 Well, notwithstanding Mary's comment that you can't predict the future, our next session is going to take a look at where we go from here in telehealth, and I'm delighted to introduce my colleague Tony Beretta as the moderator. Tony is Senior Vice President for Government Relations with Kaiser Permanente, and in that role he, in conjunction with senior leadership throughout the organization, oversees development of our public policy positions to ensure that the organization speaks with one voice on behalf of the organization, our members, and the communities that we serve. So Tony, I'll throw it to you, and thank you. Well, thank you, Murray, and I do want to thank all of you for spending a pretty intensive day with all of us to talk about this important subject. Before we get into our panel, which is intended as a kind of wrap-up panel, I do want to recognize the Institute for Health Policy team who put this forum on and who are in the process of establishing a set of public policy-related, health policy-related fora as we go forward. They've done a terrific job with this. Murray mentioned that we had a forum a month ago on mental health and wellness. They know they will be creating some forums next year on a variety of issues. And, you know, the purpose of the forums, I think, from Kaiser Permanente's perspective is really to bring people together on important public policy issues so that we can listen and hear a variety of perspectives and help to understand where we should be lining up as an organization in the public policy space as we think about our advocacy strategy, as we think about what expertise we can bring to dialogue, as we think to things that we might have to change as an organization. And as you have heard, you know, several times today, we are not above wholesale outright theft of other people's better ideas and bringing them into our organization. And I do think that as Murray and I had talked about what the agenda should be for putting on these meetings, it's really in large part about understanding how the work that Kaiser Permanente is doing, the things that we are learning as an organization, can be helpful and relevant for public policy and public policy makers as they are struggling with problems in the health care system. And it's probably as acute in the telehealth space as it is in any other space. You know, I can restate what I think you will have already heard, that our vision at Kaiser Permanente is to create an environment that permits everyone to access high quality affordable clinically appropriate care conveniently through telehealth. And I think that lines up very closely with the vision of the VA. But I think the lesson from both Kaiser Permanente and the VA is quite clear. Is that telehealth, connected care, these modalities of care can be used very effectively. We still need to study the effectiveness, but they can be used very effectively. And they will develop organically in an environment that is favorable or at least is not, does not seek to impair the development. So our medical groups have started adopting these technologies just naturally as a course of their practice. And our public policy emphasis is largely about clearing away other barriers to allow the continued growth of that because there is no real downside for us to figure out ways that we can use these technologies in a way that improves the quality of care, improves access, allows patients to access care without having to take time off work to get in the car to go down to our facility. I mean, I'm constantly amazed that when you look at it from the patient's perspective, losing a half day of work in order to have a 15 or 20 minute encounter with your physician is an extraordinary commitment. And much of the value of these telehealth technologies is really needs to be measured from that perspective. That's a half day of productivity for an individual using this. And if we can get to a point with equal quality of care, that convenience is something that can be incredibly, incredibly helpful for health care generally. People will be able to access the care they need. It will be more efficient. And as we, and the health services researchers who are held a very high standard of what efficacy looks like, what quality looks like, what comparative effectiveness looks like, the one thing that we generally don't measure is that patient convenience element and how critical that is. So that needs to be part of the dialogue. And for many years, I've been, in some respects, on the other side of this as we've looked at people bringing new products to market and wanting to say that, look at this convenience thing over here. It costs us a trillion dollars, but we shouldn't worry about it. I think telehealth is a little bit different because it isn't necessarily about adding enormous costs to the system. It's about utilizing the people who are in the system in a more effective way that's also more convenient for patients. So the beauty of an integrated system like the VA, like Kaiser Permanente, is that we're able to be a ground in which these technologies can be tested, adopted in a manner that poses little threat to the ultimate payers for health care, that there'll be new things that are adopted that don't really provide value, could potentially be very expensive. Those things are self-regulating inside of an integrated system. And so that's another important thing. So the question that that leads to is how can what we're learning in our systems be made relevant for the rest of the health care system? And I think much of the conversation that we've heard today circles around that fundamental question. What are the pieces that we're really learning that can be studied more deeply, that policymakers can look to facilitating enablement of things that look very promising, and at the same time carrying out their important role to make sure that the health system as a whole maintains integrity. So there's a tremendous amount to learn here. I also wanted to note that Helen Burston's presentation was amazing. I can't wait to go back and watch the video of it later. And Sessy, I believe that video will be available later to everybody who came here and everybody else in the world, because she provided just an outstanding outline of all of the policy considerations that need to be taken into account and the work that needs to be done in various areas here. And Susan, I wish you were here to hear it, because I couldn't read my notes when I was writing it all down. But it is, it was wonderful, and I think most of the dialogue that followed that tracked many of the things that she was talking about. But a few of the things, a few of the concepts I think she touched on that we probably want to have a little bit of discussion about after we hear your comments have to do with some appetite. I love the term she used, appetite limiting factors for uptake of telehealth being the obvious question of reimbursement. But she also hit on the problems of training and workforce. And we heard a little bit more about that as well. I think just consumer knowledge of what's possible we see intensely in the VA system and in Kaiser Permanente, but much of the rest of the population seeking services doesn't really have the experience to know what they should be asking for and expecting. We heard a couple of references to, and some very important questions around the digital divide and how can we make sure there's equal access to these services. Certainly the, I mentioned the reimbursement methodologies going to how to, because of the differences in how an integrated system is paid for, how can those lessons be made more relevant? We need to figure that out. What can we pull out of what we're learning to make relevant? We heard a lot about how this can be truly coordinated care and not just a bolt on or an add on. And figuring that out outside of an integrated system is going to be very important. We, as people in integrated systems, need to figure out how we can be helpful in answering that question. The measurement and quality questions that last, the last panel was excellent on that subject and showed that there has been a lot of thought going on here and we're moving in the right direction and a whole host of other issues that have been going on. So I'm prattling on far too long, so I do want to get to our panel so that we can hear from you and then we'll have a little bit of time for discussion. Susan Denser has joined us. Thank you, Susan, for getting here. I will tell you that Susan made the enormous commitment of getting here despite having a commitment in Boston this morning and made it down here anyway. So thank you for traveling hard to get here this afternoon. Susan's the president and chief executive officer at the Network for Excellence in Health Innovation, a national non-profit, non-partisan organization composed of stakeholders from across all of the key stakeholders in health care. Formally, she served as a senior policy advisor to the Robert Wood Johnson Foundation, had been editor-in-chief of health affairs, and when I met you, you were still on air correspondent for PBS News Hour, which so we've known each other for quite a while, a long, a long time. Susan actually sat through one of our pharmacy and therapeutics committee meetings to learn how Kaiser Permanente really organizes the prescription drug benefit process and did a story on that. That's how boring PBS can be. That's excellent. Well done. So thanks for being here. We also have Sabrina Smith, the interim chief executive officer of the American Telemedicine Association. She brings 20 years of cross-industry experience in health care, academic non-profit management settings, and you have a doctorate in health administration from the Medical University of South Carolina. Excellent. And a master's degree from the University of Colorado. And so our pharmacy team in Denver will align with you greatly because every time University of Colorado comes up, there's whooping and hollering and yelling at all the California people about their schools. And of course, Susan, you and I also sit together on the board at the Public Health Institute, and there's a tremendous amount of work on telehealth that goes on there as well. So without further ado, let me turn it over to you to some reflections on our subject. Great. Thank you very much, Tony, and good afternoon to all of you. By this point in the day, since we're just a few blocks from the Capitol, I'm reminded of the famous quotation from the late great Congressman Mo Udall, who used to preside over congressional hearings, and after they would ramble on and on for hours, he'd say, well, everything that should be said about this subject has already been said, but not everybody has said it yet, in which case the hearing would go on for a couple more hours so everybody could say the same thing. So at the risk of performing sort of an unintentional Udallian violation here and going over ground that you've already gone over, I just wanted to talk a little bit about how we're viewing these issues from the standpoint of NEHI and then tie them into some of the broader themes that you just enunciated, Tony, among others. So you heard what we are at NEHI. We're a cross-sector organization. We bring people together across all the different silos of health care to talk about common problems, common issues, and we tie our goals to the Triple A. We really want to look for innovations that will improve individual and population health, produce better quality of care, and ideally cost less, or at least not add unsustainably to the costs of health care. And as we started to look at the next big wave of innovation that we thought probably needed to happen, we did go back and look at a bunch of technologies, in particular telehealth, and has been said already many times today. Here you have a technology that is decades old. I was reminded flying out of Logan that in 1967, at Logan Airport in Boston, you could have a telehealth visit with people from Massachusetts General Hospital. That was 1967. So it's decades old and yet it's had a relatively small penetration, all things considered, in the health care system. Why? Remote monitoring. Why, as Eric Topol and others point out, when we're going to have the capacity to collect, I think we have a total of 8 billion internet connected devices in the world today, and the projections are there will be many multiples of that even within a short period of time. When we have all of that, when you take the whole aspect of health care that is really about exchanges of information rather than about the laying on of hands, why isn't more of that information exchanged virtually? And why, when we've been so willing to move to, in almost every other aspect of our lives, to virtual exchanges of information, why do we insist that in health care, only good information is exchanged, almost person to person, face to face in a physical encounter. It just was a real head scratcher. So as we started to dig into this, we conceived of a program that we call health care without walls. What if we had a system in which the part of health care that is about exchanges of information could take place virtually most of the time? Now, if you're in a terrible car accident, you're going to have to go to the drama center. If you're having surgery, you're going to have to go someplace. But so much of the rest of health care is not about that. And why would we not look for ways to release health care from the requirement that it stay within walls, as opposed to be more connected to individuals in their homes, communities, schools, et cetera, et cetera? So as we looked at this, we asked, okay, what have been the barriers? And of course, when you look into anything in health care, you say, why are there barriers? Because it's health care, stupid. Everything is constructed almost in a way to impede certain aspects of innovation. And in this case, it's a real Gordian nod of issues. And this is probably the ground that Helen went over. It is payment and reimbursement. Integrated delivery systems, particularly capitated ones, have one set of incentives. Most of the rest of the system, as we know, is still stuck in fee for service. We have engaged in our project, a payer who says, here's why we don't want to pay for telehealth right now. It's because they call it the punt. They pay for a telehealth visit. The telehealth provider says, this is what we think is wrong with you. But next week, you should go to see your primary care doctor. It gets punted to the primary care doctor. Or this is what we think it's wrong with you. You should go to the ED. It gets punted to the ED. So they end up paying for not just the visit to the primary care provider, not just the visit to the ED, but also the telehealth visit, right? So payment and reimbursement for much of the system clearly a barrier. Regulatory issues, obviously this has been a big subject already. But if you just take the fact that only 25 states now have signed on to the interstate licensure compact, we will note the nurses are ahead of the physicians on this, right? The nurses have agreed to, I think it's 27 states now. The nurses have agreed to have one license, a multi-state license, right? So at least the nurses are making a faster headway, but that's obviously an issue to have interstate capability. And when you think about the amazing ability that we might have to leverage the provider base in this country, why couldn't we think about the provider base kind of the way we think about the electrical grid? Where you can route demand to various parts of the country when you need to. So why couldn't, it's five o'clock in New York. Why couldn't you route visit demand over to California where it's only two PM in the afternoon, right? We could think about all kinds of things like that in a country if we didn't have these kinds of regulatory and other barriers. And then of course workforce and human factors, which are very closely linked phenomena. And I know that obviously Helen talked about that as well. We had in our project last week a meeting of one of our groups looking at just the human factors issues, and this was really fascinating. He said that this is a fellow Dan Gillette who's out at Berkeley, some of you may know. They talk about how many healthcare providers, guess what, healthcare providers are human beings also. They tend to think about things going on with the body through the lens of their own body. So that if you come in with a broken ankle, they're thinking about your ankle in connection with their awareness of their ankle, and that affects their decision making. And it actually may explain some of this punt phenomenon, which is that inherently even a telehealth provider is thinking, I'm not really sure since I can't feel your ankle that I really know what's going on with you. So that's why I'm going to punt you to the primary care system. It's because we can't really even think in a different way because we're human beings and we're prisoners of our own understanding of our bodies, even healthcare providers apparently. So thinking about how we tackle this gordian knot of issues that are all overlapping, the payment and reimbursement, the regulatory issues, the human factors issues, the workforce issues, that's why we created our project, Healthcare Without Walls. And we brought together more than 100 thinkers to tackle these various issues and lay out a set of both policy recommendations as well as organization transformation recommendations to try to get the system moving a little bit more quickly to embrace telehealth as well as other modalities of distributed care. I will just close and turn it over to Sabrina by saying that we think that there's a lot of opportunity here to make investments as a country in this. We sent a letter to CMS and CMMI in response to their request for information about new directions for CMMI. We and 999 other people sent in a list of suggestions. And one of the ones we said is stand up more innovation models that essentially have telehealth and those similar capabilities at the center of them. Don't just stop with telehealth waivers for the next generation ACOs, extend this more broadly, put some money into testing this, particularly in rural settings where as has been said the potential is so great. Obviously the question that came up just on the last panel about funding research in this area, to state the obvious, we still spend multiple magnitudes, multiple magnitudes, greater dollars on biomedical research than we do on health services delivery. Let's start by not killing the agency for healthcare research and quality, and maybe shovel some more money its way to try to unearth some of the, or actually close some of the research gaps that were alluded to earlier. So there's a lot that can be done as a country and as I say, part of our project is designed to really set a vision for what the system could look like in 2025. If we really applied all of the technology that we know can help move to a more distributed care system around the country, and then try to lay the path to get there. And that's why we're going to be working with Sabrina and a number of you in this room to try to achieve that over the next few years. So with that. Thank you, Susan. Good afternoon. You are in the home stretch. Only about 30 more minutes to go and I promise I won't take a long time. But I knew that I was in the right room this morning when Helen said, think big. Innovation, I thought this is it. And especially working with Susan, it's like we've got lots of big ideals, and we've got lots of good energy to make this happen. So what I'm going to do today, I think it's going to be more of a call to action than anything, but I do want to touch and highlight on some key points that Susan raised. And again, thank you to Kaiser for the invitation to ATA and myself. We're very pleased to be here. And I want to thank all of the other presenters because I think that today was very insightful, very honest, and very informative. And we need more of that. So let me jump in and just share with you a little bit of information about the American Telemedicine Association. We have about 10,000 members, and we represent over 450 organizations. And why is that important? Because not only are our members the large integrated healthcare systems that provide telemedicine, but they're also the vendors and the technology companies and innovators. It's government agencies. It is payers, where they all converge together. And I think that we may be the only organization where all of those entities come together solely focused on telemedicine. So earlier this year, working with the board of directors, we relaunched our strategic plan. And we said, look, we've got to get serious about this. We've been in this game for over 25 years, and we've helped shepherd it. But we need to get a little bit more aggressive. And I think that we hit on that. Telemedicine has been around, but now is the time. It may not have been the time before, but I think now it is. And so how are we going to work effectively with our members, which represent these large organizations and the telecommunication companies and technology companies to actually shepherd in telemedicine in a way that it doesn't add additional cost to a system that's already taxed and overburdened? So more to come on that. We'll talk a little bit about that later when I share some other thoughts and ideals. But earlier today, we were talking a lot about evidence-based and what can we do. So in June, shortly after we launched our strategic plan, and we shared that with all of our members, we launched a project entitled the Value Proposition Initiative. And we worked with Jason and his team and others utilizing the NQF framework to begin to talk with these large groups about collecting use cases. So use cases that are focusing and capturing data that may not be in the public domain so that we can begin to collect evidence and tell the stories about what's going on. And we're taking that information. We're collecting it. We're putting it in a central repository. We're creating issue briefs with it so that our members and others can actually share that information with policymakers, payers, and the like. And so when you look around, look at the span of our members, and we say, OK, well, we want to know what's going on in emergency medicine. And you have an avirah, or you have a mercy, or you have a Franciscan, and the list goes on. And you say, OK, give us your use cases using telemedicine. And you can pull up 10 different evidence-based studies in emergency medicine. They may be slightly different, but they may also be very, very powerful if you're going to have a discussion on that particular area, or to be able to pull up use cases based on a particular state when you're going to have a discussion with the legislature. This is what's going on with your states. Here's the use cases. Or when you want to have a discussion with a payer. So that is a big initiative of ours. And if there are those of you that would like to participate in that initiative, we will definitely welcome you into the fold. Again, we touched a lot on policy. Policy, we have a strong advocacy area. We'll continue to promote that. We have launched a policy work group that we're going to invite others in because I think that there is strength in numbers. And while we all have our own GR departments and our own lobbyists, we're really tackling this very one-off. And I think there's some opportunities for us to have some more focused messaging. We had an intelligence briefing in the fall. And that's one of the things that political came back to us and said, look, when you go and you're on the hill and you're having these discussions, we refer to digital health, e-health, mobile health, telehealth. That's very confusing to policymakers that may not live in our world where we understand with all of this means. So I think working together to have some common messaging is going to be extremely important. Again, that's a work group that we've initiated and we'll be working with Nihai in that regard. We also talked a lot today about education and training. Again, that's another area. We have created a educational work group looking at trying to create an educational framework or training framework for the industry. And I use that term education and training very loosely because it may look very different. And we talked a lot today about the diversity of the various provider groups. We get that. But there has to be some way that we can build in some standardization that will help enable many of these organizations along. And again, we hear from our members on a regular basis, even though they may have an innovation lab or an accelerator program, they call us and they say, OK, so where do I start? How do I incorporate telehealth into my overarching strategy? I'm hearing it. I know I need to do it. I may have a program here in Telestroke. I may have an ED. I have 166 hospitals. But how do I scale up? How do I do this in a way where it's not going to be taxing that it's going to work, et cetera? So I think that there are some opportunities for us to really delve into this as a telehealth community and really understand what is the training and how might we look at this very differently than we have in the past. Let's do some different models for training, especially when we're looking at the medical team and or the entire team as it relates to the implementation and use of telemedicine. So again, I think that's an area where we've got a work group going and we would like to invite others to participate in that. Again, it's another area where Susan and I were talking. And I think we're on the same wavelength. We have to do something, and it might look very different. And we should allow ourselves or give ourselves the leeway to explore and maybe do something very different. Quality, for many of you may not know, we went into a joint venture with the Clearhouse Quality Indicator Institute to accredit telehealth programs. Again, JCO does a lot of accreditation in the hospital system, but we have a lot of providers that are not in the hospital system that are also looking for accreditation. And we feel that this is a really good way to ensure a certain level of quality. So that's what we're doing on the quality front. And I guess, again, I would leave this as a call to action. There is a lot of work to be done. I think that it is doable. But I think that we have to find very practical ways to unify our voice and to work together. We can't boil the entire ocean, but I think that if we can start to identify some low-hanging fruit areas, I think we should focus in on that. And that's going to drive the bigger initiatives. And I'll leave it at that. Wonderful. Well, those are great perspectives and tying back to some of the discussion from earlier today. I guess, Sabrina, one question I would ask is, and we have plenty of time for discussion, about 15 minutes for discussion. So please do nine minutes for discussion. Thank you, sis. So be thinking of questions out there. Do you think that, Sabrina, there's a barrier above all that needs to be focused on in the short term to get the dialogue moving? Or do you think it is this list of eight or nine issues that we need to address simultaneously? Well, I wish there was one magic bullet that we could hit and everything would fall into place. And this is a challenge that I ask my staff all the time. We know that reimbursement is one of those key levers. And the policies are barriers. Eventually, we're going to solve those problems like we've solved a lot of other problems. And the question that I pose to my staff is, OK, then what? Then what happens? Have we prepared this industry to really launch and effectively integrate telemedicine? And so that's why I think some of these issues of education, of collecting the evidence, use cases, best practices are so extremely important. Because once we do address the reimbursement area and everyone wants to get into it, we need some guardrails up. And I think quality is another area where we need to have some guardrails up. At the end of the day, it's about the patient and it's about patient quality. And we have to ensure that when we roll out these programs that the patients are getting the best quality. Because there's some groups out there that may not be up to par. So we want to ensure that there is quality. And we also want to ensure that we're not increasing cost and we're getting value. I think it's multifaceted. I think, frankly, we should start by painting the vision for people about what this could look like. And part of the confusion around what do you call it, digital health, e-health, m-health, that's why we came up with health care without walls. We thought that starts, now you can argue, of course, there are walls somewhere, of course. But to think about the kinds of capabilities that we have now to access care across distances, across settings, among settings, et cetera, that's the vision, I think, that if you go to policy makers and paint this, and we've done this in our health care without walls project. So let's take a hypothetical example of a patient on Kodiak Island, Alaska, newly diagnosed with non-small cell lung cancer through the critical access hospital there. Let's say you have an extremely intelligent patient, internet savvy, figures out that the best care provided is at an East Coast major cancer center, wants to have a telehealth visit with that cancer center, wants to have his genome, cancer genome sequence and sent to those people on the East Coast, wants to get a targeted therapy and basically concludes, why could not this targeted therapy be shipped to him by drone on Kodiak Island, Alaska, and infused at the local critical access hospital? Why should that patient have to get on a plane and go 3,000 miles and stay for six weeks to have that care when we could figure out a way to do this? And why not democratize the knowledge that is sitting there in those major cancer centers? And spread it out throughout the country in this day and age. And as we've described that vision, nobody says that's a really stupid idea. They say, of course that's what we should be able to do. How do we eliminate the barriers that stand in the way of that today? And I think if we start painting that vision for people and get away from what we call a digital he-health or whatever, here's what we're talking about, folks, about availing ourselves of the same things that are helping us in so many other aspects of our lives. And now how do we build the system that makes this possible or rebuild our current system, re-engineer it in a way to make these things possible? It's an interesting example, Susan, because it's highlighting some of the other things in the system. And actually, when you point at those types of therapies, everything underneath it, well, that's nothing compared to how expensive that therapy is going to be. You might as well just do everything the way it is. And I think one of the interesting parts of the conversation today that came through was that it's all part of a whole. There's an access to specialty care services. And then there's a basic care, primary care, population-based care, and figuring out how we tie all of this together. And actually, I love your example saying Kodiak Island, Alaska, versus Cancer Center, Academic Health Center on the East Coast. Because the first, in my mind, Sabrina, first place people go to in the policy space around telehealth, and this is just a matter of history, is the underserved area distance place. And because there was enablement many years ago for rural areas and underserved areas, we're almost locked in this box now. And how do we demonstrate that people sitting three blocks away are deserving of any quality improvements that happen from telehealth, whether it's in dermatology or stroke care? How do we spread that out to other areas? Make them try to get across midtown New York traffic or Washington traffic for that matter to see how useful it could be. No, I totally agree with you. I just said to your thinking of something you said that, and I really like that, health care without walls, without borders. So let's fast forward 10 years. Let's just say that we actually accomplish this. We really are talking about health care and a paradigm shift. And how do we usher and bring those along with us? And I'm going to be so bold to say this. I know that health care is complicated. I've been in it for 25 years and in the trenches. And I think I was like the other gentleman that says, hey, I'm tired. But this is really, really an exciting time. And I think that we overcomplicate it in so many ways. It is complicated, but we overcomplicate it. It is health care. And these are tools just like we've had other tools. And for those of you that have been in it for a while, you understand what I'm talking about. And I realize that it's complicated. Reimbursement issues are complex. But we will get there. And we will have to do it systematically. It will take time. And I think that we just have to keep, we have to keep, we have to work together. And I think there's a lot that we can do. So I think we've got a couple of questions lined up, which is about the number of questions we have time for. So please go ahead. Thank you. Daisy Smith from the American College of Physicians. I have a question about what role we're a nonprofit membership organization. We have 152,000 internist members. And we're here today trying to learn about what you think we can do to help accelerate progress in this space. Join our Health Care Without Walls project. I will say self-interestedly enough. Or any of the other Sabrina's projects, right? I would agree. Join ATA, join one of our working groups. Either the policy working group would be a really good one or even the education. Because these are, as we've laid out, important real nitty gritty issues. And there aren't a lot of silver bullets here. But if we work together, I think we can figure it out. But it's going to take, it will take a coalition of the willing to move forward, especially on these policy barriers. Hi, I'm Brohith. And among other things, I teach strategy at the University of Maryland Business School. I had a landscape, industry landscape question for you. How do you view the CVS acquisition of ATA? And how does that change the, I mean, healthcare landscape for you guys? And also, how do you view that in the context of telehealth? CVS is going to go from 1,100 minute clinics to 10,000. That is more than the number of urgent care centers you have in the United States. So brick and mortar is still there. It's going to play an interesting different role. So how do you see the shaping up of the landscape, whether it be a vertical integration or a horizontal integration? I like to hear your thoughts. Well, I gave it long ago thinking that there would be one universal modality for anything in the U.S. healthcare system. But it is interesting to think about the CVS at an accommodation. And by the way, CVS is a member of ours. So they've talked about this with us as well as publicly. But it's part of what we're talking about. It's part of the movement of care out of the conventional settings. And as they conceive of the potential, they're already looking at a lot of telehealth from CVS minute clinics to academic medical centers, from CVS minute clinics to homes. And now having the store move to be something more like, as they're calling it, a healthcare hub of some sort. Exactly what happens out of that hub is going to change over the decades with technology. But right now, as they say, what is 90% of the U.S. population lives within about 10 miles of a CVS. That kind of convenient access, if I could walk into my local CVS store and sit down and have a telehealth visit with the people at Johns Hopkins, as opposed to getting stuck on I-95 for three hours to drive up there from Washington, they do that in a minute. And I think those are the kinds of things that they're thinking about trying to work out. And then with Edna as the financing backbone, as Mark Bertolini has said, Edna wants to be in the position of financing a system where having people have to go someplace for healthcare is looked at as a failure of the system, not as a success, right? Where you're addressing people, first of all, you're starting with the basis of trying to keep people from getting sick in the first place through prevention. Then if they do get sick, you try to manage it in a setting, a home, community, office, school, whatever. And then the default when all else fails is that somebody actually has to go someplace. That's the way they're conceiving of their role. How do they finance a system that makes that work? So we'll see. It's a big challenge for them to pull off, but as we know, it's already causing a lot of other entities around the system to think about how they're going to innovate along the same lines. Very interesting market forces at work. Absolutely. Well, I wanna thank you both for very thoughtful remarks and a nice way to round out the day. So thank you. Thank you very much. Thank you. Thank you.