Urgent Care Reinvented: Eliminating Handoffs with Clinical Concierge and Lean Design

<p>I'm not saying I have such a superpower, but what I am good at is I reliably pick the best people. And it doesn't take a lot of time for me to engage with somebody to figure out whether or not they're a rockstar. [Music] Hello everyone. This is Cole from the American Journal of Healthcare Strategy joined by a really special guest today with many years of experience at all angles of the healthc care industry spectrum. Uh Brandon Robertson.</p> <p>Brandon, please introduce yourself and what your current role is. Uh good to good to be on today. Uh my name is Brandon Robertson. I'm the founder and CEO of UCP Merchant Medicine and Intellvisit Solutions. Uh UCP Merchant Medicine is a boutique consulting firm based out of Minneapolis, Minnesota. We partner with health systems to build urgent care platforms uh help them to have capabilities, that type of thing.</p> <p>And then in the intellvisit solutions space, we have a real time clinical decision support tool that helps to deliver care consistently across uh on demand care environments. Thank you so much, Brent. And the first thing I have to ask is when you started, it looks like on LinkedIn, the first thing you have on your resume is in 2008 at John's Hopkins as a financial analyst and intern. What happened along your career path?</p> <p>What things did you see that led up to you wanting to found this organization with, I would say, a fairly niche focus compared to consulting in general, right? It's it's quite a niche focus. So, what occurred to lead up to that point? So when I was at John's Hopkins, I had the opportunity to to learn about how finance in healthcare actually works. Uh I didn't understand about the revenue cycle.</p> <p>If you've ever done work in Maryland, you understand that rate regulation is a nightmare unto itself in many ways. It's extremely complicated with all kinds of odd facets. Um but had the opportunity to learn all that. Following my time at John's Hopkins, I actually took an administrative fellowship at Centura Health, which was a joint operating agreement between Common Spirit and Advent Health in Colorado, largest health system in Colorado.</p> <p>Uh, in that space got the opportunity to, you know, operate in lots of departments in both the hospitals and in the corporate space. And then beyond that, I got into urgent care at Advent Health in Florida. Uh where I then started to figure out why I love consumer centric retail medicine models and how to think through, you know, what can you do in care delivery to make just the experience just better and what is it like when you have a better experience?</p> <p>What does that allow you to do strategically? What does that allow you to do from relationship building, patient acquisition, all those kind of things? And then why was your solution to found your own organization? What what solutions did you really want to bring to the table that you thought would be unique and that would solve some of the issues that hadn't been solved before in the health care space?</p> <p>There's a there's an idea that isn't really all that prominent in healthcare, which is the theory of constraints. So, one of my my background is in finance, but also in process improvement. And the theory of constraints as well as queuing theory talks about what what is the truest definition of a bottleneck and how do you eliminate waste focused on minimizing the impact to that bottleneck is and make that as le as minimally negative of an impact as you possibly can.</p> <p>Well, urgent care and clinics and ERS and everything in healthcare actually has a very significant bottleneck which are providers. The problem is in in healthcare we often think of providers almost calling them a bottleneck is a pjorative but it's not. It just means that patients everyone has to go through the provider layer before they can receive the completed care.</p> <p>Well, when I started thinking through an operating model that applies the theory of constraints uh meth mentality and methodology to health care, uh I had it papered that I thought I could reduce the door-to-door times in urgent care centers by 50%. And that was a very a lot of hubris went into that idea. Just saying it sounds really uh aggressive, but we we found ourselves with the opportunity to explore and try it and we were successful.</p> <p>And so we took urgent care settings from a door-todoor a national average of about 58 minutes, 68 minutes if you're a health system uh to we are now our national average is a 34 minute door-to-door time with our most recent models 28 minutes. So literally half of the national average and that's through six sigma and lean tools and all those kind of things.</p> <p>When you mentioned queuing theory, it cracks me up a little bit because it's one of the hardest courses I took was uh the operations from a systems perspective focused on queuing. I took it with professor Nadu who has a PhD in the area and so he's a tough professor to take it with. Um and it's interesting that my MHA colleagues most of them have not taken a course in that.</p> <p>They've taken of course system perspective from healthcare but um they've never uh got into usually that and one of the examples we did was um looking at you know some of Disney's kind of philosophical perspectives on how to arrange flow this is from an even larger systemic perspective I think zooming out even even further in a way but I guess one of the issues I have is you're talking about 28 minutes doortodoor for urgent care right I I guess I'm wondering how exactly that's possible Because usually the visits are I guess I'm not sure how long the visits are when you think about because I'm thinking to myself as you say that like well actually how long do I really spend talking to the doctor but can you just explain that a bit more because it seems improbable 68 seems a lot more realistic.</p> <p>Yeah. No absolutely absolutely I'd love to. So, um, when you think about the steps of a process, um, registration typically takes, if you're using, we're going to talk Epic for a moment. I, almost all my clients utilize Epic EMR software, so I'm going to talk Epic for a moment. Typical registration of a new patient in Epic in urgent care takes 10 minutes. Rooming process takes five minutes. The time for a provider to see a patient and document on the patient is 10 minutes.</p> <p>And the time to discharge a patient is five minutes. What if you add all that up, you get 30 minutes. The thing is, why do we not experience a 30 minute visit? You don't get a 30-minute visit typically because you walk in, you talk to a registration person, and then you go sit down and you fill out your own paperwork, and then you wait for someone, a different person to come from the back and get you. Well, typically that handoff time might be about seven minutes.</p> <p>Then, uh, and that doesn't include the weight, it's the wait plus seven minutes. Then you go back, you do the rooming process, someone basically exclusively takes your vitals. That's all they're going to do to you. They're going to ask you a handful of questions, but that's it. Then they're going to leave. Another seven minutes or so is going to transpire. Then a provider is going to come in and they're going to talk to you. And then they're going to order some tests.</p> <p>And then they're going to leave. And maybe the same person that was clinical or a different person is going to come in. And basically what you're going to hear as I go through this whole thing, there's a lot of little gaps. And all those little gaps have on average a seven minute handoff time. Well, when you add together all of the gaps, you're going to end up with an amount of time that's about about 30 to 40 minutes in handoff. So, what we have rewired the whole process.</p> <p>There's a person that greets you at the door. They're called the clinical conciier. They greet you at the door. Welcome to XYZ Urgent Care. My name's Brandon. What's your name? Uh, good to meet you. Uh, I'm going to go ahead and take you back. Say you've got a sore throat. We go to a room. I register you. I collect your payment. I run all your insurance. I do your vitals.</p> <p>I ask you a series of uh AI assisted medical interview questions out of Intel visit that then orders all the diagnostics on your case. I have all the tests in the room. I run those on you. Now the provider comes in. They are already they already have a pre-populated suggested differential diagnosis list.</p> <p>the system already has written their medical note which takes about five minutes of time and uh all the diagnostics are already processing and typically are already resulted by the time they get in there. And so now what happens is the provider isn't going in twice, they're going in once and all these little handoff times have gone away. Well, when you chop all that down, you end up reducing from 58 minutes down to 28 minutes.</p> <p>Furthermore, because that door-todoor time is now 28 minutes, uh I'm sure some of your listeners are saying, "Yeah, but what about sutures?" Well, sutures, sprains, frames, sprains, strains, fractures, abdominal pain on average, and things in your eye, uh typically represent about 14% of visit volume. So, in those cases, those are going to take about an hour. So, what does that mean? Every time you do a UTI, it's not a 30 minute UTI.</p> <p>You got to figure out how to do a 20 or a 15 minute UTI so that on average it weights out and you come up with that roughly 30 minute door-todoor time. I have two primary questions here. The first is why haven't we just because when you look at clinics I have I have a Jefferson urgent care right across the street from my apartment. Uh I've been into it a couple times. The reception area takes up probably about two or three exam rooms at some of these clinics. Right. right in terms of this space.</p> <p>So I think even when building clinics there's a savings potential and then again of course the staff it I get the savings potential but why hasn't you know McKenzie or or some of these other people who go in and I've seen you know I've spoken with people at McKenzie who go into clinics and they you know videotape it and they they do a lot of funny stuff to try to identify these things. Why haven't they already done away with this? What have we been waiting on?</p> <p>What have you you know you know what I mean? Why is this not a solution that was thought of years ago? Not to insult your intelligence, of course, but what are the technological barriers that have started to finally be overcome? Yeah. Um, I'll say it this way. This we existed with this workflow 10 years ago. So, this workflow has existed for a long time. It represents a pretty sign uh single digits but singledigit percent of all urgent care centers in the country.</p> <p>When you alter the workflow to this model, uh the national average net promoter score for an urgent care visit anywhere is a 71. The national average net promoter score for our clients is a 94. Um because door-to-door time is so highly correlated to experience basically. Now, why don't other groups do that? Well, there's two main reasons. One, it doesn't logically make sense.</p> <p>If you think about if you if you always heard the Toyota way is the way to do things, then you would think, "Oh, then this you would never even try it because you'd think Toyota is the way to do it." The reality is assembly line models are fantastic. If you're going to make 2 million of exactly the same car, the reality is if you're trying to be really hyperefficient at seeing one unique case at a time, you got to do it more like Rolls-Royce. So Rolls-Royce doesn't build two million cars.</p> <p>They make one car by hand at a time. In our world, we try to do that same logic. So getting to if you've ever read The Goal by Eliu Goldrat. Oh yeah. Great book. He talks about you keep having your cutting in half your batch size, right? Well, when you've h haved it down to one at a time, the lowest possible units, you're going to find that that gets to your highest level of productivity per unit.</p> <p>And since patients aren't like a factory, they come in waves throughout the day, your goal, the easiest way to see eight patients at once is to see eight patients individually as fast as possible. And so when you start to chip that away, your weight times just plummet basically. So you don't like the model where a doctor sees eight patient or usually it's four, it's not usually eight where they see four or two patients at once. You think that it's actually focusing on a single patient at a time?</p> <p>I think that one clinical conciier should see one patient at a time and a provider will ultimately have as many as three patients in a room. But let me talk some math through with you real quick. If you have a clinical concier averaging 30 minutes a visit, y how many can they see an hour? One clinical concier can see to an hour. If a provider is going to spend even 10 minutes with a patient, how many 10 minute blocks are there in an hour? Six. Six.</p> <p>So if you have three clinical conciier and one provider, that's each clinical concier seeing one patient at a time in a 30 minute block, which would then supply them six patients. And the provider has six 10-minute blocks, so they can see six. So a single provider should be able to see 12* 6, 72 visits in a day. The reality is they need a lunch. They need some other things. And so we intend, and this is how we do it, providers see anywhere between 48 and 60 visits a day.</p> <p>so that they have some breathing room in there so they're not completely running at the red line. But that puts you at a level of basically them seeing somewhere between one and three patients at any given time throughout a 12-h hour shift, one patient at a time under the responsibility of each one of those conciars. So it allows them to be a lot less cognitive load. Their job satisfaction goes way up. Their net promoter scores way up. Doorto goes time ways doortodoor times go way down.</p> <p>All of these kind of things. So you've used the clinical concierge to eliminate the majority I would say of the friction points from the sounds of it. Uh I'll call it the handoffs. So there's basically no handoffs in a clinical conciier's model. Yeah. Because that's my biggest issue is I've done what I was thinking of isn't so much of you you fit four 10-minute slots into an hour.</p> <p>I was thinking where where I had worked previously it was we had two 30 minute slots and we'd book three or four um even at a specialty you know hoping they wouldn't show up even though that didn't matter at this point and so you'd end up with a doctor going from room to room back and forth he he'd enter the room three times usually right which is very that's that handoff piece I was talking about and that actually goes into my second question you talked about how the lab uh tests were not right in the room and that the concierge goes in, they get the tests with AI, the AI determines the tests, and then they perform them.</p> <p>I just don't understand because I I thought we had to have a clinician sign off on each test. How does that work? They do with that model. You're 100% right. That's exactly the law. Um, so what happens is the medical leadership of each of our client organizations sign off on standing orders, which is a very common practice in healthcare in general. What the clinicians do is they sign off on when you meet, you know, the centaur criteria for those that know about strep testing.</p> <p>When they meet centaur criteria, I want you to go ahead and do a strep test. Very common, very simple, very safe. Well, in this world with AI, the AI can figure out because the AI is constantly attempting to diagnose the patient and as soon as they meet criteria, measurably meet criteria for centur score, then it prompts run a strep test. So the the it was signed off. It was just signed off upon selection of what the standing order criteria was at the beginning.</p> <p>And now the clinical conciier, they're approved to do it so long as they meet that particular criteria. That's great. What kind of So this is only possible with AI from the sounds of it as well. It's veryall to do it hit or miss. We before we had before we built the AI platform, we were using basically human memories to figure out when it would or would not make sense. And these are medical assistant memories to pull this off.</p> <p>Uh when you're doing that, we found out that they were only doing in about 4% of appropriate cases. And so then they turn on uh intellisite, they turn on this AI platform and suddenly that number goes way up. Uh here's a fun side story for you though.</p> <p>uh you'll figure out real fast how bad your standard uh your standing orders actually are when you have AI reminding people on every single case because what I imagine because what happens is suddenly the system is reminding them every single time uh say you've got a say you've got a policy that every time a patient has diabetes I want you to run a glucose or every time a patient's dizzy I want you to run a glucose or every time a patient has is lightheaded I want you to run a glucose well here's the reality there's a a lot more patients that come in with those uh when those conditions than or symptoms than you realize.</p> <p>And when AI identifies every single one of them, we had a client that increased their glucose testing from about two a week in their urgent care center to about 30 a day. And so not very helpful, right? it. And so then we have to help them think through sensitivity and specificity of testing because we can do all the math on the back end, but then help to refine their standing order so they're not overesting on literally everything. That's that was the other question.</p> <p>I'm glad you actually went on that that side story because that was the other question. You know, as a it makes sense what you're doing because in population health, right, you have to have an order before these tests are performed, but I mean that's you know, it's within the guidelines. So you you'd write the order, he'd sign off on it.</p> <p>But in this case, that's what I was wondering is how do you prevent that the handoff, that friction point, that slowdown, and that is the perfect answer for this. But one of the questions I have, I guess, is also um kind of a personal question when it comes to AI, which is at scale, right? You're talking about you have to tweak these things that you have to go into the clinics. Um are you working with large partners, small partners? You know, what kind of sizes are we looking at?</p> <p>Uh UCP Merchant Medicine is the consulting firm is one of the largest ondemand care consulting firms in the country. We have health system partners across the US. Most of these are very very large health systems in their respective states. And so Intella visit is being utilized by very very large health systems uh to support their operations. Now the benefit of AI actually is driving consistency in care delivery.</p> <p>So when you think about leadership uh members of leadership and how they might come through and try to you know retrain their teams or how to think about let's do everything XYZ thing exactly the same way. It's really hard to have enough managers to make sure that that's happening 100% of the time. something like AI and organizations that have large platforms of urgent care or other ondemand care channels.</p> <p>Uh this is a way to normalize all that and drive up scalability on consistency of care delivery. So this is really helpful for kind of the new age of multi-state 30 hospital plus systems. You think of Comet Spirit or Advocate Atrium which are kind of competing. Um, do you ever see this technology being able to function in smaller rural environments as well? Uh, it already does.</p> <p>We we have used it in the most densely packed urban environments of America to uh there's a it's it's deployed in a location with a population of 5,000 right now. And so, you know, it's it's total ends of the spectrum, all pair mixes, all levels of social determinance of health. Um, that's another fun thing about AI. It allows you to uh evaluate SDOH principles in an unbiased fashion across populations and figure out where you maybe work in a typically affluent location.</p> <p>But even in affluent locations, people with SO concerns come through there. This makes it possible to call them out more directly, figure out how you're going to support in the treatment plans that they might not otherwise be able to receive because of risk on, you know, lack of whatever they're lacking to pull that off. So uh it it is very different when you can hardwire everything and look at it exactly the same across massive geographies. Makes a lot of sense and that's encouraging to hear.</p> <p>I'm a big fan of rural health so I always have to ask that question. Um so I guess one of the other things that I have is about this focus on urgent care right which is really I mean UCP stands for uh urgent care. Oh my goodness, right?</p> <p>we had just discuss I forget the name of the person's company I'm podcasting with okay so it's in the name right right so when you're looking at a huge business with you know a huge hospital system with all these things going on they can't always prioritize investment in urgent care compared to other things why choose urgent care why do you think urgent care is important right why not focus on primary care focus on ED focus on something else you know why urgent care urgent care has a very unusual patient population.</p> <p>Uh specifically, the people that utilize urgent care are healthy people. When you think about a typical health system, they're highly adept at connecting with patients that are 65 years and older and folks who are pregnant or the families of people who are pregnant. If you don't fall into those two buckets, health systems don't really have a great way to connect with patients directly. Well, urgent care is minor injury and illnesses that are relatively low cost focused on a great experience.</p> <p>But the reason that a lot of strategists like urgent care is because it's a mechanism to prime patients for utilizing the health system longer term. So, one of our clients, I was looking at this just 15 minutes ago, uh they are seeing 1.44 44 visits on average per patient per year. Meaning they come a patient comes in 1.44 times per year. So that's actually more touch points than they might be getting on that same population in a primary care channel.</p> <p>Additionally, primary care clinics typically lose a lot of money. Um they do they run at a loss almost ubiquitously. They run at a loss. Urgent care can run at a profit. And so if you run it appropriately, if you run this high productivity model that I'm talking about, and I didn't touch on this, but you were talking about how much smaller clinics can be, and we agree with you, industry average square footage uh everywhere is about 3,500 square feet.</p> <p>Our centers are about 2,000 uh because you can chop that way down because of again consolidation of productivity meth methods. But ultimately, you can create a profitable model at a low uh patients per day. Our most recent centers are breaking even at 15.7 visits per day on an industry average of 43. Yeah, I was going to say that's really good. That's really good.</p> <p>And so now you have an a mechanism to connect with patients in a financially viable way that then allows you to prime those patients for the health system. So that when the health system and that and that patient specifically get goes from being a healthy person is now a sick person, they know where they're going to go. Maybe they're going to go to Jefferson Health out of the gate. They know they're going to Jefferson Health.</p> <p>And so ultimately, it's an enormously valuable tool for a health system because it's hard for them to drive patient acquisition strategies with tangible methods. This is a very tangible, profitable method to create patient relationships. It's a really big deal because even economically when we look at economic data on what percent of the population in different areas are able to access or or do access care throughout a year.</p> <p>Um there are many there's a significant portion of the younger population especially. You think about university campuses etc who never visit primary care. Usually it's only uh primary care back home or it's you know for the four years they're at college many of them do not really partake in care. They go to urgent care, right?</p> <p>So it's really important but I have some concern uh some questions about that that number you gave 14 you said seven patients a day is is where you hit break even 15.7 but same idea 15%. Okay so when we're looking at 15.7 um is that does that depend because I don't know how urgent care works. Does that depend on payer mix at all? It does. So let's say you're in a cash pay area.</p> <p>Let's say you're up in northeast Philly where when I was dealing with some of our Russian population, they really didn't want to use uh insurance. They really wanted to use cash and that was a big deal to them. Is that how does that look when it comes to break even point? Uh it definitely impacts it. It definitely impacts it. So I'm sure as you've uh studied the cost shift and all these kind of things.</p> <p>uh for every site that is going to be anticipated to have a loss of economic value on an income statement basis uh you probably need one to two sites that are going to be uh very economically viable. That same idea applies here.</p> <p>It is important to understand however a broader macroeconomic uh data point in health care systems which is if you put an urgent care center in an area that typically does not pay very well for any kind of medical bills the cost for an average ER visit is a the cost to deliver it not the cost of the patient the cost to deliver an ER visit is about $500.</p> <p>The cost for an urgent care visit to deliver an urgent care visit is about depending on who you are, $100 if it's if you're us, $135 if you're the industry average. Okay? If you had the opportunity and you were a health system and you wanted to figure out how to mitigate your losses as best as possible, you would 100% deploy urgent care centers to places with no pay.</p> <p>Because if you can keep those folks for things that don't need to be in the ER, out of the ER, it then makes it possible to save yourself money overall. And so it's kind of a change of mind shift. But there are a lot of health system clients that we work with that that is a core element to their strategy, which is how do we realign to placement of centers to cut people off and get them earlier before they cost us more money in the emergency department.</p> <p>So in a city like Philadelphia for example, let's say I was to start, you know, Lion's Health instead of Jefferson or Penn, uh would you help us with the placement of these? You know, you think about where EDS are. Let's say we had, you know, an ED in Center City, an ED in, you know, Torsdale. Would you assist with the systemwide implementation of this as well? If if you look at our typical engagement, that's exactly what we do. We we get brought in to do things soup to nuts.</p> <p>So, we start all the way from the the what is the purpose of urgent care? Like why are you doing this in the first place? If you can't answer that question, it's hard to figure out why you would invest in it, right? So, we've got to get everybody aligned around what is the purpose of what we're doing. Following that, we then say, okay, if this is the purpose, now let's figure out markets that we should go to. Let's prioritize those markets. Let's start doing site selection.</p> <p>Let's figure out the sites that we need to be capturing. Then we start designing the model. And so we actually build a specific model to every health system partner that we work with and we think about what are they good at, what are they not good at, and how do we bring all of that into alignment such that then you when you're done, you end up with an urgent care platform that looks and feels like that specific platform.</p> <p>Then we go all the way through the roll out process, turn all these sites on for them, get them up and rolling, making money, getting these high performing uh metrics, and then we teach them how to run it and we step away and they run it into perpetuity and then we're done and we move on to our next client. It's impressive about the customized models as well. I'm glad you said that. Not to name names, but uh we were doing some research a little while ago.</p> <p>There's actually a paper published on this comparing the accuracy of nationwide consulting models that uh utilize lots of data from all of their clients that they've had, which is a huge advantage, but when you apply the results, they're so generalizable unless you actually make a lot of adjustments to the point where that huge amount of data isn't necessarily as as valuable. So, I'm glad that you mentioned that.</p> <p>Did when you started this, how much knowledge do you have when it comes to data science and AI? I mean, was it a challenging learning curve for you or were you already primed for it based on your existing education? I was very fortunate in my administrative fellowship to learn how to really get through some pretty significant data sets um and and thinking through what that meant for care delivery.</p> <p>I was involved with a uh clinically integrated network for a number of years thinking through population health management. How are we going to bend the cost curve? How do we then utilize that to renegotiate rates with payers? Um just telling that whole story. Uh so I got pretty I I got some capabilities in that.</p> <p>But admittedly, when I started UCP Merchant Medicine, this would not have been possible without my partners at Health System Advisors, who is a absolutely phenomenal uh health system consulting, health system strategy consulting firm, also based in Minneapolis. And they allowed us to, you know, they helped us think these things through and ultimately brought it all together. But I had I've had to learn almost all of it on the job to be clear, specifically the AI stuff.</p> <p>That was that was I've only learned the AI stuff over the last seven years and I've learned it a lot more over the last three cuz your models show as well. Let's just we had discussed this earlier.</p> <p>Um, but when you when you want to bring up something to like a CFO and say, "Okay, what are we looking at down the road from this implementation, especially when you're talking about potentially, you know, continuing to lose money even though your firm would help reduce a lot of the losses by a substantial amount, you might still lose money in some urgent cares. Hopefully, everything would stabilize across the system or become profitable. But some of this is long term, right?</p> <p>We're talking when these people get older, when these people become sick. Your does your model take that into account and output it at an organizational level so that the finance department would be you know enthused. So think of it as three phases uh in terms of economic performance. Uh phase one would be income statement level.</p> <p>These sites are absolutely if if we're if someone said, "Hey, we just need you to make us some actual cash." We can go sight select locations that will make you profitable just all of them. And that's fine. So there's economic phase one economic income statement level returns. Phase two is things like uh downstream. So specialist referrals. How are we going to get you know nationally 9.5% of our cases have a referral of which about 34% of those are to orthopedics.</p> <p>Um we because we have the data on both the health system side and on the uh we have all the data basically all the economic data we can quantify on a specialty by specialty level what the average referral is worth. So now we can start thinking through on this phase two margin uh how much dollars are we getting based on all of these individual specialists and what is that and typically that number is significant.</p> <p>I'm not going to quantify it for you here but it is far more than the cost of the urgent care platform in its entirety. Okay. Yeah. Then there's phase three and this is the longer term view. Phase one is immediate. Phase two is sort of midterm within a year, within a year or two. Phase three is how is our outlook for the next 5, 10, 15, 50 years. Okay. What that is, we've been able to because we have access to all the health system data, we actually look at an actuarial level.</p> <p>What is the contribution margin of every single medical record number inside of a health system? So, let's say I've got a million patients and I've stratified them by gender and by uh by age cohort, right? Age 0 to 110 or whatever whatever the older oldest patient is in your in your data set. What is the contribution margin of each of those? And then what would the net present value of each age depending on when you interacted with him? What's the net present value of that patient at that time?</p> <p>Well, we can start to then quantify what is the actual value of an urgent care patient in terms of today dollars looking at all the subsequent downstream that they would ever learn or ever earn through that relationship. And at a high level, what we've calculated is it works out a say you've got a 35year-old mom with two kids and a spouse. that mom, the rel that relationship with that mom is worth $140,000 in the net present value of the lifetime economic value of her and her family.</p> <p>So what do we know? If we can capture more of we call her Katie. If we can capture more Katis, we know that the health system is going to be really well positioned for the long term because of all the future referrals and downstream and all of those things that are going to be realized up through that relationship. That's really uh that's very incredible. I think do you feel very proud of of what you and your your team has accomplished? Do does everyone have a sense of pride? Absolutely.</p> <p>If you if you looked at uh if we were to have my team on here today, almost everybody's been there for five to five to 10 years. I mean, basically since the beginning, we're we're a very tight-knit group. We love what we do. We get to have massive impact. It's just so much fun. We have we have the best time. I'm really impressed because I've not to offend anyone else who's been on. I've appreciate all of our guests. We've heard a lot of individuals talk about AI.</p> <p>We've heard a lot of individuals talk about systems uh new ways of paying. I appreciate how your system seems to tie it together from beginning to end and doesn't really leave me with a lot of gaps or it wouldn't leave me with a lot of gaps if I was a user on the other end. It seems like it really provides comprehensive knowledge. I'm going to ask you the final question.</p> <p>Is there any skill that you have as an individual which you think has allowed you to cultivate such a comprehensive system as the one that you've made now which really gives people the insights? I think everybody has a a superpower of some kind uh something that they're really good at. I'm not saying I have such a superpower, but what I am good at is I reliably pick the best people and it doesn't take a lot of time for me to engage with somebody to figure out whether or not they're a rockstar.</p> <p>I recently hired a analyst. I interviewed her for 15 minutes and I was like, she's going to be incredible and she's absolutely proven to be incredible. the same the same luck if you look at strength finders they call it individualization.</p> <p>This individualization has uh allowed me to have just great people um the best people that know exactly what they're doing and as such they've been able to build a lot of capabilities within our organization which have allowed us to achieve key performance indicators that no one else achieves. So that that's what I would I don't think I I've ever heard a better answer Brendan. That's an excellent answer from a leader. I'm sure your team will love hearing it as well. So, appreciate the advice.</p> <p>Really excited about the future of your organization. I know I'm going to be following them pretty extensively. It hopefully will give the audience a little bit of hope. I know it's given me a little bit of hope that we can improve things and make headway. So, thank you again and I hope we can have you back on in the future. Thank you so much. Appreciate the time.</p>