Episode 19: Can we fix the friction in U.S. healthcare? A discussion with Othman Laraki from Color Health

Justin Steinman:
Definitively Speaking is a definitive healthcare podcast series recorded and produced in Framingham, Massachusetts. To learn more about healthcare commercial intelligence, please visit us at definitivehc.com.
Hello and welcome to the latest episode of Definitively Speaking, the podcast where we have data driven conversations on the current state of healthcare. I'm Justin Steinman, Chief Marketing Officer at Definitive Healthcare, and your host for this podcast. I'm joined today by Othman Laraki, CEO of Color. Color provides a technology and infrastructure for large scale health initiatives for everything from population genomics programs to high throughput COVID-19 testing to immunization management. Color partners with states, cities, large employers and universities and dozens of other organizations to roll out large scale programs to tackle some of our most pressing clinical challenges at a population level. As a result, Othman has a pretty unique insight into what's working and what's not with the US healthcare system, and he's got the data to back up his perspective. So I thought he'd be a great guest to join me here today on Definitively Speaking for a wide ranging conversation around health equity, our healthcare system, and what we can all do to fix it. Othman, welcome to Definitively Speaking.

Othman Laraki:
Hi, Justin. Thanks for having me.

Justin Steinman:
Happy to have you here. So tell us a little bit about Color. What makes you different than other providers, right? I mean, you're not the first company to provide widespread COVID testing or immunization. I mean, I can get that from CVS, Walgreens, my local IDN. What's different about Color?

Othman Laraki:
Sure. Yeah, I mean, so broadly speaking, so the way Color works is that we're really a last mile care delivery company where our focus is to take healthcare services that in reality should be very easy, inexpensive, and available to a lot of people and have built the infrastructure and the service model that enables us to deploy these services at very large scale but also at the edge in some way where people's lives actually happen. And so one of the things that makes Color unique is that we don't run clinics. We're very kind of asset light, if you will, and we use ... In many ways, I mean, I think the analogy is almost like going from bricks and mortar retail to more of an e-commerce model. And so we build the software and logistics infrastructure to be able to do that for the services that really lend themselves to that kind of delivery model.
And so as an example today, I mean, we run about 13,000 sites across the country. And these are in really kind of where people's lives happen in the sense of schools, workplaces, churches, prisons, fire stations, libraries. And they're the real theory behind everything we do is that one of the biggest impediments for people to access basic healthcare is not costs, financially. Actually a lot of people have a lot of coverage in the US. We spend a lot to cover people. So we don't necessarily need more money in the system, but what we need is to make the basic services just show up in a way that is accessible to people. And there impediments is the transactional friction. If you're an hourly worker or school teacher or parent with young kids, the burden of needing to find a doctor, schedule, change your own time, go there and wait and so on, that is oftentimes really what gets in the way of people doing the basic things or simple things that they should be doing ahead of time to prevent later much more expensive events.
And what makes Color unique here is really that most of the industry, our model is not about ourselves hiring an army of clinicians and running massive diagnostics labs and so on, but rather to run almost the operational infrastructure to work with local capacity. For example, on the care delivery side for our vaccine sites as an example, we mostly work with local community based organizations to do a lot of the staffing. And so we employ kind of local people to operationalize a lot of these care centers or access points.
And that enables us to both scale very rapidly, have a cost structure that is much leaner, I think, than what a traditional model, we need to buy buildings and amortize the staff and so on, but also reach people in a way that's consistent with their communities. When you show up, all the sites and services we run feel like they are part of the communities where we're serving people. So that's where I think our model is quite different, I think, than a lot of the traditional community type of healthcare is that we enable that infrastructure and these programs but work with all of the existing capacity that's already there.

Justin Steinman:
So let's talk a little bit more about that, because I get where you're talking about traditional healthcare, but I read some stat recently somewhere that 80 plus percent of Americans live within five miles of a CVS or a Walgreens and I think they would advertise it, "We're in your community," and you see all the happy stuff on TV and transport. I get my vaccines at CVS because I live three miles away from a CVS. How is what Color doing different from that? Are you going to places in that other 20%? Are you complimenting them, competing with them?

Othman Laraki:
Yeah, it's a great question. I mean, so it's not only the 20% where there are no CVSs, where I think there's a real opportunity. It's actually even in dense areas and so on, if you think about CVS and the or other options like that, the experience is not necessarily designed, for example, for a streamlined vaccine experience. The there's a long wait time scheduling is you have to contend with all the other things that you could potentially or may not want to be doing at CVS and so on. And even thinking about if you want to go there with your kids, that type of experience is not optimized. Whereas if you think about a vaccine site happening at your kid's school, for example, as part of drop off where you don't need to literally change your kid's schedules as part of that, I think that little step, what feels like a little step you in theory is actually what drives I think a substantial amount of increasing utilization.
I mean, this to me feels like very much the lesson that we've learned through all of the last 20 years of the internet. It's why Amazon has one click checkout, why there's a search box in your browser. Why we like to use Uber more than hailing a taxi cab. Taxi cabs are driving around New York, but clicking a button and having an Uber show up is dramatically more convenient and it's all those marginal gains, I think, that really are the edge where public and population health impact happens. Because I think even for example, looking at the most recent stats around vaccines with the bivalent boosters, the numbers nationally are terrible and it's being chartered to apathy or vaccine hesitancy. And I think that's actually wrong. I think at least everything that we've seen is that you have people on either end of the distribution that are ... there are people like me who want to get vaccinated as soon as there's an option and I'll drive 20 miles and show up at three in the morning if that's what it takes.
And I really want to be vaccinated if it's available, so I'll jump over while to get vaccinated. There are other people that are also on the other end of the spectrum that are where you basically have to tie them up and force them to get vaccinated then they won't otherwise. But most people are in this center of the distribution where their actions are going to be primarily most influenced by the path of least resistance and convenience. There's still a distribution within that, but they're much more like, it's not about convincing them as much as about the availability. When we run sites at churches and et cetera, everyone, and by the way, it's not just about vaccines. And that's the thing that why I'm saying I think it's incorrect about hesitancy is we see literally the same thing happen, whether it's around cholesterol, diabetes and hypertension, screening vaccines, HIV testing, all of these things that are charted to education.
And it is true that those things do have an impact, but I think in reality it actually matters the most is simplicity, availability, convenience, and that's where all the marginal gains, back to your point about CVS, it is available, but I think it is really about that, yes, I can make it go through that inconvenient process, but if it is part of dropping my kids at school, I just need to show up half an hour earlier or had another 20 minutes after at pickup, it completely changes the game, I think.
Or it's people showing up to a library or in the workplace, these are all the things I think that really add up. And where then are the most, in some ways the "easiest," it's not easy in the sense that it just happens by itself, but it's an eminently tractable problem as opposed to winning a political battle about convincing anyone who's doubting about vaccines and trying to make it this kind of religious debate, it really is, I think, in many cases a practical debate or a practical kind of battle, much more than a philosophical one, I think.

Justin Steinman:
So if I really just sum up what you're talking about, I think you're talking about eliminating friction, right?

Othman Laraki:
Yeah, exactly. I think it's literally the most important thing that we can be doing.

Justin Steinman:
It leads to a natural question, which is around engagement in healthcare. I mean, there's the old adage, you can lead a horse to water, but you can't make him drink. Are you saying you can make him drink?

Othman Laraki:
I believe so. And again, this is all the experience that we've had where when we run, and this is very kind of diverse populations all the way from unionized workforces to school children, et cetera. It is always surprising to me the level of uptake that happens when you show up as opposed to trying to treat it as I need to convince someone to do something that's kind of inconvenient for them. And so I think right now it's, I think the analogy maybe is not like you can lead the person to water. I think really what we're doing right now is we're pointing to we're taking people and pointing where there may be water and trying to convince them to go find it as opposed to showing up with a bucket on the road that as they're going by. To me, I think the real kind of distinction there.

Justin Steinman:
So we generally try to stay away from politics on this podcast, but I have to ask, this has been covered in the New York Times, the red and the blue states, and you see vaccine adoption tends to be much higher in the blue states and the more liberal leaning states. But you're going into communities across the country and as you're going again to meeting people where they are, whether that's at their churches or at their schools or stuff like that, are you seeing a difference in a variance based on politics and political beliefs in the communities?

Othman Laraki:
I would like to go and look at the stats for this, I'm curious. Here's my impression or something where my bet would be is that the real difference, and by the way, we do a lot of work in both red and blue states. I think the difference is much more at the policy and the debate at that level and the decision about what programs to run. But when programs are actually running, for example, I mean, even if you look at California, we do tons of work across California. In California, people think of it as a deep blue state, but in reality that's in the big cities. But by surface area, California is basically red but not by population. But we do a lot of work in parts of the state that are considered red parts of the state. And our programs get the high level of adoption there too.
So I think it's when it's a simple choice for you to, especially when it's in your community, it takes away the politics. It's not like you don't see it as like, "It's the state that is trying to intrude on my belief," or whatever. When these things show up and it is in context and the choice is like, "Hey, do you want your kids to be vaccinated or not?" I'm sure the politics still move some part of the distribution, but I think I would be surprised if it's not smaller than what most people assume it is because it's like, "Okay, most parents, they want their kids to be vaccinated." There are a lot of stories about anti-vax parents, et cetera, and it is a problem, but I think it's also the availability and more political influences drive what's accessible as opposed to choices people make when they have access.

Justin Steinman:
Got it. So let's talk a little bit about access and equity topics that I know are important to you. Do you feel our primary healthcare model has failed on the access and equity front?

Othman Laraki:
Short answer, yes. And that's really what we're working on at Color. And we shouldn't think about the healthcare market as one single big blob. There are parts of healthcare services where there is a propensity or a risk to miss or over utilization, and that is a meaningful risk to manage and also risk to overcharging where things are unreasonably expensive and so on. I think that tends to be much more around acute and more elective services. And for that, the kind of insurance based model where you want to actually have machinery to manage utilization down makes a lot of sense. But when you kind of zoom out and ask ourselves, "Okay, nationally, where are we screwing up healthcare in a big way?" I mean people chalk it up as cost was driving the cost in many ways, yes, our hospitals, et cetera, are very expensive on one side, but also is driving up costs is that our burden of acute kind of care needs are much higher than they should be.
And the question is why? And the real answer is that we have a drastic underutilization of all of the much less expensive services that prevents all the downstream that are both impacting people's livelihoods, quality of life and costs. And so I think the other side of the healthcare market that I think currently is being kind of just mushed into the other side is that there's part of healthcare where actually you want to drive access and over utilization is a much, much lesser risk than underutilization. We do not have an overutilization mammographies and colonoscopies. I always jokingly say, "I have never met a single human being who wants to overutilize mammographies or colonoscopies." That just does not exist. And the same goes for things like managing cholesterol, managing hypertension, diabetes, the actual cost of screening and the cost of managing these before they become acute is extremely low.
Statins are almost free at the pill level. What's not free is everything we do around making it possible for someone to manage their cholesterol. So I think that's the part where we're really failing is that we have a system that has conversed in making the part of healthcare that should be really around transactional efficiency, around access, around just blasting supply into the system. And instead we manufacture scarcity. And I think that in the areas where Color works, so we focus on three main areas. One is essential care, which is unbundling of primary care. It's effectively [inaudible] primary care model. Second is infectious disease, so started with COVID, HIV and other STI, hepatitis and so on. And the third is behavioral health. And across all three of these, the core supply is actually extremely abundant. We talk about the mental health crisis in the US and part of the narrative is that there's a huge amount of scarcity of therapists.
I'm pretty sure therapists are literally the single largest block of healthcare providers in the country. I think 700,000 therapists in the US. So actually a lot of them. The reason they feel scarce is that the mechanism to which we pay them to which they can access patients and the marketplace is we've broken it up in a way that makes therapists scarce. Most therapists do not want to take insurance. They require cash pay. And so all of a sudden everyone who's on Medicaid and et cetera on government programs or can't afford it, does not have access. It feels scarce because there are no ... but in reality, therapists are there. The problem is that we don't constructed a market that makes it possible or worthwhile for them to participate in it. So actually it's one of these things where it's like there is supply similar with testing.
There is a huge amount of diagnostic capacity in the country, but it's putting that capacity on the market that is actually where I think one of the places where we really fail. But I think it's a solvable problem. I think it's where the solution starts is by not treating these things as things that are under the insurance utilization management's umbrella. I think that is the first kind of acknowledgement and I think once we think of it that way, actually very practical simple solution start materializing that have worked in most other industries that we can apply to healthcare. That's a very long winded answer to your question, but I think that's one way I would look at it.

Justin Steinman:
So there's a lot there that we can unpack. So let's start unpacking some of that. Let's start with an obvious one. Give me an example of something that other industry that you just talked about where we could apply it to healthcare.

Othman Laraki:
So take one example of where you want to maximize access as, say, retail. I mean, I think one big this difference in healthcare versus almost every other industry in our life where there's a lot of vibrance market is in with the thing that we call insurance in the US especially conflates two things or mixes two things. One is kind of the bank account, if you will, your insurance financial custodian. You can think of insurance as just this social bank account that money is put into either for the government or your employer or other means. And that has properties around to what kind of services you can use this money for, house collectivized between a pool of people. So you can think of it almost as a financial kind of custodian of value. The other part that we call and think of insurance is the network to access services.
Every insurance plan has a network and negotiates with labs, with care centers, providers and so on. And we all think that's normal. But when we look at most other aspects of our experience in places where there's an effective capitalistic market, those two are kind of separate. You have your money in Bank of America, but your credit card network is Visa and Bank of America does not get to go and build a network for where you can buy coffee from. And I think the first reaction everyone has to that is like, "Yeah, there's a consumer choice dimension to that." Imagine Bank of America went and did their analysis like, "Okay, we acknowledge you need a coffee provider, so we're going to do a bunch of analysis. And we decided, no, Seattle's best coffee is a great coffee provider," and that's where Bank of America customers can buy their coffee.
All of us as consumers react as like, "Okay, that's not great from a consumer choice standpoint because I like Starbucks," or whatnot. But I think even much bigger problem that I think is cause the scarcity effect that we have in healthcare is that it does not enable even something like a Starbucks and Phil's or Pete's or whatever other coffee shop you like to even exist or succeed in the marketplace because they don't have a flat market on which to compete. Because I think what happens there is that you create all these local monopolies. Bank of America would effectively have a monopoly power over where you consume coffee, where you buy clothes and so on. And what happens there is that the rents of better products go up to them as opposed to down to the people who are actually building the services. And that's literally what's happening in healthcare.
That's why in the Fortune 20, most of the Fortune 20 companies are payers, right? And actually I think that's why. It's like are they really creating the value into the system or is it just a market power? The reason why you regulate monopolies is that because they work, if they didn't work, you don't have to regulate them. But I think we think it's not a monopoly problem because we've segmented and diced up the market. But in reality we've created a system that enables all these local monopolies to happen. I think that's what breaks the market. So you're probably in your head, you're like, "We thought we were going to talk about healthcare and this is kind of a economics conversation." But to me, that's actually, that is big part of the challenge that we need to overcome.

Justin Steinman:
No, so you're right on topic here. I mean, this is the top podcast about the business of healthcare. So you're right on there. But as they were there giving that example about the coffee and Bank of America and Visa, I actually thought of one even more inhibitor on top of that around consumer choice, which is the role of your employer in your health insurance. If I love Aetna, it doesn't matter because our head of benefits here at Definitive picked Blue Cross Blue Shield. And if my favorite doctors in the Aetna network and not in the Blue Cross Blue Shield network, I don't have a choice. And Definitive Healthcare doesn't tell me what kind of coffee I can drink. They don't tell me that I only can buy coffee from the Dunkin Donuts. That's a Massachusetts law, but that's a separate thing. But my employer doesn't tell, but my employer does in some direct fashion tell me which doctor I can see and I can't see.

Othman Laraki:
Yeah, and I think it's also, to your point, I think there are these layers of, because in reality, who is a true buyer and what is their distance and their agency over what is actually bought in the market? And I think one thing that you see across all the even big buyers today, whether it's government programs or whether very large employers, everything is mediated through negotiations with plans and their network and their et cetera. And I think one question is that the right model to create an open and competitive market? Because I think really, what's the goal? Cholesterol management is one of the big problems we have. Say, you're a startup company and you made the best cholesterol management program dollar for dollar in the world. Say you have that. You save money and you have much better outcomes. In a Litmus test, in a functioning market, you give it a year or two, you just take over the market.
Whereas in reality, we all know that that is not at all going to happen in the way we run our system today. And so the question is, what are things incremental changes that we can make? Because I think also going saying, "Okay, we're going to throw everything out the window and start from the beginning," is just not going to work. And so the question I ask myself is, what are individual incremental changes that can be done that can start walking down that path? I think one of the things that is happening, I think very much so now is that, and I think it's actually been really affected by the pandemic, through COVID, all of the real buyers, the big wallets, government and large employers took a very active role in managing what was happening in reality, all the health plans were kind of bystanders to the pandemic. I think it's like they were doing a few things, but just sitting there hoping no one really noticed that they were there.
And it was the employers that really all went to set up their own programs. Every single state and the federal government all kind of went and directly bought and managed services. And I think that also changed, that really accelerated this movement that was already happening, which is them acting much more as direct purchasers of care and either requiring that things be put into network that they thought were important, or just taking them completely out of the insurance bundle and saying, "You know what? This is actually not an insurance product."
Because if you think about it, cholesterol management or annual colonoscopy, et cetera, it's not an insurance product. The risk is not of a risk of utilization, it's risk of underutilization. So the entire insurance mindset and model and terminology is completely inverted for these services. So I think that's in many ways why you're seeing a lot of employers, for example, spending a lot more drug benefits or taking a much more active role in managing some of these services where they actually want to drive utilization. Because that's the problem is access is not much less so than coverage.

Justin Steinman:
You talk about the insurance companies in the pandemic, they actually made a lot of money in the pandemic because hospitals shut down, elective surgery shut down, heart transplants shut down all these super expensive services. And it's sad to say treating people for COVID, even in the volume, was actually a lot cheaper for these insurance companies than the usual things that they were paying for. And then what was being covered in terms of COVID was actually being dictated to them by the government, you will pay for every co test, you will pay for COVID shots. There will be no out of pocket for everybody. And so I think they'll really forced to change how they interact with both their members and also their employers.

Othman Laraki:
And also, I mean, the couple thoughts there, but by the way, one thing I want to say is actually I think a lot of this is put under a moralistic kind of lens in these discussions sometimes, and I actually think the pairs are actually acting completely rationally. It's like you don't want to condemn the carnivorous animal for eating meat. It is the market, there are products, I think of the system that, and so I think they're actually acting super rationally. The question is how to change the system so that the collective rational behavior, and you can let them act rationally in this model, but then there are certain service and products that don't make sense under that structure. And so one thing that's going to be an interesting evolution now as we move out of the public health emergency, I think we're going to see literally in reality most of the services, whether it's immunizations, therapeutics for people who test, who get or who have COVID, as well as testing, theoretically there should still be ample coverage.
It's being mandated that there's coverage for people. So we know that dollars are there, but I bet you what you're going to see is a huge drop in utilization. And so that it's not a budget question, it's a financial and transactional friction question that is driving that drop. The money's there, people are still the same people you're managing, we're going to still have outbreaks, we're going to still have, et cetera. And so what drives people not getting vaccinated and so on. I think it's going to be much more that friction as opposed to funding. And so I think it just kind of shows us a good case in point of impact of using an inadequate transactional model for services where you want to drive utilization. And so I think that's, in many ways, I think the way I look at it, and I think we're seeing this a lot from employers and so on, is really a big awareness around for things where you want to drive utilization, this transactional model is not the right long term model.
And so we have to come out of it. I think one of the ways people are trying to get to it is more of this value based care structuring. I think in reality it solves more of the incentives problem for overutilization. So I think value based care is actually very good for managing costs that are unnecessary and acute management doing better acute management. I think that's really where value based care I think works where people don't need to go to the ER, you serve them at home and et cetera. And when people, someone is already diabetic and so on, how do you manage them better so they don't go, they're already in the acute state. I don't think that model is necessarily going to translate to that kind of very high volume, low transactional friction model because I think that there it's still putting it through this kind of machinery that is fundamentally trying to moderate down utilization and trying to control down utilization, prioritizing around that. So yeah, so I think the question's how do we evolve.

Justin Steinman:
It almost, if I try to put it in a nutshell, it says you're trying to drive overutilization of preventative healthcare.

Othman Laraki:
Or I don't put the word over. I think it's appropriate utilization of preventative and it's not just preventative, but also even basic chronic disease. All the things that I feel in many ways there are a lot of parts of healthcare that really should be cheap and easy to do and shame on us if we can't do that. To me, it's been fascinating. For example, we testing for sexually transmitted diseases in churches seems like a bad idea. It's like, "Who's going to want to go get test?" We have done some of these and we've been shocked by utilization. It's like 40% take rates on these and it's all about availability. And so all of these places where there are these big gaps, it's not about as much about hammering people all over the head with them as if once we lower friction then we can try to do more convincing. But I think it is there's so much more ease of impact that to be had and over such a big base of people that that's where at least I feel like all the focus should go.

Justin Steinman:
So I have to ask, you're sitting here talking about this, I can't imagine that your insurance companies are big fans of yours. So who's paying for all the stuff that Color's doing?

Othman Laraki:
Well, actually, by the way, it's interesting, we actually have some very good relationships with payers and I'll explain why. But so in general, we have three types of customers. One is government, second are employers, and the third is with payers. And so payers in many ways actually have the same problem for part of their book. It's they're on the hook for these capitated populations, whether it's in Medicaid or Medicare or fully insured populations where they too are having challenges serving people in healthcare deserts or in places with low access. For example, we are directly working with payers for their Medicaid populations. We work with them in places where it's either there are no PCPs available or there are PCPs, but they're not taking new patients and they need to get basic care to these folks. And how do you do that? In some ways they actually have the same incentives.
The problem is that they have ... It's what I was saying earlier is I think it's not that they're trying to do the wrong thing. Is the overall structure within which they're operating and the machinery they're utilizing just does not satisfy the parts of healthcare where you want to maximize access. And that's why we see this every day where payers are buying primary care practices, which is exacerbating the problem on one side too. Basically the payers are like ... but they're forced to do that. Again, it's not because they're trying to lock people out, but for them to deliver for their customers, you're like, "Okay, I need 50 PCPs in Cincinnati. Okay, I'm just going to go and buy a practice and put them on our EMR," et cetera. And the reason they have to do that is that they can't do all the gap closures without doing that. And so questions why that the market hasn't created abundance of those services that really are cheap and should be easy to deliver.

Justin Steinman:
Got it. So this has been amazing. I got two last questions here for you before we wrap up. So the first one is I'm coming back to politics, twice in one podcast here, but as I'm listening to you talk, it sounds like you're very much advocating that everyone should have the same access to healthcare regardless of the cost to deliver that care and regardless of their personal economic situation. But the frank reality is that's just not the case in the US. And so I'd ask you, should it be, and if yes, then are you advocating for socialized medicine, what they have in Canada and the UK?

Othman Laraki:
So first of all, actually that's not my perspective, by the way. So what I'm implying few thoughts or statements. First of all, I think we are already spending in the US I think more per capita than almost any other country in the world-

Justin Steinman:
We are.

Othman Laraki:
... in both in aggregate as well as even if you just look at government spending in healthcare, it's probably more than most per capita, most socialized care spending in most countries. And so it's not actually that we need more money in the system. I think we actually have a lot of coverage and I think there are places where more equitable coverage, et cetera, would be important. But I don't think that's actually the biggest problem. I think the biggest problem is that we have a broken marketplace that consumes all of the value we're putting into the system. About 25 cents of every dollar we put into healthcare goes into transaction costs, does not pay doctors, does not pay labs or therapeutics.
It goes into the transaction. Whereas you pay 3% when you use your credit card to buy a coffee or when you buy a home, the biggest purchase of your life is 6% transaction costs. And we spend five to 10 times that in healthcare. And so the question is why can't we compete that now? So I think that's really the more my ... it's not about putting in more money in, it's actually, I think we have a non-capitalist, it's almost like I'm actually now going toward socialism and going more towards using the power of capitalism to compete it down. I do think it's important for the government to have a very, in reality, essential healthcare, basic healthcare. Everywhere in the world or pretty much most places in the world, there's a base of it that is a social component. The same reason we don't pay for roads.
I think there's a core, as consumers, we're very willing to spend money to the discretionary market to do things that make us better. We're willing to pay for Weight Watchers or Peloton or hair loss meds or whatever. But the core basic prevention, screening, basic like cholesterol, hypertension, cetera, that are actually in reality should be highly available, is quite socialized everyone in the world, including the US. Even when you say it's part by employers, it is also partially because of the tax treatment for that. So in reality, we do have a lot of socialized spending in the US just through different means, but we don't get the benefits of it. And so that's really where I am with it and I think that's how we get equity is by creating a better market as opposed to just throwing more money into it.

Justin Steinman:
Got it. That's helpful. Thanks for that clarification. So the last question, it's clear that there's a lot in our US healthcare system that needs to get fixed, but we can't fix everything and we can't do it all at once. And I don't want our poor listeners out there to be overwhelmed by everything that we have to do. So before we close out here, I just want to ask you, where do we start and how long is it going to take?

Othman Laraki:
Yeah, so I'm kind of a bit tunnel visioned right now on one part of it, which is this network piece, which I think is actually one of the keys to access. And so in my mind, I think the real starting point is the two biggest blocks of purchasing, which are both governments and employers to figure out a way for them to pull out network access from being melded with the insurance plans. To me, that feels actually really the one of the keys. And so whether it's with CMS and CMI or at state levels, I think those are actually quite doable. And where there can be solutions there that, especially again for non-acute basic services where you want to maximize access with COVID, I think there was actually a lot of direct network access in some sense. And I think that is actually something that we can make a direct move on. And I think actually a lot of things are already moving in that direction, but to me that feels like one of the big unlocks that is quite available and is quite doable in a very proximal future.

Justin Steinman:
It's amazing, Othman . It's great to have you on today. Honestly, to borrow a phrase from Captain America, I could do this all day. I could talk to you about economics. In fact, I even felt like we were back in our business world macroeconomics class here today. But I learned a lot. Hopefully, our listeners did. And look, thanks for coming on, spending an hour with us on Definitively Speaking.

Othman Laraki:
Thank you, Justin. Great to see you.

Justin Steinman:
For all listeners out there, thank you for listening to Definitively Speaking, a Definitive Healthcare podcast. Please join me next time for our wrap up end of your wrap up episode. Todd and Brittany will be back in studio with me to discuss what we learned this year, who made us laugh, who made us cry, and what's our outlook for 2023. Who knows, we may even brainstorm on our guest wishlist for the next year. I hope you'll tune in to listen. If you like what you've heard today, please remember to rate, review, and subscribe to the show on Apple Podcasts, Google Podcasts, Spotify, or wherever you get your podcasts. To learn more about how the healthcare commercial intelligence can support your business, please follow us on Twitter at DefinitiveHC or visit us at definitivehc.com. Until next time, take care, stay healthy and don't forget to study for that economics exam.