Episode 17: Treating Oncology’s “Perverse Incentive”— How to bend the cost curve in cancer treatment with Dr. Andrew Norden of OncoHealth

Justin Steinman (00:00):
Definitively Speaking is a definitive healthcare podcast series recorded and produced in Framingham, Massachusetts. To learn more about Healthcare Commercial Intelligence, please visit us at definitivehc.com.

(00:24):
Hello and welcome to the latest episode of Definitively Speaking, the podcast where we have data-driven conversations on the current state of healthcare. I'm Justin Steinman, Chief Marketing Officer at Definitive Healthcare and your host for this podcast. I'm joined today by Dr. Andrew Norden, Chief Medical Officer at OncoHealth. Andrew has a bunch of impressive academic degrees, but by far his most impressive one is the one that he and I share. We're both proud graduates of McDonogh High School in Baltimore, Maryland. Now before you go on and fast forward this podcast, thinking it's just going to be me and Andrew walking down memory lane together, I should point out that after graduating, Andrew and I lost touch for about 20 years or so, before reconnecting as part of the greater Boston healthcare ecosystem. So I promise we're going to stay on topic for this podcast.

(01:08):
I invited Andrew to join me today because he's working at a really interesting company called OncoHealth. OncoHealth is tackling challenges related to cancer treatment, with what they call and I quote, "navigating the physical, mental, and financial complexities of cancer." They've got a digital telehealth platform that will help patients navigate the emotional challenges and physical symptoms caused by cancer and cancer treatment. We've talked quite a bit about cancer and telemedicine platforms on this podcast, but we really haven't tackled it from a clinical perspective. So bringing Andrew to the podcast today should offer a new and interesting perspective. So Andrew, welcome to Definitively Speaking.

Dr. Andrew Norden (01:44):
Thanks, Justin. It's a real pleasure to be here.

Justin Steinman (01:47):
Excellent. All right, so let's go back high school, 1992. What were you doing? I'm just kidding. We're not going to-

Dr. Andrew Norden (01:53):
Well, in fact, I was a sophomore in 1992. I'm a little bit younger than you, I'm happy to report-

Justin Steinman (02:01):
Ouch.

Dr. Andrew Norden (02:02):
To your listeners.

Justin Steinman (02:02):
Wow. All right. And just for that, Andrew, we're going to start with an easy question for you, okay?

Dr. Andrew Norden (02:08):
Sounds great.

Justin Steinman (02:08):
Very shortly, what's wrong with cancer care in the United States today?

Dr. Andrew Norden (02:12):
Oh my, many, many things are wrong with cancer care and it's hard to decide frankly where to start. I know that today we're going to spend some of our time focusing on cost challenges, which are really abundant and problematic. Let's see. I think the best way to begin is to say first that cancer care has seen absolutely remarkable therapeutic advances in recent decades, and survival for previously unsurvivable diseases has increased measurably and one can see that in the data that comes from the CDC, the American Cancer Society, and so forth, about overall survival rates in cancer. So I don't want to paint a grim picture of cancer care in general because, as I say, it's been a time of remarkable discovery with targeted therapies, with immunotherapies, more recently with CAR T therapy and so forth. But that said, the experience of being a cancer patient in the United States remains deeply problematic.

(03:29):
And I think one of the largely unrecognized challenges that cancer patients face is around the financial challenges. If you look, for example, at some published data on this topic, one thing that comes to mind is a study now almost 10 years ago out of Washington State where more than or nearly 200,000 patients were studied by Ramsey and his colleagues. And they found that patients with cancer in that population were more than two and a half times more likely than age and location matched controls to declare bankruptcy. And that was even worse for particular subsets of patients with lung cancer who had a nearly four times increased likelihood of declaring bankruptcy.

(04:25):
So I think the message is that the progress we've seen in cancer care is coming at a real cost, and that cost can be measured in dollars, dollars that contribute to worse quality of life for people, that reduce their adherence, probably decrease the quality of their clinical outcomes like survival, although that's been harder to show, and really are causing catastrophe for American families who are trying to get people through what is otherwise already a terrible time in their lives.

Justin Steinman (05:02):
Is cancer like the leading bankruptcy causing disease in the United States?

Dr. Andrew Norden (05:06):
It's a great question. I don't know that I've seen a published report that sort of lists medical causes of bankruptcy, but I think cancer is unique in the sense that for many people it comes out of the blue and a lot of the costs are really concentrated during a particularly intense episode. So while I don't know the answer to the specific question, what I would say is that it's hard to imagine it's not a top cause of rapid bankruptcy in patients and their families.

Justin Steinman (05:46):
Got it. So can you explain to me the economics of cancer care? Who's making money? Who's footing the bill?

Dr. Andrew Norden (05:53):
Oh my. Cancer care in the United States is big business, and I think that there are a lot of stakeholders that benefit and no doubt patients unfortunately are on the list of those who do not. So cancer care in the United States is funded first and foremost by the government payers, which include of course, Medicare, federal government program and Medicaid, largely state funded programs that vary from state to state. And then second is the commercial payers. Given your own biography, you are aware of some of the challenges that exist there.

Justin Steinman (06:41):
Yes.

Dr. Andrew Norden (06:42):
But at any rate, those are the funders. Another key funder that underwrites much of what happens on the payer end of course is the employer and large employers fund a very large portion of cancer care in the United States. Who makes money? Well, it depends who you ask, I suppose. But without question, a large portion of the spend for cancer care in the United States goes to the manufacturers of drugs. Cancer care, unlike any other disease area, I think has seen an absolute explosion in therapies and the cost of cancer drug R&D is covered by drug prices.

(07:32):
Drug prices are an interesting topic in and of themselves in the sense that the government is largely not permitted to negotiate them. And so as cancer drug makers or for-profit companies, they charge prices that the market will bear and those costs have been high. There is a debate about the extent to which the providers of cancer care make money or not. Many of the largest providers are not for profit, but they have huge budgets and recent media reports and such suggest that they have well paid executives and sometimes quite well paid physicians. So I do think a meaningful portion of the cancer care spend goes to hospitals and to outpatient providers. And then there's a very long tail of others who benefit. But I think overwhelmingly the top two recipients of the cancer care dollar are the pharma companies I mentioned and provider organizations.

Justin Steinman (08:44):
And how are oncologists paid today? You said there's some sort of relationship between the drugs the oncologists prescribe and how they're paid.

Dr. Andrew Norden (08:51):
Yeah, that's right. It's an interesting phenomenon and I don't want to imply that I'm a healthcare economist or a deep expert in this realm, but what I can tell you is that the typical oncology provider is paid by Medicare using a formula which looks at the average sales price of a drug, and added to that is a 6% margin. Now, when commercial payers pay that same oncologist, 6% typically is very low. And in fact, one might see that commercial rates maybe ASP plus 25% or 50% or a hundred percent, or even as high as 300% in some scenarios, depending on the negotiated rate between the provider and the payer who has more leverage in those conversations. At any rate, in the large majority of circumstances, drugs are paid in the way I described, average sales price plus a margin. And it doesn't take the calculus that you and I learned at McDonogh School in the 1990s to realize that if you're paid a fixed percent margin on a number, then the larger the number, the more money you make.

(10:19):
And so there is a built in perverse incentive for oncologists in this country to prescribe high cost drugs. And that is fundamentally problematic when you look at how expensive drugs have become and the fact that we really don't, in this country, have any sort of oversight body or independent group that assesses the actual value of drugs given to patients. So in other words, if an oncologist chooses to prescribe a drug and that drug has been approved by the FDA, then the oncologist gets reimbursed for that drug and there really is limited burden for the oncologist to prove that that drug is better than a cheaper alternative, which in reasonable proportion of circumstances, there may well be options like that, options that are clinically equivalent and yet much, much less expensive.

Justin Steinman (11:23):
We should pause at this point and point out to our listeners that you are a practicing clinical oncologist, and I don't practice that much anymore, but you did practice for quite a long time. So you know of what you speak here.

Dr. Andrew Norden (11:34):
Yes, that is accurate.

Justin Steinman (11:36):
That's kind of crazy, what you were explaining though, right? So you basically just told me that, I'm an oncologist, which I'm not obviously, but if I was an oncologist and there was a drug that was sold at $100,000 and it was half as good as a drug being sold for $50,000, I'm going to prescribe the $100,000 drug because I'm going to make more money.

Dr. Andrew Norden (11:58):
Well, you have a financial incentive to prescribe the more expensive drug. Now, I mean the vast majority of oncologists I think are motivated by doing right for the patient and therefore may well not make that move. But a rational human recognizes that we react to the financial incentives under which we operate, whether we like that or even are consciously aware of that or not.

Justin Steinman (12:30):
Is there a better way?

Dr. Andrew Norden (12:31):
Certainly there are other ways. It's a challenging question for which if I had the right answer, I'd have a different type of job and I'd be speaking maybe at the White House, but it's really very thorny and challenging from multiple angles. You have to think about the reality that, one, we do want to continue to incentivize drug companies to do research that leads to the development of novel drugs. And as I said earlier, we've seen amazing advances in all sorts of bad cancer diseases in recent years. So you don't want to negotiate drug prices down to a point where that incentive is lost. Similarly, you need to reimburse oncologists for taking good care of cancer patients. Now, from my view, some of the value based payment models that have been put forth by CMS and others, including commercial payers, are interesting in the sense that they may incentivize the oncologist to do a lot of high quality care and take the drug payment piece out of the picture.

(14:00):
I mean, I don't see any particular reason why the buy and bill way that oncologists are paid for drugs needs to be maintained. One could pay them higher rates for their routine office visits and the other services that they provide to their patients like phone calls and data review and interpretation of results and nursing care and all of the things that oncologists do for patients, one could start to measure and reimburse oncologists for that work in a way that allows them to maintain income levels where they currently are without incentivizing high cost drugs the way they do today. As you can imagine, if you're an oncologist and you've been practicing under this ASP plus margin model for a long, long time, the idea of getting rid of that is very scary because that's how they fund their practices. And so I think the only way it works is if one gets rid of that at the same time that one pays more generously for some of these other services which are largely uncompensated today.

(15:20):
And so we see this starting to happen. If you look at the CMS recent value based payment models, there was OCM, the Oncology Care Model, which has just come to an end and the EOM, the Enhancing Oncology Model which is going to take effect next January. These models both involve some per month payments for patients on chemotherapy and the idea is to subsidize care that oncologists deliver to patients that is not connected to or related to the drug margin. And I think that models like that are appealing, although they continue to incorporate a large amount of fee for service components that maybe incentivize volume in a way that could still be problematic. So I don't know that we've sort of found the solution to this problem, but I think those models begin to move in the right direction, looking at the way oncologists deliver services to patients that are sort of distinct from the drug and start to shift some of the dollars there. And I think that's very important and appealing.

Justin Steinman (16:42):
It almost sounds like you're talking about, for lack of a better phrase, capitated fee for service in a certain model.

Dr. Andrew Norden (16:50):
Yeah. So we've been fee for service for a long, long time. We are moving to I think something that looks a lot more like what you just said, but there's an opportunity for probably global capitation. The concern that one raises there is that drug prices are so high that a new drug that costs half a million dollars a year can come out tomorrow and really blow the capitation budget, even if it's highly appropriate. And so there's an enormous amount of nuance, I think, and complexity, particularly when you think about what's coming and when and to what extent does the oncologist have to bear risk for that. And so I think that's an important part of why it hasn't quite been solved just yet.

Justin Steinman (17:46):
Well, we like to tackle the hard issues here on Definitively Speaking. We're not going to have any real basic conversations like, "How do we fix the Patriots' offensive line?" We're talking the big issues here, right? There's no easy answers.

Dr. Andrew Norden (17:56):
Sounds good.

Justin Steinman (17:57):
So let's talk some stats, right? Let's give our listeners some context here. So according to the National Cancer Institute, roughly 1.9 million people are diagnosed with cancer each year in the United States, and more than 609,000 people die from cancer each year in the United States. And according to the American Cancer Society, there are just over 17 million Americans who are living with or who have survived cancer today. Meanwhile, the National Cancer Institute estimates that cancer related direct medical costs in the United States were $183 billion, that's with a B, in 2015, and are projected to increase to $246 billion by 2030, a 34% increase based just on population growth and aging.

(18:44):
And that's not even including the stuff that we're talking about here. And in fact, they even say on their own thing that they think their projection is likely an underestimate, that $246 billion is underestimating the US cost of cancer. Because of the growing cost of treatment, including the list price of prescription medicines, treating cancer is now averaging more than a $100,000 a year. So the average cancer drug is more than a $100,000 a year. I mean, the numbers are just staggering when you sit down and think about it, right>

Dr. Andrew Norden (19:15):
Yes.

Justin Steinman (19:17):
Another unfair question that I'll ask you here is how do we bend the cost curve in cancer treatment while still maintaining the compassionate care that every single patient deserves?

Dr. Andrew Norden (19:30):
So I mean, it's a great question. And again, in many ways, it's the key question that's very challenging to solve. I'll talk a little bit, I think, about how we try to do that OncoHealth and I would say we have a multi-pronged approach that involves some services that we provide to payers, some services that we provide directly to patients, and some work that we do with data and analytics that powers research. Let me take each of those one at a time if I could. OncoHealth is a company that was founded by a medical oncologist named Marc Fishman. Marc was a practicing medical oncologist in South Florida for whom the perverse incentives that I described made him absolutely crazy. And he wanted to do anything he could to figure out how to reduce that perverse incentive while keeping the oncologist whole. And to Marc's credit, he was motivated primarily, I think, by what he was seeing over time, which was that payers were shifting costs increasingly to patients.

(20:52):
And that's been driven in this country because we've seen more and more oral cancer drugs that end up on the prescription benefit rather than the medical benefit, like infused drugs. And we have high rates of cost sharing for oral drugs in this country. People pick them up at their pharmacy and they can't pay the bills. So it drove Marc crazy, and he found kindred spirits in the leaders of Humana in South Florida. And Marc helped them understand that we have many circumstances where there are multiple treatment options of similar or identical efficacy and similar or identical side effect profiles and yet huge differences in price.

(21:40):
And there are a lot of examples that we could talk through later. But the bottom line was that together, Humana and Marc came up with this idea that he would begin reviewing cases that represented patients being treated by oncologist in Marc's local community of South Florida and he would give advice to Humana and to the treating physician. And ultimately this evolved into what one now calls prior authorization, and the company really grew up around that. Prior authorization in and of itself is a divisive concept.

Justin Steinman (22:20):
Could you just explain for listeners what prior authorization is simply?

Dr. Andrew Norden (22:23):
Absolutely. Prior authorization is a primary mechanism of so called utilization management. And what happens mechanistically is a payer says to their provider network, "Before you can prescribe drugs A, B, or C," and they typically have a long list, "You need to submit a request to us that includes some clinical information. We will review that request and let you know if the treatment is approved or not. If it's approved, it means we guarantee we'll pay for it. If it's not approved, it means we won't." And because the costs are so high, generally denying a request like that means that the patient's going to get an alternative treatment.

Justin Steinman (23:08):
Got it. And so a prior authorization isn't necessarily a new concept, right? You're not saying that Marc created that?

Dr. Andrew Norden (23:14):
No, certainly not. Marc was not the first person to do prior authorization, not by any stretch, but I would say he was one of the first people to do it in cancer care. And I think in the early days when cancer treatment was dramatically less expensive, no one thought that a measure like prior authorization was required in cancer care. But as the cost of drugs has gone up higher and higher, and particularly because of concerns about these incentives that we talked about that encourage prescribing high cost drugs, payers have increasingly implemented prior authorization. And that has been a core aspect of OncoHealth's business for 10 years that we've been in business. And although I see this issue from both sides as a former provider, myself, as you said, a part-time provider now, I recognize that while this does interfere to some extent with physician autonomy, it also interferes with some really bad practices that a small set of oncologists are involved in.

(24:25):
And so given that, it works, and at OncoHealth, we consistently save millions and millions of dollars a year for clients all over the country by interfering with non-evidence based or low quality treatment decisions. Again, that's not to say that oncologists are bad actors, but probably a very small portion of them are. And I think there's also a real challenge keeping up with the rapid pace of new drugs coming out and new indications and such. And so sometimes I think that people inadvertently make bad decisions, doing the best they can. So prior authorization works and it helps to control costs, and the cost savings is felt by the payer and it's also felt by the patient because when we interfere with a treatment request that doesn't have an evidence basis and the patient doesn't get that therapy, then the patient doesn't bear the cost sharing, which as we've said has been going up and up, especially for oral drugs.

(25:44):
So that's one way that OncoHealth is trying to impact the cost of cancer care in the country. And it's one that I think sticks around despite people being frustrated by it because it in fact works. And I one day look forward to having some in person debates with practicing physicians about it because, as you would imagine, there's lots of negative prior authorization sentiment on Twitter and such from practicing physicians who frankly sometimes are describing pretty lousy practices that prior authorization companies may engage in as well. At OncoHealth, we try very hard to do it in a collaborative way.

Justin Steinman (26:33):
Got it. I want to pivot for a second and talk about mental health. So the American Cancer Society, in the report that I said earlier is 80 pages, and in it the words mental health appear exactly two times, both times in reference as to why someone might start smoking tobacco, which could lead to cancer. So I was kind of stunned to find in a 2022 report, there was no discussion of mental health components of cancer treatment. And so then I kept on my internet search and I found cancer.org. And on cancer.org, they cite that anywhere from between 25 to 33% of cancer patients suffer from some level of clinical depression, and yet only a fraction of those folks actually get treatment. What's your thoughts or opinions or what do you know about the connection between mental health and cancer treatment?

Dr. Andrew Norden (27:34):
That's a really good question, and it's also a good segue because it gives me an opportunity to talk about one of our second key ways that-

Justin Steinman (27:43):
That was actually not planned, by the way.

Dr. Andrew Norden (27:45):
Yeah, it's true. I feel like I should let your listeners know that I've not heard these questions until just now. So mental health is a common challenge for cancer patients, and I agree with those numbers. They comport with my own experience. If you have a serious cancer diagnosis, it's hard to imagine that you don't feel somewhat depressed, that you don't feel somewhat hopeless, that you don't experience anxiety about, "What is this going to mean for me, for my family?" So I think the data reflect that. And I also think there's very interesting evidence that suggests that failure to address those mental health concerns in patients with cancer leads to, obviously, poor quality of life outcomes and it also probably overutilization of the healthcare system because if you're sitting at home, worrying about your cancer coming back and you develop heartburn, you may go straight to the emergency room for an evaluation.

(29:03):
And in your former life when you did not have cancer or were not a cancer patient, perhaps you would say, "Oh, it's probably just a little heartburn," and you take TUMS and that's the end of the story. But if you have been treated for esophageal cancer or lung cancer and you feel some discomfort in your chest, that can be really terrifying and lead to you going to the ER. And then importantly, there's good data that suggests that if you're a cancer patient and you go to the ER, you have about a two-thirds likelihood of being admitted to the hospital just because you're a complex patient, nobody wants to screw up and miss something important. And depending on where you are, the emergency room staff may or may not have a lot of experience with cancer. And so I think the point is the mental health problem in cancer is absolutely real and it contributes to both clinical and financial adverse outcomes.

(30:00):
Also critical to point out is we have a massive shortage of mental health experts in the country, and especially a shortage of mental health experts who know anything about how to help patients with cancer or have experience doing that. And I might point out even in my own clinical practice when I was at Dana-Farber for about 10 years, where mental health needs are well recognized and Dana-Farber is consistently trying its best as an institution to improve the availability resources for patients with mental health challenges during cancer treatment, there's not enough support to go around even at Dana-Farber. And if you kind of add to that the reality that more than 80% of patients are not treated at places like Dana-Farber or Memorial Sloan Kettering or MD Anderson Cancer Center, they're treated at community sites that often have no mental health resources, you can just see how this is a massive problem.

(31:01):
So for all of those reasons, part of our approach at OncoHealth has been to build a patient-facing, technology-enabled service that we recently launched. It's called Iris. And it allows patients to select a mental health professional from a team that we've built who are licensed in now approximately 20 states around the country. And patients can engage with these therapists via telemedicine inside the app and get support for common problems that cancer patients experience like fear of recurrence, body image concerns, support in having conversations with their family or their employer about their cancer diagnosis, all sorts of things that cancer patients just go through and that they typically struggle to find good support for. And then we also have a lot of self-guided resources and content for patients who maybe are more self-directed and would rather not have a mental health interaction.

(32:12):
And we've just launched this, we've launched it with three payers in three different markets in the United States, one of which is Boston with Harvard Pilgrim Health Care, where we're sitting now. And we're seeing huge interest in the mental health side of this app, even from patients who are treated at renowned academic medical centers where they're saying to us, "I haven't been able to find time with the social worker or psychologist. And you know what? When I go into the clinic to see my oncologist, the last thing I want to do is stick around for an extra couple of hours to have a mental health visit. And the fact that I can do it in person from home on this app is really appealing."

Justin Steinman (32:54):
So it's really interesting. Actually fascinating, frankly. And so the way you're talking, you said you're going to market through the payers, right?

Dr. Andrew Norden (33:03):
Yes, we are.

Justin Steinman (33:04):
So is this a benefit that the payers add on to the employers or is this just part of their cancer treatment protocols? What's the route to market for OncoHealth, is kind of an interesting business model question?

Dr. Andrew Norden (33:20):
It is. So at this moment in time, the approach is that the payers are our customers and they are making this available in an unlimited way to their members. Those members may be fully insured by the payer or they may be self-insured employer groups, in which case the health plan introduces us to the employer who then evaluates and makes a decision whether they want to add it to their benefit panel.

Justin Steinman (33:54):
Got it. So let's pivot again because we talk about the whole person here on Definitively Speaking. And so you've got an interesting personal story. So as you said, you're at Dana-Farber and if memory starts correct, you are actually treating brain cancer, right?

Dr. Andrew Norden (34:10):
That's right. That is my clinical specialty, neuro-oncology.

Justin Steinman (34:13):
So why did you stop practicing full time and move into industry like you have?

Dr. Andrew Norden (34:18):
There are many factors that contributed no doubt. One, if I'm being really honest, and I suppose I'll just put it out on the airwaves, is it's emotionally very challenging to take care of patients with brain cancer. Brain cancer is a really bad disease. The vast majority of patients live a year or two. And when I was at the very beginning of my career, that was frankly what motivated me to do it. I wanted to help patients who needed a great deal of help. And then as I got a bit older, started to have children, and saw some of my patients who were young parents dying of cancer, I found it very, very sad. And I struggled to not take it home, if you understand what I mean.

(35:08):
And at the same time, increasingly I was interested in the technology systems and solutions that we had or didn't have. And I thought that maybe I could have a bigger impact if I could help us design better systems and technology products that would really influence outcomes for a larger swath of patients than I could handle one at a time in my clinic room at Dana-Farber. And so that was the primary thinking that led to me ultimately deciding that it was time to leave clinical practice or dramatically reduce it and spend, what is now, 80 plus hours a week working on development of these tools that I think are really helping to transform people's lives.

Justin Steinman (36:03):
That's amazing. As a father of four young kids, I get where you came from and I totally follow your decision making and I love the broad impact that you actually having to have. So this has been great. I got one more question for you and it kind of comes almost full circle to where we started 35 or so minutes ago. So as a clinician who's treated cancer for decades, because you're, while younger than me, still old, what's your diagnosis on the field of cancer treatment? Do we have reason to be optimistic and what's worrisome to you?

Dr. Andrew Norden (36:37):
I am very optimistic in a whole host of ways. I think at this moment, my biggest optimism probably relates to the therapeutic advances that I talked about earlier. Diseases like advanced lung cancer and melanoma have some really good treatments. They're not perfect and there's room to improve without doubt. But those have treatments that they didn't have a decade ago. We haven't yet seen that in my own clinical specialty, but there's an awful lot of really smart scientists at academic centers and industry sites all over the world working on this problem. And we're seeing so many interesting advances that I believe the scourge of cancer will continue to shrink slowly but surely over time. And that gives me great optimism. I think if I worry, it really is about the extent to which the business model, the medicine industrial complex that is oncology in the United States is not focused today on improving outcomes for patients.

(37:50):
It is sort of designed to enrich a few at the expense of many. And I think if we fail to sort of fix that, we're just going to continue to see more of the same. And we talked about the bankruptcy rates for cancer patients, which are unacceptably high. Well, there's also the risk of national fiscal bankruptcy as a result of this. So action is needed. There is interest within the oncology industry in addressing this, but it's come awfully slow and I think we're going to need some really aggressive action from Washington DC if we want to see this materially change.

Justin Steinman (38:39):
Andrew, that was great. Thanks for coming on to Definitively Speaking today. I say without question, you've done our collective alma mater proud with your insights that you shared with us today. Appreciate you coming on.

Dr. Andrew Norden (38:52):
Thanks for having me, Justin. I enjoyed it.

Justin Steinman (38:54):
And for all our listeners out there, thanks as always for listening to Definitively Speaking, a Definitive Healthcare podcast. Please join me next time for a conversation with Chase Supoodle, Chief Growth Officer at Beta Data. Chase and I will talk about the role of data in healthcare and why we as an industry are awash in data but limited in insight. As you might imagine, this is a topic near and dear to my heart, so I hope you'll tune in. If you like what you've heard today, please remember to rate, review, and subscribe to the show on Apple Podcasts, Google Podcasts, Spotify, or wherever you get your podcasts. To learn more about how Healthcare Commercial Intelligence can support your business, please follow us on Twitter at DefinitiveHC or visit us at definitivehc.com. Until next time, take care, please stay healthy, and maybe just think about reaching out to that guy you haven't talked to for 20 years in high school. I'm Justin Steinman. Have a good day.