1,300 Point Solutions Killed, CHF Admissions Halved, and the Mercy Playbook | Steve Mackin, Mercy CEO

[MUSIC PLAYING] Welcome to Claims Denied. One man's quest to learn everything there is to know about the business of health care. I'm Blake Madden, your host and creator of Hospitality, a health care newsletter and ecosystem discussing the latest in the business of health care transformation. Each week on Claims Denied, I sit down with health care leaders and peers to talk shop about emerging trends and health system transformation, health tech startups changing the game, and scalding hot takes on the future of the industry. OK, we are back once again with the Hospitality Claims Denied podcast. Today, super excited to be joined by Steve Macon, who's the Mercy CEO, runs a top 15 health system in the country. Steve, thank you so much for being here. And from what I understand, you're a golf fan as well. Same as yours, truly. I am actually wearing green today in honor of Masters Thursday, which is the date we are recording this. And I would love to know who is your pick to win the Masters this year? Well, my hope is that Rory McElroy will repeat this year. I loved watching him win last year. I loved his joke the other day when he'd come in at him why they're not serving Irish food for the Masters dinner. And my hope is that he repeats. Yeah, yeah, that's a great one. Rory's been playing well. Curious your thoughts on his Master's dinner? You think you did a good job with creating that menu? I think it's incredible. That is one of the best traditions of all of any-- Really is. I think come together. Really is. And all the past champions break bread and have a good time. And I think that's a special thing to see. And so, yeah, I'm Roon for Rory. Absolutely. Yeah, I agree. I think his dinner was pretty good. Lay out of various types of foods. So I wish I could join one day, but I don't think it's in the cards for me. He plays like-- OK. Yeah, Steve, Steve, thanks so much for joining me today. We'd love to dive into the nitty-gritty health care stuff, of course. So we'd love a little overview of your backgrounds. And I know you were at the Cancer Treatment Centers of America. And they moved over to Mercy. So really, kind of for-profit to non-profit. Curious what spurred that move and how your journey led you to where you are today? Yeah, I've really been fortunate to have been a part of two incredible organizations, two very different organizations. First, near 1920 years of my career was with Cancer Treatment Centers of America. And I came in as their first management trainee and then had the opportunity to just grow my way up into that organization and run a hospital for them very young in my career and then get to the COO and then an interim president role for about a year. And it just loved it. Entrepreneurial organization and love the focus on the consumer and the patient. And I would just say, you know, it was an organization that built the care model from the ground up with the needs of the patient. I mean, they put human center design on a platform, engage patients in decision making. It was a great model to learn from. But my pivot to Mercy has been great. And what attracted me to Mercy was this incredible organization and near 200 year history that dates back to Ireland. And at the core of Mercy's mission is to address the unmet needs of patients and to do it in innovative ways. And when I met Lynn Britton, who was then CEO is now our executive chairman of our board. And I have the benefit of working with Lynn every day. And I found a guy in Lynn who is an innovator, caring individual, innovator. And there's truly an entrepreneurial spirit at Mercy. And what is distinguishing is there's always a pressure in health care given the economics and the demands to focus on near term results. But Mercy had this incredible balance of balancing the needs of today with a long term vision of how we get health care right. And Lynn really communicated that effectively to me. And I was attracted to that. And we operate in very difficult communities, very difficult markets. There's a reason not for profit stone come into some of the states that we operate in, or for profit stone come into some of the states that we operate in. They're difficult. But that forces Mercy to be entrepreneurial and to find a way forward. And we've done that in a very successful way. And so those are some of the fundamentals that attract to me. And those are some of the same fundamentals that attract people that are missionally oriented and who are entrepreneurial to continue to come to Mercy, from our provider base all the way to the executives who lead our organization. I love that. Yeah, awesome. Entrepreneurial, entrepreneurial spirit. We'd love to dive into that in a second. But the first question I have for you is going from for profit to nonprofit, for profit, focused on, efficiency, still patient access and care at all those things. But then you move to nonprofit. And I imagine there's a lot more politics involved and committees and local market dynamics and those sorts of things. Was there a little bit of culture shock for you and kind of moving organizations or were you prepared for it or what was kind of like the biggest surprise in that move? Yeah, to be honest, it wasn't a huge shift for me. I mean, at the end of the day, I would just say one of the benefits in coming to Mercy was, again, we're-- we've had a health care footprint in North America over 100 years. And we date back 200 years. And so-- That's crazy. At the heart of what we do every day is how do you create long-term sustainability? And how do you take the long view to get the right care model in place to have the greatest impact? And there's also a philosophy-- and this philosophy existed in the for-profit arena that I operated in, and that is scarcity, your friend. How do you-- how do you innovate and create something out of scarce resources? And in a startup environment, you have scarce resources. You have to be-- you have to do a lot with very little in the early days, in particular. And you have to be very resourceful. Well, the same exists, in my opinion, in now for profit health care. So one, I love missionally that we will not turn a single patient away, regardless of their ability to pay. No matter the complexity of their situation, we have a moral and ethical obligation to care for those individuals, not just the commercial patients, and not just the Medicare-Advantaged Life, but all patients. And so that inherently injects scarcity into your health system, and it forces you to think differently around care model, and how you can wrap a care model around all types of patients from those able to pay, those unable to pay, and do it in a sustainable way. And so that is, I think, a unifying force in both environments that, to me, I find very attractive. And so that's kind of the common thread, the golden thread between both. Again, there's different outcome. You've got a shareholder focus on the one side. You've got a mandate to grow and to create a long-term pregnancy value that can be capitalized on the one hand, but on the other, we have to have a long-term sustainable model. And we have to have a free cash flow that allows us to reinvest in the communities that we serve. So some of the fundamentals apply, regardless. Yeah, that's so interesting. I haven't ever thought about that through line like that between a startup. I guess, really, in capitalism, everybody's kind of working and operating with some type of scarcity, whether it's capital or resources, what have you. And you also just mentioned you really like for Mercy and the folks that you attract your organization to be more entrepreneurial. So I kind of see a little through line there. And I'm curious, how have you set up one, how do you identify those types of people? And then two, how organizationally, how do you set them up for success? Is there a certain kind of team model or are you kind of more flexible or nimble in certain areas? What does that kind of look like? Yeah, I think selection is a really important thing in any environment, any organization. And I think for Mercy, we're very focused on talented people who have not just great pedigree, but also the kind of individuals that have-- can take a personalized and a personal approach to working with people who are innovative, people who like change. I think I have a bias towards really paying attention to an individual's change orientation, because that's a really important aspect. We can't-- status quo just doesn't work well enough. In our environment, we have to have people who are comfortable driving and navigating change. That's a critical thing. But I think also most important because we're a faith-based ministry. We also look for Mercy Fit. And people who have Mercy Fit tend to be other centric. They tend to look at how you create universal solutions that are good for all. And then I also look for people who can find a way to create what we call that virtuous end, like solve a problem for the consumer and simultaneously solve a problem for the caregivers who deliver the care every day and make life better for them. And so those are pretty clean-point. I think the last thing and what we often talk about is, you know, you want people who have a point of view. We're paid to have a point of view. And I'm always, you know, particularly operating in a healthcare space where we have to change, we have to evolve. We want people who are comfortable sharing a perspective that can redefine what our new standard should be. And so I tend to surround myself with people who have a perspective and who have an evolving perspective and can iterate and constantly influence my thinking and influence the thinking of my board and the communities that we serve because I think that's critically important. - Yeah, I love that. It's fascinating. I also agree. I think, you know, you want people who have opinions and can disagree and that fosters the best room for growth. So that's very cool. Steve, we'd love to shift next over to, you know, Mercy more broadly. I love your thoughts on, can you give me a lay of the land of Mercy? How would you assess, you know, the current state of Mercy as you see it, you know, thousands of you of her everything? Can you kind of walk me through, you know, your local region, local market dynamics? You mentioned earlier, some of your markets are difficult. That's why nobody else enters them, those kinds of things. What's kind of the, you know, the lay of the land as you guys see it? - Yeah, so just to give a framing, we are a Midwestern health system that essentially extends from St. Louis throughout the state of Missouri, or just provider and throughout the state of Missouri, and then into Oklahoma, Arkansas, and a little bit into Kansas. And we have over 55 hospitals. Those hospitals are arranged from level one trauma centers all the way to critical access in rural hospitals. And so we serve diverse populations, if you think about the needs of everything from people who live in the cities, all the way to the rural communities. And then we have a network of over 4,500 clinicians, providers who are our provider base who are employed, and then we have thousands of clinics that connected, connected all. We have a large urgent care footprint through a partnership, and so we have a diverse offering from a acute care, ambulatory care, and then post-acute, that helps support our patients, okay? And so it's a comprehensive health system, and pretty geographically condensed, that allows us to really meet the comprehensive needs of patients. In all of our communities, there's a variety of health systems that exist in the communities that we serve, from work number one in all of our communities, except for one, and we're growing. And I would just say, our focus is really on how do we perfect our care model? So if you, if I were just to distill our strategy and our care model down to a single idea, it's to provide proactive predictive and personalized care in near real time through the appropriate channel. That's easy to say it's a really hard thing to do, but that's at the heart of our strategy. And it's a care model that's focused on reducing friction and improving the lives of our patients. And so it's working. And so as we remove friction from the care experience for patients, more people are choosing us. We've achieved a 11.9% care for each of the last three years, and it's in part because it's a consumer-friendly model. We're also a health system that's committed to value. And so we're one of the largest ACOs, and we build risk into a lot of our contracts. So not only are ACO's total ACO and M.A. Over just under 300,000 lives, and we have over 119,000 patients in advance payment models. And over the last six years, we've saved the government over 952 million in value-based revenues. So we're a value-based model. And I think that's a critically important piece. And that's why we focus so much on care model and driving value for our patients and those that we contract with. So that's a little bit of a high level of mercy in our rear-to-world and strategy. It's a lot there. - Yeah, thank you, Nott. It's probably mildly difficult to put all the framing together with such a huge health system. 55 hospitals and all the things you mentioned. And we'd love to dive into each of those. But the first thing I want to talk about before talking about value-based care or consumerism and those sorts of things is just strategically and financially, you guys had a little bit of a lull and then more recently, you've rebounded from a financial perspective. And I'm curious, since you operate in the Midwest, lots of real presence, like you mentioned in those sorts of things, they're seeing a lot of pressure, right? And what have been kind of, in your viewpoint, the strategic levers that have resulted in this rebound, like where are the specific areas you're seeing, growth or better performance and also better patient results and outcomes in those sorts of things? - Yeah, so I would just say, and this kind of gets back to that scarcity point. We've operated at a price point that's very different than many of our competitors and we're okay with that. And we can live within that, frankly. And so it's allowed us to focus on a care model that doesn't just think about how you drive performance when patients come into your hospitals, but it's forced us to think holistically around caring for the patients when they're at home, all the way, the 24/7 experience for patients, okay? And to manage those lives to outcomes that are good for them and also then produce good results for our health system. So we're not focused myopically on just getting patients and what you commonly hear in healthcare around heads and beds, we are focused on producing great healthcare outcomes. And so when I talk about our care model, it's how do we care for the chronically ill? How do we care for CKD patients and CHF patients? And I'll just give you a couple of examples. So because we're at risk, we feel you think about CHF patients. It's a huge cost to our healthcare system, just global nationally. And those patients become uncomfortable, they tend to go into our emergency departments and because they don't have another alternative, because their doctors and their health system is not engaging them when they're at home, when crisis starts to develop for them, for those individuals. Well, we change our paradigm of care. We stay in frequent contact with those patients. Those patients have 24/7 access to mercy virtual on our care model. And then we deployed solutions out the community so they can access in a same day outpatient clinics that allow them to address their fluid management needs that tend to arise with those patients. And just in the last year, we've deployed over 12 clinics, we're gonna deploy twice as many over the next six months. And we've been able to cut our ED admissions for CHF patients in half over the last year. So that's one example of a very complex patient population whom we say in constant contact with, so we can proactively manage them. And then we can help those patients learn new behaviors around how to access care in their terms that's better for them. And it also creates capacity because there's other patients who need to come in and have that ED experience perhaps. And so that's our view of the world is, let's not just keep doing what we do and keep throwing labor at it, but let's reimagine the care experience for chronically ill cancer patients. We have similar programs for diabetic patients, et cetera. And all of the trends are the same. And so as we remove friction for complex patients, it also makes the patient experience for those that are less complex that need care in their terms to be able to come in better. And so that's at the heart of our growth is the fact that we're building products and solutions and care model and then engaging the consumers to then use the care model differently that helps them get the outcomes that they're looking for. - Yeah, that's great. And I wanna go back to one kind of strategic decision and maybe a sort of North Star for your organization based on kind of the geographies you operate in, which is you kind of alluded to the fact that, hey, we've maybe conceded a little bit on price but we're comfortable with that and we've reoriented our care model to be more, since we're friendly, more effective and those sorts of things. And we can operate within the confines of that, maybe potentially lower price. I'm curious, what kind of, what sparked that decision? in the first place to kind of go with that approach versus a, hey, let's, you know, stay fee for service and go gun hoe as much as possible on, you know, downstream in patient care or outpatient highly lucrative, like that kind of setup, I guess, if that makes sense. Yeah. So, you know, we have a perspective on what we should be appropriately paid. And we also have a perspective on where we should take risk in our contracts, both in our commercial contracts and are also on the, you know, in our, in our risk based contracts. And, and we're constantly working that. But I would just tell you at the heart of it is, um, we have to get the healthcare model right. And I believe he who does that and does it sustainably, wins community by community, date by state, geography, like large geography budget, that is the, that is the problem to solve. And we can't honestly continue to push 10, 12, 15% price increases to employers. We can't ask the federal government to pay us more and more every year for a healthcare model that becomes less efficient. So, we're either going to be part of the solution or we're going to be part of the problem. And Mercy is committed to being part of the solution. And so, of course, we have a firm opinion on what we should be fairly paid for the care that we're providing. And we, we anchor on that. But we also strategically partner with payers. I would say, of course, there's always these adversarial moments that you'll have with the payer. But the reality is, the payers have the networks. The payers can create products that drive and, and connect the employers and, and the MA plans to, to value. And, and, and together, if payers and providers work effectively, we should also reduce the administrative burden that, that, that patients feel, that is non-value added, that adds a layer of cost that people never see, but is built into the pricing. And so, we're attacking all of those aspects, because that's how we create a sustainable model and healthcare. And, and so, you know, if you think about it, how you serve commercial patients is often very different than how you serve Medicare or risk lives. But you, we have to win on both. And, and so we do it through thoughtful partnerships. We do it through creative product design. We do it through new models of care that can engage consumers differently. And I will just tell you one of our core tenants of, of the strategy that we're executing right now is, you know, we've, if you think about the consumer, you know, we've trained them to not have, to, to, to, to circumnavigate what we've put before them. We've, we've taught them bad behaviors. There, there's such low reliability in what they're looking for in terms of outpatient care, that patients have to circumnavigate and find the solution that they're looking for. And it's often they get to the wrong point of care. And so, our commitment over the next couple of years is get to a place where consumers with high reliability can engage mercy to get to the right point of care in their terms and to have the access that they've been asking for to help remove that friction and drive better efficiency, better care and better outcomes. And so those are, those are the key tenants that they'll really drive our strategy. Absolutely. Yeah, I love that. And, um, want to get back to partnerships in a second, but, but first I'd love to ask you on that kind of consumerism notes, I personally feel like, you know, AI has been responsible for kind of driving a lot of things and navigation kind of automation, those sorts of things. But are there specific areas that you were trying to reach patients, whether it's a engagement thing or a transparency thing or, you know, even just like a care care model thing, where are you kind of specifically investing in that consumer forward model? Yeah. So, um, I think the couple areas of focus. First, I'll begin with, um, I think an empowered patient has access to knowledge around quality and pricing. And so we, we will through partnerships. And I'll tell you, we work very closely with Garner. I believe they have a real great capability in terms of helping unleash, um, employers and then ultimately individual consumers around identifying doctors or high quality lower costs, higher value. We, we will lead in mercy will lead in that transparency. And we want to, um, we think an informed patient making better daily decisions around their healthcare consumption is a good thing overall for mercy and a positions us well, but it also is a great right thing for healthcare. Second, I think there's a lot of friction in healthcare, particularly around the first mile and how consumers access healthcare. And I think there's a lot of technical solutions in place. I think, um, you know, we want to support primary care very definitely. And so we've got a perspective around how our primary care model needs to be designed to support seniors and also how it needs to support the general public. And there's also very different consumption in, in, in primary care when you look at, um, Gen X versus Gen Z versus, um, the baby boomers. And so we have to have a model that can make available asynchronous care that's highly reliable in our network as well as physical care for those that want that and we have to create a mechanism in the front and put it in the patient's hands allow them to navigate in their terms. If you think about what has to happen though for that to happen is you have to have a singular EHR where all that information is connected and you have to have standards. So if you think about AI deployment, where, where it breaks down, um, whether we're talking services for patients or we're talking AI that kind of works behind the scenes, where it'll break down is if there's a lack of standardization. And so what we're focused on as a health system is real standardization and high reliability related to schedules and templates and things like that so that we can build a digital layer that allows consumers to see what's available into, to interact with us in their terms. And so that's the hard work that we've been doing and I'll tell you that's kind of like the third rail of politics and health care that's like hard place to go is around those kinds of standards, but I think our providers and our doctors are in our nurses and everyone has been great about that. And it's a game changer, frankly, because it allows patients to be able to, I would say, shop but also experience mercy in their terms. Absolutely. I love to pivot over to partnerships because we've talked about that a handful of times. The first of which being what you alluded to as far as, you know, engaging in these risk arrangements, talking to payers working together, that's not typical, you know, kosher for payer providers, right. There's usually some friction and some, I don't know, maybe a little bit of hostility there for payers or other health systems looking into risk models and those sorts of things and trying to enter negotiations or whatever what what in your opinion creates in air of transparency and working collaboration and recipe for success rather than the kind of traditional, you know, negotiation tactics, that makes sense. Yeah, you know, at the end of the day, they, they need to grow, they need to demonstrate their, you know, the value to walls for as many of these are publicly traded. You know, I just think the inflection point that we're on actually far past, frankly, is is just the sustainability. And if you listen to earnings reports and how they talk about things, I think the reality is, the employer base drives so much of the healthcare decision making in America just cannot keep taking on double digit increases on an old basis. That is a, that is a crisis and therefore, I think there will be providers and disruptors who can provide care at scale cost effectively. And I think those who can do that and manage populations effectively with high reliability and create consistency and transparency around access will win. I really think that will be the case. And I think you're seeing that I think if you look at the health systems that don't have system this and have access and have an ability to deliver care in a, in a, in a consistent cost effective way, I think they're going to really struggle. I think there's going to be winners and losers. I hate to say that, but I really do think there will be winners and losers when it comes to the long term viability of systems. And so, and I think that's an important thing. And then the other thing that has to happen is the product, the actual product that gets to the employer that makes up the benefit that has to continue to evolve so that the individual patient. have a greater influence and have greater opportunity to make better buying decisions when they're making choices too. And I think all of those layers have to line up, in my opinion. And I see that happening across the country in many communities. And so we want to be and we will be a high reliable system. Last thing you mentioned partnerships, that's a really important thing. And that was something that when we built a plan a number of years ago, we acknowledge that we have to be a system that's great at partnering with companies. And so the question is, how do you do that? And there's a number of companies that I admire in the frankly the startup space or who have disruptive technologies who we need to be able to partner with. And health systems move notoriously slow at engaging those innovative companies. And so we've been very purposeful to work on quick decision time frames to engage them effectively, to be clear when they're not a good fit, be clear when they are a good fit and if they are a good fit, let's scale. And what we've sought to do in our health system is to think of ourselves not as a pipeline of care, but as a platform model of care that can take on companies with technologies and solutions, whether it's AI or its models of care and be able to ingest them and scale them. And if you think about a problem to solve in health care, health systems tend to be poor at scaling solutions. And at Mercy inside our walls, we talk about digitally, how do we scale solutions quickly? And so I'll give you an example. ADOC is an AI platform that doesn't AI overread over all imaging. And it allows us to kind of go from the traditional FIFO first and first out imaging process to a real time prioritization of the greatest needs, the greatest images that need review faster, et cetera. It allows us to prioritize patients and our ED differently. It allows us to prioritize our outpatients differently. We deploy that solution across all of our clinics and hospitals, across over just under 4 million lives, 4,400 providers in about 90 days. And that's an implementation that in most health systems would take a year or more. And it's because we have a platform model care. We turned off over 1,300 point solutions. We moved all of our data to the cloud. And when we commit to deploying a solution, an AI solution or a technology, it has to universally apply across all of our lives. So that allows us to really be in a position of right to first refusal to apply the latest and greatest technologies allows us to improve the care model for our patients and for our providers. That's fascinating. 1,300 point solutions turned off. I think that that's pretty telling for the industry actually. More broadly, you bring up this interesting point around systemness and kind of this move from silo thinking into enterprise wide thinking. So I'm curious from your perspective, what enables that shift? Like for a health system that's maybe struggling to getting from point A to point B, how did you get there? What mentality did it take? What was it? Was certain technology needed? What was kind of what were the various components of that? Yeah, the heart of the shift is a couple of things. It does take a huge behavioral change. And I would say this has been a process of mercy. Years ago, like systemness is not new with me. It started with my predecessor, Lindbrutton. It started with how do we integrate a strong physician core that has consistent principles around value-based care? And then how do we create a move to an EHR platform? And I think we're one of the largest single instances of that thing. So all of our doctors are on the same platform now, single instance. And then it was how do we start to bridge the gap between clinics and hospitals and cities and rural communities? And that's where we pioneered solutions in the virtual care space. Now we have 15 to 20 different solutions that make up our virtual solution base for mercy. And that allowed us to transform our care model. And virtual isn't like an ad ad on. It is an integrated part of our care model. And so when you go into a rural hospital, you have the benefit of stroke care, the same stroke care, same access to stroke doctors, and the same access to behavioral health experts and the same access to other specialists, and those critical access hospitals that you would have in our largest level one trauma centers. And it's all because of the virtual platform being tightly integrated into our EDS and our broader care model. And that's allowed us to have rural hospitals that are cost effective. They have an EBITDA that they're producing that is self-sustaining and will allow us to keep care close to home for those patients. And they're not chasing that endless game of trying to hire in and overpaying for specialists to go to places and communities that aren't going to be able to sustain that. And so that's always been part of our philosophy is a singular approach to scale care. And that's just, fortunately, that's part of the mercy DNA is it's not about me, it's about community and it's around getting care right. And so the same applies when we come to deploying AI. And again, I mentioned we moved all of our data to the cloud, but that allows us to really think about AI solutions that can really improve the life of our providers or doctors less pillow time, but then also help us do things for patients we wouldn't otherwise be able to do and do it more cost effectively. There's a, we built our plan, one of the things that a problem to solve that we talked about in healthcare is this idea and it's a garden report that over the last 30 years, average labor productivity has actually gone the wrong way in healthcare. It takes more people to produce the same output as we were 30 years ago. And meanwhile, the same period of time consumer satisfaction, patient satisfaction is not gotten any better. It's been a flat line pretty low. And so we have to deploy technology in a way that doesn't add friction. And that's why point solution purgatory actually adds friction. It means there's people you have put in place to move data from one place to another. We've been very purposeful to take those that friction out. And so it has to be a win-win both for the providers and our patients is kind of how we think about it. So that's super helpful. Yeah, yeah, very insightful. And you kind of mentioned you just alluded to kind of labor, you know, productivity going the wrong direction and AI deployment and system this and those sorts of things. And I'd be remiss to ask and I feel like this is going to be a very difficult question and or trend that potentially plays out, you know, assuming that AI kind of continues its course in healthcare and in all industries. How do you think about deployment of those platforms or solutions or whatever it is versus potential job displacement and those sorts of dynamics at a local market level. Maybe you have some political pressure to keep those jobs at mercy in local communities. You are a large employer probably in certain areas. How do you kind of wrestle with that decision? Yeah, I mean, the reality is healthcare will we need more people to care for patients at the bedside. We have too few people. And there will, you know, so I don't worry about a displacing and healthcare of the labor. I actually think this will be a great enabler to help our providers work at top of license. But I think it will help nurses enjoy the care that they're able to provide because the bureaucracy is going to be taken out. There are certainly pockets within the healthcare space that will become more efficient from a labor standpoint. But the reality is I think it will actually bring more people to the bedside that will allow us to provide more care. We have a growing number of patients. And if you think about the supply pressures on the labor side of healthcare, we need more people at the bedside. We need more people engaging the consumers, the patients than what we have. And I think this is an enabler to do that, frankly. And that's what we've observed. And that's what we've observed is it allows us to bring back the joy of practice for more providers, et cetera. Another thing that we think about is, you know, think about healthcare industry. And this kind of goes to the friction question that you asked earlier. And if you think about, and the point solutions that we talked about, in healthcare, one of the greatest gifts that we have is the incredible insight that we have on our patients that tends to just sit dormant. You know, our patients, longitudinally for years, have told us through doctor visits what they need, what their healthcare status is. We have their lab work over a launch to we have the genome on many of our patients. All of that, we have so much insight that tends to not get used in the care of our patients. Okay, and that's why the point solution, addressing point solutions is important because point solutions mean you're capturing information to help you help a patient, but it's maybe not getting to the data platform that allows us to practically do something with it. And so, you know, think about healthcare over that same 30 year period of time, we've added more technology. We've cured diseases that 30 years ago weren't cured. We have better drugs and better treatments. And yet the cost curve keeps going up. And so our perspective is how do you harness that data in a meaningful way to proactively and predictively engage and support patients? And that's at the heart of what we're seeking to do with our partners like Mayo and others and any of these technology partners we work with to scale solutions across our system. Yeah, that's great. And just a quick note on that Mayo partnership, which I think is incredible. We got some numbers from your team as far as the scale of that partnership and what I understand is you guys recently expanded it. You know, it's a first of its kind, data science collaboration, 15 million patients, 12 billion images, 3 billion lab results, 10 million pathology reports, I think 1.6 billion clinical notes. And so, can you talk through, you kind of alluded to these things already, but what is that unlock for Mercy moving forward? Yeah, I think, I think Mercy, well, what it, it locks for us, but what it locks for the industry, frankly, is four clinicians. It allows us to find solutions that will help us use data to inform better care and better care models for our patients in real time and get that built into our EHR so that we can scale those meaningful solutions and manage populations. I think for researchers and investigators, I think it'll help them accelerate discovery because in one place, you have just an incredible treasure trove of information that's de-identified, tokenized, that allows them to pursue solutions that would otherwise take a lot of time to pursue independently. So, it's a very efficient way for researchers and investigators to pursue discovery and clinical trials, et cetera. For innovators and partners on the digital space, it allows them to build, test, and scale digital health solutions quickly and validate those models, which is an incredible thing. If you think about validating AI, you have to do it against incredibly diverse data sets. And this in one place allows them to do that. So, if you think about it, I think it'll speed discovery and speed solutioning. And then, you know, we'll sit there as Mercy, Mayo, and others at the point where we can validate and see how it clinically helps us help patients. And so, I think it helps on those fronts specifically. And we're already seeing that. So, that's awesome. Yeah, that's super cool. I mean, just so much data, I can't even comprehend it. So, very cool that all of that data is, like you mentioned, previously sitting there, but now being put to use a number of different pathways. So, that's exciting. And, you know, we'd love to end kind of the healthcare part of this conversation on maybe just turn it back to you. We are talking about a lot of, you know, forward-looking things and your partnerships and so forth. Curious how you see, you know, the rest of 26 and 27 and beyond playing out. There's been a ton of conversation around rural healthcare and the transformation fund and then the big, beautiful bill and cuts and all the above. Where do you kind of see Mercy's trajectory from this point moving forward? Yeah, so, I mean, our perspective is more people are choosing Mercy for more of their care. And we see that trend not changing. I think we will launch a number of new products and solutions this year that will continue to improve the life of those that we have on our serving. And I think those solutions will attract new people to come to Mercy because the care model in 12 months will be more accessible unless friction-filled for us and for our patients. I can guarantee that. I think the other thing is when it comes to complex patients and patients with chronic diseases, I think our solution set is continuing to improve. Our ability to take a new model of care for again, any type of chronic patient and model it, build a prototype and then scale it across our population is improving every month that goes by. And so that's an important capability both for payers and it's also an important capability for employers. So I think that front for us is going to continue to improve because they'll be able to access more care and more cost effectively. So I anticipate that we'll continue to grow and serve more and more cost effectively. That's definitely in the cards. The headwinds related to the legislative reform, I think they're real. We've modeled what that will mean to us and we've figured out where we can create some efficiency to address that. And I expect mercy, we've gone in the last year from a 4.5% EBITDA to some point 7% EBITDA, I expect that that be the low water mark for us and I think we can continue to grow and improve and serve more and become even more efficient and effective because when you take out huge costs for mismanaging chronic diseases and you're serving those patients better, that's a huge value. And we see the efficiency and the capacity that creates within our system to be able to serve more. And so I think we're kind of in a place where we can continue to deploy products and solutions that will allow us to better serve patients and continue to grow at a pretty rapid rate. Okay, that's awesome. Well, good to see you in your model and I'll definitely be following along with future mercy updates. So thanks for that color on all those things. So Steve, I got one more question for you. It's more of a personal question I ask everybody at the end of any podcast and it is what's a piece of content or book or video, something you've consumes that has had a profound impact on how you live your life. You know, I think recently, I mean, a lot of members of my team have been kind of into the fall in podcast lately. And I think at the heart of it, there's two things. One, I think we admire and I mercy, we work with a lot of founders of companies, okay? People that have a perspective on how to fix a big problem and that's what their podcast tends to, I think, talk a lot about. And you know, for mercy, we have the benefit of working with some incredible founders who I admire. I admire people who are pioneering and entrepreneurial and have figured things out. And so for us at mercy, we find inspiration, the fact that we get to work with Alice Walton right now in Northwest Arkansas to build, we're even barked on a destination model of care in Northwest Arkansas that's a three million square foot campus. Cardiovascular center of excellence, we're going to build other centers of excellence in this destination, medical campus in Northwest Arkansas all through in a value based model, all through our vision, the opportunity to interact with a visionary and Alice Walton, a woman who is, I, you know, I hold in the highest regard. We get to work with innovative companies like Wolvanna and you know, Devon Cardi helped create that company and, and that helps us extend a value based, clinically integrated network to more communities that desperately need it and communities and providers that want to operate in a value based world and do it really well. Garner Nick, Nick Reiber at Garner is another founder who I admire who had a perspective on how he could take his talents from a quantitative hedge fund to thinking about how we build models to help consumers and employers make better decisions every day around the total cost to care to empower them to independently make choices that help change the cost curve. So we every day find inspiration in the people that we have the opportunity to work with and the innovators that we have the opportunity to work with. You live WALUK from ADAC who is the creator of ADAC, just an incredible company that's transformed imaging and AI. And so I find inspiration from them and inspiration from my team as we get to work with them every day to deploy solutions that will transform the value proposition and all the communities that we serve. Yeah, I imagine that's super energizing to talk to those folks. Steve, thank you so much for the conversation today. This has been very, very insightful from my perspective. I learned a lot. And luck to mercy in you guys this year and we'll be looking forward to hearing more from you in the near future. Thank you Blake. Hey, keep up the great work. Appreciate your podcasts and all your writing. So keep it up. Thanks for listening to this episode of Claims Denied. Stay up to date with news and trends in healthcare by subscribing wherever you get your podcasts. You can find more resources and apply to join the Hospitality Community at Hospitality.com. Also, if you love Claims Denied, please tell a friend and share it with a colleague. Until next time, Hospitality.com.