Please note: The transcript below is automated by speech recognition software and may contain minor inaccuracies.

Erin Vallier (00:00:07): 

Hi folks, and welcome to the home health 360 podcast, where we speak with leaders in home health and home care from across the globe. I'm your guest host Erin Vallier regional director of sales for Alia care software. And today I'm joined by two special guests, John Kunyszh, and Andrew French to talk about investing in systems to personalize the patient family and employee experience. Let me introduce our guests. So John Kunyszh joined Intrepid USA healthcare services in of 2018 as the company's president and chief executive officer as CEO. He is responsible for leading the organization's ongoing growth initiatives with an emphasis on delivering personalized patient and family centered care under John's leadership. And trepid was named the 12 largest provider and home healthcare services in the country. That's impressive. He is a visionary executive with more than 30 years of diverse experience in the healthcare space, including electronic health records, as well as patient experience leadership in acute care physician, group practice and home healthcare environments. John received his bachelor of science in business administration, accounting and marketing from San Diego state university and his masters of business administration from the university of California at Los Angeles. Additionally, he is a certified public accountant and board certifi and the American college of healthcare executives. Wow, John, thank you. 

John Kunyszh (00:01:47): 

It's an honor to be here, Erin and join you and Andrew. 

Erin Vallier (00:01:52): 

Oh, we're super glad to have you. And I have Andrew French with me as president of Get it analytics. Andrew has a passion for big data and bringing innovative technologies to organizing of all sizes. When leading the development of new software tools or consulting engagements, he utilizes his experience gained over the last 17 years in the healthcare sector. Andrew has worked closely with clients to support software, product selection, implementation, and ongoing optimization within the home healthcare space. Andrew continues to work with large agencies, supporting their growth and operations. Annie supports them in navigating the ever changing regulatory environment in his free time. If that's a thing Andrew enjoys a flying advanced Aircrafts hiking out west spending time on, on lake Michigan and learning about new technologies to improve healthcare for the underserved populations. Andrew received a bachelor's of science and information systems and a masters of public policy and public administration from Northwestern university, as well as a project management professional certification from the project management Institute. He also holds an airline transport pilot license issued by the FAA where we fly in. Andrew. Thank you. Welcome to the show. Happy to be here. <Laugh> we're glad to have of you as well. Now, before we dive right in, you both have extremely diverse backgrounds, as we just learned. Would you mind sharing with our listeners how you first became passionate about the healthcare industry? Sure. 

John Kunyszh (00:03:32): 

Who do you wanna go first? Darren, you want me go first? John? 

Andrew French (00:03:35): 

You can take it, John. 

John Kunyszh (00:03:37): 

It's interesting. The diversion also has a conversion, which I'll talk about in a minute because my background, I was at Pricewaterhouse, the Pricewaterhouse side of PWC early on in my career, and then left and, and was doing a management consulting firm, kind of a boutique mini McKinsey booze Allen type firm with owner managed companies PE back venture capital act in Southern California and was always on this consulting side of the world and working with boards of directors and CEOs. And one of 'em said, I I'm, I've got this 70 million dental HMO. That's almost like a startup and they are desperate need of like a COO to join them. And I know you wanna kind of move into that track. So I ended up the 750,000 member, 14 state dental HMO out in Southern California, but my background had always been sort of project management, change management, auditing consulting services. 

John Kunyszh (00:04:33): 

And I'd also had sort of a manufacturing background growing up as a kid. My dad was in charge of process development for, for Sunki. So I always viewed process manufacturing. Things is how it was. And when I got into healthcare, I looked at it as a manufacturing process and we made our own rework more than any other industry I've ever seen. And so the, the, the DNA I share with you, Andrew, was that project management experience. And that's how I view everything that I had to do in healthcare, breaking it down. And, and cuz it's daunting. If you try to look at it in the totality of the clinical experience and being a nonclinical person in clinical environments was something there that, that I loved what clinical people did. And it was, it was truly the art of medicine, which is still there and that heart connection and ability to look at a patient and sense something's wrong is so special when I watch our clinicians. And what happens is, is it's the back office processes, the technology, things that get in the way of that moment of care, which is what I love to feel focus on. And that's what got me passionate about healthcare to begin with. And frankly, from that point on, in about 1988, I stayed focused in on healthcare exclusively. 

Erin Vallier (00:05:55): 

Yeah, I, I can imagine your background in those processes became really handy because I don't process is something that I focused on in my career before life here and it was all broken <laugh> it was just all broken. Andrew, 

Andrew French (00:06:11): 

What about you almost a similar story just probably jumped into the industry a little bit later. So my first job in, in 2004 was actually for Mercer human resource consulting. We were a third party administrator for benefit plans in Iowa. And so, you know, I came into this very young thinking, oh my gosh, this healthcare industry, this is such a polished like, well working machine within two weeks, I was like, oh my gosh, this is not what I thought this was gonna be at all. It was mainframe systems and manual processes and carbon copies and mailing things. So I really kinda kicked off from there and was like, you know, what can I do to make these processes better for, you know, just our day to day operations and from kind of a project management perspective, it's like, why are we doing things, you know, this way? 

Andrew French (00:06:54): 

Well, that's the way we've always done it. We set this mainframe up in night 50 and you know, we've always had these people that did these things. So I actually kind of like got my claim to fame, building automations that sat on top of mainframes to start with. And so I built visual basic code that would emulate a user on the system and it's like, well now, you know, this used to take us 10 minutes center. This form, we actually pull this from a spreadsheet file now. And it takes three seconds for our program to run through it. So really jumped in from there. And it was like people were open to that change. It's like they just didn't have anyone with kind of the hat on to come in and say, Hey, like, this is a way we can do it. Do we agree? 

Andrew French (00:07:29): 

Let's test it and let's get it done. I jumped from there over to blue cross pretty quickly and started doing very similar things for blue cross blue shield of Illinois. They off, so we're on mainframe still are today in, in some capacities. But just tons and tons of opportunity for automation. So from there I'm like, okay, well now I've been on the data side for a while, but I hadn't really gotten into the patient care experience. And so I actually jumped over to the provider side and started to get very specialized at that point in behavioral health and substance abuse. So I helped lead a community mental health center in the Chicago and area. And it was interesting there too, cuz while they were a bit more established and had a lot of good processes in place, it's like let's really look at the quality that we're providing for patients and figure things, just little things that we can change and make projects out of it. 

Andrew French (00:08:14): 

We ended up becoming a center of excellence for the joint commission for how we were working through a transitions from patients that were in the inpatient unit, moving to outpatient, which is a very important part of their step down. We would lose them. We would have our community mental health center as part of their discharge plan and they'd never show up the next day. So we actually built some special programs to move those patients from inpatient over to outpatient. So it was a warm handoff. It seems like such a minor thing, but for a behavioral health patient, that's so huge for their continuity of care. So from there I sort of just kind of jumped into the consulting side. So I've had a lot of these projects I had led and helping select electronic medical records moving through those projects. So kind of a robust background, I've hopped all over the place and you know, pretty much any well in healthcare. I've got some depth of data there and, and knowledge that I've worked on to date. 

Erin Vallier (00:09:06): 

That's impressive. And I love the, the subtle similarities in your background. I'm, I'm really excited about how the, the conversation's gonna go today. And I know you both really want to talk about investing in systems to personalize the patient and family and employee experience. Well, that's a really broad topic. Can you each define for the listener, what it means to you to personalize this experience for these cohorts? Like from a, an end user standpoint, how, how am I gonna feel when I'm receiving those things? What's it gonna look like Andrew? 

John Kunyszh (00:09:43): 

No, Andrew, go 

Erin Vallier (00:09:44): 

Ahead. Andrew or John? No, John, 

Andrew French (00:09:46): 

I'll let you kick this one off. I think this was up your up your question umbrella, 

John Kunyszh (00:09:50): 

As you were talking in your intro, I kept remembering that same shock and awe of the amount of redundancy and rework that we do. And why do we do these processes and the extra 30 to 40% of costs that occur in healthcare is for non-essential back office, double checking, triple checking that really added no true value to the patient care experience. And, and so, as I, particularly as I got into the post acute arena four years ago, what I realized there was, I said it was like going back 25 years. Cuz most of my career had been the acute care physician, large physician practice environment. <Laugh> we had invested, we moved away from green screens eventually. Right? yep. I was a former D base to our base coder, you know, D base three person. So I knew enough about it to be dangerous, but I freely admitted it that I didn't wanna get there. 

John Kunyszh (00:10:43): 

But what, what really struck me was how the internet started to impact our perception of things. And it wasn't about necessarily access or, or kind of the paradox of choice that sometimes overwhelms people when you gone to something and Googled something for a search, but really trying to reduce the friction that's involved in transacting and also creating a more personalized care experience because that's something that I've been been almost messianic about for the last four years of home. Healthcare is still very archaic. You people picking up a phone trying to schedule things with a patient or, you know, we're acting like, like the cable company will be there sometime between 8:00 AM and noon or one and five and that's not okay for patients that they're used to being able to say, here's my preferences I'm available at these time slots. I'd like to do this. 

John Kunyszh (00:11:41): 

Why are we sending caregivers out? And I call 'em care team members versus employees there. And it's just, you know, I, I do a lot of these weird words in our company, right? That people subtly begin to learn over two years. It matters, but why are we sending people that are deathly afraid of dogs into homes with dogs or that are allergic to cats, into homes with cats. And we've had physician preference cards around for 30 years in acute care environments. There needs to be preference cards for both patients and care team member. So we can line them up. And the scheduling systems allow us to sort of align this and it creates not just a better sort of interest experience, but it can be things that may be sort of backgrounds and interests. I've talked before about if you had somebody that was in the musical theater, what a great opportunity, if they could take care of Julie Andrews or Gole, that's kind of interesting. Now I'm enriching my experience for both my care team member. That's going beyond the compensation level of the job because people we got 59, 60% of the workforce is no longer saying that taking care of people is gonna keep me into nursing because it's something that I've value. We've gotta come up with better things that align to them personally. 

Erin Vallier (00:13:02): 

That's that's fascinating. So what I'm hearing you say, like from an end user standpoint to you, it's, I'm gonna have more enjoyment because I'm gonna get to work this shift that I want with the person that is fascinating to me and from the care receiver standpoint my outcomes might be better. I might have a, a better experience and you know, get all my needs met if, if this technology is being employed. Yeah. 

John Kunyszh (00:13:34): 

And actually this started something from you years ago, I started virtualizing the back office. As of healthcare. I, I did this in the acute care environments. I did it in physician practices. We were doing that at Intrepid when I started. So I remember in March of 2020, when I called our folks and my kids had said, Hey, they were at Salesforce and at Amazon and said, daddy, they're sending us. I called her it and said, send, buy everything you have to, to send everybody <laugh> this weekend. They go, what? I go, it's gonna be sold out, send everybody home. They're like what? And I go, just do it. So they did it. We were the first home care company to have everybody virtually at home and our revenue cycle lead. She came back to me a few months late about a few months ago, we were looking at, should we bring back to work or not? 

John Kunyszh (00:14:20): 

She goes never again. You are right. I have people in Colene Idaho that are three times more productive than the people I had at our national support center. I, I love it. She goes, the virtual world is awesome. So that's Erin kind of the side where I see this is we're getting ready to launch in January a your patients, your schedule type program for our clinicians to say, look, if you wanna work a weird schedule, that's split maybe early morning later in the evening. That's great. Our patients want it as well. Some patients have sun downer syndrome. They wanna they're up at 5:00 AM to them. Six o'clock is our eight o'clock. Why are we doing visits at nine 30 until four o'clock Monday through Friday, you have to create something that's maximum flexibility for both the patient for that personalized experience of as well, the care provider. Otherwise we can't tap into workforces that that aren't gonna go through a traditional schedule anymore. 

Erin Vallier (00:15:20): 

Yep. Yep. That's an excellent point. Keeping everybody happy. Andrew. 

Andrew French (00:15:25): 

My point on that too is retention. And so, I mean, as much as it is for, you know, the care for the family, if you can get a caregiver that's in the home on a, a schedule that they want and they're consistently with that patient, you're not staffing a bunch of other people in there cuz they've got an odd schedule. The quality of care just goes up intrinsically for that. They know the patient, they know the home, they have the relationship built with them and we're in a market now too for nurses where anyone can pick up the phone and be at another home health agency tomorrow. And so it's like if someone else starts off bring a sweeter pod or that schedule that they're looking for, they're gonna jump ship and they're gonna go somewhere else to go and do that. So I mean, as much as it is about the patient experience, it's also about the caregiver experience and making sure that you can retain nurses within your agency. If you're still on paper and you know, paper schedule requests and everything else, you've probably got one to two years before all those nurses are gonna hop to an another agency or someone's gonna come and snap your agency up and buy it because the technology just isn't there to support what people want in the homes now. 

Erin Vallier (00:16:22): 

Yep. You bring up a, an excellent point. I think I've read somewhere cuz we have access to all of our tenant data. We, we looked at it in some interesting ways, found that, you know, when there's more than one or a cycle of caregivers in and out of the, the, the home to provide care the overall outcome scores goes down. Yep. People like consistency. So you guys do bring up an excellent point there. And that just highlights to me the shift towards the consumer driven market. And it's just in the last decade or so that the healthcare industry became a little bit more focused on the opinion of the consumer about the services that we deliver while other industries like banking and retail, those industries have always been focused on what the consumer wants. Now let's look at in the healthcare, right? 

Erin Vallier (00:17:16): 

They've, they're largely consumer driven right now. So this is an example. The individual has a really strong voice and influence over all the care that they receive in the home. Now, global globally, if you wanna layer on top of the shift to being more consumer driven, COVID over the last year. So we know that COVID has really catalyze this push to make home the center of care for patients, especially the chronically ill and the elderly. Now know both of you are really passionate about personalized care. Can you share why you feel so strongly about this push to personalize the care at home experience for patient families and employees and Andrew I'd like to give 

Andrew French (00:17:57): 

To you? I mean, it's really, it's where we're going. You know, we have the technology out there to support these things now and you know, people have their iPhones, they've got apps that do all of these things and we're still probably a decade behind in the healthcare space with delivering that technology. Like, Hey, like what is my nurse coming? Or I want to make a schedule change for that. How do we do that? We still pretty much pick up the phone, call the office. They have to go into the EMR scheduling system and work through that stuff. But for anything else, doc doc scheduling appointments, large health systems, you've got all of this stuff on your phone. And so that's really, you know, F one and the generations don't really like talking on the phone as they, you know, move forward with stuff like we're missing a market where it's like, we've got people that are retired now that have home healthcare, but where you have this technology driven group that is gonna be moving into the home care space at some point in the next 20, 30, 40 years. 

Andrew French (00:18:45): 

And in some cases already are, there's older people that are just comfortable with technology and refer that modality for working for things. So the sooner we can get there in our technology solutions to bring those things they see in other verticals of the industries out there to them and get it in their hand, get it in an app. I think we're gonna have better outcomes there. The other thing too, for agencies that are still on paper in doing things, I mean just for continuity of care, if you have a disaster in Florida and there's a, her and you need to jump somewhere, you forgot to grab your plan of care. You don't know what your last medication list was, where you had five things that changed. Why is that? Not in a portal or on a phone, across the board for everyone. Those are just such simple little things in the technologies out there to do it. And those are things that they're gonna drive in the home. Like those are things that's my personal care. Like I need access to it wherever I 

Erin Vallier (00:19:34): 

Definitely, we Def <laugh> at least in the us. I know that we have that more on demand feel right now we wanna order it and have it there. John, what is that? You know, it's 

John Kunyszh (00:19:45): 

Interesting mean to you. One of the things you reminded me about in your comments was, was the fact that I look at how we've view our consumer experiences now. And, and yet in healthcare it's, it's been really archaic. And what, what struck me, and this is something that, that when I got into postacute, it's one of the most complicated care environments because you're completely virtual. You, we've got we, we a 7,000 bed hospital across 17 states with 2000 caregivers, right? That that's a complicated clinical setting and you don't have control over that clinical setting a lot in the home, but also the labeled patient that we typically have and we're used to in an acute care environment is not what we really have to pay attention to in a aging in place, senior care environment, because they may not tell us the truth. Oh, I walk fine. 

John Kunyszh (00:20:38): 

I never fall. I don't need a Walker. I, I take all my meds. I just have a little bit of a N now and then maybe a beer or two in the afternoon. Right? What what's interesting is the multimodality with which we have to incorporate patient input from not just the patient, but spouses, brothers, sisters, children, you have to do this. And, and we don't do that well because we don't have the communication. I call it this patient family communication stuff. And Erin, we've talked about this several times at conferences. I am. I'm huge about that because we know more about our chewy dog food order that we just got and, and or something from Amazon or your prescriptions from CVS and Walgreens than we do about any kind of our home care visits. And you should be able to check in and find out what was the status with a two-factor authentication. 

John Kunyszh (00:21:33): 

So it's secure and be able to ring in. So we've been looking at a lot of those technologies that help enable that. And part of Aaron, what, what drove, I've been talking about, the family centered medical home for at least 15 years. And it came back from when I went to an ACH E Congress many years ago, it was one of the commanders dressed in his dress, whites in the Navy that set up the first family medical home for the us Navy. And it was a multimodality kind of multifactorial way in which they treated patients outside of Bethesda. And they were sending them home and they were talking about what a fabulous care experience. This was reduced hospital acquired infections, better patient outcomes, more rapid recoveries. And I was like, that's where it's gotta go. So this is probably going back 17, 18 years. So COVID literally took our business model that I've been talking about for three and a half years and accelerated it forward by about five to seven years because people are realizing I should only be going to the hospital. If I'm really, really sick, I could get almost every surgery I need done in an outpatient environment. Go straight to pack you at home care at home telehealth visits, unless somebody has to really see me. And now again, the resolution's getting better. The technology's there to do monitoring. So I think it's all gonna go home based. And, and unless you have a cardiac event or a major neuro issue where you're gonna be in the big house and then you need to be in the, in the big acute care facility. 

Erin Vallier (00:23:15): 

Right. I it's fascinating to think about how this is. This is all happening very fast. I always felt like we'd always be hospital based. And just listening to you guys, both of you there's plenty of benefits to agency used to start thinking about becoming more digital, more personalized with their delivery on all ends retention, client outcomes, cost savings. I could keep going. Yep. But I I'd like to think about the consequences. So this is the direction everybody's going. Right. What happens if I'm an agency owner? I just don't really want change anything. 

Andrew French (00:23:56): 

I don't think you're gonna last that much longer out there. I mean, if you're a small agency and you're still on paper or not looking, you know, in the next one to two year to adopt technology that, you know, meets these needs, we've talked about it's slowly gonna dwindle. The other thing too, John, that I was kind of thinking of the patient centered medical home. So, I mean, in clinically integrated health systems, that's such a huge thing. And home health is generally the wild card in all of that. It's like they can manage that in a rehab facility, but as soon as they step the onto home health and it's like, that's the companies. And, you know, we can get down to a nurse in those, when we would look at data, I used to do this in a big health system. And it's like, you know, when this particular group is the one that provides the home care, there's a twofold risk of readmission back to the hospital. 

Andrew French (00:24:39): 

So it's like, we don't know what they're doing differently than other home health agencies are, but we can tell when we send them out there, that's a, that's a piece of it. And so the technology that exists in implementing these EMRs helps to start to integrate that stuff too. So medical devices in the home it's like that can plug into an EMR that can feed somewhere else for machine learning, everything else to track clinical outcomes. That's the way these big health systems are going too. So, I mean, if you're still on paper, there's no way to participate in that marketplace for, to integration that's happening across the country right now. So, I mean, that's a, you know, aside from just patient and employee satisfaction, you're probably gonna lose people that wanna do business with you down the road, too, if you're not able to, to aggregate and, and work on that data in your system 

John Kunyszh (00:25:21): 

And Andrew that's spot on. And it's interesting, you know, I I've analyzed a lot, the bias, you get a lot of bias when you have the home healthcare company that's owned and managed and staffed by the acute care system in that local market. Cause part of what happens is they were nurses in the acute care hospital, right? And their belief is those darn discharge planners. They're kicking 'em out too early. This patient should be back in the hospital. They should, you know, so they wanna do a readmit. It's just, it's just the, the bias of kind of where they come from. And, and one of the things that, that is interesting, you know, back to your original question, Erin, if they get beyond 30 to 50 patients, the entropy and the ability to communicate and do the things that Andrew was talking about, it's gonna overwhelm 'em the, they cannot do with, without making these investments in systems and technology that allow them to do this. 

John Kunyszh (00:26:14): 

And, and they, they're just gonna be very, very limited in what they can do in their market and they'll get passed by cuz they won't be able to report it or go. But I think in particular, having that ability to, to sort of patients longitudinally and to come up with risk factors and criteria that determine am I at risk or rehospitalization or not? Now the other favorite one in Andrew, I know, you know this with your background. I went to the hospital, I stopped taking everything. I got sent home, but I have a red pill instead of a white pill. The red pill is not something I take. So I don't take my diuretic and I, I go home and I party like a rockstar cuz I'm home. I watch the college football game. My team wins. You know, I had a lot of testes, Dorito, cheesy puffs and margaritas. 

John Kunyszh (00:27:04): 

And I'm suddenly getting readmitted because I didn't take my diuretic. I don't what that red pill does. They don't remember. <Laugh> that's hard. And I think telehealth and thank goodness for the waivers that have come up and, and Erin, that's something I know we've talked about before. Telehealth is here to stay. It is so much more powerful, more meaningful. Anyone who's lived through the experience of getting mom or dad ready to go to the physician for that face to face. It's a day off of PTO. It's like, it's like getting ready for Easter Sunday service. I mean they go, they show up and, and the dock. So how are you doing? Oh, I'm great. And you're like, no, you're not mom. You're, you're not sleeping. You're they don't tell it's it's the white syndrome. No they don't. So this is, this is something that's gonna be interesting to see how this, this personalized experience and the, if you're gonna be in home healthcare, you've gotta treat yourself like you're literally an acute care system and without walls and you're a large physician practice without walls. 

John Kunyszh (00:28:09): 

You gotta make these investments and it's gonna continue to be scale, continue to be organizations that can monitor report and take over. And it's something that we've talked before previously, Aaron and Andrew, I know you're seeing this. The models are not going to sodic care anymore. It's going to longitudinal care across a continuum of care. Cuz we don't age episodically, we age kind of across a continuum. That's what's different. Acute care is I broke something. I got an appendicitis. I had mm-hmm <affirmative> I had a gallbladder issue. I had a labor and delivery. You go, you get fixed. We send you home, not your agent in place. 

Andrew French (00:28:50): 

Yep. HMO model on steroids. Now they finally have the data to try and like make sure that people are doing the right things and not 

John Kunyszh (00:28:57): 

Just trying to reduce that. Correct. A, a H ACOs or HMOs at a community geographic level. Yeah. Yep. 

Erin Vallier (00:29:09): 

That's excellent advice in a stern warning for those people who are still on paper. And I know that if there's 30%, at least of agencies across the us that are still operating on paper, this is where their ears need to be parking up. Right. and you know, I wanna talk a little bit further here. I did a little research and, and learned that the very first home visiting programs in the us started in like the 1880s. That's a long time. So home health home care, this is not a new invention, but if you are paying attention in the conversations that we're having, it feels like we're talking about something brand new about shifting more of the care in the home. Cuz our care delivery model of course is still very hospital based. We've talked a little about this already. And I think in part, because to date, all of the technology that was needed to diagnose and treat was housed in the hospital. So in order for us to be successful, delivering this person centered care in the home, especially, you know, when we're dealing with the chronically ill and the frequent flyers, like we have to start thinking about leveraging these new and emerging technologies. And I know John you've mentioned some of this, Andrew you've mentioned some of this, so I am curious what role do you believe technology systems can play in both during and after we completely transition to this more personalized care model in the home. 

John Kunyszh (00:30:45): 

Andrew, why don't you go first? Cause I'd be curious cuz you do so much technology implementation. I really wanna hear that answer because that's where the failure point usually is and I technology. And then I'll come back and talk a little bit about, about avoiding fatal mistakes that I've made in the course of my career to, to give you some color to what you're about to probably tell us 

Andrew French (00:31:06): 

<Laugh> oh, it's gonna be great. So I mean right now, so we've talked a lot about moving from paper, making sure you have an electronic health record in place. So that's step one. But as far as I know out in the market, there's no electronic health record that I can go and link my apple watch to, or, or my Fitbit to track my sleep, my heart rate. Other things that are critical, vital signs that are coming in or even just linked to medical devices in the home that have a really easy integration for caregivers where it's like, Hey, go put on your blood pressure cuff you know, five times a day and we're gonna check it. And if we have an issue that comes back from that, or vitals are out of parameter, for some reason, bam, I'm gonna send that message up to a case manager. 

Andrew French (00:31:44): 

I'm gonna send it to the physician to let them know we have this technology where we know who the person is, all this information about them. What's on their plan of care, but that's the missing link right now. And like that's the call for our technology providers to know that that's ahead. And from a vendor perspective, I think that's gonna be a differentiator in the next five years for whoever can, you know, we go onto our little Amazon, you know, account and we link in all of this stuff to our electronic health record portal. That's what we need. And from there we can start to get all of this crazy amount of data that comes in. So it's like, you know, oh, if my heart rate starts going up, I have these diagnosis codes. Now we've got that fundamental data to start looking at that and predict readmission risk and other things from it right now we're just blind. We're relying on the caregivers in the home and I'm sure if you wouldn't ask the nurses out there, they would love the assist of having that constant flow of data coming in to provide better care for their patients. 

John Kunyszh (00:32:35): 

You know, one, one of the things that I think Andrew, we tend to rely upon too much in the home health environment is too much data on the medical aspects and the, the physiological aspects of what we're measuring for care. And so a lot of what I think is gonna happen, Erin, when I, when I look at this, the social determinants of health and ability to integrate an entire set of feedback loops that that start to paint a picture of the patient for changes. It it's the change that you're looking for. Where are they at? You know, I, I refer to aging as like the old plate spinners that we used to see on the old Johnny Carson show years ago. Right. And, and if you'd look at it, sometimes the plate looks perfectly level, but then it starts wobble and that's how older folks get. 

John Kunyszh (00:33:22): 

Then they level out, then they're good. Then they wobble again. But I look at things and, and you know, that we wanna start tracking, you know, are they having more sense of a, a sense of belonging and purpose or is that disappearing? Do they have a sense of hope or not? Are, are they eating? Are they worried about food of food scarcity? Do they, do they feel alone? Do they feel, you know, just things that are kind of pre indicators kind of where things are, but also doing things that are not part of our current reimbursement models, cuz they have nothing to do with an episode of care. You know, like you talked about that, you know, Aaron, I, I we've been around for 52 years and I tell people all the time, healthcare used to be all at home. Then sister Irene Krauss and her friends dressed up like Sally Petrell at daughters of charity built these hospitals with x-ray machines and everything else. 

John Kunyszh (00:34:12): 

And we started leaving the farms and going like ants to go get stuff done and leave. And even now we still bill in an episode of care, that's not how we age. We're gonna age across a continuum that requires independent living support skills at the front end. And we may have to go in and actually put in some ramps, put in a second handrail, go in and, and take the area rugs and roll them up so that they don't trip. Right. Get rid of the antler lamp because it makes a really lousy grab hold and, and put it on the other side. So they can't stab themselves in the chest like Steve Irwin, right. And put the furniture up so that mom or dad can cruise like a 10 or 11 month old and cruise to the bathroom because they're not going to use the Walker sitting right in front of them. 

John Kunyszh (00:35:01): 

You know, know this is stuff that I talk to 'em all the time about go change. The furnace filters. People are like, what? I go change their furnace filters. Have you looked at some of the furnace filters in an old person's home? They forget to change them. They're they get chronic lung infections because the filters have three eights of an inch of dust and mite in them. And people are like, well, well you can't get this paid for by Medicare. Exactly. This is where the model of, of payers. I think Andrew are gonna lead this with us lead. We're gonna take over their patient care. We're gonna avoid these hospitalizations driven by a fall because we started reducing the risk. We tore out the fiberglass tub. We put in a zero barrier thing with two seats in it so that the patient can safely be there. 

John Kunyszh (00:35:53): 

And I can safely get in, in my shorts and give a shower the, to them or the other care provider. The model's gonna shift aging in place is different Erin than an episodic care model. But I think in particular, the way people need to view their technology decisions is not about what we're doing today, but where we see it going three and five years out, because if they buy something for day, they've only solved today's problem and the market's already moved. And it it's sad to see that, but they don't, they don't realize you're locked into something and they also don't do it. I'd be curious, Andrew, for you to comment on this, the lack of re-engineering of inefficient workflows at the time they deploy technology that to me, and I'd love to hear you comment on that as you installs <laugh> because that's when I've looked at things that failed in my career it's cuz we didn't do the reengineering work at the same time you put technology in. 

Andrew French (00:36:51): 

Yep. Yep. No, a hundred percent. I mean a lot of the engagements that I've on, that's a massive part of the project is one just getting set up for the, the culture change that it's like, Hey, like you've done this for 20 years at your home health agency. It's not gonna be the same. When we go into an electronic health record, the way you deliver care in the field is gonna be a little bit different. There's gonna be steps for it. I've been fortunate that in the engagements I've been on so far, they've acknowledged that. And they're like, you know what? Like this is an opportunity for us that kind of open the book, clean slate. And it's like, let's really look at what we're doing. And then within implementing a new technology, there's generally a lot of best practices in there. It's like their implementation and their notes and other things have evolved from other agencies input. 

Andrew French (00:37:31): 

So it's like you built this one visit note, you know, 10 years ago and you've never changed it. There's a visit note we can adopt from this system. That's had agency input for the last, you know, 15 years they've been a vendor. So those are huge things for them to really like open that up and, and see, and I've seen failed implementations exactly. To your point where they're like, oh, well we did billing differently. And this can't support how we do billing. And it's like, there's 10,000 customers on this software that are doing billing just fine. Like what is so unique about you that you can't, you can't that? And it's like, oh, well we don't like clicking this button and then pulling this spreadsheet out. That's different than what we used to do. So that's a huge thing of just like the change management and making sure the leadership team gets the teams ready for that. Some are good with it. And some are, you know, I I've done this the same way. I, I don't want to change my process. Yeah. 

John Kunyszh (00:38:16): 

What, what, 

Erin Vallier (00:38:18): 

That's the, one of the major hurdle that I come across in my day to day as well, people people like change. They just don't like that transition period. Yep. Well, 

John Kunyszh (00:38:28): 

You know, bit of comment was really interesting talking about the multi modalities of different kinds of technology tools and things that exist in the home. I mean, I remember when, when best buy made their big splash right about, oh, we're gonna have this technology enabled senior living at home. So I've been to every best buy I can find in the country when I travel. You can't go see it yet. Oh yeah, yeah. Yeah. We were supposed to have that. Yeah. So at the doesn't exist and what's sad is you've got a lot of these devices and things that, that can give you stuff. Like I test the cardio mobile stuff. I, I try things out just to see is this stuff that our patients could actually use. And a lot of it is, yes, they're, they're passively being monitored like Andrew said, but it's not linking up and attaching to our, our electronic health systems in a way that allows for an intelligent alert to go off. 

John Kunyszh (00:39:21): 

But you have to be careful cuz the last thing you want is an alert that you ignore. That's a, that's a bad day. Mm-Hmm <affirmative>, that's where the lawyers. Yep. It's gotta be and say, absolutely check, are you writing? <Laugh> right. And that's not what you want to have. But I think, I think there's a huge opportunity there to provide a lot of integration with this technology in a way that's different and takes into account. It's sort of it's there, but it's not really in their face, right? No one wants to wear a life alert. It's a badge of dishonor. However, what you can do is is the, the technology exists. I was at Hewlett Packard at their national, their worldwide conference where you have machine robotics and control arms. They can image a room and they could look at the room, a living room, bedroom, kitchen setting. 

John Kunyszh (00:40:12): 

And they could tell if a patient, cuz I had the guy that developed a come over and I said, can you tell me if someone was laying on a floor here for more than like 60 seconds or two minutes and have an alert go off. He goes, oh yeah. And I said, the phone would then ring to our call center and I go, Mr. French, this is John at Intrepid. Why are you on the floor? I'm napping. Oh he's eating your ice cream. Right. This technology does exist. We haven't just integrated in a way that that seamlessly fits in within the patients environments. And I think patients and families, you know, Aaron, you talked about patient as payer, you know, the Australia model, look, you, you, the largest single growing payer in the United States is the patient as self-pay, that's gonna continue mm-hmm <affirmative> and you know, I think we all need to plan for being we're all, ideally, maybe we're 80% Medicare. Now if you're running home healthcare, that's great. You better be planning on being 20 and 30% Medicare in five years because you've gotta come up with a different way to provide value and take care of these patients because you know, you and Andrew are gonna be paying for the patient care for your families and for your family members or they're coming out of their spend down money from their retirement. It's gonna 

John Kunyszh (00:41:33): 

Have to be invested well. 

Erin Vallier (00:41:37): 

Yep. That's an excellent point. So it's definitely an interesting time where we're valuing the, the use of technology and how, and we're also valuing the whole person in terms of care. We're, we're now recognizing that this will speak to you Andrew behavioral health, like my mental status, like my mood and my environment, all of that plays a, a critical role in the outcomes of the client. And it's just super cool time to be in the industry where we have all these technologies that if you apply artificial intelligence and the algorithms, like you can be really predictive. And that's where I'm seeing lots, lots of interest on my, you know, and what I do day to day is how can we be be predictive, churn outcomes, you know, all these different things that we can solve with technology. You know, and I'm, I'm gonna shift gears just a little bit here and talk about something adjacent you know, working for our technology company myself I've seen a lot of disruption that these EVV mandates have had across the nation. 

Erin Vallier (00:42:51): 

But disruption, isn't always a bad thing. Right. I've also seen some of these agency really embrace EB B and use that to drive efficiency and improve client care. Cuz you know, they're there on time. They did all their tasks. You can't, I mean you have to do that in order to bill. Right. so I, I think that in some ways it's a, it's a pain, but it might be a good transition, but I'd like your opinion. How has EVV impacted caregivers? How has that impacted agencies like in the immediate and what do you think is gonna happen long term? 

Andrew French (00:43:29): 

So I'll, I'll jump in if you're okay. John, on that one, I, I have an experience you an experience of many, so yeah. <Laugh> well and you may buy it by state depending on what payer sources you have. So, you know, I work with agencies across the country and so, you know, we have a federal mandate for it, 1, 1 23 for nursing in the home, but states could adopt to do it sooner and many have. So I've been kind of, you know, with the agencies on the scramble of, you know, here's kind of, you know, in the short term, not a lot of communication from the states and kind of very ambiguous requirements that they need to meet with that. And ideally we, you know, to our point of making the technology easy for the caregiver, we don't want to have a second phone or app that they need to do something with. 

Andrew French (00:44:12): 

We want EVV to be integrated with the current systems that they're using. So it's like I clock in for the visit that that's my time for payroll. That's my time for billing and that's my time for EVV. So that's been a big project to make sure that that's integrated properly and, and working for caregivers. The agencies I've worked with fortunately took this on as like project early on. So it's like, we really looked at the caregiver experience. Basically. We were like, we want nothing else to change for them, except that like you now, when you get to the home need to do this, if you don't, the back office is gonna call you when you haven't checked in for an hour and be like, Hey, why aren't you checked in or you're there? Oh yeah, I forgot. Okay. And we'll track that. And eventually they get in the habit of doing it. 

Andrew French (00:44:48): 

So everyone's pretty much made that transit longer term once you're through the pain for that piece of it. It's been interesting to see the data for it. So, you know, caregivers love them. Like they are the ones that, you know, heart and soul of a home health agency, but there are some bad apples out there and it's like, we didn't really expect that we would see that, but we're like, Hey, we can see where you're clocking in for your business. And it's like, you're in an, another state called a home, the nurse isn't there. And it's like, oh my gosh, like we just got Broadway and abuse through the EV B system, which is what it was implemented for. So that's been a huge thing, not a lot of people, but it's like, it was surprising. We didn't expect there to be any, and there were, there's been a couple that I've seen across the agencies I've worked with. 

Andrew French (00:45:29): 

The other side of it too, just, you know, are they there? You have a patient with dementia. They can't remember when their caregiver calls up. They call to complain like, oh, nurse study was a half hour late today. And you know, I'm really upset about that. And it's like, no, you know, Margaret, we're looking at our system here and we can see that they were actually at your house three minutes early, all, they were like, you can see that. And it's like, it gives you an additional data point where it's like, it used to be self of times coming in. And it's like, we didn't really know as an agency, if that nurse was there or not. And who was really telling the truth in the matter, obviously we want to, you know, lean toward the nurse side, if there's a behavioral issue with the patient, but it really gives that transparency and visibility. 

Andrew French (00:46:06): 

The next thing that scares me though with EVV is, you know, we've implemented this early, before the federal mandate and you know, states have continued you to push out, you know, their reimbursement requirements and making sure that claims are matching. That's been very scary to audit the data for. So it's like in some states we can see if there's an EBD match to a claim that we submit, basically the precursor for eventually this would be denied and we'd have a secondary process for it. Those percentages are not great yet. And it's like, I think, you know, whenever they finally hit that, that's gonna be another staffing impact for the billing and revenue cycle teams to work through those denials where EBV data didn't come over. So I'm hoping states are mindful. And you know, they're looking at that to not put more burden on the agencies, but you know, I think we've got EBV and the technology down for it. That's the next piece of it is how does this impact the revenue for the agency? And, you know, we get ahead of that before there ends up being a cashflow issue down the road. 

John Kunyszh (00:46:57): 

And it's interesting when I, when I look at it, Aaron, I think to piggyback what Andrew's saying, I just see it as a normal part of the course of our business. And, and it's a great tool to ensure that we actually did what we said we were doing. Right. And, and this shouldn't bother you. It's in the background, it's occurring. Did your geolocation map what you said you are, no, Starbucks is not where you're supposed to be right now. <Laugh>, you know, but I think Andrew, to your point, the, the pressure on us that we're gonna feel is as they start to say, well, okay, so we're supposed to have contemporaneous written documentation, everything done in the home. And a lot of our care providers are like, well, I can't finish it all there. I can't finish it all in the driveway. And even though we're pushing, saying, you really need to, because if you wait to tomorrow and you're trying to finish off all that documentation, you're, you're kind of guessing it's like taking your expense report and trying to fill it out at the end of the month when the American express statement comes in. 

John Kunyszh (00:47:55): 

Okay. I know I had lunch. I know I did this. You're guessing. Right? Mm-hmm <affirmative> so I think the risk factor is, as the states use it, do they start ratcheting down? Reimbursement mechanisms say it all had to be completed right then and there or anything that was done. Now, certainly you can have modifiers and things for clarification, but I think Andrew, your point, they may try to use it as a basis for denial of reimbursement. If it wasn't all completed at the exact time and physical location of the visit that, that I, I think is something we're gonna have to, to get some flexibility on cuz there are certain things that would be follows that may be added to the, to the document, but there may be what we call core elements, right? Vitals, you know kind of medication, you know, medication reconciliation, that kind of stuff had better be documented there and not necessarily later. 

John Kunyszh (00:48:53): 

But I think that's the risk point O otherwise it's just part of business, you know, PD GM, oh my God, the world's gonna end. No, it didn't, you know, it, it, it didn't end and you know, EVV is not gonna cause the end of the world or cause people to leave the profession or whatever else, those one or two percenters that are trying to gain certain things or think they can get away with it again, you know, that's another reason to have electronic systems in the first place. You, you don't have somebody saying something and I think Andrew, your side of it helps eliminate, you know, service, recovery issues that are, cause sometimes they don't remember that they had the visit. I, my father-in-law would've been, we could have had the home healthcare person come by and leave in two minutes and say, Hey, did they come by? 

John Kunyszh (00:49:41): 

He'd say, no, I haven't seen him. And, and literally I could see the car coming down the road from the other end of the farm. And it's like, Tom, they were just there <laugh> but you know, he had had, he had some of those issues. So I, I think it's it's an important factor, but I think it's gonna be one of those things. Aaron, that's just, it's taken for granted so long as it occurs in the background to Andrew's point and doesn't put a huge burden on the care team member. It's okay. Cuz that's one of the things when I used to sell a lot electronic health records and develop them, I was always looking at not just a return on investment, but what's the return on clinician's time. I used to call about R OT and they'd be like, what do you mean? 

John Kunyszh (00:50:22): 

No one else talks about that. I go, I know because they're trying to sell you something that isn't gonna give you a return on time. I'm gonna show you why this is gonna be better, faster, easier. And yes, certain things are gonna take more time, but here's where it'll save you time on the back end and they go, now I'm interested in what you're talking about. So that's, I think the developers of the systems are the ones that are gonna have to continue to provide ways to help provide prompted checklists that are more accurate or as I'm checking things in my evaluation of the patient, that it does a good job auto generating sections of a note that I can edit and, or maybe clarify that starts to, that starts to speed up my care day. That's what I care about as a clinician. If you're asking me to take the time to fill this out. 

Erin Vallier (00:51:15): 

Yeah. And that's gonna keep you happy. You guys are just highlighting the importance of having the right technology partner to help you run your business. Which is a nice little segue to, to one more question. We have time for one more before we wrap up. I, I imagine that a lot of our listeners don't have a ton of experience evaluating, selecting and implementing technology. <Laugh> and I, I bet many of them, especially those that are still on paper are thinking after listening to you guys talk that it might be am for them to start thinking about implementing some technology tools, what are one or two things, little bits of advice that you can give to those who are thinking in that direction right now. 

John Kunyszh (00:52:01): 

I I'd love to go first cuz I, we went from paper, we went from paper to electronic about five, six years ago. So speaking of people that went from paper to electronic, right? But even if you're on another system right now and you're considering upgrading or changing number one, make sure you look at where you want to be three to five years from now, do not make your decisions based upon where you are today and where that technology that you are evaluating is today. Make sure you ask them to see their roadmap and you wanna see their technology roadmap coming out that's an incredibly important decision. And then the second thing I would share, and then I'm just fanatical about is do your business process. Re-Engineering work to change the stuff that's garbage and horrible and don't carry forward bad habits, do it now, or you're gonna have to do it later when you have a failed implementation that really wasn't a failed implementation. Your people successfully resisted the change and, and, and were able to fight you in a way to stay where they were. Don't let 'em, 

Erin Vallier (00:53:13): 

Oh, you let 'em do that. This, 

John Kunyszh (00:53:16): 

That, that that's just, and, and, and choose carefully. The third thing would be choose carefully where you pilot, because we've piloted things so many times that failed. I don't even want to go through the story and I'd go, where did you pilot this? And they'd go well at 60 some locations, I go not the right thing. <Laugh> 

Andrew French (00:53:37): 

Right. 

John Kunyszh (00:53:38): 

I just sit there and go, who made that decision? Because anyway, but those are my top three things. And, and, and Andrew, I, I'm sure you're gonna have a much more elegant and just, you know, storied answer that I, that I'll, that I'll look forward to hearing. So this would be great. <Laugh> 

Andrew French (00:53:53): 

Yeah. I mean, the biggest thing, you know, when I first come in on these engagements, sometimes, you know, previous implementations failed bad technology. Sometimes they just completely picked the wrong thing. That didn't make sense for 'em. So first part is just coming in and it's like, let's make a shopping list. Like, what is it specifically that we need to do, especially if you provide Medicaid services, because Florida's completely different than Texas. That's different than Illinois. And it's like, every one of 'em has a nuance that you need something to be done in the EMR to support those workflows. So getting those on paper. So you remember what those are, cause we've all been through demos before, and it's like used to you three different products and it just becomes a blur in your head. You can't remember who does what that also gets buy-in from those different teams. 

Andrew French (00:54:33): 

So it's like if the billing team needs something special, now we're asking about that and making sure that the system can do the things that it needs to do. Same on the clinical front. It gives you a, a roadmap too for when you start looking at products. So I don't know how many EHR as there are out there for, you know, home healthcare at this point, if there's new stuff popping up all the time, Erin probably has, you know, a number from her side, but there's a lot in, you know, some are Medicare specific, some are Medicaid specific. Some can do both things. Some are pediatric, some are adult. So that shopping list helps make sure that you're in the right spot. So it's like if you're on a sales call and it's like, I'm at a grocery store to buy things, but sporting goods around me and it's like, just eliminate 'em off the list. 

Andrew French (00:55:09): 

There's no point in sending, you know, another eight hours on demos with them. The sales people will continue to give you demo after demo, but it's just, it's not the right product. So you get down to the right ones, start to evaluate 'em and, you know, go down that punch list to your point, John, on, you know, the teams and kind of, you know, who, who does what in it. And it's like, no EMR does a hundred percent of things and it's like every engagement I'm on. And it's like, we're gonna go down this list. And we're gonna have probably 90% of these things that a vendor meets. And it's like, we need to then evaluate between the vendors. You know, who's gonna take the hit on the 10% that finance has to pull some weird spreadsheet and run some pivot tables on it to make it work. 

Andrew French (00:55:44): 

But the other one had a fancy BI tool. But the other one's better clinically. And it's like, where are our priorities in the selection? And, you know, is that something that you can live with? It takes you 20 minutes a month, but we have a much better clinical product. So those evaluations are huge in making sure that you can make those trade offs. Next thing is read the contract. I have so many agencies sometimes that I'll come in with and they've never read their contract with their technology providers. And there's, you know, tons of little just loopholes and things. And to John's point, this is a five year engagement. This may be the last EMR you ever select. So it's like, you wanna make sure that you've got a contract in place that makes sense for both you and the vendor moving forward to continue to build and, and grow that partnership with each other. 

Andrew French (00:56:27): 

And then lastly, just a key point is on the staffing side. And so it's like, if you don't have someone, you know, internally that is, you know, good at project management and helping to guide these things, you either need to hire someone or bring in a third party to support with it. Cause a lot of these go sideways where it's like, you know, Hey John, I'm also in charge of the EMR selection and coordinating vendor demos and the implementation. And you're like, okay, that sounds great. But I'm already working 40 hours a week. Where am I gonna find this other 30 hours a week that I need to successfully manage this project? And it seems like an investment upfront. It is. But also once you implement this technology, someone needs to manage that moving forward there's releases, there's a ongoing optimization that needs to happen. There's education, there's, you know, issues that come up that need to be worked through. So don't cut yourself short and, you know, implement a great technology product, but then not have someone internally support it. So in all cases, there's gonna be additional labor required for that. You're gonna hit savings on the clinical side, on the compliance side, on the billing side. So the cash is there to make up for it, but it's like, don't discount the fact that you're gonna need someone to support the product moving 

John Kunyszh (00:57:28): 

Forward. Yeah. And, and Andrew, sorry. And Aaron and Andrew, Andrew, I just wanna piggyback on, he, he, I think his point about don't underestimate the value of an independent party that helps kind of becomes part of your project management PMO office and, and the valuation team they'll help eliminate what I call the emotional political mm-hmm <affirmative>, you know, entrenched position biases. Cause they'll be like, well, we just don't like that. Well, why? Well, because the font wasn't the right font. Okay. That's not a good reason. You know, in other words, the don't that value that Andrew can bring or organizations like Andrews can bring to that process for organizations is critical because it removes your institutional bias for no change that occurs and, and levels the playing field for any of the objections to be factually based, not emotionally, or I don't know, they gimme better tickets. They take me to better events, you know, <laugh> they buy me better dinners, you know, <laugh>, you know, et cetera, right? 

Andrew French (00:58:37): 

Yeah, no, that's a hundred percent. Right. And it's like, you know, I've been the wedge in, you know, those teams sometimes before where it's like, I don't understand what the actual issue is. And it's like, let's look at us specific example, document it. And it's like, oh, well it's not really an issue. And it's like, you know, I just don't like the way they do it in this location. And it's like, I don't think that's right. Well, why specifically? I don't know. I just don't like it. It's like, okay, well we're moving on then. Cause this is a non-issue. But it's true. And it's like, and I have no political allegiance to anyone there, you know, or a third party that comes in. And it's like, once the project's done, you know, I say around a little bit to help with things, but it's like, I'm, I'm out the door. So that does help a ton too. And it, you know, it gives me a unique position to kind of help keep the project moving along. But then, you know, if you've got some teams that don't necessarily get along the best, it's a, it's a good mediator to, to help everyone have pieces, these big projects move forward, what 

John Kunyszh (00:59:26): 

Sales op in clinical don't get along. 

Andrew French (00:59:29): 

<Laugh> 

Erin Vallier (00:59:33): 

Shocker. That was excellent advice that you guys provided. And for the listener, it sounds like you need someone, an objective eyeball on the project to help you do a very thorough needs analysis and also, and analyze all of your processes because those things are going to change. And then you need to be very selective and intentional about when and where you implement this, be a phased or pilot. I think that's, that's kind of what I got in a nutshell and appreciate, appreciate you sharing. And before we drop off if somebody wants to get more information about Intrepid USA or get it analytics, how can they 

John Kunyszh (01:00:15): 

Www Intrepid usa.com? And we'd, we'd welcome an outreach and, and certainly they can click on the links and reach out to us that way we're happy to help. And, and if they're ever want any advice on different things we've experienced, we'll, we'll share the avoiding fatal mistakes discussion on a confidential basis with any of the senior leadership that wanna call from there. But thank you, Aaron, and a pleasure be on the podcast. 

Andrew French (01:00:42): 

Absolutely. And get it analytics too for the website. And, you know, if there's a link or something, we can publish that afterward, you know, to John's point as well. I'm happy to have a, you know, a quick call with anyone on the key pointers or, you know, if you're somewhere along in an evaluation process and just wanna pulse check on things, always happy to do that. 

Erin Vallier (01:01:01): 

Wonderful. Well, guys, it was excellent to talk to you today.

John Kunyszh (01:01:06): 

Our pleasure. Thank you. 

Andrew French (01:01:07): 

Have a great day, thank you so much, Erin. Appreciate it. 

Erin Vallier (01:01:11): 

Absolutely.