and beyond, and I looked at the rethink primary care and I was like, okay, my eyes are immediately drawn there. And there's so many direct primary care models in the market today. Some have been acquired, some have said no to acquisition, but they're growing nonetheless, and they're growing in different ways. Value-based contract modeling, is the primary focus for a lot of them to take the risk and to be able to manage the care with the population as they're seeing, have great cultural competency. I'm curious, is this the continued play that we'll see in communities that's off of telehealth, that's not in a hospital or a micro hospital, it's direct primary care centers, and do you see continued acquisition consolidation of this? What's your take on these big bets in rethinking primary care going forward?

John Becker:

Yeah. There were some stats we put forward. We're forecasters and we looked at 2010, 2020 and then 2030. That the dominant model of primary care back in 2010 to the tune of about 90% was traditional fee for service, primary care and physician groups. Often not aligned to healthcare systems. In 2020, it's something like 70 to 80%, is still that traditional model of primary care. We see that by the time you hit 2030 as being the minority, it's probably more like 40%, with the dominant being things you just mentioned. It's tech enabled direct primary care for transactional easy access. It's often private equity-backed outside money coming in and doing novel models to manage a medicare advantage or a dual eligible patient. Sometimes it's the pay providers, the payers who have bought up and develop provider networks that are going to be managing risk directly in primary care.

What do they see? It's another opportunity or friction point. All right. So, the opportunity would be value-based care needs investment in primary care that is analytics enabled, in order to understand which patients will exacerbate more. We need to do more advanced resource intensive care models in order to keep the patient out of the hospital, out of higher cost care sites. And they believe there's arbitrage. They see money frankly in managing those value-based care contracts, better than either unaligned or aligned physician groups are doing right now with hospitals and healthcare systems. The other is just access, that you and I might just want to go in and get an annual physical or go and get something checked out. And it's not easy to get in to our physicians because they're backed up in large medical groups. And you can use some of these really tech-enabled, purely virtual direct primary care models to handle what we want handled.

So, it's friction points, again. It's either friction points from the payers not seeing the value-based care move they need or want. And you have outside interests saying, I think we can do this a little bit differently and IT and analytically enabled physician groups, to manage that risk in the right way or it's access challenges. And we can handle it that way. Look, you and I shop, right? We all shop. It's mainly convenience, time and cost. So, is it an access point I can get too easily? Virtual is really easy. Is it inexpensive or relatively inexpensive or at least not too expensive? And is it timely? Can I get it today or tomorrow? And I can't get that easily all the time with traditional primary care. Now, will it roll up? Yeah, I think you're going to see models that work and models that don't, but the knock on private equity would be that they have a return window and they're going to exit at some point or they're going to roll these up in a different way. 

I think for hospitals and healthcare systems, the opportunity is learn. See what we call disruptors, are doing and you can either emulate or you can partner. And often we're seeing large healthcare systems partner with some of these novel startups because they believe they can do it better and they're still going to be the hospital and the higher acuity care provider, and that's perfectly fine. You can work with them.

Brian Urban:

Yeah. I like that because it's a more thoughtful look at what's happening in the landscape, rather than quickly trying to dive in and make a comparable solution or service. You can wait and see who's doing well, who can you partner with, who can you take an idea from the model and do it in your own way for certain populations and certain geographies. So, there's the other side of the John Becker brain I want to get into, is the consultative expert side of what you've seen and what you've putting in front of your customers. So, it's interesting because Vizient focused on healthcare improvement performance across the U.S., you all have, I think it's over, it's like 97% of academic affiliated medical centers.

John Becker:

Yeah.

Brian Urban:

I believe its is a huge number and then a lot of other amazing healthcare entities across the ecosystem. And they're probably all seeing things in a different way and maybe not into any particular healthcare group, but I'm curious of now the point of need getting shifted or met with the point of care. Dr. Zev Neuwirth wrote a very large chapter in his new book, Beyond the Walls, on this. I think his research is matching a lot with what you're saying. And I'm curious of remote patient monitoring being a big part of aging, well aging in home. Are you seeing a big hunger from healthcare to invest there or are you seeing, from what you just noted before, let's learn first who's doing it well and who can we slowly integrate this new technology, and where should we put it too? Urban, rural, hinterland populations, age is a big thing with RPM. So, I want to get your take on remote patient monitoring as a new investment to the future?

John Becker:

Yeah. I think it's related in a way, and I'll pull another trend together with this, which is side of care shift. We believe, we forecast volumes 10 years out, year by year, disease and procedure accommodations. How healthcare is going to change and where patients are going to show up differently in the future. And not surprisingly, the higher growth care settings are the lower cost care settings. Shocking, right? But it makes perfect sense. That's the move toward at shopping. It also, how can you shift from a higher cost care setting to a lower cost care setting, is generally technology that's enabling this, right? It's a new device that allows a procedure to go from inpatient to outpatient or in this case rather than coming into the office to get checked, can you actually use a technology that will remotely monitor in order to provide the feedback to the clinician? So diabetes, COPD, congestive heart failure, you've got the big disease states, hypertension, where this makes perfect sense. What's the play here strategically? Well, yes, geographically you can enter new markets and you can provide care in a distributed fashion. Makes perfect sense. You also, it's a throughput or a panel size as well. If I don't have to have you come back every time to do these things, I'm freeing up office slots.

Brian Urban:

Huge capacity change. Yeah.

John Becker:

So, I'm able to keep you in the community in a lower cost care site and collect the data I need. So, bullish obviously on this, the issue is your first or second question all the way back. There are a lot of different technologies. So, what do you do? So, we increasingly see hospitals and healthcare systems that they have their preferred, it's almost a formulary of remote patient monitoring devices and they're approved or not approved, and they connect to their patient portal or their EMR or they don't as well. So, you've got almost a formulary or prescriptions that can help out there. I just think this is a solution for a reality of, we're not going to have enough primary care physicians delivering care the way we do today, in order to care for the aging population that will be increasingly comorbid, right? With chronic disease states. You need technologies to help scale remote patient monitoring does that, and through AI, you can have algorithms that nicely say, when I am out of compliance, I'm out of bounds. Something is trending in the wrong way to bring me in to prevent something from happening, that would've happened had you not been monitoring me. Right?

Brian Urban:

Yeah.

John Becker:

So, cool technologies. The key is, again, integration into the system of care and ensuring that these solutions are connected to the data stream.

Brian Urban:

Yes. How is it integrated not on the sub system there and just doing work underneath the foundation. Yeah, it's great. I love the forecasting power of Vizient too because I think it's strong advice for leaders now, that are going to be making investment decisions that are going to continue to impact their workforce, how they get paid, how they treat people, how they're seen in the marketplace as a trusted brand to go for healthcare needs, especially of high need populations that are of economic vulnerability. So, it's just such an intelligent offering that Vizient has and clearly we see here from our conversation state why you're one of the leaders at Vizient because you have all of this quite quickly downloaded in your brain, and I'm just excited for the work that you're going to continue to build out in this newer team and the purview that you have, John. So, in thinking about that, let's go out five plus years from now. I'm curious of some trends, if you could give us some forecasting teases here and where we could find more information as well for our audience.

John Becker:

Yeah.

Brian Urban:

What do you see sticking in healthcare from some of the emerging things we're talking about? Data trends, SDUH, device startups, what do you see sticking that's maybe your top three things that will be around five plus years from now in healthcare?

John Becker:

Yeah. So, I said we forecasts, year by year for 10 years. So, now I better come up with something for five years.

Brian Urban:

Yeah, I guess you can dial it down a bit.

John Becker:

That's only half the forecast. Yeah. So, one, the side of care shift continues, right? A hospital matters, let's be clear. It's not that the hospital is going to be empty, but the right patients in the hospital are the most acute complex patients who need high-end work done. That can fill hospitals, many, most hospitals. The key is not having patients in the hospital who don't need to be and can you shift them to lower cost care sites. So virtual, let's just go the lowest cost care site, home, virtual or I could do that at work. Virtual care for established patients is going to be a standard. So, behavioral health is a really good example. Maybe some of those service lines like cardiovascular where you have to do testing and imaging, are a little bit different. Probably a little bit lower percentage, but we are bullish on virtual visits, provided much like our RPM, remote patient monitoring, that reimbursement continues. Okay.

So that outpatient shift continues. Clinicians are going to be more, I'm going to say data, IT, maybe generative AI enabled. If we want them to take on larger patient panels, in order to solve the scale of healthcare, you're going to need the right tools in order to do that. And to have to respond to emails when generative AI could draft those for you, to have to do back office work as a healthcare system when a technology can do it, that's the real play for generative AI and machine learning, is to do the work on the backend that allows the clinicians and others to be top of license, right? Create bionic doctors. That's the other cool thing I heard. It's not that technology is going to replace, it's not going to be a robotic doctor, but we can make doctors robotic, oh sorry, bionic, which really means just enabling them with technology. I'm old enough to remember the bionic man. He was not a robot.

Brian Urban:

Yes. No he wasn't.

John Becker:

A bionic woman. She was not a robot. They were enabled by technology, right? And the third one I'd put out there, and maybe a little more radical, maybe not everyone would agree with me, but look, we have to solve for the cost of healthcare. And a very good way to solve for the cost of healthcare is to put more onus on the provider with the outcome and the cost. That is value-based care. So, increasingly, funders, employers, the government or payers are going to ensure that reimbursement is not per click. That reimbursement is going to be tied to managing a disease state, managing a care path, managing the dollars. And I think for others who might be listening to this, which would be suppliers, so pharma device medtech, that the pay it forward happens too, which is the healthcare system is going to look and say, if you want me to use your higher cost pharmaceutical, your higher cost device, prove that it's going to help me lower the cost long term.

And if you can do that, you're going to be a partner for me. I'd say the same thing is true with digital care. So, I think you're going to see more risk sharing between the entities, as we have better data to manage the outcome that is viewed as the gold standard or the neutral third party. The data that can show that this is working from a value arrangement. So, those are three, maybe not too radical, things that I would say to watch out for.

Brian Urban:

I love that, John. That is a very clear indication, from a conversation we had upfront, about where Vizient is forecasting a lot of things, and what you see in your particular purview as well. So, I love that. How can we have bionic physicians? We're not going to be seeing reimbursement at a per click level. It's managing a disease in a population. So well summarized. I am just so thankful to have had your voice. Again, your brain on our little show here today. John Becker SVP of Data and Digital at Vizient. It is, I'd say the nation's leading healthcare performance improvement company. Not only because you say that on your website because I believe it, and obviously everything that your expertise and your team brings to the table. Love this. John. This was fantastic. Thank you.

John Becker:

Hey, thanks for having me. I appreciate it.

Brian Urban:

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