Dr. Griffin Myers, Chief Medical Officer, Oak Street Health
What’s the benefit of a value-based healthcare system? Dr. Griffin Myers, Co-founder and Chief Medical Officer of Oak Street Health, explains that when we flip fee-for-service to a capitated healthcare model, the focus shifts to health outcomes and reconnects the shared values of patient and provider.
Dr. Griffin Myers, Chief Medical Officer, is a board-certified physician responsible for the excellence of healthcare delivery at Oak Street Health. Oak Street Health is a growing organization of value-based primary care centers serving adults on Medicare headquartered in Chicago. Dr. Myers is also a Co-founder of the company.
Prior to Oak Street Health, Dr. Myers was a Clinical Fellow at Harvard Medical School, where he did his residency in emergency medicine at the Brigham and Women’s and Massachusetts General Hospitals. He previously worked as a Project Leader at The Boston Consulting Group. He is also an Aspen Health Innovators Fellow.
Show Notes
Dr. Griffin Myers shares his background as a Harvard trained doctor and University of Chicago trained economist. [02:41]
Why shift from a fee-for-service healthcare payment model to value-based? [03:56]
Viewing health care from the perspective of the patient and the provider. [08:16]
A value-based system has the potential to shift the healthcare model from provider-centered to patient-centered. [12:31]
What will the roles of the health insurance companies and large hospital systems be in 2049? [15:47]
Will the healthcare system be run by artificial intelligence in the future? [21:31]
What is the biggest obstacle to achieving a value-based healthcare system? [25:23]
What could a value-based system look like for patients and providers? [29:25]
Transcript
Jason Helgerson: I'm Jason Helgerson and you're listening to Health2049.
Dr. Griffin Myers: [00:08] What I get excited about is a universe in which you sit down with a patient and the economics that that individual provider faces are aligned with the interests of the patient in front of them. And that's going to take some work. I'm confident we can do that. And we're beginning to see some of that. But it's not all at once. So I think the answer is like, yes, it's very good news. It's going to be bumpy, but we will find a new ground state that feels better for patients, is deeply personal and solves their problems, but also feels better for providers.
Jason Helgerson: [01:43] Today's guest is equal part Harvard trained doctor and University of Chicago trained economist. He sees a future in which fee-for-service reimbursement is a very distant memory by the year 2049. In his worldview healthcare, while more complex in some regards, is more patient-centered and others. And overall is greatly improved over our current state.
Unlike many, he sees the healthcare system as being in the seventh inning of the move to value and not the second, which is a common complaint today. His opinion is especially interesting given the fact that he is a co-founder and chief medical officer of Oak Street Health. One of the hottest healthcare companies in the United States that recently went public with a valuation of over $15 billion.
I'm Jason Helgerson and you're listening to Health2049. And it's my pleasure to welcome Dr. Griffin Myers to our program. Griffin, welcome.
Dr. Griffin Myers: [02:35] Thanks Jason.
Jason Helgerson: [02:36] Well, Griffin, to start off, could you please tell our audience a bit more about your interesting background?
Dr. Griffin Myers: [02:41] Uh, sure. Thanks for having me. And on behalf of all of the Okies that I get to work with thanks for having us. So I'm an emergency doc by training and chose that field largely because I wanted to take care of patients, whether or not they could pay me. So, I got into it and passed out cold the first two times I went into a trauma bay, but ultimately figured it out. And I did, I trained at Mass General at the Brigham. And when you called me an economist, I think I got a little bit of a promotion, but I did get an economics degree at the University of Chicago and certainly appreciated learning some of the theoretical frameworks I imagine we're going to use today that I think kind of inform the way that we can use the way that we structure the healthcare system to take better care of patients.
I serve as our Chief Medical Officer at Oak Street, which my business card hasn't changed in eight years, but the job has changed a ton. But I have a really unique privilege of helping really build and support the medical group that takes care of our patients at Oak Street, work with our many partners, health plans, health systems, and the like, and until pretty recently was still taking care of patients at Oak Street. And now largely have gotten lately, especially spent time, mostly just vaccinating our patients and staff members and community members, but it's great to be here.
Jason Helgerson: [03:45] All right. So Griffin, we'll start with the question that we ask all of our guests, which is really to sort of tell us what you think healthcare will look like in the year 2049.
Dr. Griffin Myers: [03:56] Yeah. I mean, I think, stepping back it’s good to say, how did we get where we are because that'll kind of tell you how we're going to get where we're going. We ended up with the current system by no fault of any individual. And certainly from my view at least wasn't intentionally the case.
We created a system in 1964 with the passing of the Social Security Act, which established Medicare with the most administratively simple way for the Federal Government to pay hundreds of thousands of providers on main street, which was a fee-for-service model. And, at the time, I suppose as somebody who'd been really forward-thinking, you could have anticipated the unforeseen consequences, but when you do that you create a game in which you're in the business, largely of sick people. You want return customers and you want to do the things they get paid the best. And so, frankly there is no investment in prevention. We wait for people to get sick, we do things that are relative to their cost of goods sold. We do things that have high margins. So it turns out that specialty care and acute care versus other things and where there are ability to price discriminate, we look for a better mix.
So in general health systems prefer to take care of commercial patients who pay multiples of what Medicaid and in some cases, Medicare pay. And that's how we ended up here. And so, like I say that without blame. And when you look at the healthcare system as a whole, it's like generally wonderful people with strong values who want to take care of others and make genuine personal sacrifice for the health and wellbeing of strangers. But we ended up with a healthcare system as a consequence that is deeply inequitable and again, is the outcome of that model.
Where we're going is gonna be the output of the new model. And the new model is one that we call it value-based healthcare and we talk about value-based pricing. In reality, it introduces a price mechanism, which is what economists say allow us to find an equilibrium between supply and demand and creates the right quantity and the right price. And most importantly, in all of that steers capital to its highest and best IE, in the economist parlance, the marginal use.
Right now, I would say all of us would look around the healthcare system and say, we have too much of some things, we have too few of other things. I always kind of joke about this. knowing where I went to medical school and trained, most of my colleagues from those times in my life are specialists. So they kind of all want to punch me in the face when I say this, but in general, I think we can all look at the healthcare system and say, we have far too many hospital beds, far too many dermatologists and ophthalmologists and orthopedic surgeons. And probably not enough primary care, behavioral health, medical, social workers, and the like, and obviously I'm very biased, so I'll just admit that out front, but those are sort of undeniable outputs of the fee-for-service model.
And so, when we get to a true value-based model, we can talk about what that's going to look like. What that leads us to is a world where we start to allocate resources towards their highest and best use. Which at a societal level would be health disparities, health inequities, primary care, behavioral health, community health, preventative care, social determinants, and that's how we raise all boats.
I always try to leave an opinion at the door and work on facts and there's pretty good evidence now starting with a Shattuck Lecture that was given at Mass General back in 2007, later published in the New England Journal that shows when you look at what's driving population level health outcomes, under 20% is related to the quality of healthcare, the rest of it's determined by genetics and social factors. In so far as I know, we can't change people's genetics going in, so the way that we're going to make for a healthier population at large is by investing in these non-healthcare related services. They can certainly be provided and supported by great health care organizations at the community level.
Jason Helgerson: [07:40] So you certainly paint a very optimistic picture for what value-based care could mean overall in terms of the system and better alignment of incentives. And almost basically describe a rebalancing of the system and sort of reducing the level of investment in certain areas like specialty care and increasing investment in addressing social determinants of health, primary care, and other community-based services. But could you maybe help the audience sort of wrap their heads around this, and either from the perspective of a patient or from the perspective of a provider, describe what you think that the actual healthcare experience will be by that year 2049.
Dr. Griffin Myers: [08:16] I mean, there's a few underlying assumptions that I think are just like worthwhile if we're going to go down this path to break.
I think number one the assumption that we spend too much on healthcare, is not a real one. I think people say we spend 18% of GDP and that's too much. And in a universe where robots are going to be doing all of our work for us and all we're left to do is emote and take care of each other, I could imagine it being way higher.
I think the second thing is saying that we don't have enough money to achieve the goal, is also just seemingly, not a definitive thing to say. We are a very prosperous nation, the most prosperous in the history of humanity. And the idea that we don't have enough money to take very high quality, very equitable care of everybody with that amount of money. I would just challenge that.
I think it's very reasonable that we just need to reallocate those resources appropriately. And I don't mean in a top down way. I mean, in an economic freedom way, a way that when you have a functioning price mechanism would allow us to do that. The way to do that is a full shift to value-based payments and starting with global capitation. And then we can talk about sort of downstream, the way those things will look. What that implies is a whole bunch of things, you asked me to focus on a couple, one being, what's it feel like for a provider and another, what it feels like to be a patient.
There was a really good paper published in annals of internal medicine, I want to say back in 2010, that's really insightful. We've got a great table, you don't even have to read the article, that talks about eight different ways to pay for healthcare. And I teach this value-based healthcare course at Kellogg and we look at this table and we do this exercise, which is to say choose one of these ways to pay and then decide what it feels like for a patient and decide what it feels like for a provider. And we do this. So when you look at fee-for-service, time is money. And so what it feels like for a provider is that I know that I need to bill as many things as I can. And by the way, I'm not, this is by no means to criticize individual providers. This is just the incentive they face.
It turns out when you look at large aggregates, this is how folks behave, this is not an indictment of any individual's specialty or specialist or provider at all. It's true in primary care, it's true in specialty care. You're paid to bill things, and so the return on capital is that you bill things and we see that happening. So it means people go fast. They focus on the things that are most billable and the idea of losing a patient to another provider who's therefore going to sort of reduce your demand, you wouldn't do. And on the patient side, you feel the hurry. You do feel somewhat like the object of a procedure rather than a person with a complex and ambiguous life that creates the health outcomes you experience.
Meanwhile, when you flip that and let's say, instead of doing fee-for-service, you do a capitated model. Well then what matters most is the health outcome. And depending upon the patient's needs, you're going to solve that very differently. And so I would encourage people to look at that table and you can kind of derive what the macro, the micro economic incentive is going to be for that individual participant. And I would say that it works pretty well.
And we have enough of these models now to see that it works pretty well in fee-for-service, in capitated models, in sub-cap models, you can certainly look at what it feels like to be a hospital that works on per diem versus a hospital that works on DRGs or a fixed payment. And so, again, I don't want to say that once we solve the payment structure, we fix everything. There's still a lot of work to do to reorient our healthcare system and reconnect our healthcare system with our shared values. I think that's a critical, insufficient, but necessary first step.
Jason Helgerson: [11:57] So one of the common complaints, which is a complaint that I have made many times over the years, which is that fee-for-service healthcare ends up with the patient being very much secondary to the provider, in terms of convenience, user experience. Do you think that the move to value-based care is going to fundamentally change that? That ultimately, it'll really mean a truly patient-centered system? Is that what you're seeing is sort of when the incentives are really, truly aligned, that's the kind of changes that the healthcare consumer will begin to feel?
Dr. Griffin Myers: [12:31] Yes, but not immediately. And I also think it's fair to say this current model makes everyone unhappy. Patients receive pretty typically, I would say quality that is not our best and it is highly inequitable. And when you look, providers are miserable and all the literature suggests that you can do as much bagels and yoga, before people start their workday and providers are still truly miserable, and measured in as many ways as you want to measure it. So I'm actually hopeful that this is better for everyone involved. I will say that change management is real and it's going to be challenging. I think, especially for people later in their careers, because they've made decisions based upon the old rules of the game and the rules of the game are changing on them. I think that is justifiably frustrating to a lot of people.
I also think it would be intellectually dishonest for me to say that it does not create winners and losers. Anytime you reshuffle the deck and you take a fixed set of resources and you allocate that differently, there are winners and losers.
But at the very end of the day, when you're able to reconnect providers with their values and you have this functioning price mechanism that allows providers to say, I can do what's right for my patient and I don't have to wait for there to be a new billable code for my incentive to line up with the incentive of my patient.
And I'm sure there are listeners who hear this and are super frustrated and they're like, I don't think this way, this is like econo robot nonsense.That's a very valid point on a microeconomic standpoint to say, I don't feel this in my day to day. I just feel busy. I feel overwhelmed by the number of patients I have to take care of. I feel like I'm underpaid. I feel all those things. Those are outputs of a fee-for-service model.
What I get excited about is a universe in which you sit down with a patient and the economics that that individual provider faces are aligned with the interests of the patient in front of them. And that's going to take some work. As big a believer as I am in globally capitated bottles, and I do think at the highest level of the population level, that's the way it starts, if you are a really talented retinal surgeon, we are going to have to do a lot of genuine innovation and create some real intellectual property to try to solve how we're going to connect that ophthalmologic surgeon with his or her values in a way that aligns his or her interests with that of his or her patient. I'm confident we can do that. And we're beginning to see some of that. But it's not all at once.
So I think the answer is yes, it's very good news. It's going to be bumpy, but we will find a new ground state that feels better for patients, is deeply personal and solves their problems, but also feels better for providers and reconnects them with their values and allows them not to focus on what is an overwhelming amount of administrative minutia. Trying to get a billable code ready when that's not what they signed up to do.
Jason Helgerson: [15:33] So let's talk about the big behemoth of American healthcare, health insurance companies and the large hospital systems. What do you see? What is their role? What do they look like in 2049?
Dr. Griffin Myers: [15:47] You'd have to split them, they are very different businesses and very different tasks. And I call them businesses, for-profit, not-for-profit, that's just a tax status, they’re doing the same thing. And for-profits retain their earnings, not-for-profits have to put their earnings somewhere and they typically put it into it real estate portfolios and bonus programs. But, and I don't mean that pejoratively, it's just there is no difference largely when you look at their behavior.
I think on the health plan side, I'm personally very empathetic to what it feels like. I think in many cases to work at health plans, and I think frankly, they get a bad rap. These are again, folks who have a deep commitment to taking care of patients and improving the lives of strangers by doing their day-to-day work and the way that they do it is actuarially and by processing the very necessary background stuff that has to happen to get a provider and a patient together in the right moment in space and time. Processing claims is important. There's crucial data in there. Building networks is important. It allows us to measure and refine quality. Actuarial sciences is really important. It's how we price these products and allocate risk across the system. And, those are really important, and I will be a little bit provocative and saying, whenever I hear that 20% of American healthcare is in administrative waste, I think it's pretty unfair. Without going really deep and understanding what health plans do, to call their entire enterprises waste, I just don't believe that. And I think I have certainly come around to seeing the value that they produce. What I think it looks like in the future, is more tight integration between the work that a health plan does, on the risk-taking side and allocating that risk thoughtfully in partnership with providers.
So frankly, more tight collaboration with providers and helping them understand and transition to these new value-based models. Because it's not just global caps, it's sub caps and DRGs and bundles and all these things. And as you can imagine, that sounds pretty complicated. And, as I suggested to you in our prep, I do think it's gonna get more complicated.
On the health system side, this is another place that I have a lot of empathy, I'm an emergency doc. I'm not a primary care doc though, I consider myself an honorary PCP given my job. So I'm a hospital trained provider and chose emergency medicine because I wanted to take care of patients, whether they could pay me or not. And EMTALA and related regulations allowed me to do that without worrying about the underlying economics of the patients I wanted to care for and the emergency departments where the hospital world meets the real world. I think it's fair to say health systems have a real challenge ahead of themselves. Because stepping all the way back, we as a society, as a species, our goal should be to do such a great job taking care of each other and encouraging appropriate health behaviors among our neighbors and communities that nobody ever needs to go to the hospital and we put all the hospitals out of business.
Now that's not realistic, but it should be our goal. And I'm not the first person to say nor will I be the last person to say that we have too many hospital beds in this country. And they are certainly not allocated appropriately. So how do you unwind that? That's a real, that's a real challenge and I think there are a few paths that can be taken. None of them are painless by the way, but I will say, as I get to spend time with my friends and colleagues that work at these great health systems, they have unbelievable values and great leadership. And what I think will end up happening is a transition to more of these community-based services, transitioning much of care outside of big downtown real estate into the community and into patients' homes and in digital settings. And what we do with those buildings, I have some early hypothesis that they'll become a lot of primary care and behavioral health and community health and medical, social work and pharmacy services and other stuff, but it's a hypothesis and it's probably not going to feel every floor of a 25 story hospital building, but in either case that transition will be challenging.
And what I hope is, and I will just, if you allow me, I think the folks at CMS have done a really smart job laying out, not just a multi-year, but like a multi-decade path for this to happen, starting with the MSSP and then into the next gen ACO and now direct contracting later into Geo, I think Medicare advantage is kind of an early thought it trying to do some of that and allowing more, sort of private private contracts to do that work. So it’s going to happen in a bunch of different ways, but I do think it's fair to say it's going to be a challenging transition. I don't think every organization's going to manage that as well as everyone may hope, but at the very end, what we end up with is a more patient-centric, more equitable, higher quality, more flexible healthcare system based more in our communities.
Jason Helgerson: [20:35] So maybe we can move on to technology and obviously with 2049 being almost a 30 years into the future, there's a lot of opportunity for technology to further enter into the provision of healthcare services. And obviously the technology that a lot of people are talking about is artificial intelligence. And with some actually speculating that instead of actually talking to humans in the future, we'll be talking to machines when it comes to getting advice relative to our current health status and what we should do to improve our health or to address whatever our chronic illness is and basically that in essence machines that are available 365 days a year, 24 hours a day could potentially replace the human being as a caregiver. Do you see that as a possibility in 30 years time? Do you wonder whether or not the healthcare industry will face competition from machines for the direct provision of care?
Dr. Griffin Myers: [21:31] One of the things I always try to challenge myself on is the limits of our own imagination is as humans constrain us. So I certainly would not say that that's not possible. I will say I'm not particularly concerned that robots will replace all doctors on the timeline you described. I will say my imagination is limited by what that would even mean and what it would mean for the rest of society, were that to be the case in 2049.
We have great AI solutions today that are materially helping us take care of patients. And I'll give you an example at Oak Street. We talk about this a lot that we have got an unbelievable platform that in a very robust way, delivers very consistent results across very different geographies and very different patient populations with people who are new in our model and experienced in our model, which speaks to the quality of that platform.
The artificial intelligence really takes the wrote evidence-based medicine that we have and provides that right at the point of care and lets our teams get done what they need to do. Things like preventive screenings and evidence-based management of chronic diseases, all teed up and it means that what our teams get to focus on is really two things. Number one is building a deep and meaningful relationship with patients so that when when, for example, there is a behavior change required, or a difficult moment, we have those relationships as human beings in an authentic way to help our patients achieve their health goals. And the second is catch with the robots miss. When you do have a complex case and the evidence doesn't give you perfect guidance and you've got the context and experience to make a decision, get that right. So AI is already playing a huge role in those.
What I get most excited about is not that you'll log into the robot to get your care. What I get most excited about is, today when we develop new clinical knowledge at the level of randomized control trials, we're typically testing A versus B. And if you're going to draw out the options tree of all the things that are required for us to make new knowledge and everything requires very, very expensive, A versus B, double-blind placebo controlled randomized trials. It's a very slow process to build new knowledge for us as humans. And what I get excited about are using these technologies largely giant, robust, diverse datasets, and just to make a plug for value-based care, because once we get away from documenting for the purpose of billing to documenting for the purpose of better understanding our patients, we build far more diverse datasets.
Now we have this ability to use machine learning methodologies to do sort of non-hypothesis based research. We don't have to have a question to answer, we can use the data to go generate insights and then sort of retrospectively use our intuition to say, mechanistically, does this make sense?
And I get really excited that we're going to solve a lot of clinical problems that way in ways that historically would have taken a lot of time, that I I'm hopeful now won't take as much time. That's what I get most excited about. I think we will frankly understand science and human biology better in 30 years and have better solutions to problems. And frankly, the AI will help us apply those better. If you made me put my nickel on the table, we still have humans taking care of humans. And I don't think that's a bad thing. As much as an optimist as I am, I think it's a totally reasonable thing to be very happy with the healthcare system run by humans in 29 years.
Jason Helgerson: [25:01] Alright. So in terms of your vision for the future of what it's going to be like in 2049, what makes you confident that that vision in fact is achievable? And then in addition to that, what do you see as the potential biggest impediments, things that could stand in the way of the value-based healthcare world that you've described so far?
Dr. Griffin Myers: [25:23] This is a perfect example to me of we are getting in our own way. It is us. We are the biggest obstacle and it's totally reasonable and it makes sense. And I blame no one. We know the answer now. I think we all know that the current structure of how we allocate resources in the healthcare system, because economics is the study of the allocation of scarce resources. We have a certain amount of resources, despite how prosperous we are as a society it's fixed. And maybe we can go up or down a little bit, but we have to allocate those. And right now we allocate those resources in a very bizarre sort of prescribed, but well-intentioned fee-for-service manner. We know the answer is not that. And the answer is to change how we allocate that towards, and again, when we call it value-based, that is a whole bunch of terms that really all essentially just say trying to find a mechanism, a price mechanism that allocates resources to their highest and best use according to their price mechanism.
Whether that’s, Michael Porter would call them IPUs or Integrated Practice Units and paying for it that way. Others would call it Bundles, there’s Global Cap, there’s Subcap, there’s DRGs and per diems. All of these are important tools, technologies frankly, that we're going to use to solve that and what gets in our way is change. Change is hard and it's painful and it's human and what is going to be most required to get us there is genuine empathetic leadership, saying to someone, Hey, you used to get paid to do this, and you did well. And because of a whole bunch of things going on in the universe, that's changing and here's what we're going to do in the future. And here's how you can thrive in that future.
I do think it's going to require being honest about that because some of these, one of the things I always like to say to students, that every dollar we spend in the healthcare system, every single dollar ends up in someone's W2. So when we hear people complaining that the healthcare system is too expensive, really what we're saying is people are getting paid too much. Somebody is getting paid too much. And so what this means to change this is we need great enlightened, thoughtful leadership towards making that transition. And I think that's a good thing.
I think what this means is, and I spoke to a group of medical students earlier in the week as they are making specialty choices, I said to them, the last thing you should look at when you make your specialty choices is how much money you're going to make, because you have no idea what that's going to be in the future. We're in the sort of the biggest point of change I would imagine in the last 75 years in that regard, and I think there's a rough correlation between how much a specialty is paid today versus in the future. But, and I would say it's positive, but I certainly don't think it's greater than 0.6.
So people should make these decisions based upon the patients they want to serve and the kind of work they want to do. And those payment mechanisms are gonna change a lot. And they're probably gonna change based upon the practice environment folks are in as well.
So I say all that to say, you asked me what's the barrier. The barrier is time and leadership and change management. And we will get there. At the very end of the day, I have incredible faith that people who go into healthcare make real genuine, authentic sacrifice to take care of strangers and it's noble and it's an incredible privilege. And I have this unique position of sort of commenting on it at a system level, but I do genuinely feel a big part of my job, especially with the people I get to support at Oak Street is help navigate that change. And I think your podcast is a part of that helping give people a heads up of these are some of the things that are going on and I look forward to working with people to make that happen.
Jason Helgerson: [29:05] Well, I appreciate that now up to our final question, also question we like to ask all of our guests, which is to sort of take a step back and imagine a world in which your vision for health in 2049 is actually achieved. Why would that achievement be truly important to humanity and why would it in essence make the world a better place?
Dr. Griffin Myers: [29:25] You know, I think back to my own training and as challenging as so many patient experiences are, and just the fatigue, physical and mental, and sometimes even spiritual exhaustion of what it is to train in medicine and then to take care of patients, the reward of somebody really needing help and feeling like you did something great and unique, that in that moment in time, sure there are other people who are trained, but I did my job well in that moment. That's the reward and you get addicted to that. And literally every single clinician I've ever met has those moments.
The future that I see is one where yes, the complexity of how we pay for healthcare will be greater, but we're also be more, frankly intuitive and it will be aligned with the work that we want to do. And I think we're going to give people back those moments to do their job, whether you're a surgeon who does something brilliant or heroic, or a doctor who makes a great diagnosis and educate somebody on how to adapt to it or you're somebody who's a non-clinician who is helping make a process simpler, more effective, safer, more consistent. These things are all really, really valuable. And the world that I see is one that once we make a material part of this transition, we'll reconnect to those things. And rather than our work and our values sort of always bumping up against what is required to get this CPT code through is going to feel really different.
And I think Jason, the good news is not only does it mean we focus on higher quality outcomes, but we focus on higher quality interactions, more meaningful relationships with patients. We have time to do that. You know, we address health disparities, yes, out of the goodness of our heart, but also because it's in our interest, it's in our organizational's interest to look for the sickest members of our neighborhoods and make those people better.
Those are all well within the way that these models work. And I always joke about this, but when I was in graduate school, they used to sell t-shirts that said, sure, it works in practice, but does it work in theory? And I think the cool thing is these models allow us not just for it to work in practice, but there is a theoretical mechanism behind why we will go invest in communities and people and conditions that need our help. And we have a healthcare system that’s standing by and a bunch of people who want to do that work. Right now what blocks us is we can't get out of our own way because of our healthcare system of payment structure. And we're going to fix that.
Jason Helgerson: [32:08] Well, that's a very optimistic note for us to end on Griffin. Thank you so much. And that was Dr. Griffin Meyers and his vision for health and healthcare in the year 2049. If you enjoyed what you heard, please subscribe to us and share this podcast with a friend. Thank you and see you next time.
