Gregg Masters 00:07
PopHealth Week is brought to you by Health Innovation Media. Health Innovation Media brings your brand narrative alive via original or value-added digitally curated content for omnichannel distribution and engagement. Connect with us at www.popupstudio.productions and welcome everyone. I’m Gregg Masters Managing Director of Health Innovation Media and the producer and co-host of PopHealth Week. Joining me in the virtual studios my partner, colleague, and lead co-host of PopHealth Week Fred Goldstein, President of Accountable Health LLC. On today’s show, our guest is Todd Vento, MD MPH the medical director of Intermountain Connect Specialty Care and and infectious diseases telehealth service at Intermountain Healthcare. Dr. Vento is an enterprising and experienced medical director and physician with a demonstrated history of success at all levels of the healthcare system skilled in clinical medicine, infectious diseases and internal medicine, program development, health care leadership, population health, and medical education. Dr. Vento holds a Master of Public Health MPH in epidemiology and international health from the Johns Hopkins School of Public Health. Dr. Vento is a retired Army Medical Officer with extensive operational experience providing infectious diseases and public health expertise in support of military and civilian health programs across five continents. So with that introduction, Fred over to you help us catch up with Dr. Vento’s innovative work at Intermountain Healthcare.
Fred Goldstein 01:48
Thanks so much, Greg and Todd, welcome to pop Health Week.
Todd Vento 01:51
Thank you. Great to be here.
Fred Goldstein 01:52
Yeah, it’s a pleasure to have you and talk about your work and the work of Intermountain. So why don’t we start with give the audience a little sense of your background and then some of the work you’re doing?
Todd Vento 02:01
Sure. Well, I’m an infectious disease physician. I was in the army for 26 years. It was a both an infectious disease and a preventive medicine, public health physician. So it did a lot of work. Not only in our large medical centers, but a lot of overseas work international health. One of my jobs before I left, retired from the army was to be an advisor on pandemic planning for foreign militaries and also Department of Defense. We spent some time in places like Liberia during the Ebola epidemic and outbreak and helping other countries in Africa and Asia for pandemic flu planning, avian influenza, things like that, retired and had to find a job. So I looked around, and actually the Intermountain Healthcare folks and their infectious disease team actually reached out and asked to kind of knew about some of the stuff I had done and were wanting to develop a telehealth program for infectious disease. And so they asked me to come out and take a look. I honestly had lived in many, many countries grew up overseas and lots of states that had never been to Utah. So I came out and was very impressed not only with the program that Intermountain has its it has its own excellent reputation for quality and patient safety, but with the individuals in the infectious disease program, and so, but wasn’t totally convinced yet because I just hadn’t really thought well, I don’t ski and I don’t know where I should go. So I don’t know guys, I’ll wait and they said well, just you know, take your time and come back when you come back in a month maybe and see how you’re feeling or Okay, came back and then I realize up its time to jump on board. So but been here about four and a half years, we’ve implemented a telehealth program for infectious disease. Intermountain Healthcare already had a very well established telehealth program will, you know, predated that COVID pandemic public health emergency, particularly for critical care, tele critical care and a few other specialties. So we just got to run with the infectious disease program. And now we cover about 25 hospitals in multiple states and 16 of our small and rural community hospitals for Intermountain here. And so that kind of brings us up to speed for for where we are in my state and around.
Fred Goldstein 04:07
And so you know, it’s fascinating to set this up and think about infectious disease. It hadn’t been there. I really was thinking about a lot of people have thought about from a telehealth perspective, they typically think of some service offered to the patient, whether that’s primary care or console, but from an infectious disease standpoint, is that more physician to physician expert advice around for various antibiotics and thinking treatment approaches, things like that?
Todd Vento 04:28
That’s a great question. It’s, I suppose, is the answer. And honestly, we have tracked that and, you know, we’re looking at this at for the national level too. I sit on the emerging technology and telehealth workgroup for the Infectious Disease Society of America and, you know, trying to figure out you know, what is needed? What do people need in smoking in hospitals for infectious disease? Do they need you to see the patient on camera? Do they need you to look at the chart at you to be available to answer the providers’ questions, because they don’t have maybe the experience or knowledge? You know, they have knowledge and experience that I don’t have with primary care and you Family Medicine and then I have and we, my partners have the infectious disease now. So right now we’re about on our inpatient service about two thirds, one thirds, if you break down to electronic consults, where you’re actually getting on a chart and helping to give recommendations to the provider, so direct to provider, and then about third of the time, we’ll actually jump on, do a camera visit with the patient. You know, sometimes it’s about taking that detailed history. Individuals come off the ski slopes and Park City, Utah, they have a fever looks like the flu. And I was like the flu was treat like a flu. And then lo and behold, they don’t get better. They call us to say, hey, help us out with this guy. We talked to him to find out he was in West Africa four weeks ago and actually has malaria. On the ski slopes, go figure. And so there’s a lot of you can imagine there’s a lot of there’s a lot of opportunities to help the providers and the patients. And I think that’s also something that telehealth in general for the country and, you know, world is trying to figure out, well, what do you need, you know, what’s that going to look like for each specialty, and each one’s going to be different,
Fred Goldstein 05:59
right? You’ve really seen that, whether it’s dermatology, where you’re exchanging images, or things like that, or radiology consults, etc. And then, from my understanding with Intermountain, it goes from a patient sort of app portal approach, all the way to, in essence, sort of like Hospital in the home or running, helping people in units in smaller hospitals as well.
Todd Vento 06:18
Absolutely. And actually, that’s been accelerated as many programs throughout the country have in the past 12/13 months. And so we have our Connect Care service, which is really, you know, you can literally download, get on your iPhone or phone and say, hey, I want to visit with someone and then 15 minutes later, you’re on with a physician assistant or provider, and talk to him about your rash talk to him about you know, whatever your acute care issue is kind of like a digital Urgent Care equivalent. And so that’s been in existence for several years and very well established pre-pandemic. The nice thing is, is because we had already had a lot of established programs with tele-critical care, tele-infectious disease, tele-neurology tele-stroke, we’re able to blend those and one of the things we did before COVID was we realized we were also having concern for measles cases, which is probably 10 times nine to 10 times more infectious or transmissible than even SARS COVID 2 for COVID. And so we actually put in place a mechanism where the Connect Care providers can immediately reach out to a tele-infectious disease doc through our ID tele program, and then get input so that we could prevent if we can patients from going to a facility to get assessed. Because the last we want is to have a virus spread that can you know spread, really one person can affect up to 18 other people. So that was almost like a test test drive for that concept with which when COVID hit, we immediately just transitioned to same processes for COVID. And actually, through Connect Care, our first cases for COVID. In this area, were actually diagnosed on Connect Care in individuals who had traveled from Italy, back to Park City area. And we were able to diagnose that without having them go into for a full visit. So since then, to get to your point or question about up to things like hospital at home, things like that we have really expanded to where we realize, okay, telehealth is really public health, we are going to do contact investigation to help the health department because they were overwhelmed. We are going to help check in on folks who are quarantined in isolation. Then people who have been infected and left the emergency department say they didn’t get hospitalized, we can do remote patient monitoring with with our tele programs that we already had in place. And if we see indications clinically for patient to come back, we will also facilitate their entry right back into the hospital and straight to the ward, then we actually transition to things like well, maybe we can look at this patient is going home, with a hospital at home where a tele hospitalist looks at them, they still may have someone come to their house like nursing staff, etc. but but this way we prevent them from having to come into the hospital when we had say limited beds, a lot of people on ICU, ventilators, etc. But obviously we would have very strict criteria about who would who would be able to be put or placed into the hospital at home program. And that has worked out very well. A lot of resource-intensive efforts. But I think that’s the whole point is learning during the public health emergency on ways we can get better at doing things outside the hospital.
Fred Goldstein 09:20
So you really leverage this from a safety perspective, in terms of identifying people and keeping them from showing up the as well as from a quality and an efficiency perspective. It sounds like in terms of taking all those different services. And on the In-Home Services. I assume you’ve linked those up with remote patient monitoring devices and things like that, that you put in the house.
Todd Vento 09:41
Absolutely. And we have a dedicated patient safety individuals who are actually 24/7 looking at monitors, you know, checking on individuals, vital signs, etc. They’ll call them and talk to them if something has changed. And the nice thing is that’s tied into the emergency department close to where that individual lives. So the facilitation of that individual, if they let’s say something was real, like the oxygen drop wasn’t because they took it off their finger, it’s because they literally dropped their oxygen because there may be getting clinically worse. And maybe they don’t even know it yet. until they get up and walk, you know, downstairs to, you know, get a cup of coffee or something, they realize, Hey, I’m short of breath, then we can actually do a quick facilitation of transfer back to the emergency room and communicate with those individuals to have them taken straight to the ward that they require clinically.
Fred Goldstein 10:31
As you think about this, people always say, well, we’ll add telehealth, it’s this other service, we sort of do. What you’ve in essence, it sounds like integrated this. So how did you get this? The, the, the physicians and other practitioners or providers in the mindset of sort of that continuum of services? And how you leverage that depending upon the patient? ,
Todd Vento 10:53
Yeah honestly, I and my job, I was an army for 26 years, I worked for what I thought was a pretty good team, I see a lot of similarities at Intermountain, and one of the things that was really a draw for me to come here was just innovation and like, can-do attitude. My I remember my first week here a time, you know, we’re getting settled in, let’s go to some of these meetings. And I thought, okay, hey, what do you think about that, like, Oh, hey, you could do this? No, that’s a great idea. Anything, okay? That’s an idea, we’ll move it over for the next few months, well, you get an email, like an hour after me, Hey, we’re gonna we’re gonna meet again to talk about that idea to get it going. And so tele-health was already put forward really early on 2012, 2013 for tele-critical care. And even going into the pandemic, we in spring of 2020, we hit 1 million tele visits. Well, within six months after that, we were at 2 million. Now we’re, you know, almost two and a half million. And so you can see that it’s just this, I think it’s leadership and vision of key individuals, starts from our CEO on downward. And Dr. Harrison, Mark Harrison, you might be familiar with is, you know, pretty progressive. And that also existed even before his arrival. So just willingness and acceptance to do whatever it takes to bring care to individuals, but make sure that it’s done in a safe and high-quality manner. And that that has never been a compromise. So whenever we come up with ideas, it’s not like, yeah, let’s just do it. Then we say, Okay, well, let’s validate it. Let’s look and see which patients would not do well, which patients haven’t done well in the hospital, who should meet criteria for being hospital home. So we don’t just say, yeah, let’s just do hospital at home, we would never do that I have been just really continually impressed by in all lanes in our facility and across, you know, 24, 24, 25 facilities, in our system from Idaho, to Southern Utah, just this can-do attitude. So I’ll just say personally, it’s rewarding because it feels very similar to that, that that approach. And not to draw an inappropriate analogy. But when I was in a, say, a combat zone, where people say, look, let’s just we got to get this done. This is the right thing to do. Let’s just do it. Let’s figure out how to do it. And that’s what happens here.
Fred Goldstein 12:57
Well, with some of this, because, in essence, though, it’s the West there’s huge expanses area distribution of people and population versus saying inner city, was that some of the driving behind it?
Todd Vento 13:08
Oh, absolutely. I love Well, first of all, I love that your your knowledge is probably better than mine, and just teeing up the softballs for hitting them and no previous discussion. If you look at the electrical sort of display distribution for the United States, you see a big black hole in the entire sort of west of the Rockies, kind of Intermountain west. And you can imagine, right there well, you have smaller communities, smaller community hospitals, you know, 5, 8, 10-bed hospitals, what we call small community hospitals or sometimes critical access hospitals, they don’t have access to specialists. And so if you’re, you’re not going to get an infectious disease Doc, which, by the way, is one of the lowest staffed, critical shortages for specialties or sub-specialties in the country. And so you can see where well the solution is really telehealth, I mean, unless you’re going to have you know, Dr. Vento fly, you know, to 15 sites, you know, once a month, and honestly, I did do that when I was an army, we did a lot of that where we would fly and see some patients like if we had one post that had some patients who had HIV infection and they needed infectious disease care. Well, now it’s telehealth. And the nice thing about it is it’s not just taking over. It’s actually really what I like to call and I apologize, I’m just gonna say I apologize in advance. I use a lot of military analogy, but force multiplier, I’m giving advice on a patient, but each time I do to the same doc and the same community, the call I get from that individual, that family medicine doc a year later is not the call I get the year before. In fact, it makes us have to stay sharp because, you know, first time we did this in October 2016, I would say hey, he needs this, he needs this, he needs this, can you facilitate this, and then write it all down? You know, fast forward a year and I get Hey, Todd, I got this guy. I’ve done this. I’ve done this. I’ve done this. I’ve done this. What else do I do? I think I think you’re pretty much in it doc right now. You know. So. So there’s more than just a benefit to the patient, which is first and foremost, paramount, and the provider. It’s the knowledge and the learning and in in a commission And sharing it with the other providers. And that to me is the force multiplication of the benefit of telehealth. And during the pandemic, we’ve actually made that we’ve had to do that real-time with COVID because the literature on COVID has changed by the hour.
Gregg Masters 15:14
And if you’re just tuning in the PopHealth Week, our guest is Dr. Todd Vento the medical director of Intermountain Connect specialty care, infectious diseases, telehealth service at Intermountain Healthcare,
Fred Goldstein 15:28
why I’m blanking on the right term, but it’s an ongoing learning organization you’ve got there, that’s that’s being facilitated through this technology, in essence that you’ve put in place. So is the technology itself, something you had? Did they create their own? Did they use some outside private-labeled vendor? Where was that?
Todd Vento 15:46
Yeah, another great question. So Intermountain came up with their own sort of in-home telehealth platform. And actually, right now, as we speak, we’re transitioning off of that platform, it’s really a professional Skype version, Lync, etc. And in our facilities, most of those facilities have in-room cameras. So like a little cartoon, upside down R2D2 unit that has great visibility and resolution. And so you know, I could, I could say, hey, called up call the facility say, Oh, you know, talk to the nurses is Mr. so and so, can you let him know, I’m going to turn the camera on, you know, so give that little bit of warning. And then we just turn on the camera, patient sits in his room and looks at the camera, and we just start talking, zoom in zoom around the entire room also had a lot of telehealth carts, but the software would be through our homegrown system. And, you know, since that time, or since several years ago, we’ve actually transitioned to an inpatient platform using certain vendors and well being one and we’re transitioning more to the video visits at patients homes, or in their cars or in the park or wherever, because of what happened with COVID. And because of the restrictions that were loosened for the public health emergency for telehealthcare, which obviously, we’re all kind of waiting, you know, with a little bit of holding our breath for, like what’s going to happen after the public health emergency is over? Well, first of all, we would be grateful if the public health emergency were over, because that would mean and we’re not at risk as much. But we have to see how that’s going to settle out in terms of coverage for CMS, private payers, etc.
Fred Goldstein 17:13
Obviously, Intermountain you all know that whole team has done amazing work to get this out huge growth during COVID. We saw it in some of the other telehealth data, I’ve looked at up to 30% of visits for mental health, things like that. Were there areas that didn’t work, things that could have been done differently, or that you learned and said, Oh, man, we should we got to do it this way instead?
Todd Vento 17:33
Well, it’s interesting, you say that there’s still that, even though there’s broad acceptance by providers, and there’s certainly broad acceptance by with patients. And that’s coming out, you know, every week, even if you look at across the country of people serving their patients in accepting this and now wanting to actually be seen by telehealth instead of in-person for many of their visits. And we had surveyed our population before COVID. And we had about a 65% preference for having a video visit instead of an in-person visit, if they knew the, if they knew the provider, that was kind of one of those areas, things that I would say, maybe didn’t work would be a lot of providers that were not necessarily early adopters, or even late adopters of the technology or the idea. And interestingly, many of them when the pandemic came, that was their only way to see patients. And so they work quickly said, Okay, I’m doing it now. So individuals who I would have talked to say two months prior would have said, I don’t want to do it, I’d rather see my patients in person, and then all of a sudden, like, I want to see him and now those same individuals say hey, can we keep doing this for video visits, instead of saying just flooding my clinic with in-person visits, some things that still haven’t worked, though is that, you know, it really takes a lot of acceptance when you go to a new technology or new software and and making sure all the kinks get worked out. And and that’s where we lose some individuals and they’ll say, you know what, I’m just gonna go back to in-person because I don’t want to have to flail through this each clinic. And that’s where having a very robust support system like a centralized tele, IT program Operations Support. And so what Intermountain did a couple of years ago was make a virtual Care Center, so virtual hospital. So we have a one-stop shop virtual hospital where all the resources are there. And you would think, well, you’re doing telehealth and virtual care, why do you need a physical location but honestly, what that that was ingenious, because when COVID came, it became almost like a air traffic control type center where you could look at patient transfer, not just with our system, but with University of Utah with private hospital to say, okay, who’s got COVID beds, who doesn’t and it was really like a command center very much like the military. And so that those kinds of things have worked. But I will say the things that off sometimes don’t work, if you lose providers on bad experience, you really have to work hard to get them back, which you know, human behavior, but fortunately, we haven’t had a lot of those. But in terms of specialties, and so specialties and the acceptance, it’s been through the roof and you know, there’s some individuals who feel it No, I need to do more in person. And honestly, I will say telehealth needs to look at quality outcomes. What what things can or should an ID doctor do or an endocrinologist or diabetes specialist do with an E consult or with a in person visit or with a video visit to a person’s home? What can’t they do so that we don’t just say all can be done? None of that hasn’t been done. And it’s just you know, those are tedious studies, we have some data showing even mortality benefit, like the state benefit versus in-person versus telecare. So, you know, there’s tons of opportunities to do that, you know, time and resources-dependent, but we have to answer those questions so that we can help, you know, move this forward even more and have universal acceptance.
Fred Goldstein 20:43
And I assume, in this sort of hub, the center that was set up, it does all this, those are dedicated providers who that’s all they do, right? When you did COVID, and suddenly all these other providers had to suddenly learn telehealth. Did you provide certain training? I mean, obviously, some people are more comfortable in front of a camera, things like that. What did you do in that area?
Todd Vento 21:05
Yeah, absolutely. Great question. And we did we literally, on the fly, you know, we’d say, Hey, you know, let’s, let’s all meet on video, and I’ll show you exactly how to go through this and remind you of things like, you know, when you’re looking at the patient, you’re, they don’t see you looking just to give you a simple example, things we take for granted. When you’re in the room with a patient, you’re looking at the patient, they’re looking at you You make eye contact, and you make that connection, literally, when you’re on camera, if you look at the patient’s eyes, you’re not looking in the camera, they don’t think they’re you’re looking at them. So little things, like we’ll put their screen underneath your camera so that when you’re looking at them and seeing what they’re doing and their color, whether they’re pale, you know whether they’re not talking clearly things like that, then you’re looking at them, and they see you and your eyes pretty much looking through the camera at them, and they feel like you are connecting with them. That sounds like Oh, why do you have to think of that? Well, it makes a difference for patients. And, and honestly, I will tell you, you know, you wouldn’t know it by the tone of my voice and maybe my entusiasm for tele. And I was not necessarily someone who thought Tele was the way to go. When I first heard about it. In fact, I took a telehealth director job without having done a lot of actual audiovisual tele. But what I have personally observed is that there’s this other moment in time, where you get this hyper-focus with the patient where it’s just the two of you straight into the camera, they’re looking at you, you’re looking at them, and there’s not a lot of distractions. And honestly, there’s not a lot of distraction for the doc, because you’re not in the room, you’re in an isolated room on your own, hopefully, is really quiet, and you’re concentrating on what they’re saying. And you’re looking right at them. And the patients have told me that they feel like that I was they’ll say like, Wow, you really, you really paid so much attention to what I was saying like, Well, you know, I’m here, therefore, we’re gonna do this. So there’s just a lot of providers have had a similar response to that. So training our providers who had any experience was not difficult. Just have to get them comfortable. And we have a simulation opportunities. We have training for that. And we’ve actually done graduate medical education rotations where we get residents and fellows and interns experience so when they go out into the workforce after their residency, then they’re ready to use telehealth quickly.
Fred Goldstein 23:09
Fantastic did the overall response from patients was pretty good with the COVID, etc.
Todd Vento 23:16
Yeah, it’s very high. And unfortunately, we had actually surveyed our patients before COVID and kind of knew what they liked what they didn’t. When we first did our infectious disease telehealth program implementation, we interviewed a certain percentage of our our patients that we had in the first three to four months, and the median age of those individuals was 63 years old. And I will tell you, most of them did not have prior experience with a laptop or iPhone or whatever. Now the nice thing about that, I will say is that it was easy for them when they’re in the hospital getting a consult from an infectious disease telehealth provider because I’m turning on the camera. They don’t have to do anything but just look at the monitor. But that comfort level translated to most of them saying oh well when I leave the hospital can we see each other on camera from your office from your clinic? And I think it’s because they just felt comfortable you know, me check our providers checking in each day and you know, seeing them on the camera Oh, hey, Dr. Vento see you again, you know, and then they just felt like it was a natural thing without really any no training for them. Now, we do have a fairly structured process where we train the nursing staff at small community hospitals who don’t have experience with this we train the providers on the equipment on how to troubleshoot the equipment, how to access folks to fix things for them if it goes wrong, and then how, what information sheets for patients so they can know what to expect. So we fortunately had done that before the pandemic. But having talked to a lot of colleagues who reached out to Todd, do you guys have information we can give the folks because we want to flip it on during the pandemic? Well, you know, they they sort of had to do that on the fly. But that’s one way to do it. And honestly, I think it accelerated the acceptance by the providers.
Fred Goldstein 24:51
Do you know there’s been this talk I’ve been trying to figure out you know, you try to integrate telehealth, obviously you can get much more efficient You know, you could do that from a little room or whatever? Do you see that ultimately changing some of the overhead dynamics in healthcare? And as we move to the hospital home that, and that maybe we see some of this shrinkage in terms of space needs and equipment and all of that, because we’re using this for this technology?
Todd Vento 25:20
I absolutely do. Actually, that’s come up quite a bit on when you look at things like say Harvard Business Review, or furthermore, the business side of healthcare, which I don’t do as much, but you can see where they’re talking about, well, let’s look at new planning. I mean, how many people do you need an office for an infectious disease clinic, if half of them are doing telehealth from home office with their home with their work computers in a secure network? And, and really, maybe you don’t need as many buildings and you don’t need as much office space and things like that. So it’s absolutely something that’s being looked at. And if anything, you know, the zoom, zoom era has, you know, exploded in the last year to the point where I think even though there’s been these opportunities for when we’ve changed our visitor policies, and things like that, as we transition to a lower community transmission rate for COVID, that some sections of organizations and look, let’s keep doing this by video, because we’ve we’ve mastered the efficiencies. And also there’s ground rules, you know, like, honestly, people take it for granted, but put your put yourself on video, I’ll give an example. I direct a course in global medicine and outbreaks for the med school at the University of Utah, and also down in San Antonio, the med school there, and we’ve transitioned those to video programs, and even doing real real-time simulation exercises, practical exercises, so there’s so much you can do now. But really engaging folks to be engaged visually. And I’m not saying you can’t do it without having your video on. And I know this is a podcast simulcasts equivalent, but honestly, it doesn’t make a difference when you put the video on and you make that quote, figurative connection.
Fred Goldstein 26:54
One quick question, and we’ll have to wrap it up. You obviously in an Intermountain with the team, lots of really smart people, big resources, what would you advise some of the smaller practices out there? In regards to telehealth?
Todd Vento 27:07
Yeah, I think what I would say is query, survey your beneficiaries, find out what they want, what they need. Also, you would do that with your staff, and then go after the low hanging fruit or the common things, and then you know, really get good at that. And certainly reaching out to, to organizations who, who’ve done it with success, it might make more sense to have someone else do that for you that you know, gun for hire equivalent, or you know, somebody fishes for you versus, you know, they teach you to fish, and then you fish for yourself. That’s kind of how we look at it. And so you just have to decide. And also it’ll come down to obviously finances where they say, Okay, well, we don’t need to hire, someone else will do this, if we’re just going to do it for these conditions. But I would say find out what your patient’s willingness is first, you know, sometimes there is this concept of if you build it, they will come and they will get used to it. But it’s nice to know upfront, if you have that acceptance, sort of pre-acceptance or general willingness to try it first, and then decide what will work for your population.
Fred Goldstein 28:03
Oh, fantastic. It’s been a pleasure to have you on Todd, great information. Really appreciate it.
Todd Vento 28:07
Likewise, thank you so much for having me.
Fred Goldstein 28:09
Back to you, Greg.
Gregg Masters 28:10
And thank you, Fred. That is the last word on today’s broadcast. I want to thank Dr. Todd Vento, the medical director of Intermountain Connect specialty care and infectious diseases, telehealth service at Intermountain Health care for his time and many insights today. For more information on Dr. Vento’s work go to www.IntermountainConnectCare.org and do follow him on twitter via at @tventoIDMD and @intermountain respectively. And finally, if you’re enjoying our work here at PopHealth Week, please subscribe to our channel and like us on the podcast platform of your choice and do follow us on twitter via @PopHealthWeek.