Jaewon Ryu: The Power of Integrated Care

Harlan Krumholz: Welcome to Health & Veritas. I’m Harlan Krumholz.‌

Howard Forman: And I’m Howie Forman. We’re physicians and professors at Yale University. We’re trying to get closer to the truth about health and healthcare. Harlan is joining us remotely today while he attends a meeting at the White House, but I still got to ask him about what’s on his mind.‌

Harlan Krumholz: Howie, this week, I thought I would talk a little bit about a meeting I’ve been at. There’s so many big meetings in medicine and cardiology and research. This is kind of a gem of a meeting that occurs usually in December, it’s the 21st year it’s occurred, that brings together really the world of cardiovascular clinical trialists. It’s researchers, patients, regulators, clinicians. People are thinking about how to generate evidence in cardiology, how to use the best possible approaches and how can we improve? This year, I don’t know, about maybe a thousand people got together in D.C., and we’ve had a series of really fascinating sessions, and I thought I would share with you some of the key takeaways that I’ve had from this meeting.‌

First of all, there’s a lot of areas where really great progress is being made. I see this at some of the bigger meetings, I see this in articles being published, but in this meeting, we’re talking about how the evidence is being generated and the speed with which it’s being generated, and you can just see the impact that it’s going to make. So in areas like amyloid heart disease, hypertrophic cardiomyopathy, pulmonary hypertension, pediatric heart disease, you’re seeing areas where literally people had a death sentence before. Once you had some of these diagnoses like advanced pulmonary hypertension, there was very little that we could do. And now with the life sciences revolution, with the evidence that’s being generated, you can see a day where people get these diagnoses and they’re able to be treated in very effective ways and are able to live their lives in ways that would have been unimaginable before. They’re able to live, I hate to use this word normal, but they’re able to live normal lives in the sense that the disease doesn’t dominate their prognosis and really they don’t have a very limited time left after the diagnosis.‌

This is just a wonderful, wonderful turnaround, and it’s something that we should celebrate. Juxtaposed to that, though, continues to be my concerns that as we make these breakthroughs, will the drugs be accessible to everyone? There’s going to be a push for more diagnosis, earlier diagnosis. And as we do this, are we going to be able to give people the hope because, not because there’s not a drug, but because they’re actually able to get it and it doesn’t force them into bankruptcy and all these kinds of things. So anyway, the first thing is to celebrate progress. There’s been tremendous progress.‌

The second thing is that there’s a lot of innovation going on in this space. There’s a recognition that this kind of research, where we really are testing in the most rigorous ways whether a new drug or a new approach or a new strategy is better than an old strategy, has been too slow, too expensive. In fact, there have been many promising approaches, let’s say drugs, that haven’t been able to be tested because people weren’t confident enough about the drugs and the approach was going to be too expensive. The trial was going to cost too much, it’s going to take too long. So things sat on the shelf, even though they may have been effective, because no one had the resources or the will to really test them.‌

And people are employing a variety of new strategies all based on the digital transformation, the idea that so much data in medicine now is digital. And with the AI revolution on top of it, we’re seeing a whole lot of new approaches to being able to create efficiencies. One in particular I saw, Jon Cunningham, a researcher at the Brigham in Boston, presented an example where they had automated the adjudication of clinical trial information.‌

So what’s “adjudication”? So when we have people in a trial and something happens to someone, we pull together all the records and usually two clinicians will review the charts and determine what actually happened. Did they have a heart attack in this hospital? Did they have heart failure? These are the end points of the trials, and it’s been very important to take a lot of time, a lot of effort, expensive approach to be able to determine who has these end points in the trials.‌

Now, with AI, we can sift through the medical record and very rapidly make determinations about what happened to people. And what he showed was that the AI can very closely approximate what this expensive, slow, difficult system that we’ve had for forever and almost for no money. The marginal cost is so low. And it was a great innovation, but we’re seeing in lots of different areas, and I think that we’ll continue to see the cost of generating evidence go down. And that’s going to be a boon to be able to test a wide variety of strategies that maybe were beyond our reach before because you could only pick a few if these studies were going to be so expensive. And I think it’ll also fuel innovation and new discovery.‌

The third thing is global. The third thing is global. I’m seeing now more and more emphasis on clinical trials in the clinical trial community, the research community really holding hands across the world. How are we going to tap into Asia, Africa, South America, in addition to Europe and the United States, Australia, and New Zealand? It is a worldwide endeavor. And again, this may be a way to crack the need to be able to move faster because if we leverage the people worldwide who are suffering from these conditions and we implement strategies where we can bring diversity of patients into the trials, we will be able to learn faster and be able to generate evidence that’s more applicable to people all around the world. So this is another takeaway from the meeting that I see a very strong trend, a very big movement.‌

So again, I’m here humbled by the breakthroughs in advances, excited by what we’re going to be able to offer patients. I’m excited for the innovation that’s occurring in evidence generation. We’re going to be able to generate evidence faster and cheaper, better, and it’s going to unlock a lot of the value that’s being produced within the life sciences that needs to find its way all the way to the bedside.‌

And finally, the global nature is really coming to the fore, and I think in the next decade we’re going to see more and more innovation that’s global, worldwide, with people being enrolled in these trials from all around the world, more generalizable information, we are going to learn more rapidly as a community together. So these are things, really enjoy this meeting, really got to see a lot of colleagues, friends. But things are moving, and I just wanted to share that excitement with everyone.‌

Howard Forman: I’m going to conduct the interview myself today in the absence of Harlan, but he will be back next week, as I said. And now on to our guest.‌

Dr. Jaewon Ryu is the CEO of Risant Health, a nonprofit organization created by Kaiser Permanente to expand and accelerate the adoption and success of value-based care. Previously, he was the president and CEO of Geisinger, an integrated health system in Pennsylvania. An ER physician by training, Dr. Ryu’s career has spanned payers, providers, and government, including leadership roles at Humana, the Centers for Medicare and Medicaid Services, and the U.S. Department of Veterans Affairs. He has shaped health policy during his tenure on the Medicare Payments Advisory Commission, or MedPAC, and has additionally served on the boards of the National Committee for Quality Assurance, or NCQA, and the Commonwealth Fund.‌

Dr. Ryu got start at Yale, where he received his BA in history before moving on to get his MD and JD from the University of Chicago. So first, I want to welcome you back to Yale. I will say for our listeners that you spoke to my undergrads in late 2019 as part of your return to Yale tour, and we thought you were going to have two more visits that year because we had them already scheduled and then COVID interrupted that. But you have since been back several times, and we’re really fortunate to have you as an alum and as someone who contributes to our students in a lot of ways.‌

But I want to start off because I think in the Northeast, too few people understand what an integrated delivery health system is. They may have heard of Kaiser. They may even have heard of Geisinger. They don’t know enough about it. Can you give us a little background on Geisinger on what they do and why they’re special?‌

Jaewon Ryu: Sure thing, and it’s great to be here. Thanks for having me, Howie. I think there are different places on the continuum of how integrated a system can be, and maybe I should put air quotes around that. I think some integrated systems would be integrated because they have the hospital as well as the physician groups kind of all together under a single organization. Some take it to the next level and also integrate the health plan side of things, so the health insurance component. And even within that world, there are different ways that you can integrate the care, i.e., the hospitals, the clinics, and so forth, and the coverage, i.e., the health insurance product.‌

In the case of Geisinger, we do it in sort of a hybrid way, and some people would call it a pluralistic way, where half of what we do is fully integrated where it’s our own health plan, our own delivery system, so facilities, hospitals, and so forth, and our own physicians and care teams. But the other half of what we do is still partnering with other health plans, the multi-payer, and having different kinds of payment models. So it’s not entirely where you’re bearing risk for the population. We may even have some fee-for-service payments sort of more typically found throughout the industry. So there’s more pluralism, heterogeneity maybe in terms of how our operating model works.‌

And then if you flipped it around and look through the lens of our health insurance plan, we also continue to partner, we at Geisinger, with numerous other delivery systems and numerous other provider entities. And that’s a key part of how we’re able to continue to expand these services through multiple communities and geographies.‌

Howard Forman: And speaking of geographies, can you give our listeners a sense of what geography you cover in mostly, I think Pennsylvania, but as far as it goes?‌

Jaewon Ryu: Yeah, so Geisinger covers central and northeastern Pennsylvania. It sort of follows roughly along two interstates. For those that have traveled through our area, it sort of follows along roughly I-80 and I-81, which is what we call our northeast. And then getting to your earlier question about Kaiser Permanente, who is the organization that launched Risant, Kaiser’s the largest nonprofit health system in the country, and it runs both insurance and care delivery. I think the difference is it sits on a different point on that spectrum where typically, the Kaiser members get their care inside the Kaiser delivery system and with Permanente physicians, and then typically those that they see as patients have Kaiser Permanente health insurance. So that model is where you could say that the integration of the care and coverage is tighter in that space.‌

Howard Forman: And I do want to get to Risant, because obviously that’s where you’re at right now and I have a lot of questions about that, but I’m very curious to hear your take on just a couple of quick wins that you could talk about at Kaiser or Geisinger that can give our listeners an understanding of why an integrated delivery system can be better. What is it? What’s the secret sauce? How does it work?‌

Jaewon Ryu: Yeah, I think the best examples and the closest ones that I’ve been a part of are probably from Geisinger. Kaiser’s got tons of examples as well, I’m just less familiar with those.‌

But when you have the payment arm and the delivery arm working tightly together, whether it’s your own insurance company or nowadays, working in close partnership with other health insurance companies, you’re just freed up to deliver care in the model that makes the most sense for people. So certain things may not be billable through a traditional lens of fee-for-service transactional kind of dynamics, but they may be instrumental to how a person achieves their best health.‌

I’ll give you an example. Food and having really aggressive dietary support, nutrition counseling, cooking lessons, maybe free access to fresh produce and lean meats for those who are food-insecure, that’s a tremendous way to help somebody manage their diabetes, who otherwise, in the absence of those kind of services, may struggle with getting their diabetes under control.‌

At Geisinger, we launched a program called the Fresh Food Farmacy a handful of years ago to address exactly that. And as a result of that, we were able to find that people who participated in the program, their hemoglobin A1C, which is a measure of how well their blood sugar is controlled, that dropped on average by two points versus when we optimize somebody on their medications for diabetes—the average drop we typically see is only one point. So truly, an example of how food can be just as impactful and arguably even more impactful than medicine in controlling or managing a chronic disease like diabetes.‌

The reason why the value-based or the fully integrated space is a lot more convenient to do that is because in a fee-for-service payment methodology, there’s no way that you can get reimbursed for nutrition and cooking counseling and fresh produce, lean meats. These are not things that are billable events, and yet they’re tremendously impactful for health. So that’s one example.‌

Another example is, we introduced different flavors around primary care. So we know that one size doesn’t fit all in primary care. And at Geisinger, we’ve launched a senior-focused primary care model that, as the name would suggest, really targeted around folks 65 and older. Recognizing that those folks typically walk in with more chronic comorbidities, requires longer time. And we took the patient panels on average, which you would normally find for a primary care physician to be 2,000 or more patients per panel, in that model we have only 450 patients per panel. So it means more time with the care team, more time with the physician, easier, more seamless access to get into the clinics and get referred to the places that you may need to be seen.‌

Another great example, those longer, higher-touch models, those aren’t necessarily payable or reimbursable in a traditional fee-for-service world. But when you’re partnering with a health plan or when you have your own health plan, which, of course, you’re partnering with, that integrated space, the collaborative space creates opportunities for care models like that.‌

Howard Forman: And culturally, are you finding it at all difficult to bring physicians who have not been trained in the Geisinger model to be able to work within a system that really is very different than our traditional volume-based fee-for-service system?‌

Jaewon Ryu: I think there’s always, you want to bring the tools to physicians and to other members of the care team to make it as easy as possible to do the right thing. So we frequently talk about, “Let’s make the right thing to do the easy thing to do.” And if we’re doing that, then I think the decisions around the care plan and where a patient needs to navigate, I think those things sort of fall into place.‌

We’re big fans of care protocols or sort of care pathways, as we like to call them. Reduces unwarranted variations in care and also provide some information and decision support at the fingertips to try to guide teams to guide patients to those best places and best care plans.‌

So I think when we focus on those things, I think the cultural dynamics have been less of an issue simply because I think generally, physicians want do the right thing. And they want to do the thing that’s most intuitive and the thing that is easy for them to do. So focusing on those aspects I think makes the culture lock into place more seamlessly.‌

Howard Forman: So after several years of running Geisinger itself, you’ve transitioned into this new entity that Kaiser created that has Geisinger under it, which is to sort of democratize more value-based care, at least—my words, not yours. I’ll let you explain that more. I wonder if you could say a word about what the mission of Risant Health is and then maybe quickly explain the acquisition of Cone Health because I think that’s your first big non-Geisinger acquisition.‌

Jaewon Ryu: Yeah, so the mission of Risant is to bring value-based care to more populations across the country. And the way to do that, the way that we’re trying to do that is to create a suite of capabilities, have a platform that brings scale, expertise, and know-how, but really intended to be bidirectional. So we want to be a learning, iterative organism that continues to improve on the value-based platform that we’re bringing to life.‌

And by doing that and bringing together like-minded systems that are already on the journey and have identified their North Star as being this care model that truly is more value-based, it’s more upstream and prevention-oriented than downstream, we’re bringing those tools to make that pathway easier for them. And when we do that, we know that communities do better, people do better, and systems can really hit on their goal or accelerate their goal to hit that value-based platform North Star.‌

So it’s a big part of what we’ve been focused on since Geisinger became the inaugural member of Risant Health. Cone, as you alluded to, is the system that just came in about a week and a half ago, cleared regulatory approval. Also has been deeply at work for many, many years around making sure that they create an equitable, outcomes-oriented, clinically focused set of capabilities and a delivery system that yields greater value.‌

Some people have asked, what does value-based care exactly mean? What we typically think about is, if you look across the American healthcare industry, it tends to be the center of gravity sits very downstream. It tends to be facilities-centric, it tends be oriented around ERs and hospitals. And we think that there’s a better way for folks that need to be in those environments because their sickness is that acute, it’s that severe, we got to make that the best care possible and we need to bring those capabilities into those spaces.‌

But when we know that there are ways to get ahead of certain diseases—diabetes, great example—but also deliver care in certain settings so that the care needs don’t progress to necessitate those downstream environments, and when we’re systematically following best practice to focus on those preventive aspects, we know that populations and communities can do better. If you look at the Kaiser data risk of premature death from cardiovascular events: 20 to 30% less. Risk of complications related to diabetes: significantly less. So it gives you a sense of whether it’s earlier diagnosis of cancers, whether it’s preventing cancer altogether, whether it’s getting people in faster to manage diseases when they do arise, whether it’s systematizing things even when they land in the hospital, these are all things that we know yield better outcomes.‌

Howard Forman: Kaiser famously starts off as like the epitome of the employer-based plan because it was created for Kaiser Steel or Kaiser Aluminum, I forget what it was, but it was created for a company. I’m wondering, Geisinger I think has a different history than that. And I’m wondering, number one, your patient population is not necessarily a wealthy population. Can you say a little bit about how that benefits your learning about delivering value-based care?‌

Jaewon Ryu: I think you hit on a great point, Howie. Healthcare and the people that you serve, it’s always inherently local. It’s unique to each community. In some areas of the country, that may mean a population that is tech-heavy, savvy with tech tools, savvy with data, sort of consumer digitally oriented. Those are communities that look very different than communities that may be heavily rural. You alluded to some of the areas that Geisinger serves, vulnerable populations either because they’re rural, either because they’re poorer, maybe they’re older, maybe they’re sicker. Sometimes populations are more vulnerable because of the color of their skin. We know we have all of these things going on throughout the country.‌

But when you could systematize a care model and a care approach to focus, regardless of who you’re treating, regardless of community, on the things that are evidence-based, best practice, getting care as upstream as possible, getting ahead of disease processes, we know that everybody benefits from a care model like that, and that’s what’s so unique but also so special about and what we’re building at Risant and why we’re all so excited.‌

Howard Forman: When you look at how you will judge yourself at Risant five years hence, is it going to be by having more and more systems following the Geisinger way? Will it be because Geisinger has adopted more other systems approaches? You mentioned bidirectionality before. Can you speak to how a continuously learning health system can benefit from this approach?‌

Jaewon Ryu: Yeah, what I’ve noticed and I think what we’ve all noticed is that each system has so much great work and a rich history and culture behind it. And typically, there’s something that they’ve figured out how to do that’s worth propagating across the board.‌

So part of being a part of something bigger, part of the value proposition of being a part of a bigger enterprise is that there are more colleagues to learn from. So we want to create that as a culture, and we want systems that embrace that and frankly get excited about comparing notes and seeing if there are better mousetraps that have been built elsewhere, and rapidly adopting and propagating those better mousetraps. So that is a big part of the value-based platform that we’re building at Risant, is to be the channel or the conduit through which all those best practices can be corralled together, all with the purpose of figuring out how to take care of populations better.‌

I think the other aspect here, our goal, and we’ve been pretty deliberate about thinking about if you look at the next five years, we’d love to have five to six systems coming into Risant Health that are all like-minded, nonprofit, mission-aligned, want to deliver value-based care as their North Star. They’ve got to be relevant and meaningful in the communities in which they operate, and they have to have strong set of financials as well, because this work is not easy, it’s tough work. But for those who are inclined in that way, we know that we can bring some capabilities that accelerate their journey, and we know we can make a big outcome on those communities.‌

Howard Forman: Can you just briefly speak to the Medicare, the Medicaid populations? I know that Kaiser has a presence in both those markets, particularly Medicare Advantage. I’m wondering, does Geisinger and does Cone? And how do you think about that in the context of a larger system?‌

Jaewon Ryu: Yeah. I think all three organizations, and probably not unique to them, this is true of just about every community, you’re going to have people coming in through traditional Medicare, Medicare Advantage, commercially insured, Medicaid populations, even some who don’t carry insurance at all. I think that’s your typical composition of the patients that you would see. And Geisinger and Cone are no different. So, fully embraced and immersed into all of those programs. And as a result, it really does require that as you think about how you want to deliver care to meet the needs of those different segments of the population, that you develop programs and take them to meet people where they are, whether that’s in the home, in the workplace, out in the communities, trying to create access points that are further upstream, whether it’s clinics, primary care, et cetera, nowadays, even programs in the home, so that it makes it easier for them to attain their best health and access the kinds of services they need to do just that.‌

Howard Forman: I’d be remiss in talking to you in particular to not talk about your history and how you got to where you are right now. And I know a lot about what your path is like, but I’d love for you to tell our listeners about what did young Jaewon Ryu think in 1991, upon arriving at Yale, about what he was going to do with the world and how you made these small and sometimes large pivots along the way to being someone who really has had an extraordinary career? I didn’t even mention the fact that you were a White House fellow and just so many amazing experiences. Can you tell us a little about what that path was like?‌

Jaewon Ryu: Yeah, you and I have talked about this quite a bit, but it just reinforces that sometimes your best-laid plans, life just has a way of taking you in different directions. I entered college thinking I was going to be a science major, I was a STEM guy. But quickly realized that while I did like the science and math areas, I really liked some of the humanities courses that I took and ultimately became a history major as a result. But also some of the things I got involved with over the years on campus and even the year that I took after I graduated, it sort of got into the community, got into kids enrichment programs, for lack of a better term.‌

So ultimately, I ended up taking a gap year and working in an AmeriCorps program in New Haven called I Have A Dream. And it was sort of teacher’s assistant by day, social worker by night. Got fully immersed in the community and all of its challenges, frankly. And none of this had much to do with health. It was in all these other areas, education policy, urban policy. At the time, there were different social service programs that were in varying states of evolution, and I saw the impact of that. And I think it left an indelible mark, especially for a sheltered suburban kid like me, and ultimately really became interested in policy.‌

And I carried that interest with me into medical school after the gap year. And that, over time, evolved into an interest in urban policy and health policy. And one thing led to another, it landed me in a joint degree program at a time when I think joint degree programs were becoming more popular because of this recognition that healthcare and the practice of medicine was impacted by so many things beyond just what you would think of as clinical medicine.‌

So that’s how the snowballing started to happen. And it’s also why I selected emergency medicine as a specialty because I felt like it was Grand Central Station of all of the social dynamics of healthcare. And I think it’s a marvelous place where you see all comers regardless of, to your point earlier, are they commercially insured, Medicare, Medicaid, uninsured, you got them all, and you have all walks of society in beds right next to one another. And there’s something really cool about that.‌

Howard Forman: I agree.‌

Jaewon Ryu: And I loved every minute of it. But ultimately, that interest in policy then took me into some non-clinical paths, whether it was in government, and that eventually led to sort of system administration, health plan dynamics, and that’s what landed me at Geisinger. It’s a system that does do all of those things. And then, of course, Risant is even more so, I would say, bringing systems like that together.‌

Howard Forman: Well, I want to thank you so much. I didn’t even get to talk about your bike ride from San Francisco to Washington, D.C., and there’s so much more we could have hit on, but I really appreciate you joining us. I said at the beginning, you have sponsored a student, typically an MD/MBA student at Geisinger from many of the last five or six years, and we so appreciate it. It’s had such a huge impact on every one of them. And I know that you’ll continue to have an impact, both large and small, in healthcare, and we appreciate you.‌

Jaewon Ryu: Thanks so much, Howie. It’s always good catching up with you.‌

Howard Forman: Thank you.‌

Harlan Krumholz: See, Howie, that was a great interview. I was glad to listen to it. Sorry I couldn’t be there with you, but now I’d like to hear your part. What’s on your mind this week?‌

Howard Forman: Yeah, so I want to just talk about the big event of this past week that’s been in the news far and wide. On December 4th, Brian Thompson, the CEO of UnitedHealth’s largest subsidiary was murdered at dawn in front of the hotel where his company’s annual meeting was about to commence. The murderer had meticulously planned this attack, having arrived in New York over a week before and then escaped, being caught in Altoona, Pennsylvania, when someone recognized him from the many images that had been captured on video cameras. Even at the time of this taping, it’s unclear what were the full circumstances that led this well-educated, upper-class technophile and Unabomber admirer to have attacked this man. But there does seem to be a thread of anti-capitalism and anti-healthcare industry running through his social media posts. Also worth pointing out that mental illness may well be a feature here, but that’s based on only a few items that have been publicly expressed.‌

Today, I want to talk about the numerous, and I mean numerous individuals who were celebrating this murder or otherwise expressing a lack of compassion because Brian Thompson was working for a very profitable healthcare company that has also engaged in actions that have aggrieved many. Listeners of our podcast know that I have, on many occasions, called out the bad behaviors, real or perceived, of most of the major health plans—Cigna, Humana, UnitedHealth, Aetna, Elevance, to name just a few. We’ve also hosted executives of some of these firms. I have personally ranted about my own bad experiences with CVS Aetna on more than one occasion. Even if it is a minority of the population, there is quite a lot of opprobrium for health plans right now. The idea that they deny and delay care on occasion was highlighted by the murderer by inscribing his bullets with those words. And the fact that these firms are enormously profitable right now makes it all the more challenging to defend many of their actions, which include poor service.‌

But we should make no mistake, our lack of an organized health system in the United States has demanded these firms. We had traditional indemnity insurance, in other words, where denials were essentially nonexistent for decades before HMOs—health maintenance organizations—and other forms of managed care arrived in big numbers. Employers purchase health insurance for their workforce. Medicare beneficiaries increasingly choose them as an alternative to government-run fee-for-service. About 60% of new beneficiaries actively choose the private health plans over government-run Medicare. And the majority of states choose them to run their Medicaid programs.‌

For the majority of people served by these plans, the choice is an active one made by your employer or yourself. Why? Because they hold costs down compared with the alternative. They do this through buying power, they do this through strictly managing who gets care and when and where, and they do this through making hard decisions, sometimes wrongly. They are supply-side controllers as opposed to high-deductible, high-cost-sharing plans where demand-side control is emphasized.‌

Of course, for too many people, there are both demand-side and supply-side constraints. As Harlan has rightly pointed out on numerous occasions, there is financial toxicity for too many. But we also have painful back and forth between often sick individuals and health plans about what they believe is necessary care. And this lack of agency for those in pain or threatened with death is beyond demoralizing. It does not surprise me that many individuals are angry.‌

UnitedHealth is the ninth-largest company in the country by revenue, it’s the 41st largest company by profit. It’s arguably the biggest healthcare company and not totally surprising that they get and perhaps deserve more criticism. There are a lot of companies and individuals in this country that are in the uppermost echelons of income and could be accused of profiting off of disease or despair. Think of social media companies, violent game manufacturers, and beyond. And every segment of the healthcare industry has, at one point or another, been accused of being too profitable. But there is never an excuse for murder. While it is easy to plead for our humanity, we also need to take a hard look to many contributing factors to our health system’s failure and be willing to address all of them. As Pogo, the fictional character, once said, “We have met the enemy and he is us.”‌

Harlan Krumholz: You’ve been listening to Health & Veritas with Harlan Krumholz and Howie Forman.‌

Howard Forman: So how did we do? To give us your feedback or to keep the conversation going, email us at health.veritas@yale.edu or follow us on LinkedIn, Threads, Twitter, or more likely now Bluesky.‌

Harlan Krumholz: So like always, we really look forward to your feedback. Send us comments, rate us, helps people find us, and we always appreciate it and sometimes we bring it into the show.‌

Howard Forman: If you have questions about the MBA for Executives program at the Yale School of Management, reach out via email for more information or check out our website at som.yale.edu/emba.‌

Harlan Krumholz: We’d like to thank our sponsors, the Yale School of Public Health, the Yale School of Management. I always like to thank my co-host, Howie. It’s always a pleasure to do this with you. Sorry, today’s podcast was a little bit disjointed because we aren’t together, but I’m really glad that we found some way that we can be on the program through the miracle of Miranda Shafer. We’re always grateful for Miranda, our producer, Inès Gilles, Sophia Stumpf, Tobias Liu, our students who help and support us in such important ways. It’s so great to work with them.‌

Howard Forman: Couldn’t agree more with you, Harlan, and looking forward to having you back next week.‌

Harlan Krumholz: Thanks so much and talk to you soon, Howie.‌

Howard Forman: Thanks Harlan. Talk to you soon.‌