What do Civil War history and modern healthcare have in common? More than you’d think. In this episode of The Disrupted Podcast, Jamie Preston and Chief Visionary Officer Scott Middleton draw unexpected parallels between the burning of Columbia and today’s healthcare system—both fueled by mismanagement and wasted resources. Scott shares his firsthand experience in Florida’s healthcare landscape and explains why South Carolina’s approach, particularly through Your Health, is leading the way in caring for chronically ill patients. We jump into social determinants of health, value-based care, and how small changes—like making sure a patient eats their meals—can prevent costly hospital visits. It’s a conversation about history, healthcare, and what needs to change if we want to stop setting money on fire. 🔊 Key Topics Discussed: • The surprising history of the burning of Columbia • How social determinants of health are shaping the future of care • Why primary care—not hospitals—should be the backbone of healthcare • The economics behind keeping patients out of the ER • Why major insurers don’t want more primary care providers (and why that’s a problem) If you’re ready to rethink everything you know about healthcare, this episode is for you. 📌 Don’t forget to subscribe! Let’s keep disrupting the system—one conversation at a time.
www.experiencinghealthcare.com
Welcome to the disrupted podcast. My name is Jamie, and we're here with our chief visionary officer, Scott Middleton, who's he's been in the Sunshine State of Florida, and now he's back in South Carolina, and it's freezing. So Scott, how are you doing? How are you holding up?
Oh, you know, the transformation to this cold weather. Oh, it's terrible. And then, of course, we had all kinds of crazy stuff, yeah, going on this weekend. The winds got up. It was like you would thought we had March winds that were coming through. But I gotta tell a little story that I think people will be interested in. So today is the anniversary of the burning of Columbia. And so in 1865 on February 17, Sherman's troops were getting ready to come across the river the Gervais Street Bridge, if people are familiar with that. And so the citizens of Columbia and I guess the Confederate Army burned the bridge, the Gervais Street Bridge. So Sherman had to figure out how to get around. So while they did that, they went through and they pulled cotton bales out all the all along Main Street in Columbia, and put them out in the middle of the street, and the streets pretty wide there, and they set them on fire. And they did that so that the smoke would rise up and that they thought Sherman would see it and say, oh gosh, another group must have already got there. They're burning Columbia. We can head toward Augusta, and we don't have to come through here. So actually, they made the event up to August so they were cutting they were going on through the below country. So so he was thinking they would just divert and move on. Well, they didn't. They eventually got across. But what happened is our the the winds got up just like they did yesterday. I don't know if you were out yesterday.
It was windy yesterday. Up even up here in Greenville,
we had two pine trees that fell in our yard out the lake, and it was just crazy. So that wind was whipping. So what happened when they set all those bales of cotton on fire out there in Main Street? The wind picked up, and it caught all the buildings on fire, wow. And the bad part was, is that they were also trying to drink all the alcohol in town before the troops got here, and so everybody was drunk and they couldn't put the fire out.
Oh, my God, I've never heard this history before that is a That's fascinating.
And so all the buildings on Main Street, which was originally called Richland street that heads into the state house, all of those buildings burned to the ground, except for one, and that one is the current location for smoked, which is one of our restaurants. Wow, in that location,
and the name's fitting, it
was yes, because it was the only it was probably full of smoke, but it was burned. It wasn't burned. Crazy, craziness. Wow,
yeah. So then we rebuilt, yeah, that's fascinating.
Building. Those buildings back. So we own about three buildings on Main Street that were built in the year 1865 and finished in 1866 and when was the fire? Couple other buildings. This was the Revolutionary War. Fire. Yeah, Okay,
gotcha Wow. Today's 160
years. Do you think anybody in Colombia is saying anything about this? Nope, nope, you know, because it's also Presidents Day, and everybody's worried more about their vacation day.
Well, we're working Scott So yeah, on Presidents Day, and, and there's, there's a lot to be done, especially in healthcare. Now today, you know something that's been really heavy on your radar, or, you know, a lot of our teams radar, and that is social determinants of health, and why these things are so important, how they relate to value based care? Let's talk a little bit about that and why it matters, why it's so important that, you know, our providers, our care teams, everybody is on board with these things, because they really do make a difference when, especially in value based care.
Absolutely So, as we know, in the United States, we have been we spend more per capita for for individuals on health care that anywhere in the country, but we don't have the outcomes, and I think I've shared on this call before where, you know, we have, we have patients out there that are chronically ill, and we just didn't have any reimbursement to really take care of those patients. So you know, you have a patient out there that doesn't understand how to take their medicine, maybe isn't capable of taking their medication. They can go to the doctor every single day, and the doctor can see them, but if they're not able to do what the doctor's orders are, then it's not going to help that patient. Sure, and we're wasting our time, you know, with a lot of the services. So. While the in the United States, we have the, you know, if you if you have a major disease, then we probably have the best solutions in the world. So people do come from all over the world to the United States, because we have some really great health care, but what we don't do is take care of the chronically ill patients, and so those folks just keep going to the hospital over and over spending money. And as I've been in Florida for the last few weeks, I will say this South Carolina healthcare, it's so much better than any than it is in Florida or in Georgia, only because of your health and what we do for the chronically ill people out there, because we're sending people into the homes to help take care of them, and that's really the ultimate goal. Is, how do you make sure, on a daily basis, your patients are doing what they need and taking care of themselves, or we're helping to take care of them? So this past year, and we've talked about this several times before, the CMS introduced last January a program called Community Health Initiative, and that was to look at, how do we take care of people that have what they call a social determinant of health. So social determinants of health are things that are going on with this individual that would cause them not to be able to to be able to get healthy. So it could be, for example, transportation. You know, if an older person can't get to and from a doctor, then they are not going to be able to get their care, because most doctors aren't doing a lot of things.
Oh, I lost you, Scott.
So, so patients who can't get to their doctor's appointments are definitely going to be a real issue because they're they're not and follow up, you know, the the doctor being given their prescription. So I
keep losing you. There must be in a dead spot. I
don't know if you can hear me.
All right, so I was going downtown again. So let's get back. Yeah, so I'm back. Social Determinants of Health are anything that?
Oh, I lost you. As soon as you started talking again, there.
Hold on a second, let me I'm pulling into a parking space. Let me make sure we're going to be good before I start back. Yeah,
we're strong there. Okay,
well, then we're not going to move. I'm just going to say right here in the car. So a social determinant health would be any social issues that you have that are related to you not being able to to either get to a doctor for a proper diagnosis, or being able to get the labs or X rays, or it could also be a social determinant health could be based on on your inability, for example, to understand medication. So my classic example is, I'm going to take a patient of ours who has a PhD and and so PhD and two master's degrees, if you can imagine who that would be. But, you know, you take somebody who's highly intelligent, but maybe as that person has gotten older, they've been unable to really understand things about their own body, you know. So it doesn't matter how smart you are in a field. Do you really understand how your kidneys work, or how this medication affects something? I'm constantly going online and trying to discover anything I'm taking and what the impact is on my body, what the side effects are. Most people just don't know that. So social determinant health could be my inability to understand and comprehend and to follow the instructions of the physician. And I know I'll be the world's worst as I get older, because I'm going to be the one that doctor doesn't know anything, or I don't think that medicine works, or I'm not going to try that. Well, that's a social determinant of health. Socially, I'm not going to be able to follow the requirements for my physician. So we can actually get paid and reimbursed for doing things, but that will help people to be more compliant. And so the goal of the social determinants of health is look to see what those are. So there's 10 that will allow us to get reimbursed. I don't have those 10 memorized, although I probably should, but under each 10, there are subsections. So again, it could be transportation. There could be housing insecurities. So as an example, we had a provider who said, Oh, well, I don't have. Any social determinants help on any of my patients because they live in an assisted living or nursing home? Well, that's not true. So just because you live in a facility doesn't mean that they're making sure that you eat all your food, but if you don't eat all your food, you're not going to get healthy and well, right? If you're not taking now, they may make sure you're taking your medication, but are you taking other things that they don't know about, you know? And so those could be an issue. I was watching new TV show. It's Matlock, but it's not the old it's not the old Matlock, it's the mat lock. Yeah. So been watching that show, and they had a whole setting around a nursing home this past week where they obviously, none of the writers knew anything about a nursing home, because, one, it wasn't a nursing home, it was an assisted living facility, and and so they but they called it nursing home. They didn't they, they had a gentleman in there who died, who had a stroke, and he died, and they were trying to sue, quote, The nursing home, for a failure this. Well, actually, why he died was because he was taken Viagra. Nobody in the building knew he was taken Viagra, and so he ended up stroking out because he had other health issues that that didn't correspond to the Viagra, but his girlfriend was giving him the Viagra. So, you know that, or multiple girlfriends given in the diagram. So the thing is, is that's a social determinant of health? He isn't sure. So what are the things that we can do to help people overcome those, those so that they are more compliant and and again, this program that, that is the community health initiative to get people out there looking at the social determinants to help but all of our patients, for the most part, have a social determinant of health, and then we have to look at, well, what can we do to help them? So that's really what we're trying to piece together. As an example putting a CNA into an assisted living or a nursing home that works for us, the works for the doctor, and that's the real key to this. Medicare was smart in tying this to physicians. So instead of making this program and connecting it to a home health agency or to to a hospital system or anything, they tied it back to the primary care physician, but in order for you to be eligible for these services, you have to have a primary care physician. And that's our biggest issue, is most people don't have a primary care physician. They use some kind of urgent care or something. I had somebody came in the office today, and, you know, I'm really working to create a peds program through your health, right? We're starting with, you know, getting, making sure that we have people who can take care of our employees children, right? And so somebody said, Well, Scott, you know, there's a website. It's, I forgot what the thing is, called Blue Bird, or something like that. And you can go with blue bird, and they'll, they have an online pediatrician. You can call them, pay $15 a month, and you can call them as many times as you want, and you can talk to a pediatrician. And I said, Sure, but what can they do for you? And and they said, Well, you know, like you had ear infection. And I said, right. So that you could look you, they'll send you a little thing you could look in the ear so it records it and sends a link to them. And I said, but here's the thing, they can't write narcotics, so they can't do your Adderall or any other thing. They're not running labs either. You know, they have a few labs that they'll include, but this is really for my kid is sick today, and I need, I need a an order from the doctor so that my kid doesn't get dinged for going to school today. But again, we're creating this system of and young people are like this. They never go to a doctor, they only go to an urgent care. Nobody has their records, nobody's looking at running their labs, and so over time, I'm telling you, it will destroy people in their lives. Every person needs to have a primary care physician, and that physician needs to be supporting everything those patients needs and and so if you you the primary care physician has to be following up. They need to have nurses, they need to have medical assistance. They need to make sure you're getting your labs, they need to be proactive and and we need to stop waiting for people to come to us as doctors, and we need to go to them first. That's been the success of our program. Yeah. So last, last year, we saved Humana $25,000,000.20 $5 million that was just for Humana united. Traditional Medicare probably saved as much as much of that, and the way we did it is just by keeping people out of the hospital and getting those patients a higher quality of life. Yeah,
wow. And I don't think people realize Scott, you know, especially because when they think of a primary care office, they think of some nurses and. Doctors, maybe a phlebotomist, you know, we have a vast medical team that's there from case managers, you know, who, who aren't necessarily clinical but there it takes an entire group of people to do this, right,
right? So for our care groups, which average about 1000 patients plus or minus. We have 29 employees assigned to those 1000 patients. And what's crazy about it? You would think, wow, how can you afford to do that? And yet, we saved, you know, 100 million dollars last year to the Medicare system over what was the Medicare expected to pay out? So we saved the money by doing this and by providing the services. So what I want to talk to a little bit today is, what are the things that we can do because of a social determinant of the health? What are the things that would be helpful to people? And again, if you don't have a primary care physician, or if your primary care physician doesn't do this, here's an example. So I met with a nursing home group, and one of the one of the directors that was there, she is responsible for six nursing homes. So I met with her and some of her administrators, and my first question was, what is your primary care what is your physicians that come into your building do for your patients? Well, they come in, they write a bunch of prescriptions, hand them to the nursing home and say, hey, here, follow these orders. That's what they do. The doctor comes in, maybe once a week, sees a few patients, and then leaves, and then leaves all this list of stuff to do what our primary care physician practice does now is we walk into that skill, that nursing facility, and we'll have an RN in the building every single day. We'll have a nurse, a nurse practitioner in the building every day, and we'll have a a CNA, which we call community health worker who's in the building every day. So what are they going to do? Well, they're going to schedule appointments. They're also going to make sure that you have specialty appointments if you need those, and we can do a lot of that with telehealth. They're going to make sure your labs are done. But think about this. So we have a patient who just doesn't eat, and they got a wound, you know, they got a sore on their butt or something. It's never going to heal if they're not getting all of the nutritional value in, right? So one of the things our our CNA, can do is to make sure that Missus Smith gets to the dining room every day for her meal, and then she can watch how much food is eaten, and she can do an assessment, you know, so she can say, Hey, she ate 25% of what's on her plate, or she has eaten no vegetables in four days. So by that, the doctor now can come back and say, hey, hey, what's going on with this patient? You know well, but now we know she's not going to get better because she's not getting her protein intake. So the doctor can what can he do? The doctor can say, Now, hey, I'm going to go ahead and order insure, for example, you know, to give them a supplement, or there may be a medication that I need to give them to make them better, right? That same patient you know, could be out there and say, Okay, I'm also not eating like I should, you know, but they also don't have vital signs. So in assisted living, nursing homes, they don't go around every day and check vital signs, right? Just say, you know, right? So our nursing assistants can go through there and check the vital signs, maybe not every day, but two or three times a week. Then over the time, when the doctor goes to see the patient, they can pull it up and say, hey, well, your blood pressure has been averaging this. You know your your pulse ox is this, but also just by monitoring that, if we put it into our remote patient monitoring, they'll be able to trigger that a person might have an infection. So our number one reason for people going to the hospital is sepsis, which is an infection that could be we we could determine that there's an infection going on just by looking at the heart rates, the blood pressures and the weights, we can tell so many things that are going on with the patient. So now, because of this community health initiative, and because the social determinant of the health for the patient is they don't really understand what's going on. They're not taking their vital signs on a regular basis. They're also not eating regularly. I have a social determinant health of not understanding the health care that they need, also that person, maybe even though they have the food, they're not consuming it. And so now I can pay somebody to go and make sure that that's being done right? And and then, and put all the records in the doctor's records. Yeah, right,
yeah, absolutely, you know. And I think going back to what you were saying about assisted livings and not checking vitals and all these things are really important, and I think there's a big misconception, especially with assisted livings. That people think that they are medical facilities and they are not medical facilities. Matter of fact, the director of nursing, if they have one, isn't allowed to do anything medical in the building. Even though they might be an RN, they can't do that. It takes a primary care provider coming into the building to be able to do that in the building.
So we have a an employer right now, his grandmother's on our service, and the grandmother had a sore and what needed to have a dressing changed, I think three or four times a week. Well, home health wouldn't do that. They'll come out maybe once a week, but they're not going to come out or twice, but they they're not going to come out three or four times, and the dressing needed to get changed. And so they were trying to tell the that. They said, Well, anybody can change the dressing. And so they were showing the employee how to do it, but she doesn't live where her grandmother lives. That's great grandmother's husband is 90 years old. Do you think he's going to be able to change out a bandage and do what's right for this woman. No, but what could have happened with us is that now we could send a community health worker in that could help with that in the home, the nurse could go in one day, and the nurse practitioner could go in one day, so three times a week we could be there. Now what do we get paid for that? So when the community health worker goes in, let's say she's there 30 minutes. We're going to get paid about $46 for Medicare to do that. The nurse is going to go in, same thing, another $46 the provider goes in, she's probably going to bill $146 because she's going to make a medical decision. So we spent $200 a week. Let's say we do that for eight weeks. So we spent $1,600 is what Medicare paid for us to heal this person's wound. Yeah, but what it was called if she went to the emergency room? Yep, one time
minimum, just, if she just goes to the emergency room, maybe 15,000
Yeah? Well, probably no, I would say emergency room visit on average is probably in this country, 1500 to 2000 but then Right, right? They're going to admit her to the hospital because they're going to go, oh, well, she doesn't have anybody at home to fix this for her. So we're going to admit her in the hospital for three or four days, and boom, there's your 15,000 right? And whatever the hospital's incentive is to admit her, right? Because they're billing a fee for service. And so if they can admit her, they are going to that's the craziness of
all that. Yeah, and Scott are, do we have any value based care hospitals?
No, there's none. So the way value based hospitals are this, if you, if you hit a readmission rate too high, they can penalize you by taking up to 3% of your Medicare payments and and honestly, it's not enough to mess with. I mean, if you're billing, you know, there's a, there's a small hospital in the state that I was looking up recently. It's a not for profit and and their total revenue, like two years ago, was $250 million right? Yeah. So, so 3% of 250 million would be just over $6 million
yeah. Which is nothing, yeah, right. And,
and do they care about the readmissions? Well, I mean 6 million to 6 million, and they would like to have it, but what they'll do is manipulate it. So what the the Medicare regulations where you can't admit somebody from the same diagnosis and get paid
for it, right? So what do they do? Change the diagnosis under
another Yeah, change diagnosis. So we've got, you know, patient comes in, they have a lot of our patients have well over 12 diagnoses, and so you could admit them for any one of those, those other things. So again, they they figured out ways to get around it. And then the hospitals pat themselves on the back and say, Oh, look what a great person we are. I was, I was talking with a hospital, the chief data officer. I was at their conference last week, and I was talking to the chief data officer for a fairly large system. It was had four hospitals, multiple nursing homes and rehab centers and and we were talking about readmission rate. And he said, Yeah, readmission rate is only about seven or 8% and I said, Oh, that's interesting. I said, How many babies do you deliver? And he said, oh, a lot. And I said, okay, so every mama that gets admitted that has a baby discharges. That's two patients, right? Yep, most of the time women do not get readmitted back to the hospital. They go home and they're done. So if you're doing 100 babies a month, that's 200 people, that's skewing your readmission rate. And I said, but what's your readmission rate for the people 65 and older? He said, I don't know. We don't keep track of that.
That'd be a great stat.
I. Right? And, and hospitals don't do that, you know, and that's nothing that's on the radar for CMS to look at. So it was interesting, because we had hospitals there who were rolling in the dough. We had some like mayo clinic who was there, they they just had more money than God does. And and then we had other hospital systems that said, Hey, we're just barely making it. We're we may lose some of our hospitals out there because we just don't have the revenue. So what was the difference? Well, the difference is all based on the commercial number of commercial patients. So in South Carolina, we have heavy industry. Lot of people are moving here. In fact, we're rated number nine, is as the top place in the country to retire in which I thought was interesting. Number one was Tennessee only, because they don't have an income tax right? And then, and we were number nine. And so people are moving here, you know, as fairly rapidly and and we have a lot of industry. We have a lot of automotive industry and stuff. And so our commercial patients, our businesses, you know, they pay somewhere in the neighborhood of two to two and a half percent more than what Medicare reimburses us for the same services, right? So there's a real problem there, that the commercial industry is actually paying mostly for it. So the people that hospital systems that were doing good were in areas with a lot of strong business. And not miss, meaning Medicare, but when you go to Florida, their business is retirement, right, right? And their business is entertainment, with all the theme parks and the beaches and those kinds of things. And so those hospitals are really struggling if they don't have a good commercial base. And so the further you get down into Florida, the harder it's going to be to really get good get good health care with those hospital systems. But again, the goal for us and for your health is to keep people out of the hospital. Yeah? Because if we can keep them out and take care of them from where they're at, they'll be better off. Yeah, this Community Health Initiative, the set the social determinants of health, will determine whether we can provide those services. So that's the goal this this month, is for us to capture, you know, I put them as a goal today, to capture 1000 patients with social determinants of health, because if we don't have those captured on a claim, we won't be able to bill for those services, right? And so that's got to be the driving force for all of our providers. Does it mean any more money in our providers pocket, really? No. Does it mean any more money in my pocket? Probably not. Because, you know, if I send a person out to somebody's house and I get reimbursed $40 for that then and and I pay them, you know, $30 an hour, because that's what everybody seems to make in the world, right? So I'm paying them $30 an hour, plus they had to spend 15 minutes to get their 15 minutes back. And then by the time I take pay their benefits, I got nothing. I didn't make any money, but I also didn't lose any money, I actually did something great for a patient. I kept them out of the hospital, and then eventually the cost savings will bring us the the reimbursement, yeah, you know, for that,
right? It's important, yeah. So bringing, I want to, want to bring this podcast back full circle. You know, as you gave us a history lesson this morning, Scott about that those fires, if we don't take care of these chronic illnesses with our seniors, and they almost all have them, even on people that aren't seniors. Almost everybody has at least two chronic illnesses, whether that be anxiety, depression, you know, it could be a multitude of things, diabetes, etc, you know, if we don't take care of these things, and we don't take care of these social determinants of health, it's going to be, you know, a medical fire, you know, in our Country, and also in Florida and South Carolina, you know, it's going to be, it's like we're setting money on fire, because it's going to cost a fortune to deal with those things,
right? And you know? So what happens is people will, will, will think, I don't want to go, why should I go to the doctor? I'm going to go spend 100 bucks, and they're going to tell me what you know. And so we, we have a tendency to think in these shorter terms of, I don't want to spend a lot of money, but in reality, the the money will come down. We have patients all the time, or our family members are called saying, I can't believe I got a bill for $800 for the month, for for your health. Well, Medicare got the dollars. But here's the point, or Medicare paid the dollars, not you individually, and we kept your personnel the hospital, because if your mom had gone to the hospital, that would have been a $2,000 out of pocket expense for you one time, Medicare would have paid, yeah, and that Medicare would have been paying the 15 to eight. 18,000 and then, you know, once they get in the hospital, they go hog wild, right? Because there's even though the hospital gets paid a base flat fee for however long you're there for room and board. You can bill for everything else, every MRI, every test, every treatment, every medication, is all being billed out separately, you know, for that. And so it just becomes extremely expensive. You know, down the road for everybody,
it's not setting cotton on fire, but it's setting money on fire.
Yeah, but yeah. And, you know, the thing is, the hospitals are not value based, right? We The goal was to make value based a primary care function, you know, for folks, but you know, what's interesting, we go into Florida, we applied for Humana to be in network. We could bill out of network, but the bill in network means that the individuals don't have to pay a copay or deductible, right? And they said, Oh, we're not accepting new primary care physicians in Florida. How? How is that even legal, yeah, for a company like Humana or united to say we're not, we know that all the people down here don't have providers. We don't want them to have providers, right? Wow, it's the great but, but they'll build urgent care centers everywhere, and I think it's be it that's being driven by the hospitals. The hospitals want you to the urgent cares just to feed directly into send them to the hospital so we can fill up our beds and and, God knows, they're building hospitals galore. You know, I'm just, yeah, it's riding by the interstate on I 95 and hospitals being built. I know the hospital has to be close to a billion dollars in expensive billion, right? That they're going to build and and if this value based thing works out, and Medicare sticks to their guns with primary care, that building will be empty in 10 years. Yeah, there won't be any need for it.
Yeah, which? Which is the goal. I think that should be the goal, and that that would be amazing for people. Yeah, it's
just the waste of dollars in this country. So a billion dollars we spend on the hospital system that really doesn't even need, we don't need it. You know, if we had, if they had taken a billion dollars and hired a bunch of primary care physicians, they would have closed four more hospitals. Yeah, yeah. And, and people just Yeah, people just don't understand it. So it's a massive misuse of money. And I think that as we see the Trump administration bringing in Doge, they start to look at it, if they will, really, and I really do hope that that our leadership can see that I know that Robert Kennedy, while there's a lot of complaints about him and all the stuff about vaccines and that kind of stuff, but he does know is that we, and he's made it very clear, we have chronically ill patients that need to be cared for, a caregiver coming in once a week. You know, paid by Medicare for a weekly visit for four or five hours is enough to probably prevent $20,000 worth of hospitalization spent. I remember down in little town called Manning, South Carolina, there's a hospital down there. They have a they average six people a day in their hospital, or they used to and and I was down there, and they have a full staff, like their administrative staff, their CEO and and Chief Financial Officer and all these people. I mean, that's probably a million dollars a year worth of salary, you know, to take care of six people a day. So anyway, they were, they were saying that one of the their big issues is that they have a lot of drop and runs on the weekend. So families who were taking care of mom or dad at home, and then they want to go away for the weekend, so they just bring mom to the emergency room Friday morning. And and how we found out about it is like we call one of our patients one day and said, Hey, Miss Smith, we're going to run by and see your mama today. Just want to make sure you're here. Oh no, don't come today. And this was like on a Thursday. And she said, Well, why is that? And she said, Oh, I'm just taking her to the hospital tomorrow. We were like, for what? And and she said, well, she's had a little bit of a cold, and so I'm going to drop her off of the ER, because I'm going to be gone this weekend, and there's nobody to take care of her, and then I'll pick her up on Monday. Wow,
that's so crazy.
So money on fire, hospital,
family, the hospital found a reason to admit her that didn't, didn't, are treated? Yeah, wow, that's
crazy. Scott, thanks for educating us.
Yeah, thank you. Thank you so much. I'm excited about where we're headed. I think it's going to be great. We just need to, we need to roll out the program and and for your help, we've got to find the social determinants of health and, and I think we can make a big dent in a lot of the issues that are that are going on out there.
So Great Scott. Thanks so much. Thanks, Jamie. Have a good one. You too. Bye. Bye.