Will Bachman 00:01
Hello, and welcome to Unleashed the show that explores how to thrive as an independent professional. I’m your host Will Bachman and I’m here today with Mark Newsome, who is the founder and lead partner at health evaluations. Mark, welcome to the show. Morning. Well, thanks for having me. So Mark, you your entire career, you have been in and around and helping clients navigate the centers for Medicaid, Medicare and Medicaid Services, right CMS. Tell me a little bit about the overview of your practice.
Mark Newsom 00:39
So we specialize in working with organizations that are focused on government programs in healthcare, so Medicare or Medicaid, all overseen by CMS, CMS annually spends in claims plan payments and administrative spend over a trillion dollars a year. So it’s where the money is, if if you’re playing in the healthcare space. So it’s not just about regulation and compliance and laws. It’s also about revenue growth and bottom line. So we we help out different players in the health space. With business strategy as it relates to CMS, as well as traditional policy and advocacy type of issues, you want to get a reg changed, or an interpretation of a reg change. How do you go about that?
Will Bachman 01:40
Fantastic. Tell me a little bit about your career, before starting your own firm. I’d love to hear about your progression. I know you work in and outside of CMS. And just give us a little background on that.
Mark Newsom 01:52
So I’ve spent 20 years in the health space in one way or another either working government or with private sector organizations. In the one intersection for all of that is it all has to do with CMS, in that all the private organizations that I worked for were either contractors, for CMS vendors, or they were regulated entities that were also being paid by CMS in the Medicare Medicaid or now the exchange plans from from the ACA. So the whole 20 years has been at the intersection of CMS started off my career as a data analyst have moved up into the executive ranks and in some of the larger publicly traded health plans and also have been a senior manager at CMS.
Will Bachman 02:54
What What did you do at CMS.
Mark Newsom 02:57
So I had to stance at CMS, the first one, I got brought on board when the Medicare Modernization Act passed in the bush administration. And I got brought in to the regulation team to implement the Medicare Advantage and Medicare Prescription Drug programs. And I focused on payment policy and bidding policy and those two programs. And then later worked on the IT systems in enrollment payment. So my second tour duty at CMS, I ran a division called the division of payment reconciliation and the main responsibility of that team was to ensure the accuracy of Medicare Advantage and Part D plan payments. And then the second responsibility was related to the Affordable Care Act had a provision that required prescription drug manufacturers to pay a discount in Part D, called the coverage gap discount program. And my team was responsible for invoicing, those drug manufacturers to recoup those funds.
Will Bachman 04:25
To what degree duh, do companies that want to, you know, serve Medicare or Medicaid, to what degree they have to customize it for each of the different states to each different state kind of implement Medicare and Medicaid in a different way. So you have to have 50 different sets of rules. If you’re if you’re a provider
Mark Newsom 04:47
in in Medicare, it’s it’s a federal program that for the most part has a preemption clause in the law so that there’s just one set of rules, there can be different rules with what’s called dual eligibles. And those are beneficiaries that are eligible for Medicare and Medicaid at the same time. Medicaid, however, fits the scenario you’re talking about. Where there can be a lot of variations between the states and the District, Columbia, as well as the territories in terms of how their Medicaid programs run different rules, different eligibility criteria. So yeah, if you’re a player at scale in Medicaid, you got to be prepared to do some different things. In each state.
Will Bachman 05:44
What’s an example of something really specific that you might have to, you know, tweak for one state or another,
Mark Newsom 05:52
or anything from what’s on the preferred drug list two, does a state run their program through Medicaid managed care or a traditional fee for service platform down to who’s eligible who isn’t? In some states, younger cohorts, it’s really only for what’s called moms and kids, meaning impoverished males are not necessarily eligible for Medicaid. Um, and, and so on, so forth. Basically, there’s a set of criteria that each state has to meet, but then then go to CMS and get what’s called a waiver, and get all those criteria changed in various ways. And they do that there’s literally hundreds of waivers that states have. And so that’s where you get all this variation.
Will Bachman 06:52
Fantastic. Could we I’d like to walk through a few case examples of the work that that you’ve done with your firm. And we can obviously sanitize the the client and sanitize the details, but love to dig into some of the details of how you go about it and the types of things you might be called on could could you start with an example maybe a policy example where a company is trying to understand either how to interpret a policy or maybe how a policy is going to be changed or how to affect a policy?
Mark Newsom 07:28
Sure, I’m working with some folks in the telehealth space right now. Um, that’s taken on a huge importance, because of COVID-19. But, um, traditionally, the Medicare program, and both the original fee for service Medicare program and the Medicare Advantage Program did not have telehealth fully integrated into the program. And there’s been some waivers and some changes as a result of COVID that have provided some great opportunities in the space. Um, but those potentially will go away as soon as the public health emergencies Oh,
Will Bachman 08:18
and when you say not fully integrated. So let’s say that I’m a Medicare patient, like my dad, for example. And no he. So presumably, like it sounds like what that means in practice would be, he would previously he could go into the doctor and see the doctor in person, and Medicare would pay the doctor. But if my dad did, like zoom or video conference with the doctor and explained his symptoms, and the doctor prescribes something over the, you know, just electronically without seeing him in person, maybe they couldn’t get reimbursement for that same interaction. Is that what you mean? Right?
Mark Newsom 08:54
Yeah, that’s right. At a high level, um, as with anything in the federal government, there’s a lot of technicalities, but at a high level, on reimbursement issues, were a big problem for a lot of providers. And they were for plans as well. So if a Medicare Advantage plan, one wanting to integrate telehealth into what they were doing, previously, there were limitations and what they were even allowed to do. And then on top of it, there was no pathway for them to get paid for it.
Will Bachman 09:29
Okay, and how did that change with with COVID-19? Was there some sort of emergency regulations put out and what were they what, what what changed over the past few months?
Mark Newsom 09:38
So what has been happening since um, since the President declared the national emergency and secretaries are declared the public health emergency is a series of waivers and emergency what’s called interim funding. All rules with comment have been put out there. Establishing flexibilities including more benefit coverage and payment pathways. The legal authority to do that is based on having an emergency, or in some cases from from the cares act. And so there’s a lot of interest in once the public health emergencies gone. What can we do, under existing authority or getting Congress passed new laws to make some of these policies permanent? So that telehealth is a fully invested option for seniors and for providers and Medicare Advantage plans going forward? Well, that
Will Bachman 10:55
makes total sense. I mean, it’s probably less costly for the office, they don’t have to have as many people in the office or space in the office. And it’s probably easier for the, you know, people going there to get on the transport and go and train for an hour Park, etc. So what Tell me about your role in a project like that, like what would what would you and your firm be doing?
Mark Newsom 11:19
So my role in that kind of project is advising the client on how can they best convince policymakers to make this change permanently? What what are the arguments? What are the kinds of evidence and data that will move the needle? for that kind of thing? What are what are some of the plan B’s do? So getting permanent, legal and regulatory change generally takes a lot of time. It’s not something that happens immediately, it could be a campaign that takes months or, or even years or more. For example, there was a payment policy in implicating physicians, um, in the Medicare program, called SGR years ago, and it took the physician community over a decade to get that policy change. That’s the extreme on that. And so advising them who they need to talk to what are the arguments that are most convincing? What do they need to look out for? In terms of naysayers? Often the naysayers are in the oversight community, so you get auditors that will, hey, if we do more telehealth, there’s going to be more fraud, waste and abuse. So how do you respond to that? Um, what are some of the guardrails that you can put forward? That would make sure that there isn’t fraud, waste and abuse? So that’s those are the typical examples in a in a classic policy, advocacy type of advisement?
Will Bachman 13:14
To what degree when you’re trying to figure out what messages will resonate? To what degree? Do you have the ability to go and talk to former colleagues at CMS? to just say, kind of informally? Like, Hey, how are you thinking about this? Or, you know, what, you know, what would be meaningful currently inside the inside the agency? You know, is that is that a source of data for you are curious to hear, like, how you think about getting that those insights?
Mark Newsom 13:48
Sure, um, I would say they come from from one of three pathways, you just mentioned, the most direct and obvious one, that I go back and talk to somebody that I have a relationship with, do that all the time. Um, the other two are, because I’ve been in that chair myself on having worked on the hill and also worked at CMS. Often it’s an issue that I already worked on, and I know how it was approached when I was there and can look at it through that lens. And then the third is, I have a pretty wide network of folks that are in other consultancies or in organizations, private sector organizations that are regulated and paid by CMS, and they’re doing the same work. And so we compare notes all the time, including trade groups. And through those three pathways, you can usually put together a pretty comprehensive picture of What’s going on? And what are? What are the other issues competing for time and space with the policymakers?
Will Bachman 15:09
So this is very interesting to me, because just as a lay person, not in the world of policy, I almost had, like two mental models of how, you know, people might be interacting with the government. And it sounds like you’re a third. So I’ll tell you, my two that I have one is this sort of image of lobbyists, kind of schmoozing upon like a politician where they’re, you know, taking a congress person to golf or out to dinner and, you know, get some subtle way promising campaign contributions that they’ve given campaign and they get access and, and then they’re going to schmoozing that person. And then my second mental model is this much more formal process of, you know, hearings for public comment, or, you know, a commission that’s accepting public comment on some new policy. But it sounds like, the way a lot of work may be getting done is these more informal networks, not with the, you know, like the head of the CMS or the Congress person, but, you know, mid level senior level, kind of this civilian employees interacting with former colleagues or people they know in the industry, and just, you know, having calls and talking about what do you think about this are? Well, what does industry think about this just more having informal, more porous discussions, just tell me a little bit more about that, which is kind of new to me, and not how I imagined government is working.
Mark Newsom 16:44
So you nailed it, all three happen, and I’ve done all three. So let’s talk about that third pathway. Healthcare is complicated. It’s technically complex, in terms of the actual provision of medical care and pharmaceuticals. And then inherently, healthcare is an IT business. You’re trading claims, you’re doing enrollments, on you’re doing, you have electronic medical records, you have data from a testing lab results. So it’s a very data heavy, very it focused industry, both on the private side and the government. And so, in order to do healthcare, well, irrespective where you are, and the government’s no different, you have to have access to a broad set of knowledge and technical expertise. And, and that’s where this more informal, sometimes formalized to the government will go out and contract with McKinsey with, with Booz Allen Hamilton, with academic organizations of prominence like Johns Hopkins, to do technical reviews of things, to advise them on how to not just change policy, but how to implement it. I’m one of my early mentors. I had just finished working on the regulations implementing Medicare Modernization Act. And I was very proud of myself, and I just won the Distinguished Service Award from the Secretary of Health and Human Services. And he laughed and said, Well, this isn’t real until we implement on and he was right, because you can have, at the end of the day, policies, laws and policies are just paper until you have operational processes and IT systems in place that actually work. It’s not real. And so that’s a huge part of all this is, and the part that doesn’t it, it doesn’t get coverage on TV, right? There’s no, you’re not going to watch Meet the Press, and they’re going to talk about the enrollment system at CMS. And yet, that’s what’s more likely to impact a senior day to day. If something gets messed up in an IT system, then any policy will
Will Bachman 19:40
write. And I imagine that if you’re at the government agency, if you’re at CMS, I mean, you want it’s fine. It’s all fine to hire McKinsey or, or, you know, Booz Allen or, or, or to do a formal kind of hearing process where you’re asking for formal inputs, but it’s probably, I mean, you want your regular To be, you know, practical, and so it’s, it’s, it’s probably a helpful thing to be able to just call someone that you trust, who’s out there to industry and say, Hey, like, you know how the insurance company actually thinking about if we do it this way or this way, like what’s actually going to be more practical for you guys. And, and just having that more informal back and forth.
Absolutely. And all the above gets done, they got the formal proxies, and you’re submitting a comment letter, and it’s on regulations.gov, and all that kind of stuff. And then there’s the informal stuff that they’re doing with the stakeholders, but also with their own contractors. And so, you know, CMS has a lot of it contractors, for example, they will often talk to those guys and say, um, you know, this is what we’re thinking about doing. What’s, what’s the state of the art here in terms of is there for example, on a cloud based solution to what we’re trying to accomplish. And we’re seeing a lot of that right now where the traditional CMS architecture was an old fashion mainframe, right at the headquarters using a Tara data data database. And now they’re moving everything to AWS cloud. And that gives them a lot more capability to do real time analytics. And so they’re now talking to tech firms, analytic foams, statisticians about, you know, what can we do in terms of machine learning AI? What can we do in terms of deep learning, predictive analytics, now that we have this better architecture and better technical capability from an engineering perspective?
Will Bachman 22:04
So you’ve been around a bunch of different roles. What is your perspective on how much impact do a political appointees have? So the Secretary of Health and Human Services and the head of CMS, how much impact they have on this nitty gritty of regulation development.
Mark Newsom 22:30
So they have a lot of impact on more and the broader higher level, in many ways, I would make the analogy to them being more like a board of directors on a corporation, on the political appointees that have more experience, and maybe did those other jobs earlier in their career, they will, on a one off basis, get more involved. So secretary, a czar, for example, had worked in the bush administration, or when Mark McClellan was a was CMS administrator, he had lots of previous experience, including being FDA Commissioner, those kind of individuals are able to leverage that experience as well as sort of their own networks within the government to get more involved, but that’s, you know, of, of choice and capability.
Will Bachman 23:36
So I try to keep this a non political show, despite my own firmly held convictions. But, um, so I won’t try not to disclose those or get into that, but I’m curious to hear, do you see much kind of difference? You know, it’s sort of at the certainly in the political arena, there, you know, there’s lots of distinctions and so forth, and you know, and that we all know about it, but when you get into something kind of more technical, like running Medicare, or Medicaid, Is there much really distinction between who’s in office in terms of things like, you know, enrollment and, you know, reimbursement and it and all these different regulations and so forth.
Mark Newsom 24:24
There is but less than I think most people would think, um, I advise my clients and always advise folks in the corporate world when I was there, inside that, be careful of headline ice. No criticism, Wall Street Journal, or New York Times or any the traditional media sources, but those media sources don’t exist to give you actual information to run your business. There. They’re there as a media Your business to sell story. And that story is probably not going to be at the level of detail that matters. for your business. I feel more tactical something is, the less Parson it is. So you You brought the example, say enrollment system and enrollment systems not going to get politicized. On the higher level legislative and regulatory policy? Do we have Medicare for all? Do we? Um, do we pay primary care physicians more in cardiologist less? Should we have a Medicare Advantage program? And if so, are we paying too much? Those are the kind of like political questions where it really matters who gets elected on obviously, had President Obama not gotten elected, we probably wouldn’t have had an ACA, for example. And so I don’t want to make it sound like politics doesn’t matter. It does. But it tends to soak up a whole lot more oxygen than what is realistic in terms of the day to day of claims payment systems, just the general operations of wanting these mammoth health care programs.
Will Bachman 26:30
So we talked a little bit about telehealth, what are some of the other decisions or like new regulations or changed regulations, or any sort of changes that have come out over the, let’s say, the past year or two, that are totally below the headline level. So you’d never read about the New York Times or Wall Street Journal, but are actually really important, and people in the industry really care about? So what are some of these, like, you know, below the radar developments that we haven’t seen in the mainstream press, but people like yourself really cared about?
Mark Newsom 27:06
There’s a lot these things tend to happen every day. Um, so I think in the provider side, some of the sub specialties that are getting big cuts, like physical therapy, in the Physician Fee Schedule, I’m no kidding.
Will Bachman 27:25
Mark Newsom 27:27
And so and that’s not a that’s not a negative comment on the value of physical therapy. It’s widely recognized how important because therapy is. The issue is the law says that the physician fee schedules under what’s called budget neutrality. And what that means is, if there is a political slash policy, push to pay on other providers more, you have to take it from somebody else. In this case, for many years, there’s been a recognition that primary care physicians in particular, should be reimbursed more. And what we’re seeing is, in order to keep the overall system budget neutral, as primary care gets paid, more other specialty types are being caught.
Will Bachman 28:31
00 sum game there.
Mark Newsom 28:33
Yep. Um, and so, so that that’s happening, um, I think the interoperability regulation. So I’m the Office of the National Coordinator of health IT and HHS and CMS co released regulations, promoting interoperability of medical records between all the different folks in the ecosystem. Um, and that regulation was supposed to be going live already. There’s been a bit of a delay in implementing it because of COVID. But there’s also a recognition that interoperability is pretty key to providing the highest quality care, especially in a COVID situation where more things are being done on the phone or via video, telehealth. And patients can’t necessarily get to the office as easy. Um, and then in every part of the healthcare ecosystem, there are payment rules on the hospital inpatient prospective payment system. I already mentioned the Physician Fee Schedule. in Medicare Advantage and Part D, there’s something called the the annual rate notice process And all of those documents are 1000s of pages long and accurate. And have many, many technical weedy details that impact bottom line, the bottom line of the organizations in that space.
Will Bachman 30:19
I’m imagining that there is this cohort out there of people who are the VP of policy at United Healthcare, the kind of head of McKinsey’s health care policy sub practice, people who are on the hill, who are staffers focused on CMS, people who are currently at CMS and used to work in industry and vice versa, people like yourself. And I’m curious, to what degree is that network of folks like, you kind of, do you all know each other? Or do Is there some kind of annual conference that everybody goes to? Or is there a, like a, you know, a private group or something? Or how do you and the people in your sort of that sphere of people that are all relatively senior, they’re kind of been doing CMS policy for 1520 years? How do you all kind of connect and know each other?
Mark Newsom 31:24
There is a fair amount of overlap, at least in the advocacy side of the world. Um, the overlap tends to fall apart. The more operationally you get, I I’m a odd duck, if you want to look at it that way I like to talk about is this is how I’m differentiated. I’m the that not a lot of people have worked both in legislative regulatory policy and also operations. I’ve worked in acquisitions, due diligence, all that sort of stuff. Very few people have done all the above. Um, and but in terms of, you know, is there some sort of Masonic Secret Society of all of us? No, there isn’t. Are there are there are organizations and conferences, particularly in the pre COVID world? We’re sort of everybody gets together? Yes, I think, you know, in the Medicare Advantage space, on the annual medicare medicaid conference that America’s Health Insurance Plans rehab puts on in the prescription drugs space. Um, the pharmaceutical Care Management Association, or pcma, that represents the PDMS generally has a spring and a fall conference, one in Florida, the other in Arizona, where pbms and almost every major prescription drug manufacturer are interacting. I’m also exclusively focused on the AMA space, the better Medicare Alliance, which is an organization representing plans and providers in the AMA space, has an annual conference focused on that. If you’re talking about tak, m hims. If you’re talking about I’m sorry, what’s hims hims the Health Information Management, society, um, they, they’re predominantly electronic, medical record vendors, and other health IT players that gets a lot of coverage. at more of the C suite, and deal levels, you know, JP Morgan, and events like that, tend to bring everybody together. Um, and then depending on your specialty, so that these things also exist for lawyers, for example, healthcare Lawyers Association that has annual meetings and brings everybody together and I’ve spoken on a couple of those as well. So the there are events that bring everybody together, there are some events that CMS does that bring everybody together. But it totally depends on like, your specific function in many ways. Are you a lawyer and working for a GC? Are you help it guy a data guy? Are you a lobbyist? Um, that may or may implicate um, Which one of these types of events you go to? I tend to end up going to all
Will Bachman 35:05
right. Outside of these events? How do you stay up with the the news of this industry? So it’s clearly not reading the New York Times? Are you just looking at every press release from CMS? Or is there some really good like blog for the industry insiders? Or some some newsletter? How do you stay up to date on all the stuff that’s happening?
Mark Newsom 35:31
So I think two things, mostly my own analysis of the regulatory minutia and data released by the agency, then supplemented by having conversations with people in my network, people have CMS, other people that do the kind of work I do, or are in house and businesses. And I like to try to keep up on particularly a publicly traded space. All Listen, or watch earnings calls, from the most of the major players to get the perspective of, you know, where’s business approaching these issues, and, and you, you know, it, if you’ve ever listened to these calls, or been on the inside and helping out investor relations in your company, you’ll see that most of the street analysts, they’re paying pretty close attention to stuff. On the other day, CMS, for example, released the premiums and star scores for Medicare Advantage Part D plans. And, you know, in less than, like, four to eight hours, you started seeing investor notes on you know, here’s how plans performed in in that respect. Um, so in that space it people pay a lot of attention to policy developments, because it impacts revenue growth and bottom line. Yeah,
Will Bachman 37:15
speaking of that, I’d love to hear another example of one of your projects may be more focused on business growth, we talked about some of your work, you know, kind of looking at policy and how to influence that what what would another project type for your firm be?
Mark Newsom 37:32
Um, so, a good example would be a provider organization, trying to figure out their strategy based on where policies going, I’m realistically not talking about, hey, we’re going to get laws changed and regs change, sort of, if, if we can’t get anything changed, and then some prediction of if changes happen, what’s the long term look like? And trying to figure out their overall long term strategy on where the risks and opportunities are? And that’s the kind of work I also did inside on in the companies I work with, are for on on due diligence. So you’re looking at an acquisition target? Um, are you pricing it right? factoring in that policy may be shifting on that target, and they may be paid less or paid more on going forward? And, and so that’s becoming an important part of, of any due diligence activities on on deals?
Will Bachman 38:58
So some of those policy types you mentioned, for example, the just the reimbursement schedule, what are some of the maybe more technical or, or, like out of the way regulations that would actually be pretty meaningful that you’d that you’re looking at or trying to forecast.
Mark Newsom 39:18
So in the often it’s access to markets. Um, so or your ability to put together a product and service and and for to be compliant. Um, so going back to the telehealth conversation we already had traditionally, telehealth wasn’t part of the benefit structure for Medicare. So if you’re a Medicare Advantage plan, um, years ago, even if you on your own as a business, we’re willing to take on the risk of Hey, there’s not a clear payment path. For me, but I think I can do some innovative stuff integrating telehealth, well, the rules said you really couldn’t. And so those rules now have evolved even before COVID to allow more flexibilities for plans, but it took time to do that. And so, um, there were business strategists that had some really good innovative ideas years ago to use telehealth, and they couldn’t, because the rules wouldn’t allow them. Um, then you’ve got another example, in the Medicare Advantage space, there’s a lot of growth in dual eligible special needs plans. And traditionally, most of the rules for that were strictly from CMS. But over time, CMS and talking to states decided that the states should have a seat at the table. And so now our plans need to have a contracts and agreements in place with the state, they want to have the dual eligible snip in. Um, and that can create barriers to market access. Because if you look, historically, states tend to only want to do business with players that they’re already doing business with. So you essentially have to be fully engaged in that state’s Medicaid program to now to have a decent book and Medicare Advantage. And there’s literally hundreds if not 1000s, of examples like this of little tiny tactical things that can make or break your innovation strategy.
Will Bachman 41:54
To companies clearly really need to understand that in a lot of detail. What are some? Yeah,
Mark Newsom 42:00
I mean, this is why if you look at a lot of startups in the healthcare space, particularly in digital will actually actively avoid government programs. Because they’re afraid of it. They don’t think that they can play this ball. And so they’ll focus on self pay commercial on they’ll they’ll focus on self insured employer group plans that don’t have the the regulatory regime that Medicare, Medicaid, the exchanges and other government programs have. The challenge with that, if you want to scale is that’s where the people in the money are. Um, the the higher utilizers of care are Medicare beneficiaries and Medicaid recipients. More and more Americans are in government programs, it’s very difficult to scale a healthcare business and say, I’m not going to do I’m not going to do business in a government space.
Will Bachman 43:10
Amazing, this is such a fascinating view into this world that it does kind of fly under the radar to some degree. And I didn’t realize it was a 1 trillion in spend, I mean, it’s like bigger than the Defense Department. It’s amazing.
Mark Newsom 43:25
It is if CMS were a country, you would have a gross domestic product larger than Belgium. Um, it’s, um, it’s a mammoth organization impacting a whole lot. I think the other thing that a lot of people don’t realize, too, is we don’t have single payer, government run health care. But because of the size of CMS, often a lot of what happens in the private commercial health care markets are really just a cut and paste of what CMS is doing in Medicare. With some changes, give me an example of that. So um, if you’re an employer group, commercial health plan, and you’re negotiating with a hospital, to be in your hospital network, more often than not the beginning of that contract negotiation process is the hospital payment system and Medicare and then you start negotiating tweaks I’m going to pay you more than Medicare will tweak these few things. But the the it’s on the whole thing’s on a Medicare chassis. So you’re you’re starting with what CMS is doing on pretty much all claims processing starts with a Medicare claims, sort of data framework. Um, and us CPT and hickspicks codes, which are copyrighted from the American Medical Association. But it’s really CMS as adoption of that in claims payment, but then filters into the whole rest of the world. And so even if you’re not in a government program, specifically, chances are what you’re doing in healthcare is replicating a lot of what Medicare does, just with some tweaks.
Will Bachman 45:30
All right, great. So if people wanted to follow up and learn more about your firm, where can they find you online?
Mark Newsom 45:38
Uh, the best way to find me right now, because I’m, I’m working on some website development is through my LinkedIn profile or emailing me.
Will Bachman 45:51
Great, and I’ll include your LinkedIn and your email in the show notes. Awesome. Mark. Hey, thank you so much for joining. This is fascinating view into the world of Medicare and Medicaid. Appreciate it Have a good one. All right.