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Business as Usual Featuring Protecting Seniors in Long Term Care

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We have a unique opportunity to host two leaders serving at the epicenter for our most vulnerable population -- seniors citizens -- many of whom are residing in long term care. On this episode of Business as Usual today at noon, we are featuring Nick Vizzoca, President & CEO, Vincentian Collaborative System and Nancy Zionts, COO & Chief Program Officer, Jewish Healthcare Foundation. The duo will offer their expertise and insights about the current state of providing services to seniors, COVID-19, testing and how this effects all of us across our regional community.
 

Transcript:

So good afternoon everyone and welcome to business as usual, this is this may be a hump day but this is a hot topic that we're going to talk about today. I'm Audrey Russo, President and CEO, the Pittsburgh Technology Council, and I'm joined here today with Jonathan kersting, who's vice president of all things media and marketing. We are thrilled to have this conversation today. Thrilled probably isn't the exact word because the because the topic is so important and it affects each and every one of us. So, I am going to just set the table and thank our sponsors that's Huntington, Deloitte and sheetz, they believed in us Huntington is believed in us right from the beginning. Deloitte has worked in the innovation community for a really long time and sheets has been very, very active in the pit.

spark community, not just in addition to their storage, but they also have an innovation center. They're working on the future. So tremendous partners, companies that you should get to know because they're integral to the fabric of our region. And I also just want to tell everyone that we've muted your microphones only with the intent that we don't hear anything in the background. And we also want to make sure that we have a chat, and the chat is there for you to ask questions of our guests, Jonathan will monitor that and and make sure that the questions get asked accordingly. But also, we want to make sure that this isn't an opportunity for you to sell your wares. That's not what this is about today. So I am going to jump right in. I want to make sure that we have plenty of time to have this conversation just like we do each and every day. And I am pretty thrilled by the guests that we have here today. First, we have Nick Vizzoca. He is the President & CEO of Vincentian Collaborative System and we also are joined by Nancy Zionts. She is the COO & Chief Program Officer of the Jewish Healthcare Foundation.

A foundation you can't have, we have two people here that have spent an enormous amount of time in what we're going to talk about in terms of long term care. So if you saw on our invite, we talked about assisted living, we're really talking about all of lawncare. So I'm very happy to have this conversation because it's timely, it was important, and it affects all of us. And when I say it affects all of us, if you heard any of our shows before, you know that we've talked about the issues in terms of health care, but the issues that are affecting communal living, have been a huge sore spot for our entire community. So when you think about the people who are working in these environments, and the people who are living in these environments, these are our most vulnerable population, but they affect each and every one of us in terms of what it means for COVID in our region, and what it means in terms of how we treat people who are most vulnerable and in addition to their employees, we have been active at the state level trying to make sure that that the resources are pointed, so that the community environments or long term care environments can get the support that they really need. But if you look even at today's paper on the post, because that you can see that we still have troubling times all around us across the state of Pennsylvania. That is my rant for now, if you ever want to talk to me about it, again, you know where to find me. But I am going to pass the baton to these two individuals who spend their work than their time doing work that many of us do not either understand, haven't been touched by directly, but really need to know. So I'm gonna kick it off. We have Nick, Nick, come to the forefront. And I mentioned that he is here with us from the ascension collaborative, and he runs the operations and I want to introduce Nick. So Nick, thank you for joining us today. Really appreciate you being here. So just set the stage.

Tell everyone what you do. And what are the big issues that you're facing? Yeah, thank you, Audrey. And thank you, everyone for having me. Yeah, these are definitely difficult times. So as Audrey said, You know, I run vincentia collaborative system. we oversee almost 450 skilled beds, personal care, independent living, we also have childcare. So we run the gamut from you say cradle to grave, right. So we have it all. And it's it's definitely something challenging, but what I will tell you is, you know, when I took this position and assembled a team, I'm not interested in making the trains run on time, I'm interested in using different trains and changing this industry and turning it on its head because for so many years, it's been neglected and it's not been paid attention to, and everybody wants to pay attention to it when you know, the proverbial shit hits the fan. And things go wrong. And that's when you know, that's not right.

We've gone too long neglecting this industry and I'm here to tell you with with my team and with others, that we're going to change the way we do things going forward. So thank you, Audrey for having me. I look forward to this. Thank you. And then I'm gonna pass the baton really quickly to Nancy science. And I mentioned earlier, she's the chief operating officer and chief program officer of the Jewish health care foundation. So thank you for being us. Hi, Nancy. Hi, let's talk about what you're up to what you do and what you oversee. Perfect. So many of you know the Jewish health care foundation here and find Susan and I were privileged to be on this program a few months ago actually discussing this topic and others, and the foundation doesn't just focus on issues of aging and long term care. We also have agendas that overlap and patient safety in women's health, HIV AIDS, adolescent behavioral health and a whole host of other programs. But I've been with the foundation. This is my 26th year and I've always had the privilege of being able to manage a strong aging and long term care team focused on everything from advocacy.

engagement of seniors to the provision of care at the front line, and we are always focused on how do we provide the support that the workforce in long term care deserves to have in order to take care of our most vulnerable residents in our region. Okay, thank you. Thanks for joining us today. So, so next we're going to go back to NEC as someone who's leading this massive operations, what are some of the biggest issues we're going to talk about? Let's talk about COVID. Obviously, what are the biggest issues that you are facing as a leader of, you know, the ascension collaborative in terms of COVID? And because of long term care? Yeah, I think I'll start with long term care first RG right. I think this is an issue that it's been, it's been plaguing this industry for well before COVID. You know, we realize there's no funding issues in terms of reimbursement from Medicaid. And you know, you and I have talked about this as a faith based nonprofit our our focus is our mission.

And we're not bottom line driven. We're mission driven. You know, I have 68% of our skilled residents are on Medicaid. So before cobit even started, there was an issue, there was a problem. There was a problem that you know, I it cost more for me to kit care for a resident in met on Medicaid than it does that I can pay out right. So it's there's a staffing issue, let's get down to that first. You know, being faith based and there's there's 10 of us nonprofits, you look around this region, and you see a lot of for profits coming in. And these for profits will cherry pick and they'll take what they want when the money runs out, and I get them, or the folks that these nonprofits get them because you know what, we don't turn anybody away. That's our mission. That's what we do. And then competence and now all of a sudden, everybody wants to bring attention to this.

Right now. It's a problem. But I will tell you that I'm blessed with a team that's incredible here at intention. We created a Clinical Excellence team and before there was even the initiative to shut things down. Back in February, this team had the foresight to sit down and create to 15 bed COVID units in our North Hills, we thought that that was going to be used for our own residents. We thought, you know, if a resident is tests positive, we've got these two units we've just created, and there are negative air pressure isolation units marked off from anywhere else on the campus, we won't mix. We've had over 30 residents pass through those units, and not one has been one of our own. We've accepted COVID positive patients from hospitals from other facilities and allowed them to recover. And the sad part is Audrey, none of them want to go back to their facilities. They don't want to go back to the brightens of the world. And these are problems that existed before COVID. So let's get this straight like he should have fixed this, the state and the do h DHS, everybody. You should have been on this years and years ago, but you sweep this the senior sector under the rug.

I'm here to tell you like I said, My team and I and I know Nancy is in jhf is focused on this. The time for talk is over. We need action. We need doers. We need doers to step up to the plate. So let's do it. So, Nancy, let's talk about what this new collaborative is with this coalition that's been formed. Sure. So the first thing I want to say is just to level set for people in terms of the statistics 90% of the deaths of people with covid are over the age of 60. And that accounts for 70% of all of the Allegheny County deaths are from long term care facilities. So lest we think this is a small problem, this is a huge problem. It is impacting a certain sector of our community, much greater than other sectors of the community, but it impacts all of us. These are our neighbors, these are our parents. These are our grandparents. And these are people that we need to make sure that we are able to address their needs on an ongoing basis.

And these are our friends, facilities. These are the people who built our community when you think of their ages. These are the people who built our community who took Pittsburgh for where it was to where it is now. And it's not just that we owe them, they are a part of us. And it seems natural that we would give back to them. And I want to say that this particular group, and this business as usual call is behind a lot of what we're seeing now coming out of the state. For example, when you had us on a few months ago, you allowed us to get fired up and ask people to advocate on behalf of this sector. And I want to tell you that the program that was just funded now, out of the state, which is called the regional response, health collaboratives is a direct result of that advocacy. It's a direct result of people saying, we are not doing well by our seniors, we need to put money behind this. We need to put the best minds to go in with infection control protocols to go in with appropriate reliable timely testing. So we can really get control of this virus because the virus has control of us now. So these regional response teams are bringing together the best of the academic medical centers and other health centers from across the state working collaboratively assigned to facilities to go in and do what we asked for, do some rapid response, go in and find out what they're missing, provide them with the assistance they need on a on a daily basis. And I'm incredibly proud to be partnering in the western part, we're partnering across the state with a Learning Network, but incredibly proud to be partnering in the western part of the state, the best collaboration between UPMC and Allegheny Health Network. This is a time when our community said step up, do this together, and they have stepped up to do this together. So there's a lot of work and it's a horror story of what's going on in skilled nursing. But we are trying to put the best foot forward with the best resources in collaboration. Okay, so I'm going to jump back to Nick and I'm going to talk about the realities day to day. Let's talk about day to day. Let's talk about that.

Things that you and I talked about from, you know, having the right equipment and testing, and the process, etc, so that people can understand the snapshot of what it is that's going on each and every day. Yeah. So, you know, I agree with Nancy, I think it's well intentioned what this regional collaborative is setting out to do. But I also have to say that, you know, when you put together these seven academic institutions across the state to create an infection protocol and create processes, you know, I'd ask the question, did anybody ask us that anybody asked the people who are living this every day? And I get it, I understand, you know, h en UPMC. And a lot of large organizations that they're very, they mean, well, right. The fact of the matter is, I still can't get testing. I'm testing right now. And I will tell you that quest has a backlog of over 25,000 tests, so I have to wait 17 days to get a result. 17 days Well, I will tell you one of three things, one
happened in 17 days, either one that person will pass away to they'll recover or three, they're going to end up in the hospital. Now I've infected my entire facility. So so that I think is an issue. But, you know, you hear a lot of rapid testing, rapid testing, I can tell you, you can send an employee right now to an emergency room and they will get rapid testing within 40 minutes, they'll get results. Why can't I have that? Right? That's what I need in our facilities. I don't I can't wait two weeks. I can't. It has to be right now real time. So all this is talk is great, but it's going to come through late. So I couldn't agree with you more. So these were only literally conceived of in June, and literally are just being stood up.

Now. I can tell you, I don't know one rapid response team that has yet been able to deploy out to a facility because they still don't even have their contracts from the state and it's not their fault. This this is something that the state came up with, and the infrastructure for anything have you on this call of getting something through government is very complicated. I will tell you that I do think that some of the best clinical people are being put on this. But Testing, testing, testing, we don't have across this state, adequate supplies, the adequate reagents, we don't have reliable tests, if 50% of it is if a test has a 50% reliability and a zero percent reliability, in my opinion. And if the turnaround time is anything over 72 hours, I couldn't agree with you more, you may as well throw it out. If by the time you're finished testing the second unit, the first unit has been reinfected. And this is coming from the outside. So one of the things that I think is really critical for everybody on this call to understand is you may not step in a skilled nursing facility ever, but your behavior impacts what is going to happen in that skilled nursing facility in this in this county and others. You're wearing a mask yourself.

distancing, you're making sure that you're washing your hands and that you're not going out at, for almost anything, we'll keep people in skilled nursing facilities safe because the staff that Nick has to put out there every single day, has to go home has to go to the grocery store has to go to the pharmacy has to take care of their family, we need to give them the full name to do that, not surrounded by those of us who may or may not be practicing the best socially responsible behaviors, and all of us. So let's go back to Nick. Thank you, man for that. And that's that's what I was trying to set the table early on is saying why this is so important for all of us. But now I'm trying to teeter back and forth in terms of reality. So here's Nick running this operation, trying to keep everyone safe, trying to make sure that he's accommodating. What about like protective equipment? what's what's the status of that neck? Yeah. So early on.

In this, we were fortunate enough to stock up. You know, I will tell you I was the guy at Home Depot at midnight, when the when the trailer came in and tried to buy whatever I could it felt like I was buying stuff off the black market, right. And I think we need to continue to do that. But Nancy brings up a great point, you know, you go out it's it's selfish not to wear a mask, it's selfish, not because you are affecting everybody else. And I will tell you, in two to three weeks, if these school districts reopen, it's gonna get real, it's gonna get real, because I'm telling you, these kids are going to go to school. And they're going to come back whether it's a hybrid or a folded, and they're asymptomatic, right, and they're going to give it to mom or they're going to give it to dad or they could potentially when they go to the grocery store, they may run into one of my employees. So I think that once fall hits, this is going to become even more critical to Nancy's point that this testing has to be rapid. This PP has to be available. And I'm not interested in those facilities that can't get their act straight and have an infection prevention protocol already in place. I don't need this collaborative to come in and tell me how to do infection prevention. I know how to do that. You should know how to do that. If you're in this business, if you don't, you should have your license taken away. You this collaborative needs to help us with staffing. Because unlike the big health systems, that here in western Pennsylvania, we've been fortunate, we haven't seen what happened in New York City or in other places across the country. And a lot of these health facilities and hospitals have been laying nurses off because there's no volume. And we don't have the staff. I can't get staff. I have to go to agency and now you're introducing new people in staffing is an issue. I need help with staffing from the regional collaborative, I need help with testing. I need help with resources in terms of getting the PP that's where the Help is. I don't need I don't need to understand that.

Hey, you're you've got documentation on infection prevention. Yes, we've had that for years. That's what you should be doing. Um, Nick, let me clarify a little bit here because these are not people coming and from the Department of Health and they're not coming in to regulate you and they're not coming in to report on you. So this program is completely voluntary. Your your facility's participation in this program is completely up to you. And you can also pick and choose what parts of this program matter to you. So let's be really clear. Next facility is like none other. There are some excellent facilities in our region. And then we know that there are some others at the other end of the spectrum. So I think it's really important to know that everybody is going to need something different from these regional collaboratives. And you need to articulate to them what you need. And if it is staffing, push the staffing button. You don't need them to come in and teach about infection control. You could teach others and I'll call on you to teach others but you need to get them in for staffing and you need to get them in potentially, to help you deal with protocols of what do you do with patients who don't want to return back to their home facility, so you don't have to have them come in and do infection control.

Boy, aren't there facilities out there, Nick that you want to have experts go in and do infection control for. So I think not not only do the infection control, but I think it's up to the state Nance, right to also say it's time for these places to be shut down. It's been long enough, right. But but so you brought up a good point, if it is staffing, and I will say I'd raise my hand and say staffing, but the answer is not well, here's here's two phone numbers, two staffing agencies, go call them and good luck. No, I need you to help me, I need you to deploy staff to me, at least for this short period time. Look, we've been very fortunate by the grace of God. And I tell you that our sisters pray for us all the time. And this is why we don't have any negative resonance. But I'm not going to fool myself either. You know, things can change on a dime. We've seen it happen and an outbreak can occur in my facility. But I'd like to think that that our, our staff and our residents in our employees are, are, as you said, they're there. They're one in a million, I mean, and then I would put them up against anybody and I've worked a great year.

organizations in this region I've worked for Highmark, and I've worked at at UPMC. And I'm telling you, this clinical team that I have here at Inception is incredible. And you're right, Nancy, but but it's a focus, and it starts at the top, and leaders have to lead, I'm not going to manage this. I don't manage that every day. I need to give my team the resources that they need to go out and do it. But they also need to bring, I am extremely grateful for the regional collaborative I am because you're absolutely right. I, if one of us fails, we all fail, right?

Because as you see in the news, and whether it's in the post Gazette, or on Ktk, or whatever news outlet, when one facility goes up, we're all lumped into that man, we're all horrible. So one of the things that we learned Nick, in the early part of the strength of spring, when we were helping to provide education and training for personal care, assisted living facilities in some of these clinical providers, where we're having call in hours for them to help them, we found out that the breadth of skill in these facilities it runs the gamut from from zero to 100. Some of them I'd say minus and the ability to reach out, this is probably the first time that they've had coordinated attempt to get them the resources that they need. This does not take away from the initial part of this conversation there. There's something to be done here for COVID. But if COVID were to magically disappear tomorrow, this conversation needs to continue. We need to be as a region committed to only having facilities that are of high quality, that deliver high quality that are committed to improving themselves. And they can only do that if they are staffed appropriately. And that can only happen if they are paid appropriately. That's right. Yes, it all goes right back up to what is the policy that overlays all of this. We are now realizing that we should pay people hero pay. I'm going to tell you, I don't know when we should ever stop paying them here, okay. That to me if we if we can find the money to do with short term, it's a recognition of the fact that we should have had that money placed here. Long.

term and for the long term, you're absolutely right. Let me let me ask you this night ask anybody on this call this. What do you think's going to happen here in two months when the flu reemergence, right? How are we going to how are we now going to figure out whether you've got COVID? Or you've got the flu, or you've got this or you've got and I agree with you, man. It's that hazard pay? That's wonderful. But I will tell you and no, I'm not taking anything away from hospital nurses and doctors because they're fantastic. And I think what they do is great, but my nurses I will challenge anybody come and do what what these folks do in these nursing homes for one day, and you'll leave running on what they get paid. They deserve to be paid double what they get paid. If not triple they are the true frontline heroes in this battle. The irony is we'd like to take everybody in and show them the work these people are doing and we are at a time when these facilities must be locked down completely. And as painful as that is for some of us who are worried about the isolation of seniors, it is incredibly painful to know that families haven't seen family members. And to try to find creative ways to connect them.

echnology has been a godsend to these facilities, whether that's using FaceTime or whether it's connecting them using zoom, or whether it's doing to telephones across a glass so that they can meet with people. That has been wonderful. But we're not going to be able to do those sorts of distance visits in the winter, right? We're going to have to find new technology that will allow us to bring the outside in while leaving the virus on the outside. That's going to be really, really critical going forward, because we are not going to be able to just turn a switch and say, We're going back to the way it was because frankly, the way it was wasn't the way it should be in the future. Anyways, long term care needs overhaul, right, new facilities that meet the needs of seniors that are safe and that are respectful of their workforce. So will this work address something that Nick mentioned when I see someone brought it up.

I'm gonna sort of paraphrase that other states, their Medicaid rates are almost double that of Pennsylvania. Is that in fact true? And is it in fact through the PA is not raised the Medicaid reimbursement for like many many years? Seven years, Adri seven years. So will there be some focus on this Nancy in the collaborative is there? So it's very funny before not so much funny. But before COVID this was an area that we were very, very focused on as a foundation. We were focused on it with people like Nick and with senior care and the Jewish Association on aging. We have been focused on doing right now working with leading ATMs to do the case for funding for long term care in Pennsylvania. The case is easy to make. Finding that funding is not that easy to do, but the case is easy to make. We can see that we are not adequately paying or staffing. Nick, do you want to jump in? Yeah, yeah, that's I agree with you.

I've gone to Harrisburg, and I've lobbied in with some great people. And right, the funding goes elsewhere. So my point to them was great that the funding will go elsewhere. Let's sit down and figure out an innovative way to do this something. I don't want to come to Harrisburg every year with my handout saying, I need another 2%. I need another 2%. That's crap. Like I'm saying
that we need complete overhaul this system is fractured, it is broken. It is broken when when most folks are going to personal care, and they're paying 567 thousand dollars a month private pay without any help from the government. And then their funding runs out. And now they've got to come and live with one of one of our facilities and they could potentially be there for 10 years. And you're losing 100 to $200 a day depending on the condition of that resident over 10 years. That's a lot of money. Right? But what I'm saying is let's sit down and figure out some innovative model let's figure out a way to save money.

Not everybody qualifies for Medicaid. And I think Nancy, you brought it up, we owe it to the people in this region, the largest chunk of the people in this region are the middle class. And those are the people like my mother, my father, who my father was a Port Authority Bus Driver, and he served this county. Well, my mother was a stay at home mom, but you've got people on this end of the spectrum that are wealthy and don't care, they don't need it, they're gonna pay for it. Then you've got people on this and they go up, I depleted everything. I'm on Medicaid, Medicaid will pay for that large chunk in the middle says, I'm crap out of luck, because I don't know what to do. I don't qualify for Medicaid. I don't have enough money to go into these facilities. I'm stuck. Right. So is there a way to maybe be innovative and say instead of spending our money on Medicaid, which is hundreds of millions of dollars a year, should we be reimbursing some of these people for personal care and bring the services to them into those facilities, bring the home health there and let them age in place truly age in place.

We just build an independent living facility in the North Hills and we leverage technology we work with K for connected North Carolina we that places a smart building. So those people can age in place that should be their last thought you shouldn't have to go from independent living then to personal care and then to scale and then stay here, we'll bring the services to you. Other countries have done this better. I've spoken to Adri about let's try to use a forum like this to bring in best practice from around the world. Let's try to look at what could be innovative in how we give our seniors whether it is five years or 40 years of their life, what is it? What should it look like? What should living look like, what should maximize and we call them the golden years, we owe it to people to make sure that these are satisfying years, and it probably in some cases will cost a little more and in other cases, there'll be a lot of savings, but there isn't a lot of good planning going into it in this country and not in this state and there's an opportunity to do so. There's no niche I couldn't agree more. And this is one of the reasons why I've got five college students living with our seniors in the North Hills, and soon to be in the next week, 16 graduate students from Chatham university that are going to move into a personal care facility chudley Gardens. Let's start to and to Nancy's point that wasn't something that was that we took from a best practice here in the US. It came from Belgium. It came from the Netherlands. And I agree with you, I'm done. I'm done. We're going to look elsewhere. I'm looking at other industries, I'm looking at unlike industry, so if anybody's on this call, you want to talk to me reach out because I want to be different. I don't want to talk to other senior operators. I want to talk to other industries. So what in terms of technology and in terms of the tech community here, obviously, we have a platform and start we're continuing this dialogue. How do we help? How do we help in in a concrete way? I would, I would ask in a few areas.

Part is we're going to need help in continuing telehealth, which is now not going to go away after COVID, which is terrific people can age in place and get care that they need. We need strategies to reduce isolation. I think that's going to be really important. And then we need creative minds to work with people who understand seniors, people who provide long term care, and architects and designers to try to design new types of facilities and living arrangements that can be offered to various people. Let's try that out in the tech world. Let's figure out what those can look like and be configured. And I think that would be a great bringing together of a range of different industries. Nick, what can we do for you? What can we do for sanction collaborative?

Yeah, I think the biggest thing that it's already been done for us is we've we've implemented karate, which is telehealth through all of our facilities, and it's been a godsend. It's been a godsend because these residents don't have to go out. But the screening technologies, you know, that are out there to help before folks even come into To our facilities, you know, how do we screen them and make sure that they don't have? I cannot tell you how many folks workers, agency workers have showed up at our door with a fever. You know, and we have to turn them away. So is there a way to work with these tech companies? And listen, we've got a lot of bright minds in this region. You know, it's not it's not meds and EDS for for no reason. And whether it's Carnegie Mellon or the University of Pittsburgh, there's some bright people out there. So is there a way and Nancy's right this is not going to go away? You know, whether a vaccine comes out or not it this is going to be with us for a while but is there a way to virtually connect these seniors other than just maybe an iPad or a FaceTime? Is there a way to connect them through virtual reality platform to make them feel a little different like so let's let's get our innovative juices flowing. I am not interested in running a nursing facility I'm not these people are smart. These people in our homes are tech savvy.

hese seniors in our independent living, we always to them, not just to care for them, but not to treat them like indolence, they are able to learn and they can teach us. Let us hook everybody up in your facility to the virtual senior Academy. We talked about that the last time we were here with Marilyn. And we, we have opportunities for seniors to learn everyday together from each other from
let's continue to give people the vibrant life that they deserve that matches the life they had before, and and matches the contributions just the next chapter of their life. That's what it is. It's not the end.

So there have been a lot of comments on this chat, we will save them, okay, and send them to both Nick and Nancy. We don't have enough time to go through it all. And I really want to be sensitive. I mean, people are offering some suggestions. They're talking about collaboration. Obviously, there's a lot in the tech community. But for me, and the purpose of this conversation is to keep this at the forefront in terms of all the topics that we address at the tech Council and across the tech community.

This is one that needs to be highlighted. And this is one where people actually want to help. They want to help. You can see this by the chat, you can see this by the engagement, and you can hear it in, you know what's happening in our community in terms of the actual facts, because the data in and of itself, is not being shared in a way that Nancy articulated early on. And here's Nick is alone. You know, I don't want to call you a lone ranger because you got a lot of support. But the point is, is that we all care and caring has to turn into action. So I cannot thank you both enough for spending the time with us today. As you could tell, we could have gone longer, but really appreciate it if people want to reach out to you Is it okay if I share your emails, your contact info? Absolutely. I welcome that. And, you know, stay connected to us neck as well. If there's anything we're already connected to.

The Jewish health care foundation. We're passionate about trying to create innovation and solutions. But we need to hear it, you know, from leaders like you. And Jonathan, I know Jonathan was here the whole time. But really appreciate Jonathan being with us, as well as the tech community realize that we are going to continue to have these conversations. And thank you to both of you for the work that you do. Thank you so much for the opportunity. Thank you, Audrey. Thanks, everybody. Awesome conversation.

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