Key Takeaways
- CKD patients fall through care gaps due to complexity and limited provider bandwidth, necessitating nurse navigators to bridge the disconnect between clinical plans and daily adherence.
In the U.S., millions of adults have CKD, yet identification, follow-up, and day-to-day self-management remain uneven across communities and health plans. In this episode of the The Strategy of Health podcast, we spoke with Howard Shaps, MD, MBA , Chief Medical Officer at Healthmap Solutions, about why patients slip through the system and how Healthmap’s care navigators help close the gap.
Dr. Shaps’ perspective spans the emergency department, plan leadership at national insurers, and population health operations. His central point is disarmingly pragmatic: “We need to have patients see their doctors, take the right medications, stay on their medications—and if you do that, as well as diet and lifestyle, you go a long way.”
They fall through the cracks because complexity meets limited bandwidth. CKD coexists with diabetes, hypertension, and cardiovascular disease, and the clinical plan is only as strong as what happens after the visit. As Dr. Shaps explained, “The docs are really good… what they don’t have are eyes and ears outside their four walls.” Patients may mishear instructions, lack transportation, skip refills, or face food insecurity and behavioral challenges that derail adherence.
Late recognition: Many patients aren’t identified until Stage 3–5, when risk escalates.
Fragmented accountability: PCPs, nephrologists, cardiologists, and pharmacies operate in parallel, not as a coordinated system.
SDOH headwinds: Transportation, literacy, and affordability issues hinder execution of even the best care plans.
Short clinical touchpoints: Fifteen minutes can’t compete with daily habits; as Shaps put it, “It’s hard to change behavior overnight.”
It’s uniquely hard because CKD isn’t a single disease—it's a risk multiplier woven through multiple specialties and settings. Community physicians can write the right prescription; the challenge is what happens next. Plans can see claims, but not always the nuance of readiness, knowledge, or barriers at the member level.
From Dr. Shaps: “Patients may forget to fill prescriptions or they don’t have transportation… I can’t tell you how many times we’ve talked to patients who said, ‘I didn’t understand anything that was told to me.’” For health plans, the difficulty is prioritization and timing: Who is most likely to decompensate in the next 12 months, and what intervention—clinical, social, behavioral—will matter most right now?
Healthmaps' navigator model identifies high-risk members early, activates support outside clinic walls, and closes loops with providers. In Dr. Shaps’ words, “We’ve looked at millions and millions of lines of claims data, clinical data, and other data points… our risk-stratification engine shows who is higher or medium risk for an acute event in the next 12 months.” Technology spots the signal; people move the needle.
The “secret sauce” is an operating system that blends analytics and human connection. As Shaps put it, “The secret sauce is technology—but there’s a people component as well, and a clinical operations component.”
Because time, talent, and tight execution matter more than theory. Plans can build, but accruing the data science, protocols, clinical operations, and feedback loops that work at scale takes years. “Can payers do it or can other companies do it? Yes—we think we do it really well,” Shaps noted, pointing to a decade of iteration.
Speed to value: Ready-made models and workflows compress the learning curve.
Operational depth: Hiring, training, and supervising navigators at scale is nontrivial.
Provider trust: A vendor that acts as an extension of the clinic earns access and attention.
Governance and economics: Risk arrangements reward those with proven reduction in avoidable utilization.
The outcomes that matter most are preventable ED visits, unnecessary admissions, avoidable readmissions, and slowed CKD progression. Healthmap orients interventions squarely around these. “We reduce unnecessary hospitalizations, reduce emergency department visits, reduce readmissions… we slow CKD progression,” Shaps said. Why these? Because they reflect both quality and cost, show up in Medicare Stars, and align incentives across member, provider, and plan.
Medication optimization: Reconcile meds; escalate cardiometabolic therapy opportunities.
Timely specialty care: Ensure nephrology and cardiovascular follow-up happens on time.
Lab vigilance: Close gaps in eGFR, UACR, and other required tests for risk staging.
Barrier removal: Ride coordination, refill reminders, caregiver education.
Behavioral activation: Brief motivational coaching that sticks after the call.
When navigators act as “eyes and ears,” physicians can practice at the top of their license—and members arrive prepared.
Because Stage 3 is where trajectory becomes malleable at scale. Shaps emphasized, “We try to identify patients that have Stage 3 CKD… identifying them early is really important because sometimes it’s not identified.” Many Stage 3 patients can be managed expertly in primary care with selective nephrology referral, but someone must orchestrate labs, meds, and comorbidities consistently.
He added a stark reminder: “There’s a lot of kidney disease out there—15% of all U.S. adults, about 37 million people.” For leaders, that prevalence means a broad early-stage strategy beats a narrow late-stage rescue. Early detection paired with navigation also nudges upstream screening—catching Stage 1–2 among patients with diabetes or hypertension.
They prepare, guide, and prevent “crashes.” For Stage 4–5, Healthmap’s navigators begin with readiness assessments, then move quickly to key decisions. “We’ll start the conversations early about transplant—and transplant first, because that’s always the best alternative,” Shaps said. In parallel, they demystify dialysis—options, home modalities, and lifestyle impacts—and ensure vascular access is planned before a crisis hits.
The aim is a planned start rather than a chaotic, on-the-floor initiation. “We’ve seen our planned start rate go up, the crash rate go down, and home dialysis go up,” Shaps reported. That sequence protects quality of life and bends the cost curve.
Yes—when navigation is systematic, measured, and relentlessly iterated. Healthmaps solutions uses knowledge assessments and repeats them post-education to confirm progress. As Shaps summarized, results show movement in the metrics that matter: “Planned starts up… crash rate down… home dialysis up.” Equally important, feedback loops with providers reinforce adoption: navigators bring back specific med and visit opportunities, not generic advice.
Report these quarterly, with trend lines and dollar translation—linking clinical wins to financial performance.
Because daily choices compound more powerfully than any single prescription. “It’s hard to change behavior in a 15-minute conversation. Repetition goes a long way, and having a caring nurse goes a long way,” Shaps said. And yes, culture is candid: “Pizza and cheeseburgers taste really good—it's hard to get somebody to stop.” Navigators add the repetition, empathy, and problem-solving that clinical teams can’t sustain between visits.
This is where analytics becomes outcomes: when it is delivered through a human who knows the member’s name, context, and next best step.
On Healthmap’s trajectory, Shaps is intentionally modest: “We’ve got our heads down—bringing on new clients, keeping clinically sound programs, staying current when new literature comes out.” Expect steady iteration, not hype cycles. For CKD broadly, Shaps points to therapy and technology tailwinds—new medications that may slow progression and improving options in dialysis access and home tech. The counter-currents are familiar: “There’s a lot of diabetes and hypertension out there… the ability to get healthy food can be a challenge.”
The strategic mandate is clear: keep the programs clinically rigorous and relentlessly practical.
Start by focusing on avoidable acute care and readiness for the next stage. “We want patients to get the right care at the right place at the right time,” Shaps stressed. Partnering where it accelerates impact—and resisting the urge to reinvent every wheel—delivers faster gains. As he added, “The unnecessary care is where there’s a lot of opportunity.” That’s where quality, cost, and member experience converge.
An executive action plan for the next 90 days:
<p>Welcome to the strategy of health podcast from the American Journal of Healthc Care Strategy. My name is Cole Lions and I am joined with a very special guest today, the chief medical officer of Health Map Solutions, also an esteemed professional with many, many years uh of experience, Dr. Howard Shaps. Dr. Shaps, thank you for joining us today. I really appreciate your time. How is everything going with you this afternoon? >> Everything's great. Thanks for having Paul. I appreciate it.</p> <p>>> Of course. Really happy to have you on. And I wanted to just take a minute and ask first question is how long have you been practicing uh you know medicine in the medical field for and why did you go into the medical field to begin with? >> I'm going to give away my age in a moment but I I practice full-time u I practice full-time emergency medicine for 10 years and then I did part-time work as well for six years uh on the on the weekends and some nights and some holidays.</p> <p>Um but that's you know I'm a emergency physician by trade and uh I've moved on to some other roles in my career but that goes back few decades there. >> You've worked in uh the insurance space the uh you know clinical space you you've done a lot of business work. Why have you settled now with Health Map Solutions? How did that come about? because with your experience, you could have gone and worked in private equity or in VC, you know, done all kinds of things.</p> <p>So, what has led you to where you are now? >> Yeah, I just looking back at what I've done over the years. The emergency being emergency position really set me up well getting a good understanding as to how the healthc care resource went back and got my MBA at one point and was fortunate enough to work for a uh a small consulting company that worked with CMS.</p> <p>I worked with Express Trips as well and then was able to leverage that experience as you mentioned going into the um health insurance world. But it in the health insurance world it was a little bit of a unique role in that I had a lot of market experience meeting with local uh understanding care management, understanding quality, understanding how the health plan thinks and and runs from a local perspective.</p> <p>Then I had the opportunity to do it at a national level where I became deputy chief medical officer for healthcare invent where I got a really good view as to how a corporate function works. Uh and able to see how from that lens how to interact with the markets, how to interact with different vendors and make sure that we are delivering services that are responsible um for our members and our providers.</p> <p>And then help app came along and it was I was in a good place where uh I can make a transition to being on the vendor side and helping you know looking at a population that well in our case we're taking disease and associate coorbidities and see what we can leverage clinically as well as from a clinical operation standpoint as well as the IT and all the other functions you have in order to help this vulnerable population.</p> <p>I have taken care of countless patients with front disease, those with endstage kidney disease and I've seen her from both, you know, the paired perspective, the clinical perspective, and now I was given the opportunity to look at it from a pop health level, you know, with an IT focus, which was great. So, it's been a it's been a great transition, and I've been here for four over four years now.</p> <p>And that's one of the reasons why I wanted to talk with you specifically as well is because you know after talking with some of the the past folks about CKD it is really that complicated situation where you have a lot of moving parts. It's very expensive and so you know the business folks and the quality folks are very much involved but it's also requires a lot of investment from the the payer from the medical team and then from the patients family as well. It's it's a it's a big deal.</p> <p>And so my question is uh how are you solving some of these issues at health map solutions? How does that model work differently than kind of what the traditional model has been? >> Yeah.</p> <p>Well, we start obviously as you said with those with kidney disease and we look at uh be associated associated coorbidities and when you look at kidney disease like a lot of diabetes, a lot of hypertension, a lot of cardiovascular disease, but when you look at it at a little bit of a different lens, there's a lot of social barriers to care. There's behavioral conditions that are come with the disease. There's a lot of pharmaceutical care.</p> <p>when you were a physician in the ED, uh I'm sure as you you had mentioned earlier, you had gotten CKD patients. Why is it challenging for the physicians in the in the community to deal with, you know, these coorbidities along with uh CKD and and endstage renal disease itself? Why is that challenging from a clinical perspective? >> When we look at it from a physician perspective, the docs are really good. They know what they're doing.</p> <p>Uh they, you know, they know which medications to prescribe. They know how to take care of their patients. What they don't have uh are eyes and ears that have four walls and patients may forget to fill their prescriptions where they don't have transportation to the office where they just don't understand what was said during the visit.</p> <p>I can't tell you how many times we've talked to patients that have left the office where they end up charge one more care navigator and said I didn't understand anything that was told me on no fault of the provider. It's complicated and and by enabling us to help outside those four walls coordinate the care educate you know work with members to understand why they need to do certain things. So for instance, if they're stage five member, they might meet dialysis.</p> <p>It's important to go see the surgeon for that dialysis access that should be placed prior to starting, you know, that needs to be placed well prior to starting dialysis. We do a nice job with that care formation and bringing information back and forth to the offices. Again, the nefologists and the primary care provider from physicians, cardiologists, they know their stuff. It's just h having us augment what they do outside the four walls goes a long way.</p> <p>>> Coordination, continuity of care, those are super important things. Not just for I think making sure the patient gets treated and reducing that cost, but I do feel pretty strongly that from a payer perspective, having continuity of care and navigation increases your stars ratings. It increases your experience. My question is as a previous kind of executive in the payer space as well, why not bring the teams internally and set all this up inside.</p> <p>Why work with a partner like Healthmap Solutions? >> Yeah, this some will call it the simple answers, but we built our program over the last 10 years plus or so. Uh, and the technology we have is lack of a better way to put it is was pretty cool. And a number of things that we do. Number one, we've looked at millions and millions and millions of lines of PL data as well as public data and we as well as other data cos.</p> <p>So we incorporate that into our risk stratification um engine and that gives us the ability to see which members are higher medium risk for having an acute event the next 12 months and it's something that you just can't can't build. It takes time to build those models. We've got a great artificial intelligence team and that really starts us with how do we identify the right member who's potentially have the biggest problem in the coming 12 months or so.</p> <p>We also have our technology that looks at different opportunities and care and that's automated as well. So we'll know who's taking their medications and who's not who hasn't seen their provider who needs certain lab testing.</p> <p>You can from the data we see as well we can see who's been utilizing the emergency party who's been admitted to the hospital although the payers can get that but we have a really you know sophisticated platform in which identifies what we need to do when we need to do it and we can act on it. So can the payers do it or and other companies do it? Yes. And I think we do it real well.</p> <p>>> And is that how you're able to also be able to take on that risk because I know that was one of the big things is you guys take on a lot of risk. Um, you also uh are fairly, you know, financially or expansionally stable, right? I was talking to Tom on a few episodes ago and he says, you know, you guys don't expand like rapidly. Instead, you guys expand very intentionally. Is that technology what what helps? Is that kind of like your secret sauce, you could say?</p> <p>>> Yeah, the secret sauce is technology, but there's there's a people component if there's a clinical operational component. And you can look at the way that we've been built, but we understand the health care space. You understand how to take risk, the executive leadership team all come to either help plan vendors or had that hunting experience and we know that when we do bring on board a client, we're confident that number one, we'll do the right thing.</p> <p>Number two, we know that the the program is sound and number three, we work well with our clients that across the boards with providers and members. And if we can do what we say we can do, we we reduce unnecessary hospitalizations, reduce mus visits, we reduce readmissions with slow CKD progression and it's pretty consistent across clients. Uh and you continue to iterate on the program how we look today we get it a year ago. So we look different six months or a year from now in in a positive way.</p> <p>So they there's a lot that goes into it but having the experience and working with the clients in fast as well as all the other stakeholders that I mentioned really helps when it comes to bringing out a new client and being really deliberate and intentional what we do. Why are those things that you mentioned important? You mentioned a few just now which was the inpatient and then ED utilization uh and then also admission and readmission. Why are these things what you have decided to lock on for?</p> <p>Why is that especially difficult also for insurance companies to try to you know overcome those issues?</p> <p>Yeah, the you know we want patients to get the right care very close to any time and there's always a indication for someone to be admitted to the hospital and have you know have the services provided and the inpatient where we see the opportunity is reducing those unnecessary admissions to the hospital were unnecessary each department visits and if we can prevent somebody from being readmitted for a similar reason as to why they're admitted first time goes a long way with from quality standpoint a stars perspective as well and we would be focused on those conditions that are preventable.</p> <p>So for instance, yeah, patients with chronic kidney disease often have cardiac disease and a lot of them have park. And if we can help, we can help you know a provider see which medications they're taking, which ones they're not taking, we can bring information and opportunities to them. Perhaps there's an opportunity to put somebody on on a new med or a different medication which can go a long way into keeping somebody at a hospital that doesn't necessarily have to be admitted to hospital.</p> <p>So it's the unnecessary emissions uh ED business and remission which is what we focus on and they're expensive and again we're all trying to um improve the care of our memberations but we're also trying to be conscious when it comes to cost and if we can help again reduce those unnecessary Q care you're looking visits it goes a long way to helping number one the patient and number two you know provider if they're progressive insurance companies as long as we share dates >> that makes a lot of sense Why does the industry So, one of the things that I've I've talked a lot about is you guys really do focus on these co-orbidities earlier in the the stages than really almost anyone else does.</p> <p>Um, and my question is, you know, as a clinician, what are your kind of thoughts on that? Because with the current system, a lot of times these patients don't really even get identified with having kidney disease until from what I understand is pretty later in in the stages, right, that it actually ever gets addressed. Why is that the case from like a public health >> Yeah. Well, we look at patients, we try to identify patients that have stage three CPG.</p> <p>So, there's well, five stages, you know, stage three, four, five, progress to endstage disease. And we know that the there's a lot of stage three kidney disease and we know that the PCPs are primary care providers or physician are really good at taking care of those patients. Uh some of them do need seeologist uh those withic kidney disease those who are younger those who might be pregnant.</p> <p>Uh but they you know you may need a nefologist at at an earlier stage but if you look at nephologist across the country um everyone always says there's a shortage and there's also probably a shortage of TCPs as well but the PCPs understand you know what to do when it comes to taking care of those diabetes hypertension cardiovascular disease they know when to refer as well and we can help you we can really get to a larger number of patients that way but identifying them early as you mentioned is really important because sometimes not identified and I you know I've seen cases where someone thinks that functions is absolutely normal and and it's not and we can help we those providers uh ensuring that certain lab tests are done even those who have you know as we'll work with those stage three patients and providers it also gives them the the impetus to check blood on somebody or urine test on someone who might be stage one or stage two or has diabetes.</p> <p>So there's there's a lot of ways to identify these patients early and it's a um there's a lot of kidney disease out there. I think um the stat is 15% of all adults in the United States have committees. 37 million people in 37 million adults have kidney disease. So it's it's pretty prevalent >> when patients get to a higher acuity though and that was the other question is you know we've had uh Dr. To Makowski and Dr.</p> <p>from Elco and we've had a few others from Healthmap and we've discussed a lot about kind of the lower acuity minimizing costs minimizing risk. How about when people are are getting into higher acuity or people are are getting um you know endstage renal disease what does health maps uh do for those individuals in those cases?</p> <p>So when we see a patient or a member uh stage four then stage five and when they're working with our their care navigators or rare disease once we get through the initial you know understanding what's driving their their healthcare what's driving them just in general when it comes to taking care of their you know their health uh and we get comfortable having those conversations we'll then start the conversation early as possible about transplant uh and transplant first because that's always the best alternative um when it comes to getting toward HTT disease and as well as educating growley about you might need dialysis and what it entails and how it's going to change your life and we'll do different assessments when it comes to transplant and dialysis.</p> <p>We'll talk we'll talk about diialysis early.</p> <p>They'll talk about the benefits of essentially dializing in the home and different types of diialysis you can do and if you can start that early it goes a long way and to have somebody progress smoothly uh if they get there to endstage kidney disease when it comes to hemodialysis or correction diialysis you need access that which I proved a while ago you have to make sure that that patient was aware that they have to go see their surgeon go see their vascular surgeon uh keep their appointments and there's a lot that goes into getting somebody ready for dialysis and then starting starting dialysis and understanding how it's going to if you're not transplanted understanding how it's going to impact you know how you feel every you know every day with how you feel after dialysis nearful plot that goes in there in order to make that transition from take four to stage five to ESRD AD as smooth as possible you know you we try to prevent our members from having planned start to dialysis you know the the optimal starts starts are really important when it comes to getting those patients ready to make gas.</p> <p>>> Have you been successful in trying to eliminate or prevent that you know crash to dialysis? Has that have you seen good results from that effort? >> Yes, we have and we spent a lot of time on it.</p> <p>uh as I you know I mentioned a few moments ago we do knowledge assessments for our for our members and we'll see how ready they are for diialysis and then we'll you we can go through education and then we can actually ask those questions all over again see whether or not we've made a difference and we know that doing this and doing this well at focusing on it we've seen our plant start rate go up the crash rate obviously go down uh you'd seen the home dialysis rits go up well so we've done a knock on wood we've done a nice job Yeah, but getting our patients ready and we continue to to work on it.</p> <p>Again, it's as I mentioned before, everything is everything is always um getting evaluated to see what we can do better the next time. >> And one of the things I wanted to ask about that about your kind of your day-to-day and and your team is, you know, a lot of this depends on this the patient navigators and and the patient care team. uh any insights on on what that experience has been like kind of building up the medical teams and reviewing this clinical information for you?</p> <p>Has this been different than your previous roles? >> Yeah, it's different just from a different different angle and different perspective in that I'm not in the pay space anymore.</p> <p>I'm on I'm on the vendor space and the you know the team is really focused on patient for kidney disease with associated coorbidities and the nice part is that at the population health company we're focused on uh changing member patient behavior improving behavior as well as working with providers specifically to help improve the optimal patient which is a whole lot different than on the other side where there's other initiatives there's other aspects of ability to interact with providers is interacting with with members here.</p> <p>We get to focus solely on the clinical outcomes uh the quality outcomes and in making sure that we're acting as an extension of provider's office and we keeping their eyes and ears and working with their patients to make sure that to the best of our ability we can help coordinate their care, make sure that they're getting the best care from their physicians or providers.</p> <p>uh and that it takes a lot but just getting them indoor and making sure they're keeping their pointless as I mentioned a little while ago the tops are good lers are good and you have to deal with chemical farmer >> so in a way it allows you to build those efficiencies and to build that almost culture of excellence because you are targeting this one kind of area that's great what do you think the future holds because you you know there's been acquisitions of course discussed you know with the recent I forgot the name of the company that was recently acquired but you We already have AI technology.</p> <p>You know, Healthmap Solutions has a really good team of experts as you've been mentioning, such as yourself. Where do you think the future is going with Healthmap Solutions, but also where do you think the future of CKD is going? >> Yeah, I'm going to give you a vague answer is from a healthmap perspective, I don't know. I know we've got our heads down when it comes to bringing on new clients. I'm making sure that we continue to add saltical programs.</p> <p>uh when something new comes out in the literature that we're we're addressing it and making sure that we're staying current.</p> <p>So from a what's you know future for healthmap I think the future is let's continue to be a clinically sound company and you know then we'll go from there from when it comes to CKD and who has endp disease now there medications that are or there are medications that have come out that shown be helpful when it comes to slow CKD progression you know they need to be used responsibly as well and you I know that there's different technology coming out when it comes to like getting access for people as as well as in the dialysis side.</p> <p>So there's a lot that we're watching and unfortunately there's a lot of diabetes out there. There's a lot of hypertension out there. Um you know the ability to get healthy food can be a challenge to a lot of people.</p> <p>So there's which means and there's a lot of obesity as well and all of this you know ties together because a lot of it is it leads the kidney disease and those have to be addressed as well and there's always a hope that you could help the country and we can reduce seals to the disease and um patients will help there.</p> <p>So when you look at the whole economy in the whole country really with that scale, are we thinking that there's billions of dollars kind of up for grabs in the the larger healthcare economy by reducing some of these coorbidities through solutions like health map is that >> yeah up for grabs is an interesting term.</p> <p>We we believe that in especially at health map that if you can help you know as I mentioned few times out of providers and our patients live your health your life uh you're going to reduce you know the cost of care reduce the medical expense.</p> <p>So those dollars are definitely up for grabb and it's the unnecessary care is really where you know I think there's a lot of opportunity and not that people are doing a bad job and they're not doing a great job but it's hard to change behavior and like humans heard me say this when they listen to it they'll start laughing with their pizza and cheeseburgers just really good >> and it's hard to get somebody to you know stop eating pizza and cheeseburgers. >> Yeah.</p> <p>Can you give us just before you go brief context on on what it's like when somebody comes into the ED because you've dealt with that for many years, right? And you've dealt with many CKD patients that have come into the ED. What can you just give us the time frames that you have to spend with the patient and and to influence behavior as an emergency physician or even as a primary care physician? >> Yeah, it's hard.</p> <p>You know, I I would spend I can't tell you how much time, but I would spend time with my patients and when they were ready to hopefully go home and go over what we talk about, what we did, what they need to do.</p> <p>uh the primary care providers are there's they're busy in in a given day there's still a lot of patients and it's although I know they educate and talk to their patients the beauty is is that they can add us on to that care team and we can be an extension of their of their office and provide that education as well. It's hard to change behavior overnight and it's hard to change behavior in a 15-minute conversation. Repetition goes a long way.</p> <p>uh having a a caring nurse is a long way and having somebody you can call aist is a long way as well but those behaviors are are too challenging to take. >> Well, thank you so much Dr. Shaps. What a really good look into things and also um a good overview of kind of where the industry I think needs to head as well.</p> <p>And I I hope that other partners and vendors, you know, look at Health Map as well and use them as an example because there's so many chronic diseases out there and it seems that they all uh need to get treated earlier from based on this conversation. That seems like to be like the biggest takeaway is we got to get this treated earlier. >> Yeah, it's true.</p> <p>And you know in in a perfect world me say this a million time but you need to have patients see the doctors take take the right medications stay on their medications and if you do that as well as dietive lifestyle and address the other you know other aspects of care that can influence how someone does such as the social and behavioral site it goes a long way into improvement out but getting in front of it early is is really important and the health map we fight to that and then you go through all the typical coorbidities um somebody needs needs to see a you know a doctor because you know they sprain or ankle we'll help them with that as well.</p> <p>But there's there's a lot that goes into it and we've got a dedicated team and every day wakes up trying to figure out how we can help our members and our patients be healthier and it's challenge but you know it's fun. Yeah, it's uh it's exciting but we'll continue to blow the way it. >> Well, thank you so much Dr. Shaps and uh we'll have you on again soon to discuss more. >> That's great. Thanks. Thanks for having me.</p>
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