Risk & Resolve
The Risk & Resolve Podcast is your go-to resource for insightful conversations at the intersection of leadership, business ownership, and the insurance industry. Hosted by Ben Conner and Todd Hufford, this podcast dives deep into the challenges and opportunities that leaders face in an ever-changing world.
Each episode features candid discussions with business owners, industry experts, and thought leaders, exploring topics like innovation, risk management, and the strategies that drive success. Whether you’re an entrepreneur, executive, or insurance professional, you’ll gain actionable insights and inspiration to navigate today’s complex business landscape.
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Risk & Resolve
Transforming Healthcare: Rebuilding a Broken System with Dave Chase, Co-Founder & CEO of Health Rosetta
Dave Chase shares how Health Rosetta is creating a blueprint for employers to deliver world-class healthcare at half the cost while building an entirely new healthcare supply chain model. As a former Microsoft executive who founded Health Rosetta after witnessing a friend's death due to healthcare system failures, Dave explains how the current system is collapsing and why it needs complete replacement rather than incremental changes.
• Health Rosetta consists of a framework, ecosystem, technology platform, and Nautilus Health Institute for open-sourcing solutions
• System collapse evidenced by hospital closures, provider burnout, and 100 million Americans in medical debt
• Alaska Native healthcare system transformation provides proof that community-owned health plans can achieve world-class outcomes
• Access to claims data is essential for employers to understand and optimize their health plans
• The Plan Grader tool helps employers objectively evaluate their health plans and create improvement roadmaps
• Open-sourcing successful strategies accelerates healthcare transformation across communities
• Employers implementing Health Rosetta principles reinvest savings into employee benefits like education and expanded healthcare access
• Rosetta Fest brings together benefit advisors, employers, clinicians and solution providers to share successful strategies
Join us at Rosetta Fest in August to learn from employers implementing successful healthcare strategies and access resources from the Nautilus Health Institute.
You're listening to Risk and Resolve. And now for your hosts, ben Conner and Todd Hufford.
Speaker 2:Welcome to another episode of Risk and Resolve. I'm your co-host, ben Conner, along with Todd Hufford. Today, our special guest from the Pacific Northwest is Dave Chase. Just for our audience, a background on Dave. Dave is a visionary healthcare entrepreneur who founded Health Rosetta Looking forward to digging into more about that, but that organization is dedicated to catalyzing a transformation in the US healthcare system through practical, scalable solutions. Dave has an awesome background in not only healthcare but tech as well, as a former executive at Microsoft and then later co-founded Avado. Others may know Dave through his writing ventures as an author for some of his best-known books the Opioid Crisis Wake-Up Call and the CEO's Guide to Restoring the American Dream. Dave, we're glad to have you and welcome to the show.
Speaker 3:Yeah, looking forward to it, Just catching up on some of your backup episodes over the weekend, so I appreciate the opportunity.
Speaker 2:Yeah, excellent. Well, if you could as we get going, let's just dive right in and if you could give a brief explanation of what Health Rosetta is and is doing and really the mission that you're on through Health Rosetta.
Speaker 3:Yeah. Yeah, it's not always the easiest to summarize Sometimes. You mentioned the books, and then there's one more recent book called Relocalizing Health. So the book titles you know the subtitle. They sort of explain what we do and kind of the mission. The subtitle of the CEO's Guide to Restoring the American Dream was how to deliver world-class healthcare to your employees at half the cost. So we're definitely focused on that. My TED talk was titled Healthcare Stole the American Dream. Here's how we take it back. So it kind of speaks to the mission and then Health.
Speaker 3:Rosetta itself is really four things and are kind of three plus one. I count how you're counting it. It's a framework. That's this kind of blueprint that you know. I joke that I was an archaeologist, you know, digging around for healthcare's Rosetta Stone, and we didn't claim to invent anything. We just sort of discovered what was out there that allowed people to crack the code. So it's a framework. It's an ecosystem. That's what people tend to know us about. That's where we have a benefit advisor program, where we train and tool out benefits professionals and that's where we have the event, rosetta Fest. That's the second thing, an ecosystem. The third thing a lot of people don't know about because we're a little weird in that we are a tech company as well and, you mentioned, I have a pretty strong tech background, but it's only sold through our sort of ecosystem, so there's not any real reason for us to be advertising that on our website. But that's the bulk of our team is actually our technology and services team, and we can talk about what that's about. And then the fourth piece is originally it was called Health Rosetta Institute. It's now called Nautilus Health Institute.
Speaker 3:It was always our intent to open source what worked, and we needed to prove out what worked, and ultimately we realized that what we're trying to do is sometimes people talk about having a supply chain mindset. That's certainly good at the micro level. What I'm talking about is the industry supply chain and, to be really candid, it's pretty apparent that we're going through a system collapse right now and there's really no saving the current system. You can definitely do things to make it suck less, but ultimately a new industry supply chain has to emerge, and we have some background doing that type of thing, and so it has to be way bigger than has to emerge, and we have some background doing that type of thing, and so it has to be way bigger than Health Rosetta, and so we open sourced. After we go through a term, we stole from you a performance lab. We have 400 employers that we work directly with in tandem with advisors. So once it goes through that, there's about 400 employers and then there's about 10,000 employers stewarded by advisors in our program, further battle testing and then eventually we make it available for anybody for free, and so that's kind of the long-winded four things that we do and some of our mission.
Speaker 3:So what launched you in this direction, to where you were digging around and found this health Rosetta Stone? What propelled you in this direction? It was actually a friend's death. That was a system failure by the healthcare system. She'd had a similar career trajectory get cancer, um, within two years, their life savings are drained. As if it's not bad enough to get cancer, you're ruined financially. So she left behind a 10 year old daughter uh, you know, basically bankrupted, and ruined her financially, emotionally, um, and physically.
Speaker 3:And I'm one who tries to find some meaning out of, uh, tragedies, and that's what got me digging and it's like it was evident it was a system problem. It wasn't like there was a single bad doctor. And in that journey I find that, um, you know, the third leading cause of death in america is a preventable medical mistakes. That doesn't even include wrong diagnoses, which is sort of a similar number of people. And so it became evident that you had to rebuild from the ground up and that the status quo was so bad. You know the way I was raised. I was one of the lucky ones. I had amazing parents, great, involved parents, you know, couldn't have had a better role model than my dad, and you know the way they raised me. If you see a wrong and you don't do something about it, you're complicit. I had a job when I got out of college and then I had a career that was pretty successful, but ultimately, to me, the ultimate place to get to is it's a calling.
Speaker 2:You find out your purpose for being here and I know what I'm going to be doing the rest of my life. Moving from career to calling is just hard to describe, but it's just no longer a job or even a profession, it's just. You know, I've similarly felt like I've made that change and it's actually very difficult to describe. Anyway, so you founded Health Rosetta. Through this experience with your friend, what did you set out to fix? And maybe how has that changed since you started?
Speaker 3:Yeah, no, it's funny, you know originally just thought, oh, I could write about it. I'd done that with direct primary care and wrote the seminal paper on direct primary care and had a bunch of docs say, um man, I, I read your stuff in Forbes and this, and that these other publications and and I've pulled, you know finally made the change I thought. I thought health Rosetta would be like that. You know, I could just write about it and some people would do it. And it turns out that's not the case. They were like no, you should do it. I'm like no, you should do it. And so initially we thought, oh, this is, you know, we can train and educate people on this and they'll pick up and run with it. And we still do that. That's still really important.
Speaker 3:But it really came down to, oh you know, kind of an obvious point in retrospect, if you're suggesting something as bold as an entirely new industry supply chain needs to emerge, of course there's a whole new tech stack to enable that and of course no startup in their right mind would ever pursue a tiny, tiny market, which it was at the time. You know, it was like maybe five or 10 employers doing this around the country versus millions. But we were very mission driven and, you know, made the bet. Oh, you know, as we got in, you know, once we launched this program basically it launched almost eight years ago, basically it launched almost eight years ago and we got in and saw some of the best what they were doing and we're like, oh my gosh, this is amazing, it's working at all. It's, you know, it's just kind of a cluster and bubble gum and bailing wire and just it's a testament to how bad the status quo is. That that could work. And, you know, credit to those people. They were workhorses and they still are right. That's really necessary step. You always want to figure out things analog and kind of inefficient before you automate it.
Speaker 3:Um, but ultimately we realize, oh, you know, this is a new tech stack, you know, as we say in the tech business basically almost like an operating system for rebuilding health plans from the ground up, and so there's like a project management element to it. There is basically a kind of marketplace. You know, there's all these vendors you know some are good, some aren't and ultimately being able to have, you know, what we found pretty early on was the best health plans in America. The single most common element was they had full, complete, unfettered access to their claims data.
Speaker 3:People are, you know, there's point solutions and people trying to do this, and they're all duplicating effort for something that's actually not differentiating them. Like, let's say, they got some diabetes solution, well, you got to prove it. So you develop some engine to take in the claims data and make sense out of it, dah, dah, dah, and to do it right, you're probably into it for $3 million or like this is crazy, like we need to just invest in this and then make it available to everybody. We got to figure out a model to make that possible financially, but we figured that out and so that's, you know, ultimately very different than what we expected to be doing when we started out. But in retrospect it's kind of like oh, we should have figured that out, you know, from day one.
Speaker 1:Dave, I see your constituents can be not only the benefit brokers but also the employers. How has that shifted from when you started? Did you start with one and migrate to another, or did you always start kind of thinking of those two constituents from the get-go?
Speaker 3:Well, I think we kind of intuitively knew we would need to work with them at some level. But the benefits advisors were the tip of the spear, right. I wrote a piece a couple years before even founding Health First that I said this job could save America, referring to benefit consultants, benefit advisors. And they play such a pivotal role and will as far out as I can see. But ultimately, you know, they have huge influence but they don't dictate what the employer does. And so just in the last couple years we went from we would have these annual gatherings called Health Reset, a Summit. That was just basically our community, our benefit advisors, some solutions. But we really realized, oh, this is a team sport. We have to have the employers or unions if they're involved in the plan. We also have to have the clinical leaders. So today, if you look at Rosetta Fest, like last year, it was pretty evenly split about 250 benefit consultants, advisors, about 250 employers, about 250 clinicians, about 250 solutions and tech companies. So you know, a little up or down those numbers, but roughly it was split evenly. A little up or down those numbers, but roughly it was split evenly.
Speaker 3:And that's one thing we realized, particularly as we're doing this tech platform. We needed to be kind of the connective tissue between these industry silos. You know you could go to, you know perfectly good events for orthopedic surgeons or benefit consultants or tech or whatever. Right, it's all good, but at the end of the day, it needs to be brought together and that's why we did that. And as we took more of this industry supply chain and tech ecosystem mindset, it kind of became clear that we needed to do that and we also for this.
Speaker 3:You know you can. One way you can look at this is this is a revolution, this is a social movement. This is not something that's just going to be. Oh, there's a new photo app and everybody runs to Instagram Like this is a different type of thing and you needed to have these other folks involved. And, as we've seen in our community and there's some other great communities Ben, you know he's in the NextGen thing as well there's like these nice communities that have really been very collaborative and open source.
Speaker 3:We needed the same thing on the employer side and, frankly, the industry has done a pretty players the carriers and whatnot kind of peel them off one by one and sooner or later you realize you know you need to be yes, do what's right by your business and all that, but you need to more lock arms and like. Health Transformation Alliance is a good example. It's a cooperative of large employers and one of the members of the Health Rosetta program Lee Lewis, is, you know, is one of the senior guys there and so mostly we're working with mid-market employers like below 5,000. But we're happy to work with the larger ones and sometimes when they do good stuff, it's very helpful and complimentary.
Speaker 1:At the top of the show. You mentioned that the industry is clearly in collapse. Joe, you mentioned that the industry is clearly in collapse. Can you give us, from your perspective, some of those news articles or, above the fold on the newspaper, things that are?
Speaker 3:happening in your mind that signify that the industry is collapsing? Yeah, there's a few different things. One that's pretty known, which is rural hospitals right, they're closing, maternity wards are closing. Which is rural hospitals right, they're closing, maternity wards are closing, and it's really devastating to the health of those communities and you see that more and more. And they basically get they're sort of vultures who come in and sort of or maybe vampires is a better metaphor to kind of suck the life out of these things and just sell them for, you know, parts. So that's one element.
Speaker 3:Also, critical access you know you go to some parts of big cities and their medical deserts, even though you know in the richer parts of town there's plenty of hospitals, for example.
Speaker 3:So that's one element. There's also the clinicians record levels of burnout and suicide amongst nurses and docs and you know you saw an acceleration of, like, nurses leaving the profession and I think it was 300,000 nurses at least that left one year during COVID, during COVID, and you know, just having nurses day once a year and giving them some pizza isn't going to, uh, make up for the moral injury that's being inflicted on them. Um, and then you see, uh, you know, we all see, right what it means for employers and employees to where, um you know, tens of millions of people probably the majority of the workforce are functionally uninsured. Their life savings are less than their deductible Like and when you have 100 million Americans in debt to healthcare, that's not a bug in the system, that is a feature, and so to me that is an element of the collapse too. So I wouldn't start there, but there's probably other things we could go into as well.
Speaker 2:Well, in part two of that statement, dave, you said that more or less the system can't be fixed, it has to be replaced. Was that apparent when you first saw that experience with your friend? Or has that been an evolution for Health, rosetta? For hey, we're going to help fix the system, and then again, as you continue to dig and find, you're like, no, this thing has to be totally replaced. And ultimately, what does replacement look like from your perspective?
Speaker 3:Yeah, it was an evolution, and it's one of those things where you just sort of it just kind of grows and all of a sudden it's like dang, it's so obvious, like how did I not get that before? And then you know, you think about you know these guys. You know, you think about you know these guys. We didn't get these smartphones by tweaking. You know landlines and rotary phones, like it's always the case. And healthcare goes through major shifts every 50 to 70 years and it's overdue. And so I started studying revolutions and social movements and even just tech ecosystem shifts and as you did that, it became obvious that's the nature of the change. And then the question is what will replace it? You know, our general point with Health, rosetta, is to recognize that no matter where you are in the world, people are problem solvers, and maybe they don't have all the resources in the world, but one way or another, maybe they don't have all the resources in the world, um, but one way or another they get by and they fix things. And and that was really the the gist of my archeologist metaphor Just dig around who's who's got it going, um, and I don't care where they are in the world. Can we pull something out of that and and really what we're about is repeatability and verifiability. Like you have the Rosens of the world you had. You know the smattering of employers doing stuff, but the pace we were going, you know it's going to take till like year 3000 to have all the employers and all the communities have it. And so they're like, oh my gosh, how can this happen more rapidly? And certainly what we coming out of tech, where open source is something that you know, there's this term that you sometimes hear in healthcare nobody ever got fired for hiring IBM and you know old big blue, I'm like, yeah, but I was there, you know, dot dot, dot. Until they were like, yeah, absolutely they were. And IBM in a few years went from their most profitable year to being on track to losing $16 billion. Guess what. They got open source religion pretty quick.
Speaker 3:And it's in the pantheon of been most compelling to me, one in the US, one outside the US, and I just came up with the term community-owned health plan for what they're doing and it's kind of like health rosette, it's as much an idea as a super precise thing. So in the US you have the Alaska Native peoples where, the way you know, basically they were getting their health care was through the Indian Health Service and it's one of those scenarios where, you know, into the late 90s, worst health outcomes in America, some of the worst in the world, you know. Check all the difficult boxes geographically spread medical desert, substance abuse, obesity, like you name it right, as hard a challenge as you can imagine. With the Indian Self-Determination Act there is a method of taking over control of that and they rebuilt from the ground up and they call their care model the NUCCA model, n-u-c-a, and today it's a system that many consider the best in the world.
Speaker 3:Only two-time winner of the Malcolm Baldrige Award in the healthcare industry, like that's the Nobel prize of business, basically. And people from all the world Singapore, sweden, you name it come there. It's incredible. People from all the world Singapore, sweden, you name it come there. It's incredible, incredibly tough situation, right, and they just don't make excuses.
Speaker 3:Like you know Douglas Eby, who's their chief medical officer, you know they're dealing with rural medicine all the time. Does anybody think that we're going to snap our fingers in the next year, two years, even 10 years, and solve? Not, they're not being enough doctors in some of these remote areas, like nobody raises their hands like, okay, let's move on. How do we solve that? They saw, there's telehealth, there's people. When people come in, there's, there's always a solution. Even in a remote island, in the illusions in alaska, you can come up with solutions and they do that. And so amazing outcomes and it really goes beyond just the traditional health care. You know there's been a lot of unemployment, other challenges. When they took over the system, there were three people that were Alaska Native people in that entire system and there was oftentimes, you know, six, eight hour wait when you went to the doctor. You know it was like one doc had the dubious record of seeing 160 patients in one day and they're like that's terrible, right, I don't even know how that's possible. I know Like that's a, it's just like incredibly bad, and so they one of the things that they did, they ended up taking over a community college. Now half of the 3,000 healthcare you know, or staff basically in this system, are Alaska Native peoples, from medical assistants to doctors, to the.
Speaker 3:You know this longtime CEO. She was a MacArthur uh genius grant winner. Um, she was a 16 year old single mom receptionist at one time and became this incredible person, so that and they've been open source about what they're doing. So very inspiring. Um, outside the U S? Um Jan Chopin, sweden, um, they, they, uh, people perceive sweden to be a monolithic, nationalized system. Well, yeah, they have a national framework. It's actually governed at more of water, fire, congressional district, school district scale like 25 to 500 000 seems to be the sweet spot. Um, so we're like, okay, how do we create these? You know, we're relatively early in that journey and we could talk about that. There's a guy, bryce Heinbaugh, I know, you know, who was kind of the OG on, like, hey, do you want to be our guinea pig on how to do this? Right?
Speaker 3:And the thing with the word community is a community. Most people think of as a place-based thing and that's indeed appropriate, particularly in health care. But you know, a company is a community, a union is a community, a faith-based, you know, organization community is a community. So there are different ways to pull that together and what it does is say, hey, you look at the dominant players. Blue Cross doesn't say, oh, acme Corp comes up to them and like, okay, we're going to build a new health plan from scratch. Every time they have certain package solutions that you know you could argue whether they deliver value, but people buy them and some might be great for a small business, some might be great for, you know, macy's. They don't have infinite different solutions.
Speaker 3:And so we're just saying, kind of like what happened in tech? You know, microsoft and Intel started breaking up the IBM hegemony and then open source, you know, blew that open. But then there was this kind of reassembling of this heterogeneous set of tools so that you can go to Amazon or you know Azure for Microsoft and kind of boop, boop, boop Like you don't have to, you know, build your own. You know data centers and servers and you know all the different components, so you can kind of get the best of both worlds. That's what we look at it as like. How do we make this more Lego-like?
Speaker 3:I've been a part of two large-scale industry ecosystem shifts and one in healthcare, one not and what I have found is that for those to be successful, you need to have three things One, proof that your thing is better ideally 10x better. Two standards to make adoption easier. And three, kind of education to let people know about it. And when you do that, that's how these things grow much more rapidly and they go from you know. So you know we still have a long ways to go within the Health Rosetta ecosystem. But you know, when I wrote that CEO's Guide, I managed to find five successes. We now have thousands of successes in the Health Rosetta ecosystem.
Speaker 3:I know there's more than that. Do we need tens of thousands, a hundred thousands, absolutely. We got a long ways to go, but you can't get lucky for five, seven years, across thousands of companies. We've actually, as a community again, we don't take all the credit by any means We've cracked the code. We just need to continue to lower the burden, like, yes, the benefit was up here, you know, relative to status quo, but guess what? The effort was up here too. We're just trying to ratchet that down. So it's just as easy to buy a world-class health plan as it is easy to buy a cruddy status quo plan.
Speaker 2:Yeah, Can we double-click into no pun intended, into the concept of open source and the way I understand it is in the tech world in particular, it's a, it's a, it's a used term, where closed source means it's a kind of a scarcity, like.
Speaker 2:This is all mine kind of kind of mindset, and usually in industry or organizations are closed source when they're winning, when they're leading, and the idea of open source is for basically the competitors to catch up where they're sharing, you know, basically found success and really they're building on each other's success to go faster for, you know, obviously for their corporate benefit, but for consumer benefit as well. How do you see that type of and please correct if I didn't describe it very well but how do you see that helping to win in healthcare when, in my opinion, when I look at healthcare and insurance and everything that's around, what we do, everything is closed source. Hey, I just got a good deal, but I'm keeping it for myself. Or I have a direct contract, but that's just for you or just for me, no one else. So how does open source, what does that look like and how can that change healthcare quickly?
Speaker 3:Yeah, I mean you're right on in terms of the way the industry is operated, but it can go into if you look in tech and you look at the internet. The operating system of the internet is Linux, right, it's got the majority market share. The most common content management system, you know that puts all the content on the web pages, is WordPress, and in both cases there is the open source. You know, like Linux Foundation, wordpress Foundation. In the case of WordPress, you know powers, like at least half of the websites have that they also have a for-profit company called Automatic. It's like with two Ts at the end, for because the founder's Matt Mullenweg, so it's M-A-T-T-I-C at the end of Automatic and so you have the both.
Speaker 3:And the idea is that there's actually a guy pretty early in the open source I think it was Bill Joy from Sun Microsystems said no matter what organization you are, the smartest people in the world are outside your organization and if you can harness and get them together, um and do that, um, it can, you know, move much faster and, as you see, it can work incredibly well. Um, and even like you look at that, um, uh, you know ev market right now, um, tesla, they open source their charging standard. Um, so it used to be just go to the tesla stations and just tesla vehicles had that charging standard, and there was this other one called ccs. Now all the car makers are going to the north american charging standard, which is basically Tesla standard. So, like you see it outside of traditionally, just like you know, information technology, computing, and there's lots of examples like that, and so within our context, one of the things that's been very gratifying is, yes, we came out of tech and a lot of people don't necessarily know you know that. The three founders of Health, rosetta, we came out of tech and a lot of people don't necessarily know you know that, uh, the three founders of of health was that all came out of tech. So we understand that and this sort of the way we think. I guess, um, and I've been at Microsoft, I saw open source, you know, swamp Microsoft and ultimately Microsoft, like IBM, sort of embraced it, um and so.
Speaker 3:And also, you know we are not gonna, you know, do the. You know, imagine if the revolutionaries had done a frontal assault with the British army, like they were gonna get squashed. You have to do asymmetric strategies and go where they ain't, you know, and do things that are very counter-cultural, and so the fact that you know we slogged away, you know it's been a grind and we still continue to get kicked in the teeth every day, but, like you know, we've been around. Basically, we started when I left WebMD 10 years ago and launched about almost eight years ago and you know, we just finally had a break, even year of last year, like, we've deferred a lot of gratification on this, but have managed to grow. You know, and and not looking for any um sympathy we made that choice, um, but we then open source, gave away you know, translated, gave away basically $4 million of investment. Now that investment had been amortized across all these employers. Right, that's how we made it work, because we didn't take venture money, because we knew that would put us down a bad path.
Speaker 3:And people, one of the things that's been really cool, especially since we officially launched Nautilus Health Institute at Rosetta Fest last September, is, you know, you kind of get this. You know people tilt their head and, oh, why are you doing that? And then what we found is that the people who are the best in the industry let's say they're PBM, they're TPA, contracting, whatever these people are incredibly busy and they see the dysfunction in the market. They want it to change. There's no lack of opportunity for them to help people for a long time and they're giving people. People call them. They'll go on podcasts and talk about what they're doing and basically we have this discussion where it kind of ends with their go. Okay, you're saying if I pour my intellectual property into this thing you've created, you'll make sense out of it and when people come knock on my door, I can just point them there and it's going to be freely available. Yes, and it is granted a lot of work to organize that make it digestible. You know, in terms of our own ecosystem, like it can be a mess, but once we make it available to anybody and kind of toss it over the fence like we're not there, it needs to be more packaged and it just getting this virtuous loop going.
Speaker 3:Now you're hearing about I don't know if it was because of us, but like now Mark Cuban's talking about open sourcing hospital contracts. You know we, the National Alliance of Healthcare Purchaser Coalitions. You know they represent there's about 90 million employee lives represented in all these regional coalitions that they have back. Um, I think earlier this year, late last year said hey, dave, do you guys have something to help employers select a benefits consultant, because we think they really need help there? Um, I'm like, yeah, actually within our system we've had a rfp that's available. Um, I'm like we could open source that. And they're like, heck yeah. And so I was just there, you know, at their, their national gathering for their strategic leadership um, just last week, and they I mean man that meeting talk about people realizing they really, um, and not news to you but the status quo, big benefits consulting shops have dropped the ball and not delivered value to them. There's some severe conflicts of interest and there's some real anger there. And so they announced we're putting together a committee advisory council of how we do this. And we said, hey, you know this broker compensation disclosure form, which is one element of that. That was the template for the Consolidated Appropriations Act. Right, take it right Again. We didn't create that out of thin air. We got that from a bunch of input from people. And so those types of things people go.
Speaker 3:You know what, if you look at these health plans, when they've got great primary care, they've got things like centers of excellence, there's no barriers in front of getting medications to people that actually work. Not all do, but the ones that work. Why would you put a barrier in front of those things? If you look at the health outcomes, this is a pretty dramatic statement, but I'll stand by it. If you could put that into a pill, it would be the blockbuster drug of the century. There is no medication ever that has that level of positive health.
Speaker 3:This is better than cure for cancer. And you know, todd Ben, I'm sure if you had the cure for cancer, you would share it, right. You would want all these lives to be saved. You would share it, right. You would want all these lives to be saved. Once that light bulb goes on like this is not like, oh, we're just going to add a penny of EBITDA to some random, you know company on the New York Stock Exchange. This is life and death and that's dramatic. But it's absolutely true and that's, you know, one of the reasons we're all willing to eat a lot of dirt and, you know, get kicked around because this is hard. What you do is incredibly hard. What we're doing is hard. But guess what? You know, the best sports outcomes, the best marriages, the best parenting, those are all hard, right, they always are hard. And when?
Speaker 2:it's a call-in, you're doing it. Well, that's right. Always, um. And when it's a call, well, that's right. So, when you look at system disruption or open sourcing to change the system, what parts of the system are at biggest risk for disruption or significant devaluation? Is that's a word? Yeah?
Speaker 3:yeah, um, yeah, not. You know, having had trevor on your podcast, you know not breaking news pbms, there's a lot of abusive stuff, the whole. You know supply chain there. Um, there's the um, you know the whole, you whole. Ppo shenanigans it's just about as bad. There's spread pricing there, the dollars are bigger and so- let's double click into that for the listeners.
Speaker 2:PPO disruption or spread pricing, meaning that the bill that the employer is paying is not what the hospital is receiving. There is a delta there that is being retained by the insurance company, correct?
Speaker 3:Yeah, I mean, this is a real example. Granted, it's an extreme, but smaller versions of this example. This is public record. Chris Deacon has talked about this.
Speaker 3:This was a case that I think about a year ago was publicly available. It was an inpatient, it was actually an inpatient site provider I believe that it was called TML Recovery, I think and they had a $996,000 bill and then, uh, then the fun began. Who knows whether that all those charges were legit. Generally, you know, we see a lot of questionable charges and bills, but let's just say those are 100 legit charges for the sake of argument. Uh, signa said no, no, actually there was 11 million dollars of billed charges and then they quote unquote saved $7 million because they had a shared savings program. So Cigna made $2.5 million. Multiplan, who was their partner in that, made $667,000. The employer paid $4 million for that. Less than one million dollar build charges and the provider, I think they got eight hundred and seventy thousand or something like that. So, granted, that one's extreme, but that's public record and that type of thing happens every day. So why do they keep you from wanting to get access to your claims data? There's a lot, of a lot of monkey business going on.
Speaker 2:Closed source right. They're in control of a very profitable system. I've been thinking about over the last year or so of like, how do we really solve this and where are the problems really lie? And I think there are a lot of constituents that have their hand in the pot, no question about that. But I think to your point that you just made. You know you go through the supply chain in and of itself and you're like, hey, you know what is egregious. And the reality is you look at hospitals, physicians and drug manufacturers. They certainly could have their hand in the pot and they do have their hand in the pot, but it's pretty necessary to the supply chain of health care. You kind of need a doctor and the hospital and the drug company and the PBM and you look at the revenue extraction versus the value delivered.
Speaker 3:Yeah.
Speaker 2:And the value of like an insurance company is in their network, which there's no reason to even have a network. Why do I need to be told where to go, especially if every single doctor's in your network anyway? Just total excuse to extract revenue, um, and then obviously we have another podcast for others to listen to with trevor about the pbm side of things. But you know, it seems if we move uh the employer, um the community, if you will closer to the care deliverers, then we've improved the system. Maybe it's that 10x number that you said, even with those simple actions, because once you remove waste from the insurance company or PBM, that can probably dictate action from a hospital, uh, with maybe some, you know, extra money they're charging to fund a lot of their internal operations and that sort of thing. So it's just kind of a fascinating. So I I arrived at the same point you did, dave. The system can't be fixed, it has to be uh replaced um, and there's a bridge.
Speaker 3:It's not like I mean it could. There's some pain along the way and and that's already happening I don't know if it's any worse than what's already happening um, and certainly we want to have as much care, but the more we can be proactive about it, the more we can lean into it. Um, yeah, I'm doing a pretty major rewrite of um, my last book, relocalizing health, because so much has happened in the last five years, both in our world and, you know, the broader world and, um, the conclusion of my book, and I'm working on right now kind of editing um is editing is really around. All this dividend from reclaiming that waste is really vital as we have this transition to an economy that's going to be very impacted by AI. And to me it's super clear that there's not going to be some magic solution coming from DC to address the AI challenges, but there is at the community level if we take a proactive stance. And so I go into that in significant detail and you know I'm not a Pollyanna person, but there is a very positive future that can happen, and that's what you see and that's, you know, we call this health presented dividend. I mean I was just with Russell DuBose of Pfeiffer, this company out of Alabama, at the National Alliance meeting last week and it's so inspiring what they're doing for their workforce by reclaiming that waste. They're funding college scholarships and separate enrichment programs for the kids and opening up clinics and they have some really novel stuff they're dealing with, you know, wellness and GLP-1s, and not just like just rolling the dice on that.
Speaker 3:And then the latest thing he's like hey, you know what we're doing, the latest thing. I'm like cool, what are you doing, russell? He's like we have, I think, two or three clinics and he's like we have some capacity and we have retirees who don't have a primary care medical home. There's 300 of them. We're letting them use our clinics for free. There's no obligation for them to do that, yet they're doing it Super cool. And the thing is, healthcare doesn't start in a pill, doesn't start in a hospital. It starts with mom and dad at home and then fans out from there. And that's what we're you know, we that into fertilizer for restoring the American dream, like there's so much money there, like more than the entire Russian economy, is what we waste every year. It's pretty gross.
Speaker 2:Kind of the idea of um. You know, I'm part of a C12, which is a Christian CEO peer group, and one of the key sayings there is, you know, no margin, no mission.
Speaker 3:Yeah.
Speaker 2:Or if you're not running a healthy business, you can't invest in missional aspects that your heart's desire. And, to the point of what you just said, when we're removing waste, it's creating margin and for that organization, they are able to use that margin to invest in retirees, to have primary care, medical home, for you know to care for people. Yeah, imagine that you know using extra funds to care for people.
Speaker 1:Dave, I was going to ask you we've got this education piece where we're educating the employers and the brokers. We've got the tech piece, which I want to dive into a little bit. But before we get there, is there any comparable in another industry that looks like what you guys do? You know you're kind of part association, part college part. You know you're kind of an amalgamation of different functions. Do you guys ever say, do you guys ever reference some other organization that looks like what you guys are doing, but maybe in a different industry?
Speaker 3:Yes, yes, definitely. You know, no analogy is perfect. You know you pull from what you can from different places, but the one that I've used the most is the way. There's an organization that has they're called LEED Standards, the US Green Building Council. True, right, 25 years ago or so 30 years ago, they came up with this concept and they basically had a framework blueprint. They trained you know, quote unquote well, not literally architects I call what we're doing architects of health plans, right, that's where the air quotes comes in. And then they developed a certification. So you go into a lot of new buildings and a lot of public buildings. They meet their procurement standards. So an entirely new supply chain emerged.
Speaker 3:I use that because the built environment's kind of like healthcare. It's like this incredibly local, entrenched thing. You don't just like one day, all these inefficient, you know polluting buildings that you know have bad air for the tenants, they're all raised. The next day they're all magically green built. Now, the old wanes over time, the new, you know, grows over time certain locales or earlier adopters of it, and then it disseminates. But it's just the way things are done. Initially it was kind of environmental zealots who are doing it. Now it's just like it's the most cost-effective way to own and manage, build on and manage a building. So there's been a lot of lessons and ended up meeting the guy who was the chairman of them during their hyper growth phase. So we've learned all we could from that and there are a lot of analogies there.
Speaker 1:Yeah, that's actually that helps me a lot because I've got a good friend in Denver who works on lead projects. She's a civil engineer by trade but does everything from landscaping to structure and everything in between. And you're right, when the project gets that rubber stamp of being a lead certified building, sometimes that comes with extra dollars but it definitely comes with a different level of efficiency and a certain level of pride as well when they know it's been a LEED project. So that's actually a good example On the tech services team. So still kind of interested in sort of the business model and revenue sources Is this a potential revenue source or is this still today one of the expenditures?
Speaker 3:Yeah, yeah, no, it's definitely both. In that, yeah, I mean our business model. We're pretty fairly transparent about it. You know, you join the program. There's an initial fee and an annual fee. It's like $1,500 to renew. We have the typical event economics. You know we want to at least break even with our event, but then the way the 400 employers pay us is on a per-employee, per-month basis and they pay up to $5 with our current offering and that includes this data platform and the tech and handles all the claims. And it's called METL, which is Medical, etl, which is Extract Transform Load that's kind of a term in tech and it's cleaning up the data and adding value to it and then putting it into other systems that can work. And so the worst result that we've driven when we've been involved for that $5 PPM that employers pay is a 200 PPM reduction. So it's a pretty clear ROI and that's what funds our tech development for this platform.
Speaker 3:And you know, a key part of it is something we call a plan grader. So it took us probably four or five years to come up with this concept of being able to score a plan. We thought, gosh, this is weird. You know, we have, we can go to Amazon and my silly example here I'm waving for people on audio is a Bic pencil and there's 55 55 000 reviews for this stupid little big pencil probably cost 19 cents 20 of the economy. There was no objective market value of health plan um, so we it took us a while to figure that out um, but it was the largest project we did at the time. Largest content project we did at the time. Largest content project we did at the time. You know it started with me filling out 800 different cells of content depending on what people answered, and we have a rules engine and document management system. So it's like kind of magic happens um behind the scenes, but it was real work. Um that you know.
Speaker 3:Some advisors said you know reports like this, particularly for larger employers. You know people would have spent 20, 30,000 bucks to get a report like this, these custom recommendations and scoring. And you know benchmarking and as more people do it, we can do more geographic and industry and size benchmarking. So we have more to do there, but it becomes a pretty powerful tool. So people can see gosh, you know what. We got a 17 out of 100 on our plan grade. Like I'm not some health plan womp, you know, as a CFO, ceo, but like that doesn't sound like a passing grade and, granted, we're really tough graders, but these things aren't impossible. We have people getting 60s, 70s, 80s, even 90s right.
Speaker 3:It starts to shift some of that mindset, you know, because that's by far the biggest obstacle. Like most people think solving health care is like trying to solve Middle East peace, you know, and it seems kind of out of their control and maybe hopeless. Well, if you believe that you're right, but if you don't believe that you're also right, it gives people a good roadmap and that that you're right. But if you don't believe that you're also right, it gives people a good roadmap. And that's another good use of tech, where we kind of aggregate all this wisdom and experience and iterate and then be able to give people kind of almost like a gps and, you know, google maps on how to get there the visual I'm getting is a serpentine belt on your car where it's, you know, driven off of the main engine, but then it powers your alternator, powers your fan.
Speaker 1:So your technology is really the serpentine belt that the engine is the data from the employer and if it's not hooked up to anything, nothing happens, nothing gets improved, you're not able to take that energy and apply it. But as soon as you lock that serpentine belt in there, it just moves around and starts powering. Probably what it sounds like is maybe a lot of these other vendors that you guys work with and are doing very specific things, but without that very specific data can't do much without it.
Speaker 3:Yeah Well, and going back to the Linux and WordPress examples, there's a whole ecosystem of solutions built around that. Right, they're not having to redo that plumbing level. Likewise with us. You know we launched it with a limited beta, so it's not yet on GitHub, which is where open source is. But we have seven companies in production, from TPAs to point solutions to underwriters and, you know, putting it through its paces in addition to us. And then there's 20 in kind of an evaluation phase.
Speaker 3:Eventually it'll be available to everybody. That's why we're raising some money so that we can actually support that level of. But it means that not everybody has to reinvent the wheel Like, oh, let's take this module, maybe somebody's got great thing using the NCI care protocols, the National Cancer Institute, on. You know, for this you want to follow this care protocol and all kinds of examples where people can build around that. And back to our earlier discussion things can move a lot faster and it was funny somebody mentioned, you know, here we're the scrappy little organization and they're like you know you've open sourced more stuff to the healthcare industry than UnitedHealthcare, which has a two more bucks than us.
Speaker 2:And so, yeah, you know we have a little bit of good Just on the plan grader real quick, just. I think that is an incredible tool, dave. So I'm really thankful for you and your team for creating that, because what I think that it does is it allows an employer to get outside of the bias and or education of their advisor capability or capacity is for them as a, as a purchaser of healthcare. Uh, because it goes through a huge um and it's not hard Um. You know, I completed for our company. I completed it in probably 35 minutes, I get. I am an insider in the industry so I kind of know some of the answers.
Speaker 3:I wouldn't take more than anybody else more than an hour. Yeah, I mean it in the industry, so I kind of know some of the answers. It wouldn't take anybody else more than an hour.
Speaker 2:Yeah, I mean it really isn't, the barrier is not huge, but it really allows us to see some of those questions You're like, oh, yeah, yeah, man, we need to get on that. That definitely needs to be the next thing, or tell me about this, or how would this strategy fit within our organization? So I think it allows employers to get outside of the bias or capacity of their own advisor. Another thing I found that is really helpful in communication on the plan grader is there is a misconception that fixing your health plan or solving health care for your community or for your workforce is reserved for big companies. Well, I'm not Southwest Airlines, I'm not Coca-Cola NRN said large company, I'm not them.
Speaker 2:So I can't, we don't have enough people, we don't have enough premium and that's just not true. There are employers of all sizess, which is actually pretty high for a plan grader and it's work, but we're really trying to solve healthcare and be an example, that performance lab, to our clients. I think. Another thing with large employers which is interesting, because small employers say, well, we're not the large employer and the large employer says, hey, we're not the small employer. It's hard, we have to navigate 60,000 lives and we can't disrupt that many people, but the reality is there are large employers that are scoring really well also by managing their community and really putting in extra, extra effort to deliver excellence in their instance. So it's kind of interesting how there's like this perception like finger pointing over the fence. Well, we're not them and we're not them, but they're all finding success in your platform, which I think is a testament to what you've built and a testament that it works. It's doable.
Speaker 2:The question I had, dave, you've written several books. You talked about relocalizing healthcare and even taking another bite at the apple on that book. Where did your passion for, for writing come from?
Speaker 3:oh, it's funny, you know, I, I hated english in school and didn't like writing, and they forced it in journal and like, like people, like I've got a goal to write a book, I've got a goal to never write a book, was what you know. I would say um and uh. And it's funny because I'm by far the worst writer in my family. My kids are exceptional writers and editors, my wife is too. Yet I'm the one who's published books and it just started out early on. You know, I was in the Internet.
Speaker 3:There was a thing called blogging that came along, and I'm kind of one who's an experiential learner. I'm like, ok, I'm just, I got to learn this. It seems to be. It was kind of like almost the first social media and um, so I just like, okay, well, you know, it actually kind of forces you to crystallize your thoughts. Um, that's kind of a good thing. Um, and then like, oh, man, people are reading this, what? Um, and then you realize that I can have influence. And then I, it just kind of grew and I kind of went for, oh, somebody wanted, you know, me to guest blog on their thing. And then some trade pub, and then, you know, huffington post and Forbes asked me to do some stuff, and, and I was like, oh, wow. And then there's some people who are perceived like they think I'm a writer, which is still kind of hard for me to self-identify that way, um, and and so it just, you realize it is a very powerful medium, um, and it does really force you to crystallize your thinking and if you have a good editor, you know, you can look halfway intelligent, you know, when you're, uh, with the finished product, and I've definitely had good editors, um, and so that's really been the.
Speaker 3:The journey is, um, well, and actually, you know, sort of a little kind of my first book I wrote was a co-writing, where somebody asked me to contribute to a book, and so that's, like, you know, a little fun fact. The first book wasn't in health benefits, it was around patient engagement, um, and it was published by HIMSS, which is the trade organization for the health IT industry, and so that kind of demystified it, where I was the co-editor and I contributed a chapter or two of that and I was like, oh, that's not impossible. And then I wasn't really that happy with the way they marketed it and I have a number of friends who published through through, um, you know big publishers and they're like, yeah, they, you know they don't do that much. You know, I mean they do filter books and that's good, but, um, so it just kind of demystified it, um, and I was like heck, I just I have all this body of work I've been writing now If I can make some sense out of it, maybe there's a book there, and so turns out there was, and then some people read it and you know, you kind of get the you know attaboys and like, okay, well, I guess I can continue to do this.
Speaker 3:And so that's my weird little journey on the book writing front.
Speaker 2:Well, you do a great job and you certainly catalyzed many advisors employers to action and a meaningful cause of solving healthcare. Before we get to our last segment of our questions that we ask everybody, I wanted to highlight Rosetta Fest, which is the conference for health Rosetta that's coming up at the end of August, and just wanted to get a sneak peek from you about Rosetta Fest and maybe some of the things that you're excited for and maybe some things that employers can expect to learn, or maybe for people who have never attended, why they should.
Speaker 3:Yeah, yeah, um, great question, I would say. You know, one of it is the fact that you have people across the industry coming together across the different industry silos, people who attend for the first time. Like wow, a lot of the healthcare events you go to it's pretty dismal. Um, people are pretty down and this is a can-do group, not like techno-utopian can-do, but they've actually done it. And so I would say number one excited about is getting all these employers together, them creating the community and them sharing their playbook. Much of the agenda of the event is these rosy award case studies where the people who've actually done it are sharing how they do it. So you know we have a bunch of public sector employers, so there's going to be kind of a track around that. There's actually a bunch of co-ops and ESOPs. You know your credit unions, your grocery co-ops, your ESOPs right, there's a bunch there. And then there's a bunch of manufacturing. So you find there's birds of a feather. So to me like seeing those people connect and being inspired and kind of raising their game. You know the verse iron sharpens iron. It's big time there, right.
Speaker 3:And then I'd say number two is Nautilus. What I talked about we're going to have a major drop of new resources. We're going to have a PBM field guide, we'll have an update for the TPA field guide and if you go and look at that, you know, you just go to nautilushealthorg and fill out the little form. It's going to be just very simple. We threw out that website in a day, kind of off the side of our desk, but it sends you a document, opens up a Google Doc that goes to other documents, but you go to the TPA one. You'll go there and you go, whoa, like this is a 60-page document, right, that's kind of the playbook of the best of the best, and at the bottom there's a link off to like eight or 10 other documents or spreadsheets, and so it's really helpful. And we've got, you know, 16,000 company employees using employers, using this for RFPs. You know the advisor, rfp is one of the other resources and you know I, mark Cuban, we're expecting the hospital open source contracts to come in, and so it's both creation that we do but also curation, like with the PBM. There's more curation because there's already some good resources, but then organizing, making sense out of it, um, and so that's number two.
Speaker 3:The other thing that's happening is, um, you know know how important DPC docs are in the direct care industry, and so Hint Summit has generally been the biggest direct primary care event, and Hint Summit's actually happening at Rosetta Fest. We're going to have a ton not only direct you know specialty care, but a lot of direct primary care care, but a lot of direct primary care, and so I'm psyched about that because they're really play a pivotal role. And you know, again, it's no state secret there's no well-functioning healthcare system in the world not built on great primary care, and so we're all rebuilding it and they're a big part of that. So all those things and we actually.
Speaker 3:The other thing I should mention is non-health Rosetta advisors are invited. We want them to be able to get a taste of this we have again, nautilus is bigger than Health Rosetta. This is becoming kind of the standard for how employers are choosing folks. So we want to give them a taste of it. They want to join the program? That's awesome. They want to just go use the Nautilus resources? Have at it them. That's awesome. They want to just go use the Nautilus resources, have at it. So I want to call that out.
Speaker 2:We definitely invite anybody to come. Yeah, rosetta Fest is always a highlight for me. I know just thinking through last year of just some of the insights I've picked up from other consultants from around the country. Again, you talk about open sourcing. Just a lot of knowledge to be had there. That is an abundance mindset. You know. Last year you had Dr Marty McCary speak.
Speaker 3:Launched his book at our event.
Speaker 2:He did launch his book.
Speaker 3:He did it for like five or six days. That was pretty cool.
Speaker 2:Yeah, that was excellent. Now he's the FDA director, and another highlight for me was Sonia Allen speaking about the Marshall Allen Project. So just a lot of excellent content. And you know, listening to employer stories of how people are solving health care in different forms and fashions, and you know, sometimes you have to ask, but other times people are just sharing. That's what we do. If you want to know more, feel free to ask. It's really, really valuable. Well, I wanted to get into our last segment. We have two questions that we ask every guest of the Risk and Resolve pod. The first question is what is a risk that you have taken that has changed your life?
Speaker 3:Yeah, I'm going to talk to indirectly a little bit. It was really just pursuing health rosetta. All in right, as I mentioned, I thought I could just write about it and that it would happen magically, and I had actually like the Health Rosetta idea sort of came to me. I think I registered that domain Health Rosetta like in 2013 or something, and that was around the time when my last company, Avado, you mentioned, was acquired by WebMD and I thought we might be able to do it within WebMD and they had a big footprint on the clinician side, consumer side. That was not meant to be and it was.
Speaker 3:I was in Europe, hiking around the coast of Italy, and I was like it just came and I'm getting goosebumps right now. I was like this is it? Like I don't know what this is going to be and how it's going to take? And actually another little trivia like Health Rosetta started as a little investment fund with sean, my co-founder, so it took us an iteration to get where we are, but I just like this is the rest of my life. I know what I'm going to be when I grow up.
Speaker 3:You know not that I was that young, um, and so that was a big leap. I had no idea what the business model, what that would be, any of that and and you know, it's like probably like parenting. If you knew how much work it was going to be, maybe you'd question it, but you're super happy. You know that. You're that and it's the most rewarding thing you've ever done and for me, professionally, absolutely has. But it was a big, big blind leap. But you know, you, I have a lot of faith and that really guides me and like, okay, you know, I always believe if you have a lot of faith and that really guides me and I was like, okay, I always believe if you have a goal that you can achieve on your own, without God's help, it's too small a goal and this is a hard one and it's the granddaddy of them all, but it's an incredibly satisfying, rewarding journey, even while we get kicked in the teeth every day.
Speaker 2:So you were called into the arena on the coast of Italy. Yeah, that's, that's awesome.
Speaker 1:Dave, the second last question. I feel like I've got to caveat this for you. You seem like a guy that would have a lot of answers to this question, multiple, so we kind of have to limit it to one. So you got to pick your best one. But here's the question what is left yet unfinished that you, sir, have the resolve to complete?
Speaker 3:Doing it, doing what we've been talking about in my own community. So I've been in my community. I was involved as the high school track and cross country coach. That was kind of my community give back and I've enabled that and we're like I got to make it happen here. I actually think our community is well suited to do it and while we have a lot of the health plan side of this figured out, always more to learn we're not perfect, just to be clear, the way to engage the community. We have not cracked that code and so that is definitely unresolved.
Speaker 3:Like what am I doing to make that happen?
Speaker 3:That's like I'm literally one of the suggestions that I was given by somebody who's kind of been in this community a long time is they said, go to the county and city council meetings, they have public comments and start to do public service announcements, like they have kind of some crazies who come there they're going to say, oh, this guy isn't totally crazy, or at least he's crazy in a good way, and you know they're big employers themselves.
Speaker 3:But you know, and I had a meeting, you know, a few days ago with a group of employers and so it's bringing this into the community and trying to figure out how the HADC right do as critical as benefit advisors are they can't do it alone, right, and it's going to take a community level effort and figuring that out. You know I got there was a. There's a one of these conversion foundations that's you know I got there was a there's a one of these conversion foundations that's you know, focused on healthcare. I participated in some stuff last week and, and you know we need to have all ages, all people across the different areas of the community to be involved, and so I'm trying to figure that out. It's definitely unresolved but hopefully it will happen before too long.
Speaker 1:Are we talking the greater Seattle area or something a little more localized?
Speaker 3:Yeah, I'm about 100 miles north of Seattle. It's a county up against the Canadian border, about 250,000 people. It's big enough but not too big.
Speaker 1:What town should we put into our BizWire automation to make sure we're checking for those public hearings? What town is most close to you?
Speaker 3:Bellingham, washington. All right, sorry for my dog, I apparently am going over on our time limit.
Speaker 1:I thought that was your phone alarm. No.
Speaker 2:Dave, you're right, though, about not being able, not doing it alone, as I've thought about health care, I think, in terms of like the state of Indiana in particular, and I think that it's about three to four hundred courageous Hoosiers that it will it will take to solve health care in the state of Indiana. So you know, whatever the transition is for Bellingham Washington, it's got to be you and some others that go boldly. So we'll be following, for sure. So, dave, thanks for joining us today Always enjoy the conversation and thanks to our listeners for tuning in to another episode.
Speaker 1:Thanks for tuning in to Risk and Resolve. See you next time.
