Rethinking Risk: Innovating Benefit Design for Whole-Person Care

Welcome to another insightful episode of "The Only Healthcare Podcast," where we unpack the demand for change in risk management for employers within commercial insurance and benefit design. In this episode, our host, Dr. Randy Vogenberg, is joined by Rajiv Sood, the founder of Sood Health Advisors. With over 30 years of experience spanning healthcare, clinical settings, insurance, and InsureTech, Rajiv brings a wealth of knowledge and a unique perspective on managing financial risks in healthcare. 

In this episode, you will learn: 

• Innovative Risk Management: Explore how innovative financial strategies can mitigate risks for employers, touching on the significance of tier five initiatives. 
• Demand for Benefit Design Innovation: Explore the transformative impact of innovative benefit designs on equitable access and whole-person care, addressing the evolving needs of patients with rare diseases. 
• Essentials of Reinsurance: Delve into the function and importance of reinsurance in the healthcare sector, highlighting its role in mitigating financial risks associated with benefit designs for rare diseases. 
• Challenges of Asynchronous Timing: Unpack the issues stemming from asynchronous timing in stakeholder collaborations and discuss strategic approaches to enhance synchronization and efficiency among all parties involved in healthcare management. 
• Future of Healthcare Financing: Discussion on the future landscape of commercial insurance and how upcoming changes will affect stakeholders across the board. 

Join us as we unpack these complex topics, providing valuable insights for employers, HR professionals, C-suite executives, and insurance experts. Connect with Rajiv on LinkedIn for assistance in reinsurance and with Randy on LinkedIn for aid in benefit design and stakeholder collaboration. 

Hosted by:
Michael Navin & Dr. Randy Vogenberg

Michael's LinkedIn

Randy's LinkedIn

Sponsored by:
Peek: A game-changing prescription shopping solution that allows its members to view all their prescription cost options across cash discount programs and their insurance in one easy-to-use platform. Peek is currently being offered to organizations to help both employees and plan sponsors save money on their prescription spend. https://peekmeds.com/.

Institute for Integrated Health (IIH): Health care benefits, insurance coverage regulations, and doing business in the healthcare industry can be complicated. At IIH, Dr. Randy Vogenberg and his team understand these unique challenges and provides strategic guidance customized to every client. To help overcome your unique challenges, IIH delivers education, planning and advisory on market trends, and U.S. health care market intelligence. The firm’s decades of proven success are due to strategic collaboration with associates from the business, clinical, and scientific communities. https://iih-online.com/.

Music by:
Hanu Dixit, https://www.youtube.com/hanudixit

Transcript

(0:00) Welcome back to the Only Healthcare podcast. (0:03) I'm your host, Randy Vogenberg, (0:05) and today we have a special episode. (0:08) Michael is not on today because we're discussing (0:11) a deep dive in a niche topic around the business (0:14) of healthcare and commercial insurance. 

(0:18) Joining us today is Rajini Sood, (0:20) the founder of Sood Health Advisors. (0:23) Together, we've collaborated on a tier five initiative (0:27) which addresses innovation and financing risk for employers. (0:32) So employers, HR professionals, C-suite members, (0:38) benefit advisors, insurance executives, (0:40) today, this episode is for you. 

(0:44) So I'm first gonna ask Rajiv to give a brief introduction (0:47) about his background and experience in the area (0:51) of reinsurance and secondary insurance. (0:54) Rajiv. (0:54) Great, thank you, Randy, for the invitation. 

(0:57) It's a pleasure to be here with you today and do this. (1:03) As you know, but for everyone else, (1:06) I've been around the industry a little more than 30 years, (1:09) and over that 30 year career span, (1:11) I've worked in healthcare and clinical settings, (1:15) insurance, risk reinsurance, (1:17) and even more recently on the insurtech side. (1:20) So I've spent a good chunk of my career (1:22) in one end of healthcare, (1:24) all the way through the ecosystem to the other end. 

(1:28) And it's given me an interesting perspective. (1:30) And one of the reasons I launched Sood Health Advisors (1:33) was to share my perspective and expertise with the industry. (1:37) So thank you again for the invitation (1:39) to be with you on this podcast today. 

(1:42) That's our pleasure. (1:43) And it's that background and experience on the end to end (1:47) of what happens in the real world, (1:49) which we really want to explore today. (1:52) This for a way of background, (1:56) there was an article back in June of 2024 (1:59) in the Journal of Clinical Pathways (2:01) that I was a co-author on that touched on (2:05) some of the aspects of what is happening (2:09) in terms of commercial insurance and risk financing options. 

(2:13) So there's a kind of general article out there, (2:17) but I thought it'd be helpful for our audience (2:18) for you Rajiv to give kind of a basic lay of the land (2:23) where we stand today around the use of secondary insurance (2:30) or reinsurance in the marketplace, particularly for the US. (2:35) Yeah, thank you for that. (2:36) So I'll start by simply saying, (2:39) let me just spend a moment defining the term reinsurance (2:42) because a lot of people think they understand (2:45) what the term means, but it means something else entirely. 

(2:47) So reinsurance by definition is an insurance company (2:52) or an insurer further buying insurance, hence reinsurance. (2:57) If someone is not an insurer, (3:01) they may be using the term reinsurance (3:04) as a means of buying protection, (3:07) but technically speaking, they're not buying reinsurance, (3:10) they're actually buying insurance (3:12) since they are not an insurance company themselves. (3:16) So within the reinsurance world, (3:19) typically you find two really main types of reinsurance. 

(3:27) One is considered to be what the industry refers to (3:31) as proportional reinsurance, (3:34) which is, I may take a dollar of claims (3:37) and I may pay a dollar, I'm sorry, (3:39) I may take a dollar of premium (3:42) and pay a dollar of claims as well. (3:44) So it's a very direct correlation. (3:46) The other is what the industry refers to (3:49) as non-proportional reinsurance, (3:51) which is you may take a dollar of premium (3:54) and if a claim meets a certain set of criteria (3:58) and qualifies, then that claim could get paid. 

(4:02) So at a very high level, (4:03) those are the two kinds of reinsurance (4:06) that the industry and the two kinds of models (4:08) that the industry operates on, (4:10) proportional and what they refer to as non-proportional. (4:12) So one of the questions that I get quite frequently (4:19) in talking with various employers is, (4:24) is there a particular type of insurance (4:27) I should be looking at? (4:30) Or what kind of insurance should I be going after (4:33) to cover my risk exposure (4:36) in my medical benefit in particular? (4:38) Sure. (4:40) And as you can imagine, (4:41) it depends on a lot of different factors, (4:43) including time, what an individual organization's (4:47) risk tolerance level is, (4:50) how much of a financial exposure they can bear themselves (4:55) before some degree of protection kicks in (4:58) to help them absorb that expense. 

(5:01) But let me start by saying that many people (5:06) think of the term in a much broader sense. (5:09) Medical insurance or reinsurance is not the same (5:14) as what the industry defines as health. (5:19) Health is a much broader term. 

(5:21) Health insurance is a much broader term. (5:24) Medical is considered to be a subset of that. (5:28) So depending on the nature of the risk (5:31) that is seeking to be protected by itself, (5:35) then based on that, the timeline, the risk tolerance, (5:39) the underlying nature of the risk, (5:41) what kind of drugs need to be covered, if any, (5:45) what the employee population may like, (5:48) all of these factors come into consideration (5:51) to help determine what is the appropriate pathway (5:56) to go down and ultimately what that structure (6:00) of the risk protection should look like (6:03) for that individual organization. 

(6:06) And it's also important to point out (6:07) that what is true for one organization (6:10) and the way one organization handles things (6:12) may not be true for another. (6:14) So it really is a very customized, (6:18) individualized conversation based on (6:21) what I outlined a minute ago in terms of risk factors, (6:24) timeline, tolerances, the underlying nature of the risk, (6:28) and things of that sort. (6:31) So one of the kind of follow-up aspects (6:34) is why we're having this conversation today (6:37) is looking at the extraordinary risk profiles (6:41) that are coming out of the R&D pipeline (6:46) for manufacturers, particularly around rare disease (6:50) therapies, the cell and gene therapies, (6:53) and even some of the more expensive (6:56) second and third generation biologic products (6:59) that may be used in cancer immunology. 

(7:03) So in defining that risk, as an example, (7:06) that risk profile is now changing, (7:09) it's a little bit different (7:10) than what we're typically used to. (7:12) And a lot of this is still on the medical benefit side, (7:15) not necessarily the pharmacy benefit side. (7:18) How does that get factored in (7:20) to what you were just talking about? (7:22) Yeah, I think that's a really critical point that you made. 

(7:25) And although that's true today, (7:27) as these more advanced therapies (7:30) move increasingly towards the mainstream (7:33) and deal with sort of normal chronic conditions (7:37) like diabetes or osteoarthritis (7:39) or many of the others of that kind, (7:41) they won't be as rare as they are today. (7:44) The prevalence will certainly go up (7:46) and the doorways will open to these therapies (7:49) being used as potential treatments (7:50) for a lot of these other conditions. (7:53) That's not all that far away from a scientific perspective. 

(7:57) So one of the issues that the industry typically has (8:01) is access to data, the sharing of that data, (8:06) patient-centric, patient-centered data, (8:09) how it applies to a particular employee population, (8:13) how do you address the care (8:16) for the entire individual whole person care, (8:19) patient-centered care, (8:20) how do you couple that with evidence-based medicine? (8:23) So the bottom line is in today's environment, (8:26) the industry remains disjointed. (8:28) Although the science is advancing fairly quickly (8:33) between the pharmaceutical (8:34) and the biotech part of the industry, (8:37) the rest of the industry from employers to insurers, (8:41) to reinsurers, to technology vendors and others (8:44) don't operate on that same timeline. (8:47) And so the answer really needs to be (8:51) for all these different parts of the ecosystem (8:54) and all these different stakeholders (8:56) to come sit around the table together (8:59) and have these conversations (9:00) and find a way to thread the proverbial needle (9:03) and come up with a solution (9:05) that's going to work for everyone. 

(9:07) It's not going to work very well with the industry (9:11) for these therapies to get developed, (9:13) receive FDA approval, (9:16) and then all of a sudden be brought to market (9:18) when the rest of the ecosystem (9:20) perhaps isn't even aware in some cases (9:22) that these are under development, (9:24) much less actually being brought to market, (9:27) certainly much less how to design (9:29) a particular risk protection structure around it (9:33) when they don't understand it, (9:35) they don't understand the efficacy, (9:37) they don't understand the timelines (9:39) and all of the other factors (9:40) that go into determining what that ultimate risk is (9:45) and how to design some protection around it. (9:49) So let me just recap what you're saying here. (9:53) So we have a clear problem (9:55) around what I'll call asynchronous timing, (9:58) where stakeholders are operating in different schedules, (10:04) different silos, (10:05) and really don't understand each other's dynamics (10:08) because of those different silos, (10:10) as opposed to more collaborative dynamics (10:13) that might help both sides be more effective (10:17) and even efficient in what they're doing, (10:20) whether it's researching and bringing a product to market (10:23) or whether it's trying to determine (10:25) how do I afford that product (10:27) and make it accessible to my plan population? (10:31) Is that where we're heading in terms of a solution (10:35) to combine those elements? (10:37) It is a combination of several elements, including those. 

(10:41) There may be some changes in manufacturing processes (10:46) that need to happen as well (10:47) on the pharmaceutical and the biotechnology side. (10:50) The rest of the industry needs to understand (10:53) what those changes might be (10:55) and what the implications of those changes are. (10:57) Perhaps that extends the timeline a little bit. 

(11:00) It may delay a therapy (11:01) if it needs to be manufactured slightly differently. (11:05) They need to determine cost. (11:07) They need to determine what the patient pool is, (11:10) the eligible patient pool. 

(11:11) They need to determine what kinds of industries, (11:14) what kinds of employers, (11:15) what the tolerances are. (11:17) Small to medium-sized employers (11:19) behave sometimes very differently than larger employers. (11:23) So in the absence of this dialogue that needs to happen, (11:27) it really becomes a binary choice for employers (11:30) in that employers will simply determine (11:33) do I cover this or not? (11:36) And in the cases where you have a lack of information, (11:38) you don't understand what you're getting into, (11:41) you don't understand how big the problem may be, (11:43) you don't understand what the total cost (11:45) of a particular solution may be. 

(11:48) Most employers, understandably so, (11:51) will ultimately reach the conclusion (11:53) that they're not ready to cover these therapies (11:55) at this time. (11:56) So gaining a better understanding (11:59) all around the ecosystem, (12:02) collaborating with information, (12:04) sharing data, (12:07) a better understanding risk, (12:08) that collaboration among all the different parts (12:11) of the ecosystem and all the stakeholders (12:13) is really the only way to grapple with this issue (12:17) going forward, (12:19) especially if we are to do that on a sustainable basis (12:22) over the longer term, (12:24) which ultimately is where we will need to arrive. (12:28) And we will need to reach that point (12:29) because as we said a minute ago, (12:31) as these therapies deal with more mainstream (12:34) chronic conditions and become a much more (12:36) integrated part of the mainstream patient population, (12:40) eligibility will dramatically increase (12:42) and numbers are going to look very different. 

(12:46) So clearly the solution that we need to be talking (12:50) more about is kind of addressing and bringing together (12:54) that medical management activity and functions (12:57) that are out there together with the insurance financing (13:01) and risk approach that we've been taking. (13:05) And this is a very different environment (13:07) that we're talking about today (13:10) compared to what has typically occurred in the past. (13:14) So reassuring really becomes more important. 

(13:17) It does and that's very true (13:19) because we haven't yet talked about, (13:21) and it's an important part, (13:23) is the clinical pathways that are involved (13:26) in handling these therapies and dealing with them (13:29) and providing them for patients (13:30) and determining eligibility (13:32) and making sure that patients can tolerate these therapies (13:36) and stay committed to them over the longer term (13:39) over their entire duration to reach an end point. (13:42) So the fundamentals of the industry (13:44) when it comes to these therapies are changing. (13:47) You can no longer develop something, (13:50) throw it over the wall and hope that it's covered (13:54) and hope that it reaches some degree of market success. 

(13:57) This kind of environment, (13:59) as we will increasingly go into as we go forward, (14:03) will require a much more integrated (14:07) and collaborative approach (14:08) not only on the financial and the financial protection side, (14:12) but on the patient clinical management, (14:15) evidence-based medicine, operational side as well. (14:20) And when you bring those two parts together (14:23) along with the rest of the ecosystem, (14:25) then we will be in a much better place (14:28) where we can all realize the benefits (14:30) of these amazing therapies. (14:33) So let's go back to one of the earlier comments you made (14:37) around the system demand that's out there (14:41) and we'll break it down into three pieces. 

(14:44) We'll start with talking about data (14:46) and the problems in addressing who has access to data, (14:51) what are people doing with data (14:52) and what really needs to be happening around data (14:55) is the first piece. (14:58) Do you want to expand your thinking around system demand? (15:04) Sure, sure. (15:05) As I think the industry will appreciate, (15:08) much of the industry relies on claims data, (15:12) which is backward looking and retrospective in nature. 

(15:15) The challenge with these therapies (15:16) is that as they are undergoing development, (15:19) there is clinical data, (15:20) whether it's through the clinical trials (15:22) or other parts of the process, (15:24) that data isn't readily shared (15:27) with the rest of the ecosystem. (15:28) So the industry can get a better handle (15:31) on what's actually coming downstream, (15:34) what that looks like, what the clinical efficacy is, (15:38) how many patients, not just in the US, (15:40) but across the world may be affected. (15:42) So that data that is sort of constrained (15:45) and kept within the scientific community (15:49) needs to be shared with the rest of the ecosystem (15:51) so that we can all understand (15:53) and more importantly, prepare for these therapies (15:57) that are coming to market. 

(15:58) And certainly using existing claims data, (16:02) as the industry often does for a variety of purposes, (16:05) continues to play an important role. (16:07) But this forward looking data is important as well, (16:10) particularly when it comes to these therapies, (16:13) because we're talking about such small numbers. (16:15) So while there may not be enough (16:17) of a patient population in the US, (16:20) there may be when you look at the world (16:22) sort of as one pool, (16:26) that may result in a much more viable population (16:28) where the data actually makes sense (16:30) and has a certain amount of additional credibility to it. 

(16:33) And that's what the financial (16:35) and the risk management community is looking for. (16:37) It would be looking for data with some credibility (16:40) that they can use to better forecast, (16:42) that they can use to update their models with (16:45) and leverage these things, (16:47) not just for one particular therapy or one disease state, (16:49) but others as well, (16:52) especially those that may be (16:54) in somewhat of an adjacent space. (16:58) And so that data sharing, that data aggregation, (17:01) that data provision, (17:03) that is still relatively siloed (17:05) in the different parts of the industry (17:08) really needs to be shared much more broadly (17:10) for us to realize these benefits. 

(17:13) Yeah, totally agree on that one. (17:15) The second area around system demand (17:18) that you touched on was the issue of access (17:21) and probably really people think about it (17:24) as equitable access from either the plan sponsor perspective (17:30) or from the patient perspective. (17:32) Do you wanna expand on that? (17:35) Sure, sure. 

(17:35) And as we were talking about earlier, (17:37) I think where we are in today's environment (17:39) is that employers and others (17:42) really have somewhat of a binary choice. (17:45) Do I cover this or not? (17:46) Because they don't have enough information (17:47) to make an educated, (17:48) certainly much better informed decision. (17:51) So when you think about equitable access, (17:54) it's a really tough situation (17:58) because you may have a patient population (18:00) that could significantly benefit from these therapies, (18:02) but how do you make them available (18:05) when you don't have enough information (18:07) to determine cost and efficacy (18:10) and how to manage that patient (18:12) in their own clinical journey over time? (18:15) As you know, some of these therapies (18:17) are essentially one and done. 

(18:20) One dose may be all it takes. (18:21) Others may go on for years. (18:24) And so all of these different parts and pieces (18:26) have to go into the equitable conversation (18:30) to be able to better understand (18:32) not only how an individual employer makes that decision (18:37) to have equity among their own employee population, (18:41) but how do you make that available on a much broader basis (18:45) so that the entire country and indeed the entire world (18:49) can benefit from that? (18:51) So that equitable access piece of it (18:54) is certainly important on a humanitarian level, (18:58) but it is also equally important on a data level (19:01) and a risk management level (19:03) so that when you look at the picture, (19:05) you're looking at it in totality (19:08) and certainly holistically keeping the patient (19:12) front and centered throughout that entire process. 

(19:16) Yeah, I think that's a really important concept (19:19) that we don't always think about (19:21) when we put those terms together (19:24) around equitable and access. (19:26) And your last point, (19:29) which was the third area around demand (19:32) is this whole issue of looking at the whole person (19:35) when we're talking about these types of care (19:39) because it's not in a vacuum, (19:41) it's not just a product or a therapy, (19:43) there's a lot of other aspects of care (19:47) and daily life that have to be addressed. (19:50) So if you want to expand on that- (19:52) Sure, sure. 

(19:54) And it's not really just the patient, (19:57) you also have to consider patient's family, (20:00) you have to consider whether travel may be required, (20:02) there may be caregivers that need to be involved. (20:05) You have to look at it (20:07) not just from the production of the therapy itself, (20:09) but its administration as well, (20:12) its transport, its logistics, (20:15) much like transporting vaccines in the pandemic, (20:17) you had to have a certain degree of refrigeration. (20:20) So the entire process from start to finish (20:22) needs to be looked at thoroughly, (20:24) but we cannot lose sight of the fact (20:27) that it's not just the patient. 

(20:28) Many times in these conditions, the patients are children. (20:33) So you have to also contend with (20:35) how do you provide patient-centric care (20:37) not only for the individual receiving the therapy, (20:40) but for their caregivers as well? (20:42) Is it even worth it for them to go through this process (20:45) to be part of it, to take the therapy? (20:49) What might that involve? (20:50) What duration is it? (20:51) What comorbidities would they have? (20:54) Are there any other underlying conditions? (20:56) Do they have the family support (20:58) to be able to deal with this (20:59) and maintain it over the longer term? (21:02) So when you think about whole person care, (21:04) it's not purely clinical whole person care. (21:09) It is certainly the clinical part of it (21:12) plays a very important role, (21:14) but you also have to look at, dare I say, (21:16) the softer side of it and the family side of it (21:19) and the social side of it, the mental side of it. 

(21:22) So that when you talk about whole person care, (21:24) it covers all of these dimensions (21:27) and not just the clinical one. (21:29) In order to have these therapies be successful (21:32) and for access to be equitable (21:34) and for us to realize the benefits (21:36) of these therapies as a society, (21:38) all these different aspects have to work together (21:41) hand in hand in concert. (21:43) And that represents a fundamental paradigm shift (21:46) from the way the industry operates today. 

(21:49) I think just to put an exclamation point on that (21:52) is we tend to think of these in silo financial terms as well (21:58) around the therapy that may be used on individual patient. (22:02) And in fact, there's a lot of other costs (22:05) that get rolled into these catastrophic claims. (22:08) So a claim to maybe one or $2 million on a drug product (22:13) may actually be a four or $5 million total claim, (22:17) but it's not done if you're the plan sponsor. 

(22:20) Sure, as long as I've been around the industry, (22:23) I remember many years ago when the industry (22:25) would think a million dollars was a large claim. (22:28) Now that million is very rapidly becoming 10 million (22:31) and it's likely to continue on that progression. (22:34) So you're absolutely right. 

(22:36) When you look at the total picture, (22:38) it's not just one component of it. (22:41) When you look at all of the costs involved, (22:44) you may be dealing with large numbers very quickly. (22:49) So that brings us to a logical next step. 

(22:52) How are we gonna begin to address this? (22:54) And you kind of started throwing that out there (22:58) in terms of the collaboration that's required (23:00) and needed across stakeholders. (23:03) So let's explore that a little bit more. (23:05) Let's talk more about that collaboration. 

(23:07) What would that look like and how would that be started (23:11) where it doesn't exist today? (23:14) Sure, sure. (23:15) And this is something I'm quite passionate about. (23:17) I've been working on this and writing about it (23:19) and talking about it for almost a decade now (23:22) and even spent some time being involved (23:24) in parts of conversations (23:26) where there are actually folks (23:28) across the different parts of the industries (23:31) thinking about this, working on it, (23:33) but we clearly have a much longer way to go (23:36) before we do this. 

(23:37) But one way to begin really (23:39) is some really solid round table conversations (23:45) where you have manufacturers represented. (23:48) And by that, I mean, not just the scientists (23:51) who understand the chemical makeup (23:53) or the biological makeup of these therapies, (23:55) but folks that can actually speak (23:57) to how they need to get manufactured, (23:59) what the timeline might look like. (24:01) You need clinicians there, whether they're oncologists (24:04) or other MDs or other parts of the ecosystem (24:07) to represent the clinical side. 

(24:09) You need employer representation, (24:12) perhaps chambers of commerce or others (24:14) that can speak on behalf of employers. (24:17) And even that employer component needs to be thought about (24:20) because small employers are quite a bit different at times (24:24) than medium-sized employers (24:25) who are quite a bit different at times (24:27) than certainly large multinational employers. (24:30) So those components need to be represented. 

(24:34) And coming full circle, as I pointed out in the beginning, (24:37) since these are not insurance companies, (24:40) they are looking to buy insurance (24:42) and buy insurance and risk protection. (24:45) You need insurers represented at the table. (24:48) And because the dollars are so large, (24:50) insurers themselves look to protect their risk exposure (24:54) and hence buy reinsurance. 

(24:56) So you need reinsurers represented at the table as well. (25:00) And this can even go one degree further than that (25:03) because although individual insurers (25:06) sometimes buy reinsurance, (25:07) they may also buy that from more than one entity. (25:12) So sometimes reinsurance itself can be syndicated (25:15) or shared among a pool of other reinsurers. 

(25:20) So as you think further along the continuum, (25:23) these are some of the parts of the industry, (25:25) and you could make a legitimate argument (25:27) that this would ultimately reach Wall Street (25:29) and be securitized at some point in some way (25:32) through an insurance-linked security or some other means. (25:35) But these are the different parts of the industry (25:37) that need to be brought together (25:39) in order to have a holistic, well-informed conversation (25:44) so that we can actually arrive at solutions (25:46) or at least make meaningful progress (25:49) towards arriving at a solution that would benefit everyone (25:53) that may be made up of some combination of insurance (25:57) or warranties or securitized risk and reinsurance. (26:02) We don't know what that is today. 

(26:05) No one in the industry knows (26:06) where we will ultimately wind up. (26:08) And the only way to figure that out (26:10) and achieve a goal for the benefit of society as a whole (26:14) is to get together and talk about it in earnest (26:17) where we can find the right solutions (26:20) to make these therapies available (26:22) to the people that need them (26:23) and have all of humanity benefit (26:26) from these wonderful therapies (26:28) and the scientific progress they represent. (26:30) Yeah, so clearly in addressing the how, (26:33) trying to take stakeholder interactions up to the next level (26:37) and expand it, as you suggested, (26:40) to stakeholders that I think many people (26:42) haven't even thought about need to be around that too. 

(26:45) Yes, it's unfortunate that in the industry, (26:49) most people that work in the different parts (26:51) are very good at what they do, but they're narrow and deep. (26:55) And in that regard, they may know reinsurance very well. (26:58) They may know insurance very well. 

(27:00) They may know manufacturing very well. (27:03) But to solve this kind of an issue, (27:05) you need to have and gain a better understanding (27:09) of what the other parts of the ecosystem (27:12) are dealing with on a day-to-day basis. (27:14) So it's only through that dialogue and collaboration (27:16) that we will ultimately reach a future state (27:20) where these therapies are made available (27:23) and we can all benefit from them. 

(27:24) And it won't be reached overnight. (27:26) These are complicated, thorny issues. (27:29) They're complicated conversations, (27:32) but you have to put one foot in front of the other (27:36) and begin to make some progress. 

(27:38) And the way to do that is to bring (27:41) all these different stakeholders to the table (27:43) and start with gaining an understanding (27:46) of what each of these siloed (27:48) and different parts of the industry ecosystem deals with (27:52) so you can find some common ground (27:55) and build on it further from there. (27:57) And so that really is a great call to action (28:00) and something that's really tangible that we can work on. (28:05) And as consultants, both with what I do (28:09) with the Institute for Integrated Healthcare, (28:11) what you do as suit health advisors, (28:14) the helpers are out there. 

(28:16) We are able to help work towards solving this problem, (28:20) which clearly is not gonna get any better. (28:23) So what are some of the other ways (28:25) that we can actually get started on this call to action? (28:28) Is there a simple first step in working (28:32) with either one of us, with both of us? (28:34) Or other consultants? (28:36) Sure, I think the first step is really, (28:39) again, I have to thank you for this opportunity (28:41) because even talking about it is really a great first step. (28:44) I think the other part of it is to reach out (28:46) to various folks in the industry, (28:48) such as yourself, myself, certainly others as well, (28:52) who have spent our careers in the industry (28:55) and on a regular basis, (28:57) interact with different parts of the industry overall (29:00) where we have some understanding (29:03) of what their challenges are (29:04) and where the opportunities are. 

(29:06) And so I think that dialogue and that outreach (29:08) is a great place to begin. (29:10) Talking about it is a great place to begin. (29:12) Writing about it is a great place to begin. 

(29:14) If we were to even perhaps put an event together (29:18) where these different parts of the industry stakeholders (29:21) could join that event, (29:23) that would be a great place to talk about it (29:26) and actually begin to build something. (29:28) So I think there are certainly tangible steps (29:31) that could be taken and they all sort of start (29:33) with outreach and open-mindedness (29:35) and a willingness to engage in a dialogue (29:39) with those of us that have spent time (29:41) in the different parts of the industry over our careers (29:44) and an open-mindedness to listen (29:47) to what those challenges and opportunities are (29:49) and share your own as well and build on it from there, (29:53) as I said. (29:53) And that could be done virtually, (29:55) that could be done in person, (29:57) that could be done at a conference.