 Good morning and welcome everyone. My apologies that we're starting a couple of minutes late. I was just testifying before the house healthcare committee and as you know, you can't really leave in the middle of a question that's been asked to you. So again, my apologies, but we're gonna get back on track. We'll save the minutes and the executive director's report till this afternoon because I left Susan to continue answering the questions posed by that legislative committee. So at this point, Tom, I'm gonna turn it over to our data team who I'll ask to introduce each of them themselves. And we're gonna talk about the exciting work that they're doing. So Sarah or whoever's gonna lead it off, if you could. Good morning, I'll try that again. This is Sarah Lindberg, I had our data team and I'll actually ask each member who have to introduce themselves as they are gonna present a section of our presentation today. However, I do want to make everyone aware that there were some last minute changes to the slides we'll be presenting today. So if you downloaded them before this morning, you might be a little out of step with what we present. And so I'm going to attempt to share my screen now. Let's see, one day I'll be really fast at this. Are people able to see it? We are, yes. Okay, wonderful. So I am thrilled to talk to you today about the great work that data team has been up to for the past year. The team is fantastic. I feel really privileged to be a part of it. And if you have questions, I believe custom would have us wait till the end. So again, I'll just start by setting things up and then each team member will have a chance to talk with you some more about a project that they are working on. So the work, when we organize our work is according to the analytic plan that we developed that is for calendar year 2020 and 2021. That plan was developed through a series of one-on-one interviews with each board member to develop a direction for the data team. So there are three main domains of direction we found from that process. The first is expanding the utility quality and the ease of use for our data resources. And the major kind of objectives we have under that domain are improving our data products so that they're accessible to a wider range of users and just making sure that their quality is better. So that means validating the information and having more people use it so we can catch problems that it might have. The second domain that was identified relates to patient care. This is really kind of the bread and butter analytical work that we're doing. And a lot of that really falls under the bucket of understanding access and cost of care both for the care delivered in our state and also the care delivered to people who live in Vermont. And finally, and I think this really transcends our team and is a real objective throughout the GMCB's work right now and that is regulatory integration. And the major umbrellas for that work fall under the health resource allocation plan also known as HRAP. And then just really taking a look at the information we're providing to decision makers and making sure that we do a better job of presenting that in meaningful ways. So on slide three, I'm just highlighting some recent accomplishments in each of those domains so that first one in terms of expanding the utility quality and ease of use for our data products. We recently released a business intelligence tool or BI tool, which leverages Tableau to use higher level information in dashboards. So any state user with approved access to vCures can use these kind of easier to use interactive reports or tools to access vCures in a new way. We also developed a new policy for how vCures and the hospital discharge data may be linked with other data sets and we'll highlight that a little bit further on in the presentation. We also held data education classes for board members. So those classes were held last fall and we plan to kind of do booster sessions about annually after that. In the patient care domain, three major reports that were produced was the patient migration report. So that's using our all payer claims database and says of people who live in Vermont, where are their dollars going both in and out of state? Are people kind of staying in the same HSA on which they live or are they traveling for that care? We also put together a patient origin report which says of the care delivered by Vermont hospitals, are we seeing any patterns in where patients come from? So are people coming across the borders more often or is utilization declining? That sort of high level information. We also put together a summary, executive level summary dashboard related to the all payer model. We also have a deeper dive on the total cost of care and we plan to further develop these tools as data and understanding develop and more data points come into us. And a lot of the regulatory integration work is again under that healthcare allocation plan which is trying to help support the sustainability project that is underway. So we are undergoing some cost and pricing analysis. We're looking at some capacity information and trying to anticipate some trends and needed resources as we go forward and also trying to kind of bolster some of the quality information that we have as part of that work. We also have a series of new interactive reports under this domain, some devoted to primary care and other kind of underlying access issues. And we'll feature some of those later on in the presentation. Current projects that are underway in each of these domains. So again, on slide four, the expanding utility quality and ease of use. We are about to close the book on a proposal that has helped us specify ways that we could present data in a way that is more friendly to the analyst. So if you're doing a fiscal analysis, the way that you would want the claims data set up to begin with is gonna be much different than if you were looking at population health as an example. And so we've asked for some guidance informed by stakeholders about how we could best do that. So we look forward to digesting that report at the end of the month and presenting some more information about where that might go at a future meeting. We also redesigned our data user classes. So historically we had a data users group that was really topical and it was a lot of information that seemed hard to actually remember to use when it was time to do an analysis. So Lindsay will be talking a lot more about how we've tried to do a better job of that later on in the presentation. We also are in the middle of enhancing our data validation. So that is a very broad and complex process, but we are starting with reaching out to providers to identify services that make sense. And these are both hospital-based providers, independent providers as well as FQHC and RHCs providers to try and get a variety of perspectives on what services make sense to validate. And what we wanna do is compare the information in vCures with what the payers have on record. So the people who are submitting data to vCures and ultimately wrote the checks and comparing that with what the providers have and their ledger for the revenue or reimbursement that they recorded and trying to get a sense of how much error or variability there might be in that will really help make sure that we're responsible in future analyses. That project will also include a comparison of the hospital discharge data with the all payer claims database. So there's certain variables that should marry up there, but we've never done an in-depth comparison of those two resources. We also will be focusing on some real blind spots we have in the data world, most notably race and ethnicity data are something that everyone's eager to have. So trying to talk with these stakeholders about the best avenues for improving that information is part of that project so that we can do a better job of kind of assessing equity and racism in our health delivery system. And then we also are going to be including a assessment of how hospitals in particular vary in their record keeping and data available as it relates to free care, bad debt, and people who are paying out of pocket for healthcare. The reason for that one is this will ultimately, we know one deliverable we're on the hook for is a price variation report, which is the first project that appears in the patient care domain that's next on the slide. So to do that, we felt if we're ever going to try to expand that to include things that aren't paid through insurance, we would need to have a better sense of the data landscape. So that price variation report will be coming out about this time next year. So once we actually validate the information, we can do a better job of putting some constraints and error lines around what we think we're seeing and how the reimbursement that providers receive varies depending on the type of provider they are, the person who's paying and where the care was delivered. We also in the patient care domain will be putting out a decomposition of how the cost of care for joint replacement has changed over time. So part of it might be more people are getting during replacements, part of it might be people are older relatively. And so there's more need for that service. There might be some more intensity in the services that are provided with technological advancements. So we're gonna try and just pull that apart and see if we can understand some of the changes we're seeing in that line of service. We're also gonna be producing a hospital market report why patients travel for care. So that's trying to pull together what being cares is good at, which is wherever monitor seek care with the discharge data, which is where people come from to get care in Vermont to see if we can kind of start looking at a high level about what it is that might be driving some of these patterns. And finally in the regulatory integration piece, I already touched on some of this work underway. We have the health systems capacity and quality assessment to work underway. We also will be looking at the relationship between Medicaid price changes and the asks that we see in the hospital budget process just at a very high level to kind of examine that relationship. And we also are just launching a couple of projects related to the ECO and how providers might look different about based on whether or not they're participating and if we're seeing any differences in outcomes among patients whether or not they're attributed to the ECO. And another thing to keep in mind on slide five is just some examples of how our team supports work both throughout the GMCB, the state of Vermont and beyond. So as I already alluded to, we're supporting the hospital sustainability planning. We're doing our best to help support the data collection effort. So we think that if we're able to get data in a more ready to analyze format that'll give us some advantages in producing things more quickly. We also are really committed to transparency through reporting and data and doing that in ways that David will touch on in a minute. We also are a data provider throughout the state. So we provide information to the Department of Tax, historically, the Department of Labor, the Agency of Human Services is a pretty heavy user of the data that we have. We also were able to include a much more robust access to our big data for approved state users. So they now have much faster and more reliable access to the database so that hopefully they can have more fun in there. We're helping support the work that the pharmacy work group is doing. We were able to integrate the analytic work of the Blueprint for Health in our contracts so that we can even be more aligned in our analytic efforts. We also contributed information to the NASCO primary care report that was, I'm never sure exactly where that is in the publication process, but if it hasn't been published yet, it will be soon. And then the National Association of House Data Organizations, or NADO, is working on some more comparable information for the quality of data information that states offer. And so we're participating in that effort as well. And again, this is kind of a smattering of some of the work that we're doing, but we really try to be foundational in our work, both here at the board and throughout the state. So with that, I'm gonna turn it over to David Glavin. Please, team, start by introducing yourself to the board. I'm wondering if you're on mute. Okay, I'm gonna try that again. Sorry about that. My name is David Glavin and I'm the Data and Reporting Manager for the GMCB. I'm gonna talk a little bit, or go a little bit more detail about some of the topics that Sarah just alluded to with regards to improving access to the data that we use to generate reports and also how to make that data a little bit more easy to consume for end users. So on slide six, I'm on slide six now for those folks who are following along. As the stewards for the V-Cures database, our goal is to be as open and transparent as possible with the data that we use, especially within the V-Cures dataset, which is limited in terms of how we can share that information. And that's because we need to maintain compliance with HIPAA with regards to the personal health information that's contained within that dataset. And because of this, we have to make certain choices with regards to what data is released and how that data is aggregated to protect PHI. And that can limit some of the granularity in terms of looking at the information that's available. So our approach is driven by serving two domains. One is the state of Vermont agencies and how do we allow them to have outside of the GMCD, how do we allow those data from our agencies to access this information for use within their own agencies? And also, of course, the public access to the V-Cures data and information. On the state side, we are set up to have direct access to the data for approved users. These are state agencies that have access to what we call the analytic enclave. And within that, there's what's called the SQL Workbench, which is a tool that's used to query the database and create tables for final reports or to share with other departments within your agency so that they can generate reports. In addition to that, we also have developed the Business Intelligence Tool and the Data Marks that I'll talk a little bit more about later that Sarah alluded to earlier in the presentation. On the public side, we've developed over the past several years interactive reports and that are accessible by the general public and also the data that's used to generate those reports is also available. And in addition to that, we are also in the process of creating the analysis ready data files that Sarah has also referred to earlier. And those are for, to be, there's two elements within that. One are non-state entities that are requesting data with personal health information via the Data Governments Council. And in addition to that, we're also in the process of developing some public use files, which would be instant use of data sets that you could just go to our website, download and use those for exploration or research, et cetera. I'd like to move to slide seven now, please. Thank you. So as I mentioned, in terms of public access, we've been developing a series of interactive reports since about 2017. And the data sets are curated from vCures and are HIPAA compliant and they can be found on our web GMC website on our data and analysis page. These reports are designed to provide user-friendly, data-rich tables, charts and graphs. And they're designed to be a little bit easier to consume versus a set of spreadsheets or standard written reports. Essentially, the layout of these dashboards is, excuse me, it allows for views of the same information on the same page. So you're not scrolling or flipping between pages as you would in the report, maybe to compare a couple of different tables that have similar or related information in them. They are also comprised of a series of interactive dashboards that allow the user to explore the data within a set of parameters. So for example, you're able to filter on a particular item. In this case, on slide seven, we have one of the dashboards that are available within this report for the hospital finance, our annual hospital finance report. And on it, you can see that we have a map and that map is used to switch the views of all of the tables that you see on the dashboard to a particular hospital. In this case, we have Brattleboro, but all the hospitals information are available in the same layout there. So without having to flip all the way to the Brattleboro section of a hospital financial report, you can just click on one of the hospital locations and it'll bring up relevant graphs that are associated with the finances of that particular hospital. And in addition, there's also some of those parameters include like, on the right-hand side, you'll see that there's a filter on there for dates that are specific for the net patient race ratio. So you can over time kind of check out the NPR for each hospital by selecting those different filters. Let me think here. And the base data set for all of these reports are available for download via our reports page. Can we move to slide seven, please? Or eight, I'm sorry, yeah. So I've got a couple of snapshots of just sections of our, these are our website pages. And as you can see, we have on the left side, the left view is a list of some of the interactive reports under public reports. We also have summary briefs, et cetera. So I want to make sure that public is aware and also the board is aware that we do have and have been compiling this record of reports over time since about 2017. And these are readily available right now. I have a red arrow pointing to our all-pater total cost of care report. And I just want to, if you click on that, well, you'll come to a page. And that page includes a little bit of a brief about what the report's about, a link to the interactive report. And then in addition, what's most important is that we also have, I shouldn't say most important, but I think it's very important is that we have methodology and background to clearly define the constraints of the report and what the report is designed to tell you and not tell you. In addition to that, also the data that's used to compile each of these reports is available for download in a flat table format, CSV. We're also working, in addition to this, I want to point out we're making some improvements at this point for these pages. I'm working with Christina McLaughlin from our strategies and operation team to streamline how to access, how to actually start from our starting page, the GMC webpage, to more easily access these reports so that they're not so buried within a series of breadcrumbs to get you to the actual reports themselves. Once you get to the data analysis report, you can select on the report, as I mentioned. And like I said, those report pages have all the information available that supports that particular report. One of the things we also are improving is rather than selecting on the interactive report link that you see on the all-payer total cost of care report page, we're working with the state of Vermont's website vendor to embed the report so you don't have to leave the page or it doesn't launch a new page for the interactive reports. The report will either pop up or it'll be physically embedded in that website so you don't have to leave that particular website. So, like I said, we're trying to really make it a lot easier for folks who visit our website to find the reports and actually use the reports. And next slide, please. So, slide nine, thank you, I'm sorry. So, one of the, like I mentioned earlier, we also want to have a greater availability for accessing the data in vCurse both by our state employees and in addition to that to the general public. So, I like to think of the vCurse as sort of this large set of data, which it really is, it's hundreds of millions of records and it requires a high level of understanding of claims data and technical ability to actually query these, to query the data source itself. And this actually limits who can directly access these of the raw data. In addition to that, we also have to protect the personal health information in accordance with HIPAA, which also restricts access. So, we have a couple of different methods in terms of how that data can be accessed that we're working on. Currently, for the state of Vermont approved users, they can use the analytic enclave that I mentioned earlier to get in and use that SQL tool to actually directly query the database and create tables, et cetera, for reporting. We also have a process now for non-state entities to access datasets or request datasets that contain PHI and are more granular in the level of data. However, this process to access this, you have to go through a formal data request process that's reviewed by our data governance council and this can take some time to procure the data due to the state's due diligence in protecting the PHI contained within V-Cures. We are currently working on methods for the general public to access the data used or the data files through public use files. And in the short term, it's essentially public use files with content focused on certain health measures and claims data analysis domains. So, we're working with VPQ HC to develop some research domains. Sarah mentioned this earlier and at aggregation levels and sets of variables, for example, like for population health, so that you can just go to our website, download a dataset and it's focused on a particular research domain. And long-term, we're hoping to also create data extracts that are more robust in content that may perhaps contain PHI, personal health information, but have a more streamlined DUA process and a request process with the data governance council. So that these sets you would request, these datasets you could request, but they'd be more streamlined. We would know what's contained within those datasets. They would have a little bit more information, but you'd still be required to go through a request process, but it would be a little bit less robust in review because we would have pre-reviewed these reports. So that's one of the things we're working on for the future. And with the slide 10, please. Like we mentioned a couple of times, for internal users for the state of Vermont, we've created these BI tools and data maps that are basically consolidated formats of the larger V-Cures dataset and database. They're ready-made interactive reports using Tableau that allow the state of Vermont users with access to V-Cures, but may not have the technical background that I mentioned to create the V-Cures database. So on the right-hand side of this slide, you can see that this is a snapshot of one of our slides that is similar to what I mentioned earlier about. You can filter and change the graphs, et cetera. And these graphs can be printed out to be used in presentations, et cetera. And they're just a little bit easier for folks who don't have the technical ability or the claims data knowledge to actually directly query the database. The data on aggregation is for selected measures. So there are three interactive reports that we have prepared to combine five data mark categories. The categories are the submitter, member, episodes of care, provider, and geographic areas. And those are combined in different combinations to prepare a submitter level report, interactive report, which is comprised of like five or six dashboards, member level report, the same deal, and the episode of care reports. And this is assisting our folks. I know that we've gotten positive feedback from both Diva and VDH in terms of how these data marks are structured and their use and their ability to use these data marks. So we're really happy with the product that we developed here. And we move to slide 11, please. And then finally, I just want to kind of wrap up with how we're kind of, we're trying to improve our data intake and data request processes. Kato Neal, one of our team members has developed a web-based analytic services request process for internal state of Vermont and GMCB users. This is just for our analytics team so that we have a way for people to submit requests for data. And we're also able to track that. And Kato did a great job of developing a web form for people to submit that their information for the request. And that allows us to process that request, assign it to the appropriate analyst and streamline the output for that information to the requester. In addition to that, we're also discussing methods with our stakeholders to improve the quality and efficiency of gathering data. So for example, our hospital finance team we're working to, I'm exploring methods to use what's called an API and application program interface that would query the adaptive database and directly put that information into the Tableau Interactive Report software without having to create a flat file. And so they're directly querying information out of the adaptive database. And that makes for a little bit more efficient process in terms of, and quicker process in terms of developing reports. On the ATRAP side, I'm just using ATRAP as an example. We're trying to do this across all of our departments. We're trying to think about what the final use is of our data and how that drives how we request the data. I know with ATRAP we get a sundry of different data information from the hospitals. And what we're discussing is how do we request that information such that when we receive it it's easier to compile that data into formats that we can then structure that data into a format that can be used for report development, be used by different types of statistical and data management software tools like R, Tableau, Python, and we can also upload some of these into the vCare schema and use those to cross query with our vCare schema and create other base data reports or I should say data tables that can be used for reporting. In addition to that, we're also writing and employing some code that would format the data that instead of having to use what I call the old Excel method of sort of copying and pasting data to structure it in a way so that you can create a pie chart or something as simple as a couple of bar charts with just a few keystrokes the data would be transformed using software and it would create the base tables and then make it a lot easier for you to create your reports and graphs. And one of the reasons for this is we want to minimize the when we touch the data and when I say touch I mean actually copying, pasting there can be keystroke errors and that can create problems in terms of misinformation. And so what we're trying to do is use the software. So when we get the raw data in from a hospital, for example, that we're not physically touching the data the data by moving it around an Excel sheet we're using software to reformat that data in the final format that we want to use. So like I said, our philosophy is be as open and as possible with regards to our work and the data used to support it. Like there are some trade-offs, for example with the public use files that require some choices in terms of how we aggregate the data and what level of information that we put out and that's like I said to really maintain that compliance and maintain the security of personal health information for the individuals that are reported within V-Cures. And overall our goal is to improve the information that's available to a wider audience and make the processes that we use to report this information as transparent as possible. And so up next I'd like to pass this along to Jessica Mendesable, our data project director. Thanks, David. Hi, everybody. I am a data project director with a team at Green Mountain Care Board and I have been focused primarily on the health resource allocation plan and Sarah and David both talked a little bit about our efforts there already. So I'm just gonna walk folks through sort of a little bit of a refresher but then also kind of what we've been able to produce to date. And I'll just say upfront that this is kind of an ongoing process and it was a long time since the last HRAP had been produced. So we welcome any and all feedback around the work that we're doing and I'll just put that out there right up front. So HRAP is set in statute and I'm gonna actually go ahead and shut my camera because I'm distracting my own self. And the plan is actually meant to look at healthcare needs and resources and identify realistically where those needs are being met and where there might be some gaps. And so you could do this in a number of different ways and I think the possibilities are really endless and so we're focusing our priorities using some of the areas that have been identified in the state health improvement plan as well as the community health needs assessments of the hospitals conduct. We're looking at workforce information and as well as materials that are provided to the board through their standard regulatory processes and we've done a lot of stakeholder engagement and involving the public when we're presenting at these meetings. So, oh, yes, thank you. Next slide, we're in slide 13 by the way. So this is just a nice infographic that Marissa Melamed made for us really early on in ATRAP and I think it really still stands to illustrate what we're trying to achieve, identifying those healthcare needs, looking at resources and how they inform each other, understanding not only the availability of those resources but eventually taking it one step further to understand the healthcare access. We can move on to slide 14. So over the last few years, we've been working to complete this kind of initial phase of the plan and I'll just say the plan isn't any one thing. It's more of a combination of work that we know is taking place throughout the state, work that we engage in naturally through our regulatory processes and really engaging with those partners to understand how they're addressing needs and how they're addressing unmet need. And so just to name some of the partners that we've been working with, we've engaged heavily with the Department of Health, Blueprint for Health, as well as the Department of Mental Health. We've also worked with Oz, the Department of Aging and Independent Living, the VNAs, as well as our primary care advisory group and our GMC advisory group. We've also worked with some key legislators to make sure that we are on the right track with all of this work. And so really engaging those stakeholders early on and gathering requirements because one of the components of HREP is to make this information available digitally and with some interactives as well as really laying out by geography what resources are available. And so knowing that this work is taking place sort of at different levels and throughout different agencies in the state, we did try to compile as much information as we knew about and put that up on our GMCB website so that link is listed here and folks could go ahead and explore that. And I just again encourage people to, if there's work that's taking place that we don't know about, just let us know and we can be sure to make those connections. So some ongoing work. Like I said, that this is kind of a continual process. We'll always be continuing to engage with stakeholders and developing these interactive visualizations. David's given you a couple of screenshots of what we have available generally. And then we'll look at some of those in a few seconds that are available specific to HREP. Okay, we can go to slide 15. So one of the requirements for HREP is to conduct health services inventory. And we'll not just services, but also equipment and beds as it's applicable. This information is specific to some of our regulatory processes such as certificate of need and hospital budgets. We have conducted inventories on the sectors that you see here. So hospital-based services, substance use disorder treatment services, as well as mental health and home health and hospice. And we will continue to inventory additional sectors as time allows and also as priorities are identified. This information that we've managed to collect, as David mentioned, it was a timely process. I think it was really necessary, especially since HREP hadn't been updated in quite a while, that we take the time to really noodle through what we wanted to collect and what was gonna be the most relevant. And so we're looking at ways to increase the efficiency around that data collection going forward because we are required to maintain these inventories. And one of the big changes with this sort of new iteration of ATRAP is that we wanna make sure that the data is up to date as folks need it. And so I mentioned our certificate of need program. One of the focuses around this work is that we have ATRAP standards that, I'm sorry, just one second. Sorry about that, I'm the child at home. Okay, so we have some ongoing work related to the standards that certificate of need applicants need to adhere to when they make their application. And in developing this new ATRAP, we really wanted to take a step back and understand what it was we really needed to ask for upfront from the applicants in order to understand what the needs are in the community that they're proposing to serve. Okay, so we can go to the next slide. So we're on slide 16 now. And so some of the digital interactives that we mentioned, we wanted to start with some beta visualizations to really just try to get a feel for ATRAP and what it could look like and the kind of information that we could represent visually, not only with maps, but similar charts and different metrics that are related to needs and resources. And so we took our stab at looking at primary care access. And there are two different visualizations that were created looking at hospital service area and some more granular geography. And those are both available from our website. And so I would just encourage folks to go ahead and explore those tools. We've already had some initial discussion with the health department on kind of where we could take them next and maybe some changes that we might wanna make in terms of looking at different sub geographies and really considering looking at a longer stretch of workforce information. And so those are things that we're gonna take into consideration so that we can look at trends over time. And I'll just say that all of the different healthcare sectors that we've met with, we know this, but workforce is really a major issue in being able to provide care and throughout the state. And that's not new information but it's just something that we hear over and over again. Okay, we can take a look at slide 17. Okay, so just a few screenshots here on the visualizations that are accessible through our website. And really again, just trying to illustrate where there is adequate services and where there are needs. And so this particular snapshot is looking at health insurance and there are some measures related to access in this visualization. One thing that we know that this tells us is that Vermont has a good insurer population. And so if we were kind of trying to dig into some of the underlying reasons why folks can't access care, this might be a good way to say, okay, maybe it's not necessarily health insurance. And it would just kind of give us an idea about where we needed to dig a little deeper in order to understand why the people still are not able to access their care. So I'll let folks go ahead and kind of explore both and let us know what you think. So slide 18 is just another snapshot there. And this is actually a profile look. So you could use the map to click on any hospital service area. And you could see the most current metrics related to access for the most recent year that we have. I'll say that we know that 2019 data is being curated currently. And when it's available to us, we will update these visits with that information. So we can move on to slide 19. So this is just another screenshot from the second visualization and our analyst Jeff Batista created this for us. And so Jeff, when I finished, feel free to chime in, but we took a look at travel distance in this phase as well as broadband access. So this is one screenshot, but we can kind of walk through a story with this visualization to look at folks proximity to primary care, as well as some underlying socioeconomic measures that may determine healthcare needs such as age. So it's a really interesting look at how people could potentially access their care and whether or not there are any gaps there. I think I mentioned this before, but we are looking into a more detailed subgeography. And if you click on the next slide, Sarah, this shows you a little example of that whereby we're taking a look at this measure by town and then rolling it out to HSA. So just an interesting way to visualize the information. And so I don't know, Jeff, you'll be coming up next. If you wanna share out anything else around this work, feel free, but I think that's it for my question. Thanks. Cool. So if you can go to slide 21, advancing from the past two slides, health access and its impact on health outcomes, it's quite a complex process. It involves a lot of things that aren't necessarily quantifiable or mappable or even under the GMCD's purview. Traditionally, the payers and providers have been the core or how we look at access. For example, can someone get insurance? Where are people going for care with certain types of insurance and analysis like that? And we see in patient origin and patient migration building onto that. We see that physical proximity. That is where services are provided. Cancer treatment versus primary care. We're looking at elements like driving time, transit access and non-emergency medical transportation that we see from providers across the state. Also, we'd like to begin considering the rise of telework that includes broadband access by town and by provider, which are also on the current visual access on the web. As well as 4G access is something I'd like to consider as broadband rolls out into more rural areas that may not just be lined to begin with. It could be a more of a wireless distribution of the internet there. And finally, we want to consider not just how these physical things and digital things are built across space, but how different groups interact with them. For example, one may be close to a medical facility, but not have the insurance or the language abilities to access that care easily and rely on other resources to get them. So looking at all these factors, I'd like to turn to the two figures to the right. These are not from GMCB work that they are a statewide analysis of Vermont from about 2012. And in this case, in the red box, we'll see the access to adult day centers. So we have physical location centers and as we don't have things like Star Trek style transporters, I'm not Captain Kirk, we need to consider the friction of distance. This includes the driving time from the centers, the transit lines that start within a quarter mile of the centers and some sort of a base layer of universal paratransit access. And to sort of demonstrate how we might conceptualize this from the top down state view, we aggregate these into a simple nine to three scale and then throwing in the demographic data of where people over the age of 65 reside in census tracts in towns across the state of Vermont, we can roughly figure out, we can gauge the relative access in different healthcare areas that people have to the adult day care centers or adult day centers in their area. So what's missing here? Obviously we don't have the variation in paratransit performance, we don't have social network, social capital, there's no real sense of the interacting factors of whether someone has an income or they don't or whether someone's can easily access the services. And we're also not considering telehealth services as well as substitute programs such as SASH, which could substitute for adult day services. So all these factors, they're aren't static like in the figures of the previous slides, they're woven into the bill environment, the social structures and the rhythms of everyday life people here in Vermont in those seeking care for Vermont providers. But we can work to ensure that our analyses don't perpetuate the socioeconomic inequalities that may occur if we aren't bringing in these factors from the beginning. So as the analytic plan advances, we're gonna parse out the causes and effects of access in greater detail. This can include what shapes hospital choice for certain procedures and diagnoses where adverse populations are underserved by care and why, is it a question of physical access or not having access to transport or insurance? And what interventions could best improve access to care? This is an ongoing collaboration. There's a lot of cross-pollination going on. Just to list a few, we've reached out to Blueprint VDH Diva in regards to the transport stuff. And the lower case S for state would be the healthcare advocate. We spoke with him in October and we'd love to continue that conversation. So moving on to Lindsay on slide 22. Thanks, Jeff. Hi, everyone. My name is Lindsay Kill. I am one of the healthcare data analysts on the A team. After wrapping up such a rich discussion of all of the work going on with my teammates, the wealth of information from analyses and all of the efforts we're making to expand access to this information, I'm going to change up and talk a little bit about the complexity of the data that we work with and what solutions we're proposing to help not only ourselves, but our partners address that complexity. So to kick off, one of my favorite quotes from President Donald Trump is that it is an unbelievably complex subject. Nobody knew that healthcare could be so complicated. Slide 23. So we know all of us here today, we know that our healthcare system is complicated and by extension, the data are also really complicated. I'm comfortable saying. Typically to navigate and research in the raw claims data, which to refer you all back to David Glavin's slide is the largest circle, what is in features. To successfully use raw claims data, ideally requires familiarity with relational databases and their structure, an understanding of medical insurance types and enrollment or on the opposite hand ineligibility, knowledge of medical and pharmaceutical billing and coding, which is incredibly complex and is its own career specialization unto itself. Some knowledge of medical practice in the US and then also coding experience, SQL, our Python, any of these, how we access the database. And while we steward the vCurus database, the, sorry, while GMCB more generally stewards this database, it's the A team that sits on the front line to help other users along the way to obtaining the data to meet their needs. So slide 24. In the previous model, how we've gone about doing this is we use our partners at on point health data. They were providing the vCurus, what's called a data dictionary, which is sort of exactly what it sounds like. It's a massive list and inventory of exactly all of the variables in the database. And in addition to the data dictionary, they provided other documentation and user support as requested. We also hosted previously a data user group and that took place about every other month. Those topics featured were broad-based topics, all the way to like the most narrowest of, you need these variables to find this disease type. And the users that were invited to this meeting were really anyone who had an affidavit to access vCurus and that's our state users. The picture here is just kind of, it's what you would see when you logged on to the vCurus collaboration zone. It's a SharePoint site also hosted by on point health data with just again, a very wide range from very broad to very narrow information for claims researchers. And then project specific requests for assistance from these other state researchers would either come to us or go to on point health data, sometimes both depending on the complexity of the question. And those would just arrive ad hoc and we'd kind of take them as they came. So that's the previous model. Next slide, slide 25, please. Thank you. In the new model, what we are proposing going forward and what we've started to do, well, first I wanna talk about what's the same. So we have ongoing user support. On point health data continues to provide the same supporting materials such as the data dictionary and their transmittal reporting for our end users. They've also done great work to expand the documentation like for more current health issues like COVID-19, they're providing some high level COVID-19 related summaries, which have been helpful. And on point also continues to help our end users in the form of online presentations and learning opportunities. These are scheduled ahead of time, totally free to the end user and I think they do a really great job. What has changed primarily for us is our data user group structure. Now we move to a model where the invitees must apply to the course with specific projects that can be accomplished using claims data. So what we're really asking our state partners to do is to think of their current research and think about can this question be answered using claims? And if it can propose that question to us and we will dissect it together. The topics for this data, this new data analysis course are some examples of those are eligibility. So the impacts on our results and how we measure eligibility. We also are going to do a deep dive into medical claims and pharmacy claims, what's included on those claims and exactly what tables to use to get that information. And lastly, but of course not least is our data quality and structure. So there are many other sources we can use and that the A team does use to check the validity of our findings from claims. And we also, we wanna share those resources with other people so that they don't go thinking that claims is the answer, it's part of the answer. And we also want to review with them how to structure their results to be useful in other programs such as Power BI and Tableau. Typically when talking about healthcare analyses, we phrase our questions in terms of impact on populations. So the people, we talk about the people, we talk about the episodes of care, we talk about the epicenters of care like hospitals. Unfortunately, none of those three things that I just listed are easily interpretable from a claim. So we want to review with our end users how to structure their results to aggregate to that level. And lastly, you know, as an extension of that class, we are gonna be providing, I hope, much more in-depth resources for these course members, like code examples, we're gonna have the meeting recordings and meeting notes. We'll have the question and answer from each week. So every question that individuals ask, I will include a written response so that they can refer to that over time and hopefully it will be useful to other analysts. All of this will be posted on our SharePoint site, which is available to all state users. Invitees will also have access to office hours. And in general, all state users are gonna be encouraged to attend our data governance council meetings for those more broadly applicable updates around data sharing and use. Slide 26, please. So we think, we hope that the benefits of this new model are that the smaller group are gonna allow for more in-depth training. That all attendees who are in this training, we know that they're actively researching in their fields because they had to send us the project. So we hope that this can facilitate better collaboration between state analysts and end users. We think this is going to more effectively utilize 18 times since we will be responding less to those ad hoc project requests, project assistance requests. And lastly, it's going to create a catalog of resources that we can always go back to. Again, those question and answers, the class recordings, other documentation I'm gonna share. And so not just now, but in the future for new people who join the state and have questions about navigating the complex data of claims, this will be a standing resource for them. So we're really excited about this class. That's all I'm gonna say about that. I'm gonna hand it over to the next person. Thank you very much. And I'll take your questions at the end. And the next person is me. Hi, everybody. I'm Kate O'Neill. I'm on the data team as well. I am the chief data steward. So my responsibility is more around the data governance and the data stewardship of our data assets. And I staff the data governance council. You've heard much about that along the way or at least reference to it. And so all I'll say about that, for those of you who are less familiar, the data governance council is a committee of the board with delegated authority to address concerns around our data assets around issues of data quality, sustainability of our program, risk management as well as data release. And so to that end, that's me in a nutshell. And I'm gonna just share with you to wrap this up and then we'll move on to your questions. So we as the GMCB and the data governance council specifically are always looking for ways to make our data more accessible and used in enriching ways and to support rich research that supports the state of Vermont and Vermonters. And so a couple of things that we've got on the horizon are exploring ways to make the data assets that we have and information just more meaningful for broader audiences. We are looking at opportunities for data integration like with electronic medical records and vital statistics. And we are starting to think about larger statewide efforts like through the health information exchange. And I think that we will probably be in a better position to share more about that at a later time because those conversations are really just getting started but that's some exciting potential on the horizon. And Sarah, if you could speak to slide 28. Recently in December, the data governance council voted to approve a data linkage policy and this was really important because it gives us the parameters for allowance as well as restricted usage for when our data assets are linked with other state data assets. So our policy supports meaningful use and it allows for more robust data that then can be obtained from one individual source, say claims or say just vital statistics or that sort of thing. And it allows linkage projects that still maintain consistency with the existing principles and policies that we have in place for our data assets as well as GMCB's legal authority. So it was good to put that in writing and to have that approved so that it makes it easier for us to contemplate requests for data linkage within those parameters. And I'll share with you just a couple of examples of some pretty exciting work that's happening. The UVM Larner College of Medicine, they have a Center for Health Services Research and they recently were approved to link vCures with the cancer registry because they are interested in studying trends in lung cancer screening, particularly in the more rural areas of Vermont and to look at screening incidents and outcomes. And so we're excited to see that they're using these two data sets linked together to do this work and they are very willing and able when they're ready to come to a board meeting to share the results of their work. Another example is the Blueprint for Health and they've linked vCures with the clinical registry to enhance blueprint reporting on clinical outcomes. And that's been around for some time and they've got that linked data that they've worked with that for quite a long time and you see the benefits of that in the Blueprint reporting. That's it for me and I think we're on to questions. Yeah, so I just want to take the team again, putting together the annual report. I was struck by what a busy year it's been and I couldn't feel more blessed to be working with this superb group of individuals. So we're happy to address any questions about either the breadth or the depth of any of these projects. Super, thank you very much. Starting with the board, board members, any questions? Oh yeah, it's Maureen. Just a question on, do you think the data is being used to the fullest? I guess, who are the primary users? How do we get more people to use it? Because there's a lot of great information in there. But as you pointed out, it's somewhat complex for people to use and understand. So just like your input on kind of who's using and how do we get more people to use or are you satisfied with the number of people using things like that? Yeah, great question. So that is one of our primary objectives is to get more people using the data. Currently, the primary users of the Clean Database is the Green Mountain Care Board, the Department of Vermont Health Access, the Department of Vermont Health Access, and the UVM College of Medicine. I think those are kind of the power users. Lots of other people do have access. There's a few people at the Department of Health who are using the data. But we think that that learning curve is just really intimidating for a lot of users, which is why we're trying to both package the data in ways that are more accessible and also cultivate more kind of experts across the state. For the discharge data, I would say the Department of Health is by far the super user of that data set. And that's one that I feel is underutilized. I think because there's not real dollars in there that people maybe don't realize how rich that can be. So we're also trying to promote the use of that. And again, with these integrated data sets, we're hoping we can even expand use outside the healthcare space eventually to inform policy. And I can add that there are a couple of non-state agency users of V-Cures, our claims data to do a variety of different projects. And that, we do get requests from time to time. Currently Archway Health Advisors is doing a research project. N-O-R-C has our data as well for the all-payer model evaluation. And I think that's probably it for the non-state users. And for the hospital discharge data, we get many requests throughout the year. I would say 30 or more in a given year to access our public use files. And I think the projects there range from graduate students doing a short-term project to do more robust research. But we do get a lot of requests for the public use file for hospital discharge data. So I just want to mention that that does get a lot of usage. And we think that in the way in which we are making the claims data more accessible through interactive reports that we're creating with the downloadable data, as well as the analysis-ready data files that we will get more interest and that it will be more accessible. So that we'll have a more broad usage. Okay, other questions from the board? Maybe I'll build a little bit on that question because I see the value in expanding the use of the dataset, but I wonder how does the data team balance their time supporting all these external users with the needs of the board and other entities requirements that we have for data analytics and how do you balance that need as use increases? And what's the optimal amount of time to spend on external users? That's a great question. And something we'll probably have to do a little, guessing and checking about along the way. But the reason that we're having this formal data class and we're also going to be developing a user manual to help guide users is we're hoping that we can strike a better balance. But our hope is that some of these more derived tools, I think we'll probably address 80 to 85% of the need. And I think that that will be pretty self-serving. It's really the in-depth analysis where we just need to balance our time and we try to be responsive, but certainly we know our core work for the board always has to come first and people are sensitive to that. As I like to say, there's no emergencies in healthcare research. So well, this is, I mean, incredible. The amount of work that you all have done this year and the depth of information that we now have and the way you're making it more accessible to everybody, including board members and other health policy wonks is incredible. So thank you. In the most immediate short run, I'm wondering with all of this analysis that we now have at our fingertips, how do we incorporate it, for example, in our hospital budget guidance that's coming up, right? So that's the next big probably area where we're going to be thinking about our regulatory process. And so the hospital budget guidance usually typically comes out in March. How can we integrate some of the information that's captured by all these analytics in that hospital budget guidance in ways that will be improve our decision-making, you know, come budget season next year. And then the ACO budget guidance follows that, QHPs. I mean, how do we start to incorporate all this wonderful data that you all have put together to make better decisions internally at the board? Yeah, and that's something we'll be working actively across teams with to help cultivate because we often aren't necessarily the content experts in those areas, but we can help answer questions with the data so that if we can work together and I think really the biggest trick is kind of packaging things in a meaningful way because you guys have so much information all the time. It's just figuring out a meaningful summary. And I think the hospital financial dashboard is a good example where we had to work with the hospital team to kind of come up with that longitudinal snapshot. And that's the type of stuff we want to start to develop and then kind of turn into standard reporting so that it's available. Both the board members and other interested parties, you know, on an ongoing basis. So we're open to feedback. We want to help. Well, I appreciate it and you will, I have no doubt. Let me ask one quick question, one more quick question. On one of the projects you talked about the hospital markets and doing an analysis of why patients travel for care. And I'm just wondering, I can imagine doing a, you know, when you have done some work on where patients travel for care, but the why seems very motivational and behavioral related. And I'm wondering what variables you are using to get at the motivation for travel versus just distribution of care. Yeah. Yeah, I think in the first generation it will be pretty limited to demographic information. So is the payer type, influential, age, service lines at a pretty high level, just trying to predict that sort of thing. I think the data integration piece is where I think we can get a lot more interesting in maybe folding in some social determinants of health or financial risk variables and, you know, stuff like that. Sounds exciting. I can't wait. Thank you, Ateem. The other questions from the board. Yeah, I have a couple just following up from what Jess said. I think it is, I think I am looking forward to the market study, because I think that will the patient origin and migration information is fascinating. And, but some of it it's sort of like, huh, I would not have predicted that. So I'm looking forward to unpacking what we can about the lies. And on the regulatory integration stuff, I think that the other piece of that is figuring out how our regulatory teams can build into their normal process, the new information and data in sort of a systematic way so that it's just part of what we do going forward. So I'm looking forward to more work on that too. Thank you. And then lastly, also thinking about, you know, trying to juggle external pressures and internal pressures of your time. I wonder if we think at some point it might make sense to have a conversation about how to financially support some of that external work. I think that requires a legislative conversation probably, but it seems like in other areas of state government when you're a shared service, so to speak, the other agency is expected to financially contribute, which could actually give us more capacity for that support to external users. So I don't know if that's a good idea but it just occurred to me as we were talking about it and thought I'd just throw it out there for future thought. Thank you. Thank you. Yeah, I have a couple of observations. I'll run with Robin here in terms of kind of thinking about other people, whether it's a good idea or a bad idea that might have some interest, at least in understanding the infrastructure you put in place might be the joint fiscal office in terms of having this as a resource they're aware of and maybe some of the people in the reporting community so that we've reached out in an open-handed kind of way and because what I see today is light years from where we were two years ago. You people have done a tremendous job. I remember coming here and sitting there trying to figure out using blueprint data, some relationship between operating margins and hospitals and the Medicaid population and it was probably Jess or Robin kind of effort I got through it kind of debunked my whole approach by saying, but what about patient migration? And it's like, oh, well, you can't just use the Medicaid population in the HSA. So that's one area that I'm just wondering if me might want to expand awareness or have people come into a class or something so that it doesn't happen in a chaotic way that all of a sudden you have someone knocking at your door saying I insist this or the chair of this committee wants that and that we've thought about that. The other is thinking through what happens if we get a FOIA request. This data is very complicated and I'm sure people from the real world don't understand how complicated it is other than Donald Trump. Thank you for that, Lindsay. But a FOIA request could be a chaotic experience because in the end we are a public entity and I'm wondering if that has been thought about at all. It's like, okay, sorry to fail this one, thank you. It has, yes, it's not subject to the public records request and we've, our legal team has done the research to identify the sort of put together the explanation for that but the quick response is that the access to vCures or to our hospital discharge data in potentially identifiable data is not available by public records request because it's not HIPAA compliant. So we're restricted to the restrictions put forth in HIPAA and there are a couple of other good rationales for not providing the data because it's not really usable and it's way too large of a database anyway. But yeah, so we have thought through that, we have gotten public records requests over time and we just work with those folks to identify a better way to add the questions that they're looking to answer and generally that's been a helpful process. Well, that's good. I understand that the HIPAA level that I get patient data but I'm just wondering at some point as you climb the ladder of information and the data gets less and less HIPAA risky, where are the guardrails around that? Should we get a request? But to end, go ahead Sarah. I was just gonna say that's part of the reason that we feel sort of strongly about being really transparent in anything that we were producing and making the underlying data available even though that does come with a risk of misuse but then we kind of show our work in terms of documenting the methods and assumptions we made to producing it. Because yeah, I think that you're totally right. There's nothing, I feel like anything we do just sparks infinite, it's like a fractal. More questions always just keep sparking. Well, you all done a wonderful job and I can't wait for my booster session to kind of get my, I spent a little time yesterday just kind of wandering through some of this information and it's seductive actually. You get all of a sudden wake up the next morning and still looking at it. It's a lot of work and it's interesting stuff and I'm sure it's gonna be very helpful to all of us. You don't know what you're talking about. So somebody should mute themselves, whoever that is. Other questions from the board? If not, I'm gonna open it up for public comment. Is there any member of the public? Starting with Jeff Team. Thank you, Mr. Chair. I appreciate the hard work that has been described today but also just kind of want to raise a concern or a set of observations about it. The data team described several tools and data access processes and reports that are available through the Green Mountain Care Board to name a couple of business intelligence tool and APM dashboard, a total cost of care resource, a data mining class and extensive data for alleged public consumption. My question is simply really who uses these tools? It sounds like a lot of time, money and staff resources have gone into creating and managing them and I just like to understand what value they deliver and who benefits and why this falls under the responsibility of the Green Mountain Care Board. If the audience's health policy wonks, for example, I would just wonder if it's Green Mountain Care Board's job to inform sort of academic analyses. And then it seems unlikely at best that the general public would have the sophistication to be able to use or understand the information that was described today. So I would just be interested to learn sort of what all of this costs against the value it allegedly delivers. And I think Vermonters deserve to know the same. You know, with the hospitals that we represented, Vaas, the Green Mountain Care Board, as its responsibility to do, thoroughly questions and cross-examines hospitals about every financial decision they make about the usefulness of their programs, their spending decisions. So I would just put the same question back to the Board as it pertains to all of these projects and products and data mining initiatives. Thank you. So before I turn it over to Sarah to address that, I would just say that the Board's decisions are only as good as the data that it has. So I believe it's extremely important to have useful data. And with that, I'll turn it over to Sarah. As I tried to tee up in the beginning of the conversation, our whole work plan is modeled, predicated on the information that was requested by the Green Mountain Care Board. And so to the extent we can extrapolate that information, everything we do is considered a public record. So we're just trying to do our best to make the information available to as wide audiences as we can. I agree, it's probably not every person off the street who would be interested in it, but we do wanna do our best to again, show our work and be transparent in those methods. Kevin, can I chime in too with a historical perspective that might be helpful? Certainly, go ahead. Sure. So the state created an all-pair claims database prior to the Green Mountain Care Board, which lived in what was then banking and insurance securities and healthcare administration, in part because the legislature and others felt like having claims data available for health policy analysis would really support decision-making in the regulatory sphere as well as the rest of state government. So it is created as a statewide resource, not simply a GMCB resource. So to that, in that vein, it is a little bit broader than the board. However, I think when the Green Mountain Care Board was created, it made sense to put that resource at the board because the board, both because of the board's regulatory functions, but also because of the board's evaluative functions through the expenditure analysis and other reports that we are required by the legislature to produce. So that was really the historical rationale, I think, for the legislature moving it from Bishka to the board. So I don't know if that's helpful, but that's how that all rolled out. It's also too important to point out that it's used across state government, Department of Labor, Department of Health. You can just go on and on from there. So the next hand that I saw was Eric Schulteis. Yeah, I just wanted to, this is Eric Schulteis from the health care advocate. I just wanted to expand on something that board member Holmes said, looking forward about hospital budget. I think aside from the linking to or using specific products, I think one of the key facts or real ways that data or data use in other regulatory processes can benefit from is taking the kind of conceptual approach of the A team of clear documentation, deeply interrogating the data, what it can say, what it can say, making sure that when we're measuring something that we're all measuring it the same way, could really improve those processes. So it's kind of more of a meta issue of working with subject experts, but bringing that capacity to interrogate data that I think went out of a tremendous amount of value. Thank you. Thank you, Eric. Next in the queue is Mort Wasserman. Hi. First of all, thanks to the A team for an incredible presentation that was wonderful, great to see what's going on. I was especially pleased with the HRAP piece of the presentation, which showed a much broader view of what goes into Vermonters health than the claims that they generate when they actually see health care providers or cared for in hospitals, because it touches on what happens to the Vermonters who don't get to clinicians who don't get to hospitals. I was also delighted with the measure, the mention of different integration efforts that are going on. The Vermont Health Information Exchange was mentioned and that's very valuable because it draws directly from electronic health records. It's in its infancy as a database, I believe, to be explored. But that's the place where information on race and ethnicity is currently sitting in a database, whereas it's not in the cures at all. And in the issue, the issues of health disparities are just looming larger and larger. So that kind of work of integration is critical. And I guess the question I have, not so much for the analytic team, but for the board members, is who drives these integration efforts? How do they actually happen? The VEI is part of vital, vital is not really a state entity. It looks to be an independent entity, although its budget comes under Green Mountain Care Board and it's also under DEVA. Who drives the effort to make those things happen and the resources needed to make them happen? As a pediatrician, I'm always amazed that there's so much data on Vermont's children that the Education Department actually has a database on every public school child in the state and how well they're doing. And as part of social determinants of health go, education is a huge one. So there's a data resource there. There are data in children services as well on an especially vulnerable group of children. And although they're not expensive now, they're gonna be inexpensive in 20 years. So, to the leaders of the board, is who drives the process to make this integration happen? Where does that energy come from? So, Mort, I would say that it's driven organically by the interactions that we have with all our different partners in state government. When you get into specifics of the, I'm glad you really brought this up too, about race and ethnicity, we had actually placed that in our budget request for this year. It didn't get funded. We're trying to work to get a grant to make sure that that happens, regardless of that. And it's something that is just driven organically by everything that we're required to do by statute and to be successful in doing the duties that we have under the statutes. Sir, do you have anything to add to that? I don't know why it's so hard to find your name button sometimes. But yeah, I would just say that it's the future period. I think everybody understands that these things are significantly limited in a vacuum in that the comprehensive picture is so much bigger. And so I know there's within agency efforts, even just at the agency of human services to figure out how to pull things together so that we can better serve the needs of our residents. And health is just one, it's expensive, but just one piece of that holistic kind of picture. Yeah, so I would just say as a member of the public that organic may not be fast enough. That's all. And I think leadership is involved. And I think members of the board are leaders and they do speak to the legislature and I'm aware that you're making those efforts. So I just would like to encourage you to continue. Thank you, Mort. We appreciate that. Next in the queue, I have DL Hackett. Good morning. So compliments on what you're doing with the data. You made me smile several times. I seriously think you make it sound way too easy. It's far more complicated than you make it sound, including the idea that data sets as much as we use them, they can only answer so many questions. Those are the only questions they will answer. You got, just change the context around the question. You need a new data set. Anyways, whoever that was, I was talking about how to integrate data. I was actually thinking along the same line of just like in the legislature, they create walkthroughs when they have bills and they wanna compare them side by side. For the general public, I can totally appreciate that they may not be able to look at the data and understand the data. So how about something like a walkthrough that can bridge that gap so that it helps the general person out there to understand what they're really looking at. Sometimes people understand words with numbers, but they don't understand numbers. So that's just the way it works. So, questions and how the context reflects and the question, what the data can really answer. The other one would be the children's data. What I'm interested in going forward is after reading about the pandemic of 1918, if I got the year right, I was recognizing that the pandemic we're in now is gonna affect children for decades to come. It's gonna show up not just in healthcare. It's gonna show up in educational performance. It's gonna show up in social skills. It's gonna show up in emotional health. You can go across the board no matter what you name, it's gonna affect it. How are we gonna track that and do we may have plenty of data on children? Well, we've got a whole new data set. We need to answer really what the children are experiencing already. How are we gonna do that? That's it. Thank you, Dale. Are there other members of the public? Kevin, this is Ham. Can I get a question? Yes, Ham, go ahead. I'm curious. It seems to me that one of the most valuable pieces of information that's already out there is the Tableau. And the Tableau sort of has a cousin that was born in Vermont, which is the Dartmouth Health Atlas. The problem with the use of the Tableau right now is that the data has never been adjusted for anything, I believe it hasn't. And the difference between that and the Dartmouth Health Atlas is that the Dartmouth system is age adjusted, which is probably the single most important variable from to separate one practice area, a practice pattern from another. There may be others too, but so my question would be to the data team, how should, I think that we really need right now as soon as possible to get the Tableau data that you've art that you generated and it looks really good, but it's not adjusted for either age or any secondary characteristic like income or educational level. What I'm curious is, can you get the, can you take the Tableau that you now have, the Tableau data and get it adjusted? And how soon? Thank you. So yeah, the reason that, and I believe you're specifically talking about the total cost of care dashboard and the reason it's presented that way is because that's what we're on the hook for as a state. Unfortunately, we don't have the ability to age adjust or risk adjust those results. So that's why it's presented that way and we're trying to be clear, but the effort we're currently undertaking in evaluating kind of differences between those attributed to the ACO and those who aren't will in fact, include risk adjustment, including for age. And so that's where we're going to kind of do a bit of a deeper dive to figure out if we can do a better job measuring these differences. Also, we want to better align some of our analyses with the levers available to us. And so for instance, how are these growth trends looking compared to care delivered out of state versus in state for groups under some sort of control for their premium versus those that aren't those sort of cuts on the data. So it's a good point and we are actively working on it. That particular dashboard being updated for risk adjustment, how soon? Gosh, I'd say this year, but probably not this quarter. So I know that's fine, soon enough for you. Well, that's okay. I just a follow up question to Kevin, to share through Kevin. You have two consultants now working on the field, working in the field on trying to get gathered data that would be useful in a sustainability question that's been, that the board has been involved in for something and I like a year and a half. My question is, are you going to be able to, are you going to be able to provide those consultants or the board be able to provide those consultants with the total cost of health, total cost of care data of the type that is some kind of a hybrid or some kind of, I can't say every good word now, but a combination, a mashup, if you will, between the tableau data that you folks have, which I found very valuable, with the Dartmouth Health Atlas, which is similar, but which is in fact age adjusted. I think you need a working number in order to run sustainability and I don't think we have it now. Yep, they are, so their lens is broader than the total cost of care because that by design excludes some pretty big drivers of healthcare costs, such as pharmaceutical costs. So they certainly have, they're getting information from our entire healthcare database, which includes the claims data and the hospital discharge data to inform that work for sure. And I believe there's every intention to include the variables you're mentioning in that work. So in other words, Sarah, it might come in, if these consultants are supposed to report by say the end of February, I don't know what's actually, I can't remember what's actually in the contract, but if that is the case, can we get at the kind of, the real question in sustainability, in sustainability is not national drug prices. The real sustainability question is in medical practice patterns in Vermont by hospital and service area. And I'm just trying to figure out, is that doable in real life in the near term, that near term defined as being able to affect the next budget cycle? Yeah, that's what we're working toward. I don't expect the issue to be resolved, but there'll certainly be a lot more information to inform the budget this year. Thank you. Okay, other members of the public? Other members of the public? Seeing none, I want to thank the data and analytics team for a very thorough review of the work that you're working on. And the proof is always in the pudding, but I'm optimistic that this data is going to be of great value as we move forward in making better decisions, not only at the Green Mountain Care Board, but other decision makers, including the legislature and across state government. So thank you for all the work that you're doing on behalf of Vermonters each and every day. And with that, I am going to recess the meeting until one o'clock this afternoon when we will hear from our consultants, Mathematica on the all payer model, payer differentiation. So see everyone again at one o'clock. Thank you.