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Episode 94
Duration 30:46
Ted Long

Ted Long: A Model for Effective Primary 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. We’re excited to welcome Dr. Ted Long today. But first, we like to check in on current hot topics in health and healthcare. And Harlan, you’ve been a true leader in the development of evidence and understanding around long COVID. In fact, you brought us a long COVID patient as one of our first guests on Episode 12 back in December of 2021, that was Liza Fisher. And you just recently attended a long COVID conference and—our principal investigator, one of the largest trials. You want to give us an update on all of that? And I have a lot more questions to ask.

Harlan Krumholz: Well, you’re giving me way too much credit, I mean in part because the field still remains rather fledgling. I had the pleasure of attending what was called a keystone conference. Keystone is sort of a conference, usually bring together basic scientists, of which I’m not. But they had a conference. It’s a nonprofit group. Leaders, investigators, even patients from around the country came to New Mexico, which was nice, and had a chance to spend a couple of days together presenting information to each other and learning from each other. I’ll tell you the thing I took away. By the way, there was a story in NPR about it, and some other reporters were there as well.

Howard Forman: Yeah. It had great coverage.

Harlan Krumholz: So I think the one thing that impressed me was that that person after person who was really focusing on data about measurements of the patients, that is, some of it was biopsy, some of it was imaging, some were just physiologic exercise-based testing, were demonstrating objective findings of abnormality. So I still hear people saying, “Is there really a thing? I don’t really believe that there’s a long COVID.” I can tell you, there’s no question people are suffering. I’ve talked to hundreds and hundreds of people who are reporting this kind of syndrome after having been infected with COVID.

And now there is really, I think, strong evidence about the pathology that’s emerging, that you can see with this kind of objective testing. And so it really led me to say that there should be no doubts. If people don’t want to believe what people feel, there’s definitely a lot of other confirmatory evidence and information that puts us beyond a shadow of a doubt and really, I think, starts to put long COVID in perspective of a syndrome that, by the way, I’ve believed in from the beginning, but I think everybody else needs to get on board with.

Howard Forman: There’s a big trial that you’ve told me about, the RECOVER study. Where do we stand with that? What do you know?

Harlan Krumholz: RECOVER’s interesting. Early in the pandemic, Congress voted to give the NIH about, I don’t know, something like 1.22 billion dollars to start investigating long COVID. And that group has been moving along. There’s been a lot of controversy because people always want scientists to move faster and do better. And it sounds like a lot of money. It is a lot of money. And Gary Gibbons, the director of the National Heart Lung and Blood Institute, who’s one of the leaders of this effort working with people like Leo Horowitz, our former colleague, friend, student from Yale and others, many others around the country, cast of thousands, but Leo is playing a central role.

You know, they’ve put together what I think is kind of a blockbuster study. They’ve enrolled about 13,000 people around the country. They’re also enrolling a cohort of children, and now they’re going to enroll a cohort of pregnant people, and they’re doing a whole bunch of testing and assessments to try to characterize who these people are.

And then they’ve just started a few trials. And yeah, of course, there’s always things to wish would’ve gone faster, better, cheaper. But this group, I think, in the end has put together an amount of information that will yield important insights. I think the frustration is it’s taken them a while.

Well, that’s not a big surprise because they were also committed to a representative study. So they’ve spent a lot of resources and a lot of time making sure that it’s not just homogeneous with regard to race, ethnicity, income, but really representative of the population of the United States, population that’s affected with long COVID.

I’m hopeful that this will yield important information and targets for interventions. It’s complement... It’s a much bigger study than what we’re doing, but I think that there needs to be multiple shots on goal. This is the biggest shot on goal. And I was actually listening to them. It buoyed my spirits about, yeah, I think in the end, I’m still hopeful that this is going to help us make important advances, but it’s a big investment.

By the way, Congress and no one else is putting in any money after this. So there’s also a big question. The money ends in 2025. What’ll happen? I think they’re going to have to show what they can do before that, and then I hope that they’ll show good stuff and people put more money in.

Howard Forman: And you’ve got multiple studies ongoing right now, including I think, a randomized trial that you’re a PI on that you’re leading and then there’s an observational study. Where do you stand with those? I know you’ve been doing a lot of recruitment.

Harlan Krumholz: Thanks much. A lot of this has been on the shoestring with some support. Howard Hughes Medical Institute through Akiko Iwasaki, who was a co-lead with me on these studies, has gotten some support of this. There was some FDA study to money that came to Akiko looking at sex differences. And Fred Cohen and Carolyn Klebanoff, Yale graduates who are very philanthropic, have provided us some support, and that’s much appreciated.

The one study is a randomized trial of 15 days of Paxlovid for people with long COVID. But what’s cool about this study is, in both the studies is that they’re digital and decentralized, which means we’re really leveraging modern technology to reach people where they are, make it convenient to participate, not force them to travel to an academic center or take time during their day, but on their smart devices, their phones, their computers, they can enroll, answer questions, connect their medical records.

On the trial, we can ship them drugs so they don’t have to leave. We have blood samples and saliva samples, we collect them. We can send someone to their home to do that. And actually, we’re going to cover all 48 states and the District of Columbia. Because of shipping, we can’t go to Alaska and Hawaii, but we’re going to cover the entire United States.

This is unprecedented, Howie, and it really represents, I think, a model for future trials that can be faster, cheaper, and more responsive because they’re really leveraging modern ways of moving data and engaging people. And all these are participant-centric. The observational style trial we’re doing is called the LISTEN study, and we called it that because we thought in order to learn, we have to really be partnering with patients and listening intently to what they’re telling. Again, it’s digital, it’s actually international and it’s decentralized.

That means people consent online, they’re answering questionnaires, connecting the records, and we’re just going to start, I think, producing a bunch of papers out of this. We just started with a pre-print on people who are exhibiting internal vibrations and tremors.

But I think, again, these are new ways of doing research, and so I’m excited both because I think we can make progress. I’m excited to work with Akiko Iwasaki, who’s a rock star, and we’re bringing together the best of clinical science and basic science. And I’m excited because of the way that we’re partnering with patients and providing a model for going forward. But we’ll see. In the next couple months, I think we’ll be able to put a lot of good stuff out.

Howard Forman: Yeah. Well that’s really helpful. I’m grateful that you’re working on this and that so many others are working with you.

Harlan Krumholz: Oh yeah, just very fortunate. It’s really a cast of so many people and like I said, I hope both studies will contribute to this. We’re also looking at post-vaccination syndrome. And we haven’t talked about that in this session. Maybe we should take time in a future session to talk about that. We’re also looking at that, steering from the politics saying it’s saved millions of lives, but there still may be some people who developed a chronic syndrome. So yeah, thanks so much, Howie. I really appreciate it.

Howard Forman: Dr. Ted Long is senior vice president of ambulatory care and population health at New York City Health + Hospitals leading a program that provides over 5 million healthcare visits annually. He led the organization’s COVID-19 Test & Trace Corps, which was integral to New York City’s exemplary response. He’s a faculty member at NYU with adjunct appointments at other very respected institutions, and he’s previously served as the senior medical officer for quality measurement at the Centers for Medicare and Medicaid Services, and he was medical director at the Rhode Island State Department of Health, where he also provided leadership and quality assurance and access to care.

So he holds up a bachelor’s degree from Yale, graduating in 2006. And I first met him when he was a third-year medical student, and I think you met him, met him shortly after that, Harlan. He also has an MD from the University of Southern California’s Keck School and a master of health services degree from Yale. He was one of our Robert Wood Johnson Clinical Scholars, and he did that after he finished his medical residency at Yale. So he’s a true Yalie almost through and through, and honestly, he’s also somebody who’s one of the most committed people to seeing improvement in healthcare delivery in quality and patient-centeredness. So we want to just first of all welcome you to the Health & Veritas podcast and just when—

Harlan Krumholz: Just to say we love Ted. Ted—

Howard Forman: We do love Ted—

Harlan Krumholz: one of the most remarkable people, and you referred him to me. I remember Ted when we went on this walk—

Ted Long: I remember—

Harlan Krumholz: ...on the green when I first met you, and I thought like, “This guy is spectacular.” We got him to come into the Clinical Scholars program.

Howard Forman: And I’ve known his wife long enough that I can’t even call him “Ted” sometimes because I think I’m supposed to call him “Teddy.”

Harlan Krumholz: Look, I want to pepper you with a few questions about primary care, and then I want to end with something about the readmission, stuff since you were really an expert in the readmissions. Well, that’s an issue for me, but let me get to this issue about primary care.

Primary care in this country is in real crisis, and yet what we’re seeing around us is that these corporate giants are buying up these primary care practices at a rapid pace, maybe changing the face of what it will be in the future. CVS paid, I don’t know what, like $11 billion to buy Oak Street Health, a fast-growing chain of primary care centers. Amazon bought One Medical for about $4 billion.

So on one hand we’re seeing primary care wither, in a way in terms of having trouble attracting people in and not being enough. Anyone who wants a primary care physician has trouble finding them. These corporate entities coming in. What do you see as the future of this, and what both hopes and fears do you have about this changing face of primary care?

Ted Long: Well, I think you’re pointing out a good, important point, which is that in the past year as primary care has really had a reckoning. It’s a hard field. People were burning out, and they were getting paid the least of any field in medicine. So who would want to do that? People that are mission-driven, but it’s hard to be mission-driven, doing the same work every day and not seeing an end in sight.

But what motivates me now, and is the direction primary care must go in, is further convergence with value-based care. And we’ve done some remarkable things in the public healthcare system in New York to show what the promise there is. I’ll give you an example. If you would’ve asked me, among New Yorkers experiencing homelessness, could you ever achieve even close to the same chronic disease outcomes as other New Yorkers come into our practices? I would’ve said, “Absolutely not. That’s impossible.”

People experiencing homelessness have every challenge in the world, let alone “housing is health,” and they don’t have housing. But in New York City Health + Hospitals last year, we achieved the unbelievable. We actually in these primary care practices we set up for people experiencing homelessness, achieved better, better diabetes, A1C control than the rest of our diabetic population put together across our whole system.

To me, that just shows that with good primary care, anything is possible. But now with that sort of promise there that’s achievable, we need to figure out how we’re going to pay for it, and that’s the next reckoning, is going to be how much can we go towards value-based care to pay for what primary care needs to be, especially for higher-risk populations. That clinic that achieved the impossible is very expensive.

Howard Forman: How did they do it? How did they do it?

Ted Long: So we went to an open access model. We have now four of these clinics across my system connected to eight mobile health units that are on the street every day with roving teams, approaching people experiencing homelessness and addicted to drugs. Our approach of engaging people in care is the same question we ask at the beginning of any encounter: “How can we help you today?”

That actually arose from back in the COVID efforts where I was the director of the Test & Trace Corps for New York City. We had this challenge of trying to vaccinate New Yorkers experiencing homelessness. People told me they’re against the vaccine. I said, “I don’t think that’s true. I don’t buy that.” So I did the only thing I could do. I listened, and I talked to a lot of people experiencing homelessness. None of them were against the vaccine. What they needed though was they weren’t going to get vaccinated if they had a wound on their leg that really hurt and they needed Keflex and maybe ibuprofen. Some even told me they’re worried about their blood pressure. They were out of medications. They didn’t know where they’re going to sleep. They’re worried about their mental health.

When you address people’s actual needs, it opens up the doorway for you to really, I think, achieve the impossible and address what we view in the healthcare system as important. They view it as important too; it just may not be the most important thing to them. So these clinics are open-access. When they’re ready to engage in care, they can come in, they don’t need an appointment, and they’ll be paired with the social worker as well, so who will also ask them, “How can we help you today?” So that model put together, again, is achieving what I would’ve thought would be impossible health outcomes, but it’s expensive and the revenue outcome, the question has to be how much would’ve been spent on that patient if we didn’t have the model?

The question can’t be, what’s the fee for service that we’re going to get for that patient and does that pay for everything else? The answer is absolutely not. But if you look at what these people experience in homelessness would’ve cost New York City and the federal government that year, you’re going to be saving a ton of money, I’m convinced. That’s what we need to show and prove and then do more of.

Howard Forman: Your hospitals exist almost physically side by side in some cases with elite private institutions, and NYU Langone being a good example next to Bellevue, but Kings County and downstate, another example, and there are several others. Your outcomes there also have been really very good. You recently won an award for your ACO [accountable care organization], I think the 10th year in a row or something like that. How is this a model? What can we learn from this that the rest of the country can learn so that we can move toward a model where everybody has the same care and the same outcomes?

Ted Long: Yeah. For me, the goal is to have everybody have the same outcomes. That’s what it will take for us to achieve equity in healthcare. And I think it’s a good example of your point is, if we can achieve these outcomes in a public healthcare system that has traditionally struggled financially. When I came here with Dr. Mitch Katz, we were running a $1.8 billion deficit each year. Our deficit is now closed.

But how can you, in that context, make the right investments, figure out what care needs to look like and be able to fund that? That’s been our challenge, but we’ve succeeded because we also own a health plan. So as we’ve made improvements, we actually get to see the return on the investments that we make in New York City. That’s enabled us to, at many of our sites, like where I practice primary care in the Bronx, almost nine out of 10 of our hypertensive patients have their blood pressure under good control now. They meet that quality metric.

Almost, or well over two-thirds, it’s about three quarters of our diabetic patients in the clinic where I practice in, have their A1C [diabetes] under control. I would challenge you to compare those numbers to any institution in the country, but my big point is, if we could do it in our system here, where we have people experiencing homelessness, all of the social challenges that anybody could have anywhere, it really does show that anybody can do this. We’re happy to share our model. Other models could look different, but the important point is, as you said, Howie, everybody must achieve the same outcomes, because that is what equity is and that is what equity needs to be for our country.

Harlan Krumholz: One of the, I think, key things that you’re saying here is that we need to address the issues that face the people in front of us. We need to recognize their needs. You and I worked on this issue of readmission for a long time, and this is what percent of people end up back in the hospital 30 days later, and a lot of hospitals around the country were indignant about this measure saying, “It’s not our fault. It’s really the patients. Some of them live in difficult circumstances. Some of them don’t have resources. Some of them aren’t educated. Why are you blaming us?” And I thought the very best hospitals rather dug in and said, “Who are the people that we care for and what are the kind of needs and services that they need to improve?” But how do we bridge this? Because you’re now in a system that you’re describing as fairly enlightened.

You didn’t just say, “Hey, it’s not our fault their hemoglobin A1C is high. They’re having trouble with housing, so that’s not our fault.” Instead, you embraced it and said, “How do we dig in help health?” But that’s not broadly felt throughout the healthcare system. How do we get others on board with this idea that we need to take, “ownership” is too strong a word, but we need to understand the challenges our patients face every day and recognize that’s part of our charge. It doesn’t fall outside of our boundary to say, “Hey, I took care of writing a prescription. It’s not my fault if they can’t afford it.” It’s actually the whole picture is our responsibility. We need to work with systems, not as individuals—as systems. How do we solve that?

Ted Long: Thanks, Harlan. That’s a great question. I think what needs to happen in healthcare, and this is from the point of view starting with primary care, is there needs to be further convergence of how we practice medicine, which should include what a patient’s overall needs are and the financial system. So some of the ways that we’ve been able to start to address that at New York City Health + Hospitals is we’ve made investments in things like community health workers and certain programs that may cost money upfront but show a return on investment, like a “Treat to Target” program we have where we have a frequent follow-up of patients with high blood pressure or diabetes to make sure that we can control their chronic diseases effectively and quickly.

On the back end of that, though, the question is always who’s going to pay for these nurses doing this incredible work or who’s going to pay for the community health workers? And the reckoning that still needs to happen there further is that the system needs to be able to pay for the outcomes of the patients that we’re able to achieve, compared to what patients would’ve otherwise cost the city or the country. And that doesn’t need to be taken from the overall city budget perspective. You could start from the point of view of just what the city is otherwise spending.

So we’ve made substantial investments because again, we own a health insurance company, so that enables us, if we’re able to take better care of a patient, including through investing in taking care of their social needs, if overall they spend less money from the point of view of the health insurance company, we’re able to reinvest that money into further innovations in primary care. I’ll give you a couple of examples. So we have a community health worker program that now has 250 community health workers that are embedded in our primary care practices, our behavioral health practices, and our clinics that specialize in taking care of patients with more health and social needs, like people experiencing homelessness or people that have spent time that are justice-involved at either Rikers or state prison.

The outcome of these investments that we’ve made are that we’re achieving incredible outcomes for these patients in terms of the quality measures that we have and in terms of patients’ satisfaction and experience with us. We today have more patients in primary care than we have since before I started, and we’re seeing patients grow for the first time in a decade at New York City Health + Hospitals.

New Yorkers vote with their feet. They wouldn’t come to us if they didn’t see value in coming into receive care from us. An example of this too is we started a program called NYC Care, which is where, a program that we created with investment in primary care for people either that were undocumented immigrants or made too much to qualify for Medicaid but not enough to actually afford a health insurance plan. Through creating this program, we have 120,000 members today. Half of them didn’t have a primary care doctor before the program and were just going to the emergency room.

Among those with high blood pressure or with diabetes, more than half of each of those groups has had a substantial improvement in their chronic disease, averting the need for them to go to the emergency room for any care that they would need or to control their conditions before things get worse. That program, we’re able to look at the investment of that program, and I think that needs to be the point of view of the healthcare system. What investments can we make, whether it’s a program to connect people to primary care, whether it’s community health workers addressing people’s needs to go beyond the four walls of my primary care practice, or what about clinical innovations that may cost money to hire more nurses but get better outcomes for people with diabetes and avert their need to go to the emergency room.

That’s what we need to look at. That’s what we need to invest in. I think that’s the way that primary care is going to go from a field where people feel beleaguered and get paid the least to where we’re able to actually value our primary care doctors and they can see that that is the backbone the healthcare system needs.

Harlan Krumholz: Let me just say I think it’s really great the way you’ve aligned incentives. Very few large health systems have been able to pull this off with the insurance company. And a lot of talk about moral crisis of American doctors’ sense of betrayal by their leaders, and I think that happens when they’re sort of forced to do one thing after the other, but they’re feeling like it’s not in the best interest of the patients.

Just kudos to you guys for providing this kind of leadership and that mission-driven approach in getting that kind of alignment. I know you, Mitch Katz, entire team of people that Howie and I both respect and admire, that you guys have around you. Anyway, I just want to express, Ted, and our appreciation that you joined us today.

Ted Long: Thank you.

Harlan Krumholz: And it’s really great to be able to share these ideas because we often talk about all the flaws in the system, but it’s also great to talk about systems that are still facing challenges but are making progress. And I think your team, it’s an example of that progress. So thank you so much. Thanks.

Ted Long: Well, I want to also say, if I may, as we conclude here, I want to thank you both for training me and making me believe and giving me the conviction that the impossible is possible. That’s what motivates me every day and seeing us actually be able to achieve this for our patients. What could possibly be better than that? So thank you both.

Howard Forman: You’re great. Take care. Good luck. Thank you.

Harlan Krumholz: Well, that was a terrific session with Ted. I think we’re very fortunate that we could get him on today. But let’s transition to your segment, Howie, and I think you’ve got a couple things on your mind about the Inflation Reduction Act and what’s going on with the medications.

Howard Forman: Yeah. So you and I have talked about this in the past. We’ve had Anna Kaltenboeck here on Episode 69 in the past. This is expected to save Medicare beneficiaries and the federal government tens of billions of dollars, I believe more than a hundred billion in that 10-year window. And we’re finally seeing it put into action. So as of August 29th, the Biden administration had finally selected and released the first 10 drugs that will be subject to price quote negotiation in the year 2026.

And among those drugs that are going to be subject to negotiation are Eliquis and Xarelto, both so-called blood thinners that are widely used. And then multiple other drugs or diabetes drugs, including a form of insulin. But I do want to point out, there’s already numerous lawsuits pending. I would not bet the ranch that this will even go forward, although I’m pretty optimistic that it will. But we’ve got a lot to watch until 2026 comes around. But at least we’re starting to see the fruits of the labor of the Inflation Reduction Act being put into force.

Harlan Krumholz: How people hear about Inflation Reduction Act, their eyes kind of glaze over. This thing, though, it seems to me is something which affects the pocketbooks of almost every American. It’s so widespread, but yet I didn’t hear widespread cheering for this. Why isn’t the administration getting more credit? Why aren’t the people who passed this bill getting more credit? This is a huge deal, isn’t it?

Howard Forman: It’s a huge, huge deal. And there are so many ways in which it’s going to save money for people, but only a few of them are really kicking in now. The insulin reduction for copays has already kicked in, but most of the other things are put off. It starts to really have incredible savings in 2026. It gets better in 2028. And much like the ACA, which passed in 2010, but didn’t really become reality until 2014 and beyond.

I think people don’t believe in anything until they have experience of it. And even then, until somebody says it’s going to be taken away from them, they don’t realize how good they have it. So I’m hoping that from a political and a policy point of view, this is a winner. But I can say with confidence watching this move forward, it does seem to be a well-written piece of policy.

Harlan Krumholz: Well, that’s terrific. So for the people who are fighting it, what’s the basis of these lawsuits?

Howard Forman: There’s this sense that the government is not allowed to take things away from you as a private citizen or a private corporation. The takings clause. You can’t just take away from people. And so I can’t just move and say, “The government wants your house, Harlan. We’re going to take it from you.” There’s real recourse in that situation.

Here, they’re coming and saying, well, you’re actually, you’re claiming these drugs that we own. We own these patents—that’s written into the constitution, patents. FDA regulation is firmly in statute, and now you’re reversing some of that. But there’s very strong arguments to push back against that, not the least of which is that Medicare already regulates physician reimbursement. Medicare already regulates hospital reimbursement. And so this is not that different than that.

Harlan Krumholz: Yeah. So what I hear all the time is, “You’re going to stifle innovation and the U.S. has to pay more for drugs because we’re the engine for innovation.” What do you say to those folks?

Howard Forman: Yeah, so first of all, Larry Levitt had a great op-ed in The New York Times this week. But the point is that I do—you’ve said to me, “You don’t believe this”—I do believe this will stifle innovation, but the tradeoff of the tiniest amount of stifling of innovation, and I think Larry Levitt’s number was 1% of drugs 30 years from now might not appear because of this legislation.

But the tradeoff is so far off that it’s sort of like, do you really want to let people die from lack of access now with the promise of 30 years from now having one new drug out of every hundred being discovered? And I think we do make tradeoffs like this all the time, and this is just one more example of that. So I do think, does it stifle innovation? Yes. On what scale? A tiny, tiny scale.

Harlan Krumholz: They picked 10. I was wondering, on what basis do you pick 10? There’s so many drugs they could have picked.

Howard Forman: Yeah. So they pick them on the highest-spending drugs that Medicare is already spending on. And then further narrow it down by saying, we’re not going to include drugs that have only just been released and therefore haven’t had an adequate time to recoup profits. We’re not going to pick drugs that have generic competition already. There are little things that narrow the list down more.

And so one of the things you and I have talked about is when will the obesity drugs, for instance, hit this list? And in all likelihood, the next wave of this negotiation, which will be in, I think, 2025, 2026, which will impact 2028, will almost certainly include those drugs.

Harlan Krumholz: Just finally want to ask you that, it seems like every other country like us, I mean every other country that has a sort of economy at our scale, is imposing price controls on drugs. They’re negotiating with them. We’re paying so much more than everybody else. How is that fair? How is it fair?

Howard Forman: Yeah, look, I think if you look at it and say, we’re getting slightly earlier access than some of these countries and that it is a very productive industry in our country as well. You can say there’s some benefits from having that. But in aggregate, we subsidize the rest of the world. Some of that subsidy is a good thing like when we subsidize the HIV care in sub-Saharan Africa, where they would not be able to afford it, that’s a good thing. But when it comes to—

Harlan Krumholz: The vaccines for COVID—

Howard Forman: That’s right. And India and other places. But when we are starting to basically subsidize the cost of research and development for pharmaceuticals for countries that are absolute peers that we compete with, there’s a failure in that way. And so we’re looking forward to a time when that won’t be the case. And I do think it’s something that our trade authority does have within their rights to negotiate.

Harlan Krumholz: Oh, that’s great, Howie. Really, it’s wonderful to hear your views on this stuff. So you’ve been listening to Health & Veritas with Harlan Krumholz and Howie Forman.

Howard Forman: So how did we do? Give us your feedback or to keep the conversation going, you can find us on Twitter or X or LinkedIn. I’m not sure, Harlan. And it’s a good question for our listeners.

Harlan Krumholz: Yeah. People should tell us whether they think that X is the place to be anymore. Well, I’m not sure, myself, but we are looking for feedback. One of the feedbacks are what’s the right length of this program. We’ve been keeping it about 30, 32 minutes. Some of our listeners actually would like us to go longer. Others tell us this seems like about the perfect length. We’d like to hear from you.

Howard Forman: We’d love your feedback. Yup. So you can contact us at Aside from Twitter and our podcast, I’m fortunate to be the faculty director of the healthcare track and founder of the MBA for Executives program at the Yale School of Management.

Feel free to reach out via email for more information on innovative programs or check us out at

Harlan Krumholz: Health & Veritas is produced with the Yale School of Management and the Yale School of Public Health. Thanks to our researchers, Ines Gilles and and Sophia Stumpf, and to our producer, Miranda Shafer. They are incredible week in, week out.

Howard Forman: Thank goodness. For sure.

Harlan Krumholz: Talk to you soon, Howie.

Howard Forman: Thanks very much, Harlan. Talk to you soon.