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Intro: 00:00

Warren Smedley: Welcome to TKG's Healthcare Insights, where we explore healthcare's critical issues, challenges, and trends with the focus on achieving the quadruple aim of enhancing patient experience, improving population health, reducing costs, and improving the work life of healthcare providers and staff. Thank you for joining us today.

Welcome. We're glad to have you listening today. I'm Warren Smedley with the Kinetics Group. A recent article in the Boston Globe raised a red alert on hospital operating rooms being temporarily closed due to staffing shortages and other pandemic related challenges. In the article, Dr. Eric Dixon, CEO of UMass Memorial Health, he reported that Closing ORs is a nearly daily event.

He stated that UMass Memorial has nearly 2,000 staff vacancies, including 500 openings for nurses, making it really hard to keep the ORs functioning at normal capacity. In that article, it also mentioned Mass General Brigham, Beth Israel Lahey and Lowell General, all reporting similar challenges in keeping their operating rooms open.

This raises a red flag for me too. Not only does this impact hospital margins, which depend heavily on elective procedures to support profitable operations, But it also delays critical cancer biopsies and surgeries that our patients are counting on to help them diagnose and treat their conditions. Our special guest today is Richard Palarea, CEO of Kermit, a Baltimore based healthcare cost reduction and spend management company focused on maximising operating room efficiencies and profitability.

Rich is a serious expert in hospital OR operations and has seen the good and bad side of healthcare systems from a business and management perspective. Welcome, Rich. Thank you for helping us dig in a little deeper into this emerging challenge we're facing.

Rich Palarea: Yeah, it's my pleasure, Warren. It's great to be here.

Warren: Excellent. Thank you, Rich. I've been keeping my eye on the advisory board's research into the future of surgery in addition to these other problems I just mentioned. And in addition to my training as a healthcare administrator, my son's actually a general surgeon in Arkansas, so this has really caught my attention.

The advisory board compiled a special report at the end of last year on the top trends impacting the future of surgical care. They highlighted things like new cancer vaccines and drugs, liquid biopsies, using mRNA technology, genomics and precision medicine, and the increase in medical management of conditions.

The way we care for our patients is really changing. Now, Rich, you're an expert in operating room operations as well as revenue cycle enhancement for surgical procedures, especially those implantable devices. And I'd love to tap into your expertise today to explore what you're seeing as it relates directly to patient care.

So how do you see patient care being impacted by the current operational challenges?

Rich: Well, it's interesting you just raised some really good points about the advances around the clinical side. And I think we've never been in such an innovative time as we are now. Things are coming to market. I think some of the red tape with getting things through the FDA process, although probably some of the companies that we see and work with might disagree with those that have those advancements are bringing technologies to market more quickly.

The one thing I will say about that though is that staffing shortages and the like, have been a huge impact. Doesn't really make sense. If we can get clinical issues solved if we can't deliver them to the patients. And so the hospitals that we work with, Most of their top line revenue comes from elective surgery.

And so you have a pandemic that takes place and hospitals really didn't know what to expect. And you and I, as just citizens, didn't know what to expect. We thought maybe this whole thing might blow over 90, 120 days and here we are, still well over two years later talking about this.

So when hospitals close down their operating rooms I don't think that those administrators, those surgeons who rely on that OR time for their livelihood, those implant vendors, all the people that are impacted really thought that this would be a systemic long term thing we're dealing with. But here we are, right?

We're still dealing with it in some way, shape, or form. And when you think about that, we had some help from the federal government, which I think was well received in the Cares Act money. But that's all dried up now, largely. It's been distributed and it's hit the bottom line wherever it's gonna hit.

So now we're faced with looking at this from an operation side of things, not just the revenue side of things. How do we optimize all aspects of healthcare? And I think what's really exciting for the area that we participate in is this has brought a spotlight and it sped up a lot of the discussion around this area.

Whereas before it was kind of a back burner issue. As long as we had patients coming in, we really didn't have to address some of these hard issues. You think about the patient care part of this, we've got to produce more lean environments that can weather another pandemic or whatever it might be coming down the pike.

And I think largely the pandemic that isn't being talked about right now, is this lack of qualified people to staff the beds and staff the operating rooms.

Warren: Are you actually seeing your customer shutting down their operating rooms?

Rich: They're slowly reopening them. I think things are getting back to normal.

You mentioned UMass Memorial. They are a customer of ours and we have direct experience with what's going on there and everybody is handling it a little bit differently. When you think about what the patient might be experiencing, that is the most interesting thing to think about.

And you've got elective surgery mostly taking place for folks that are advanced in age maybe. They're mostly Medicare patients for the most part. They were sitting at home watching TV, this whole thing unfold with, unfortunately, refrigerated trucks being filled with bodies and so that I can understand that being a frightening thing.

And they may be in pain right now with hip or knee replacement that needs to take place or shoulder surgery or spine surgery, whatever that might be. But they could be reticent to come back to those environments where that was kind of ground zero for what they were seeing.

It would be great to see, not just the rhetoric that's out there about the vaccine, but real data from the hospitals being published about, operations are back to normal. We are committed to community care. We're here to help the patient population and we're ready to service you, and we'd love to see you come in and have that surgery done.

And that's a marketing message that needs to be communicated to the population.

Warren: Now, I assume emergency medical care has not been impacted as much, but it's mostly these elective procedures.

Rich: Correct. Trauma rooms are still open. We're still seeing emergent patients, but the majority of the spend on the cost side, and again, a lot of the revenue on the other side are coming from these elective procedures.

Things like knee replacement, hip replacement, spine surgery, cardiovascular surgery, where we have significant efforts to get those patients in around for example, pacemakers that need to be implanted. I think that by and large, those patients are getting surgery. There's no issue there.

It's the folks who are sitting home with a knee replacement, who were diagnosed two years ago thinking I'll deal with the pain. I'm just not ready to go in for surgery yet.

Warren: Now, are you seeing in the operating room different types of staffing shortages, nurses, techs, anaesthesia, surgeons themselves?

I mean, where are you seeing the real problem there?

Rich: Yeah it's across the board, Warren, and very interesting to me, coming out of the pandemic or maybe kind of right in the middle of it when supply chain, which is where we play a big role in helping supply chain understand these costs, making sure that they have these materials, the right material in the right place at the right time for that surgery, at the right cost.

The cost is a very large focus of what we do here at Kermit. Those administrators all the way up to the executive vice president and C level were down in the operating room areas, not in the OR itself, but down in those areas at the receiving dock, managing with sterile processing. These are things that they weren't trained for, but they were called into action.

And on the one hand I was very proud to say that we work with these people. The work ethic is something that when modeled for the people here that work at Kermit, I would point it out and say, That's dedication, guys. That's what that looks like. That's leadership by example. And I was very proud to work with some of these organisations.

At the same time it broke my heart. What it took for people to get things done and to make sure that the trains kept running on time was just nothing short of monumental. So yes, from clinical staff and clinical care folks all the way down to folks that are in the supply chain and making sure that those items get to the surgical floor, clean, safe, and wrapped and all of that.

There were shortages across the board, and it still exists largely today. And you've got this great resignation that took place that has affected both hospitals and health systems.

Warren: So on the supply chain, are we seeing an improvement now of things getting back to the hospital more quickly, more supplies?

Rich: Yeah I got back just yesterday from the AHRMM conference, which is kind of the flagship conference in healthcare supply chain, and almost every track that I sat through that dealt with supply and throughput and managing the supply chain had a theme. We're not back to normal. It may never get back to normal.

This may be the thing that we deal with from this point forward, a heightened awareness that we can rely on especially foreign sources of some of this material that we need. The just in time supply chain that was really in vogue to manage costs and the lean approach is kind of the pendulum swinging back the other way.

And so we're talking about managing warehouses and having that stuff in multiple places at a moment's notice. The leaders that I heard from, and these were esteemed leaders in supply chain from big health systems and big brands that you would know. All kind of had the same theme.

Resilience is super important right now. And concentrating on different ways of thinking about this that put supply chain more in control of all of this. There were even talks of shadow supply chains and I was wondering, what were they talking about? What they were referring to was that by and large, 70% of the supply chain activity in any hospital is under supply chain's purview in a corporate venue and being controlled.

That means that 30% of other supply chains exist unbeknownst to the supply chain executives. Other things are being managed by side of line workers and managers and even different folks. IT people, there's all these other supply chains. And so when supply chain leaders took that step to become not just a blue collar, we're in the basement under fluorescent lighting type of approach, but we are the white collar office. We demand an audience with our C-suite. We are strategic business solutions providers. We will take over all the supply chain and they really have elevated the whole industry for healthcare supply chain.

I was very pleased to see that. That's what the pandemic has brought about for healthcare. It's much overdue.

Warren: Very interesting. Is there kind of a yin and yang between the big suppliers and the local hospital trying to make sure they have what they need? And yet these big suppliers out there playing games with who gets what and who's my favorite and all that, is that taking place?

Rich: It takes place. I think that happens in almost every ecosystem. You have the players. Who maybe don't want to capitulate on price or they want to kind of hold out and you have those that maybe don't have market share and they could be the national leader. They just don't have market share in a particular market or environment.

But by and large, I would say, a majority of the vendors have stepped up as partners really trying to co-own this problem and solve this alongside the hospital. And sure there are places in any negotiation where there's give and take, but most of those suppliers at the higher level, at the vice president level and above, they see a negotiation truly for what it is. I need something and you need something. How can we both get that something? Let's come to the table and mutually work that out with terms that can be governed by a contract that's easy to read. Let's try to cut the red tape out and get to that place.

And of course, this is the business that we're in. We negotiate these contracts on behalf of hospitals every day. So yeah, there are still games being played, but look, anybody that digs in your pocket to take away your profit or your margins, that kind of right size. There's going to be some obstacles to that, no doubt.

Warren: Well, that's a major problem for hospitals right now with people trying to dip into our pocket, leave us with the uninsured, poorly insured, the high risk patients that are difficult to deal with and really skim all the profitable patients up off the top. And if you look at profitability of patients across a hospital system, it's kind of an S-curve where you've got a small, maybe 10% are really profitable, 10% are really unprofitable.

And in the middle, every bounce is just kind of neutral. They're kind of breaking even, and you kind of live or die, whether you can balance the profitable and unprofitable in some way over that entire ecosystem. So it's a constant battle and people are trying to tap into, third parties are trying to tap into that profitable 10% and take it away from us.

This is where you insert yourself, as I understand it, that Kermit inserts themselves. To help the hospital and the operating room in particular to really stand their ground. So we do actually, as an administrator, I do know that the supply chain folks sit in the basement and haven't typically gotten the respect they need and they may or may not be qualified to do that role.

Tell me about how you insert yourself to help prop that up a little bit.

Rich: So we are, I'll just kind of give you the quick synopsis. We are an implant cost reduction and spend management firm. What does that mean? There are 23 different categories of implants where we look at the cost, try to bring that cost down to the market rate and then not just produce cost reduction that impacts the bottom line in a meaningful way, and we measure that. We also provide spend management, and this has been the most elusive part of this for 50 years. An implant rep stands in the operating room with the surgeon tendering devices into the sterile field during surgery.

There's no price tag on the box. It's tallied on a piece of paper by that sales rep. Barcode stickers come off the boxes, they write down the price they're going to charge and they have that piece of paper signed by a nurse in the operating room, which signifies something. 

But then the rep walks that paper down the hallway to purchasing and turns that in and expects to receive a purchase order from a buyer who doesn't really have any understanding of the clinical nature of what was used in the surgery. And so you have this kind of bifurcated process.

The only person who has visibility to both sides of that is the vendor servicing the hospital. And so on the one hand you've got the surgeon who relies on the rep to be there. They're providing a very important role, but you also have a supply chain who's tasked with keeping these costs down, negotiating these parts.

And I think, frankly, we've done a disservice to our supply chain professionals in asking them to be experts in this category. We're asking them to negotiate capital equipment like MRI and CT machines and all, and the various big things that are in the hospital. We ask them to take care of contracts for landscape and food services and linen and all of that too.

And oh, by the way, be an expert on the technology of implants across 23 or more different categories. And what Kermit does is we walk. Primarily to a CFO, and we can tell them that we can reduce the costs by 30% or more in any category. It doesn't matter if they've tried on their own, if they've used their group purchasing organisation, we typically will find that on average, 30% can come back to their bottom line, which is a meaningful number.

When you're spending $90-$100 million dollars on a category like that. So they will then introduce us to supply chain where we'll kind of work out what the project looks like. The second piece of what we have is a piece of software that we manage on behalf of the hospital. They can log into it, it collects all that data in the operating room.

So we don't have this paper based billing process any longer, and we transform that into analytics and tell the hospital what's okay to pay and what isn't through. A number of business rules that we've programmed into Kermit, and Kermit is a cloud based software that's housing all of the pricing for the hospital and also all of its contracts where we've distilled down those terms and conditions into business rules that get executed in real time.

And so there's never really been a process for auditing this. It's been seen by a buyer who's looking for anomalies or things that just don't make sense. And what Kermit is doing is looking for everything. What price was charged? Was that correct? Was it the contracted price? Was an item wasted in surgery?

Who wasted that item and who needs to pay for it? It's very granular, and then taking all of those analytics and bringing the clinicians in for the first time and saying, Here's what's going on in the operating room as it regards to cost. We've leveled the price for every single vendor. It's agnostic.

We don't care who the vendors are. We're not taking anything away from the surgeons. You get to keep all your favorite vendors. We've just leveled the price for all the products. And now for the first time, surgeons have visibility to the case data. They ask for this all the time. Nobody can ever produce that data.

Because as administrators at the hospital, we need to go offline and tap a business analyst and an enterprise system and stitch together various enterprise systems and electronic medical records and purchasing. So all of that is self contained in the current system. There are dashboards and visualizations.

With a few clicks, we can drill down to the actual case data and the surgeon can see a photograph of that paper bill sheet I mentioned before. It's right there, front and center, and really engages surgeons as a collaborator. Rather than finance or somebody else coming back and telling the surgeon, You're spending too much money, you've going to get the price down.

That never goes well, and surgeons saying, you run the hospital, take care of the patients, and we'll be just fine. So it's more of a collaborative play. And to answer your question directly, Warren, the one person who's kind of been in the dark all the time, not just the surgeon, it's been our CFO's.

They don't know that 90% you're talking about in the middle of that bell curve, if they're even profitable on some of these cases. So they no longer have to wonder if the type of data that we're providing is granular. Within two hours of the surgery taking place it’s on everybody's dashboard.

So we can drill down on any category, in any sub-specialty and see, I'll be profitable. Let's manage this cost data right alongside the really good revenue cycle solutions that we already have out there and put it all together.

And the surgeons would have access to this through their administrators for their practice would have a line of sight into the data as well.

We offer surgeon logins to the system. Not every hospital wants to burden the surgeon with one more thing to look at, but I've really been surprised as we've brought this solution to market. It's been 10 years now, and when we first designed it and we were doing the dashboards and really pretty data visualizations, we thought, surgeons aren't going to want to be bothered with this, but you know, I was wrong about that.

We have surgeons who are very interested in the data and they like the comparative aspect. They want to see how they rank among their cohorts and their peers, not just within their own hospital, but across large health systems. We're bringing a lot of visibility there, and they like to see this. They'll drill down and spend some time.

And we had one surgeon where there was over a hundred thousand dollars of wasted implants, kind of on his watch. It was one of his surgeons. He was the chairman of the orthopedic department. And he took an interest and said, why don't we drill down into my case? And so we took a few clicks and he said, I was in the operating room and I remember I pointed to the back table and I told the rep, you've wasted that item and you're going to take care of that.

And the rep says, don't worry, doc. I got it. I'll take care of it. And that's how he took care of it. He billed the hospital for it. He'd billed the hospital thinking the surgeon would never see it, and the surgeon grabbed his white coat, put it back on, and wanted to walk down there, down to the operating room down to the corridor and find that rep and tell him he has visibility.

So yeah they're good corporate citizens. I think they want to be a partner in helping the hospital save money.

Warren: That's excellent. We've needed this for a long time. Thank you for what you're doing. Let's talk quickly about what you see happening in the future. Everybody's trying to reduce cost, which is a good thing, but you know, we talked earlier about third parties coming in and sort of taking things away from the hospital.

So your primary customer. Is it going to be a hospital with operating rooms, and if we're moving things to outpatient settings or we're moving things to other types of therapies that don't require an operation, where do you see this kind of going in the future?

Rich: Well, for the categories that we manage, I think there's always going to be surgery.

There are non-surgical options for. For some of this stuff. I mean, you can do therapy for a torn rotator cuff, for example, but when it gets to the point where we need to go in and place different implants that's always going to be the case. What we are seeing is a large scale migration mainly.

The impetus of this was Medicare rules that were passed for moving this from the setting of the acute care to the setting of the ambulatory surgical center, or even a specialty hospital trying to reduce the length of stay, trying to eliminate the stay altogether in some cases. A lot of the sports med cases have been done in that setting for a while now, but now we're starting to see total joint replacement cases being done in those settings as well.

So the challenge for a company like ours is to appeal to the owners of those environments who, interestingly enough, many of them are partially or wholly owned by surgeons. So you had surgeons who are largely not interested suddenly taking a market interest.

When it's their P and l, right? But we need to right size our efforts and our solutions. We're built for the acute setting. We go into hospitals and large health systems, IDNs, academics, and help them with what we do. If we can have a solution that makes sense budget wise for the ambulatory surgical center, I think we'll have a very receptive marketplace there because they're very key to cost reduction.

They want to look at the analytics, they want to look at that data. They manage it very tightly. Smaller budgets and some of them have private equity, a lot of them have private equity ownership. So you have very business minded people. Decisions get made quickly there. And culturally, that's the way we would like to work.

It's tough sometimes to work with. Hospitals will take a long time to get things done. We move very quickly. But I think that's a big opportunity for us and it's something we're looking at very closely.

Warren: We talked earlier, Rich, about how most hospitals really make a lot of their profit on these elective procedures.

So what have you seen that can make the biggest impact on the actual profitability of these procedures as you've kind of gone through this process?

Rich: Well, the rules that came out from Medicare over the past few years, especially in orthopedic joint replacement, have been around bundle payments.

And we're trying to move from this era of this environment of fee for service to more of a value based approach. Kermit is located in Baltimore, so we're in the state of Maryland, which is kind of the demonstration state for a lot of these payment models because Medicare is located here in our backyard.

We have a global branch here in Maryland, the hospitals are told at the beginning of the year how much money they're going to be able to make. And, doing patient 1,001 doesn't help. They're only getting paid for a thousand patients or whatever the number is.

A capped amount. So the biggest thing that can really impact after you start looking at your post-acute and a lot of, there's been a lot of optimization around that skilled nursing and all of that stuff is we're starting to kind of climb up the pipe a little bit more into the OR itself. 

And when you look at implants, they represent 60% of supply chain spend in any hospital. So this is a very large category when you optimize the spend. And a lot of hospitals believe they've already done this, but think about this Warren, what are they comparing that number to? They know they went through a negotiation. They know it was hard. They know it took them 12 months. They know they had arguments with their surgeons.

We know we have some level of savings, but we don't really know did we get the best price? We're being told by the vendors and even our GPO that we have the best price. So looking at that in a way that is independent with a third party and I didn't mention this to you. What's really interesting about our model is we only get paid on savings.

So we're incentivized to drive savings for the hospital if we don't provide savings, and in a way where we can actually measure that savings and show the hospital they had what I call a savings event. We can't send them an invoice. So you can just think about the last two years was a very interesting time for Kermit.

Hospitals had their operating rooms closed. No surgeries were taking place, therefore no savings were being driven in our projects, and we weren't billing anybody. So I think hospitals need to look at these implant costs. CFOs and other C level folks need to give permission to their supply chains, to use third parties, to be creative, to use innovation, to look at everything and not think that when we come in with a solution like what we have, we're stepping on anybody's toes or anybody's pride of ownership.

I want to make everybody look like the star when we come up with 10, 15, 20 million in savings. I want the supply chain to be able to walk into the CFO's office with a big smile and deliver that information and be able to take credit for that. And thank that CFO for saying, I'm glad you introduced an idea where, we are free to go out and look at solutions like this, right?

And so implant costs aren't a big deal. We're driving meaningful savings, sometimes upwards of 30% of their annual spend in any one of 23 categories. And then bolting the software on top of that to police everything. We make sure that there's spend management, not just cost reduction, but long term spend management in the category, which has really been tough because the moment everybody gets done with a negotiation of the hospital, they want to go back to work.

So they high five, they leave that table, and what they do is they leave a void. Where the implant companies rush right back in and grab that margin back. And so there's never really been a software approach to manage the spend until Kermit came along. And now, fortunately, and I'm flattered, we have a couple of imitators who come into the market.

I have real competition, which has been easier for me to be able to sell because I'm not just explaining the problem that a hospital has. They're aware of the problem now, it's been 10 years of this and we have the market leading.

Warren: Let me ask you on the other side of this equation are the manufacturers and a lot of our customers are life science companies.

Obviously they probably see you coming in. They go, oh we could be in trouble here. The reps are thinking, Oh, I don't want Rich coming and messing around with my ability to kind of manage things in the OR. But how are you approaching collaboration? Because my perspective is, no one can solve the problems of our bigger global healthcare system on their own.

We all have to come together to do this. How are you seeing the opportunities for collaboration with manufacturers and life science companies and others on that side of this equation? How does that work?

Rich: I have to be honest with you, Warren, I think the uptake for manufacturers has not been as quickly as I would've liked this tenure journey.

I've seen us start at one end of the spectrum in negotiating with them in a very kind of fierce type of way and there's a lot of tension in that. But there have been, along the way, whichever challenger brands might be there who want to take out the incumbent, who want a shot.

They're very appreciative of the process that we run because it's a very fair process. It levels the playing field. It gives them a real opportunity to show up and see what kind of a partnership might be available to them. And in doing so I've had vendors who have come to me, even very large vendors who say, I just want an opportunity to bid through your platform. I think that you run a very fair process. Here's a hospital where I would like to get in. Can I make an introduction for you? And so that's been surprising and it really opened our eyes to say, while we don't charge a fee to the supplier community, we are providing a service.

In some cases it can take them weeks, maybe even as long as a month or two, to actually receive a purchase order after the surgery is done. In the case of the way that Kermit works, they get that purchase order on the day of surgery, so we're speeding up their cash flow. And also we see less of an adversarial relationship and more of an opportunity to be a facilitator of the transaction for both parties.

So while we are very focused on the provider and returning the, what we call the balance of power in this category back to the hospital, we're really just a facilitator or a marketplace facilitator to make sure this goes smoothly. There are a number of opportunities that have recently emerged on the technology side.

So we're being asked to take this really clean data that we're capturing and send it into enterprise systems where the data might not be so clean. Purchasing systems, ERP electronic medical records in the EMR, places like that. So we're starting to do more partnerships with companies, large companies, big brands like Oracle and Workday, and the like.

We're doing integrations back into those systems, and that's taking FTE or partial FTEs out of the hospital for keying things in and making mistakes and just automating that flow of data to various systems that need that. So I think that's probably the next frontier is seeing how the ERP especially.

In purchasing can be extended without those big manufacturers committing a lot of time and resources to be experts in things like implant spend management, but they can partner with us and we have a seamless way of taking that data and sending it in. It makes them look competent, it makes them look better, it creates more traction for them on that particular hospital account.

And it's great for us because now we can say we partner with a large company like Infor, for example, or Oracle. And that's meaningful for a small company like ours.

Warren: Oh excellent. Are there opportunities for demonstration projects? Sounds like there might be. That's my area of work is putting demonstration projects together to prove that something, a new process would work well.

Rich: We have to do those as part of our sales cycle because I think we walk in with such a value based message that most people are skeptical that we can actually pull it off. And so when they say but you know, we're special here. We're different. We're probably not like the hospitals you've helped over the past 10 years.

And Yeah, we all say that, don't we? I want to be able to say yes to that because everybody is different. I mean, everybody has different people, so they have different workflows and processes but by and large it's the same problem. And when you go into a large health system, they're just more zeros on the end of that number.

It's the same exact problem. It's a similar workflow. And the thing that we do is we've developed something that's very flexible. Can easily be adapted to a workflow. We don't charge for that effort. That's part of the consulting we do to bring the software to life. And yes, for sure, I think we look at those opportunities to demonstrate what we do.

And we'll go in and we're very bullish about the fact that we know we can save the money. They just have to give us a shot. And when they do, I think then they're pleasantly surprised. They move from a skeptic to more of a fan. And the first hospital we ever signed 10 years ago is still a customer.

Warren: Excellent. Well, Rich, this has been a great discussion. Thank you so much for sharing your insights and kind of giving us a picture of what's happening in the operating room. I know for you and for us, patient safety is a huge concern. We certainly want to be able to manage the operating room well and we deal with this impact of staffing shortages and of course clinical team exhaustion. All these critical hospital services are being impacted and it's something we all need to keep close eye on.

Thank you for helping us to see that today at TKG, we are committed to collectively achieving the quadruple aim of enhancing patient experience, improving population health, reducing costs, and improving the work life of healthcare providers and staff.

So thank you, Rich. Appreciate your insights.

Rich: Thank you, Warren. It's been a pleasure

Warren: And if anyone wants to get ahold of you, how can they do it?

Rich: They can find us at Kermitppi.com. We post a lot of thought leadership there. We have other podcast appearances and lots of blog posts, and we even give the cheat codes to do this on your own.

If you want to try to see If you've got the bandwidth to do it we'll give you some of our goodies up there. We also post quite a bit and are frequently active on LinkedIn. So look for Kermit and anything that you find that maybe is not green or a frog is probably going to be us. And follow us there on LinkedIn.

Warren: Yeah, you come right up on a Google search, so that's true. Well, thank you Rich. That wraps up another week of TGK's Healthcare Insights. Thank you for joining us. If you're interested in the articles referenced in this episode or more information on Kermit's services, please email me and I'd be glad to share these with you.

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