Why Nobody is Winning The Payer-Provider AI Arms Race w/ Dr. Marc Harrison, TowerBrook Healthcare Institute

Welcome to Health Care Rounds, where we give you smart conversations with the people moving Health care forward. I'm John Marchica, CEO of Darwin Research Group. Quick reminder, if you have a question or a comment for me, please send it to Health Care Rounds at darwinresearch.com. And of course, if you're not receiving our weekly newsletter, you can subscribe at darwinresearch.com. Today, I'm pleased to say that we have Dr. Marc Harrison, a pediatric critical care physician who spent the last three decades testing the limits of what the American Health care system can become. He led Intermountain Health care through one of its most ambitious periods of expansion and innovation, and then left that world to co-found HATCo, or Health Assurance Transformation Company, backed by General Catalyst, with the explicit goal of acquiring and operating a health system as a live proof concept for a different model of care. Today, he chairs the TowerBrook Health care Institute and serves as a senior advisor to TowerBrook Capital Partners, where he convenes the CEOs, technologists, and investors working to close the gap between what Health care is and what it can be. Marc, it's so wonderful to have you. Thanks for, for, uh, joining us today on Health care Rounds. Great. Well, thank you, John. It's a absolute pleasure, and I'm really eager to see where the conversation goes Well, we'll see. Here's the plan. Okay. So I wanted to, to touch a little bit on, uh, the history, uh, actually starting back at, at Cleveland Clinic, uh, in Intermountain, and then we're gonna get a little bit into value-based care, uh, and then eventually to TowerBrook. And I'd like to close our conversation, and I emphasis, emphasize, uh, close here because we could spend a lot of time talking about this, but a little bit on AI and the future of, of medicine. So with that, um, I'm actually intrigued to hear your thoughts on your days at, at Cleveland Clinic because as I was, you know, going through and, and preparing for this, um, it's something that I just-- I forget about you. I just as- I associate you with Intermountain and then of course the things that you've done since then. Um, but, but really especially your time at Cleveland Clinic and Abu Dhabi and, and what you were able to do there. So tell me about that experience. Give us a little bit of an orientation of that part of your background and, and maybe some of the lessons that you, you brought to Intermountain from there. Well, thanks, John. Um, that was a really happy period, um, in my life personally and professionally. Um, I know there's some physician leaders out there who ended up going into management positions because they, you know, just didn't love the clinical milieu. Uh, on the other hand, I loved it. I loved everything about taking care of patients, and I specifically ended up at the Cleveland Clinic because I really felt like, um, we were practicing the best medicine that I could personally imagine. It was set up, you know, with the group practice model in such a way that, um, we never had any conflicting priorities except for car- taking the very, um, you know, the focus was always on taking the very best care of every patient. And I got to work with the most talented clinicians, you know, great technicians, great thinkers, um, huge brains, and, um, it was just a phenomenal, phenomenal experience. And, um, the ambitions were high. Um, the leadership set, um, sort of the sky is the limit, and the expectation that we'd reach for that limit every day was, um, was an imperative. And I, I felt really, uh, very privileged to work in a pediatric intensive care unit that ended up achieving the best observed to expected mortality of any unit in the country. Um, it just felt really good to know that we were doing everything we could for every patient every day. What about that starting from scratch, that, that little episode in Abu Dhabi? I mean, really starting from nothing, right? I mean, that's gotta be, um… Did, did you feel a little entrepreneurial, I guess, in that setting? Um- Well, I, I think entrepreneurial nature is kind of baked into the clinic. Pr- now I haven't worked there, granted, in a long time, but my assumption is, um, that's still there, and it's still alive and well. Um, I, I went to, um, Abu Dhabi specifically because, uh, Dr. Cosgrove, Toby Cosgrove, who was the CEO at the time, asked me to go. And at, at that point in time, I was on, uh, Toby's executive team, and I had crafted a role, um, uh, here in the States of a chief medical operations officer. I think the first title of its kind in the, in the country, sort of a COO for clinical care. Um, and was really happy on hi- Toby's team. Uh, worked very hard on, um, turning the clinic, which was a health system in name to a large extent, but into a health system in reality, an interdigitated Um, relatively seamless organization that moved patients around so that the right patient was the right time at the right place. The, I was the fifth CEO in five years, um, when I went, when I went over there. And, uh, for various and sundry reasons, the other four folks had not worked out. And, um, Mary Carol and I moved our family over. Uh, our both explicit and implicit messaging to the society that we were in was that we're your neighbors, we're here to stay, and we're here to get this job done, and we're here to make Health care as good as it possibly can be anywhere in the world. And, um, I think that really resonated. It resonated with Mubadala, who owned the project, um, and, um, for whom the clinic worked. It worked for the people who, um, uh, were on my team. They knew that I was there for as long as it took to get this thing right. And, um, we dove in, and it really was a remarkable exercise in understanding how to replicate culture. Uh, so, so you leave there and you go to Intermountain, and that's again, as I said, Marc, that's kind of, at least in my mind, what I associate you with. You know, that block, that period of time. Maybe it was because that's when, when Darwin was really kinda getting going, and we were really living in the world of health systems, and I was getting to understand who the, who the people were and, and, and who the, who the movers and shakers were. I think during that time is when you were, uh, named, uh, one of the top leaders, uh, period, by Fortune, right? Wasn't it- Yeah … during your time at, at Intermountain? It was. It's a pretty big honor. Um, but I, I'm, I'm curious about, and I, I haven't read this any place, so I'm, I'm making an assumption here. Um, that did you feel that you, you'd sort of gotten to a point where you'd launched a number of these initiatives, you'd done a number of things, and please, you know, feel free to share if there's any memorable experience from your time there, um, or that outweighs the others. But did you get a sense that maybe you were a bit constrained? That maybe you had some sort of vision of what a health system could become, but maybe you were con- even in, in a system as excellent as Intermountain, that, that you had to, that maybe that was what encouraged you to start thinking about Hatco and kind of the next stage of your career. Like- Yeah … I'm trying to get to your thought process around what was going on around that time. So I'm a, I'm a pretty intentional person, John, and, um, uh, I've worked hard and been lucky, um, and generally been able to see where Health care has been going. So way back when at the clinic, I could see that systemness was important. Um, in Abu Dhabi, I was able to see The potential for international collaborations, um, and, um, and growth as well as learnings, um, for, for US Health care. And I went there very much in an intentional fashion to understand what population health could do. So as terrific as, uh, as the Cleveland Clinic was and is, um, at that time, I can't speak for now, its strength was not in keeping people well. Its strength was, um, was primarily in taking care of people when they were very sick, and it did it better than anyone I, that I knew of. And I really thought Health care should be, um, focused on that prevention. So I was-- here I am, an intensivist who wanted to keep people out of the hospital. And, um, and that experiment, um, at Intermountain went very well. And in fact, when I interviewed, in my final interview, uh, for CEO, um, and I got asked this question, "Why Intermountain? Why now?" And I said, "Look, you guys have a, really a huge swath of territory geographically, um, that's covered by the right kind of assets to actually be a, a model for, uh, health, um, maintenance, health, um, injury, uh, injury and illness prevention." And I wanted to see what we could do in terms of, uh, propagating that model. And in fact, as you know, we, we did. Um, by the same token, we grew Intermountain, um, enormously during my years that I was there. We went from about five billion to about fifteen billion in revenue, um, over that period of time. W-lot of accretive growth, a lot of organic growth, um, all with an eye towards population health and value-based care. Uh, and to be, um, honest, we got pretty darn big, and, uh, I began to be concerned that my greatest strength, which is to innovate and to drive change, that Intermountain, A, needed a period of time where it would get its ducks in a row, um, uh, operationally. Um, and B, would start to, um Um, sort of ingest and digest the changes that had been made, and I thought much more needed to be done. And so very fortunate that Rob Allen, who was my chief operating officer and an incredibly talented leader and a good friend, uh, became the CEO, and I moved on to HatCo, uh, very intentionally to see what we could do, um, using, uh, venture-backed companies, um, and a captive or owned health system, uh, to s- to drive the next level of innovation and change. Yeah, I think, um, Rob was on this show a week before he was named CEO. And, and an impressive guy, right? Incredible. Incredible. Yeah, incredible guy. Just… And, and, and the kind of person that you just, I don't know, just wanna sit and have a beer with and talk for hours or have dinner and, and just- Oh, he would be drinking- Just- um, root beer, not, um, regular. Yeah. Not- Sure. Um, but he is- Fair enough … he's just a down-to-earth person, dairy farmer's, uh, kid, grew up, you know, in the West, um, working his tail off. Um, nothing has just been handed to Rob. He earned everything he's got, and, um, I'm just privileged to have him as a friend still. Yeah, very, very good guy. So, so you go off to this, this new venture. And what was at that time, you know, I'm, I'm, again, I've kinda have… I mean, we've written about it here at Darwin. We've written about, about HatCo from the very, very beginning. I remember writing about it. Um, but there's the sense that, that I had that you wanted to own a system, that that was part of it, but then there was a, there was a vision before that. Can you, can you talk a little bit about- Yeah … you know, what you were thinking when you say, you know, transform it. What were you trying to transform, and what was the, the, the bedrock principles of HatCo? Health care is not easy for Americans to navigate and to access, and it's really very firmly stuck in an analog mode in a digital world. And it was important, uh, for us to, A, own a health system, um, so that we could, um, have the influence necessary to actually make relatively sweeping change, and B, choose the right portfolio companies who are willing to work together to create an ecosystem, uh, that provided digitally enabled operations, um, to the benefit of the clinicians and the patients. Um, you know, I'm sure that, John, if you're like me, uh, and you look at your phone, you've got a sprinkling of apps that deal with your health on there. Maybe you've got a diet tracker or an exercise tracker, and maybe you follow your s- your sleep quality. Maybe you have a digital front door to whatever health system you use that allows you to check your labs or, if you're really lucky, make an appointment. But none of this stuff talks to each other, uh, very effectively. And that's both a huge opportunity and a huge, um, uh, waste of time at the same time, the way things are set up currently. And, uh, there's a vision and a hope that things could be much better for people. Uh, we were really, really fortunate to, um, have a friend of, uh, mine introduce, uh, Cliff Deveny from, uh, Summa Health in Akron, Ohio, could see that, um, things were gonna have to change for Summa if they were gonna remain an economically and clinically viable enterprise for their community. And, um, uh, he could see that, um, a different model with a different level of technological support, um, as well as the financial backing of a powerful, um, uh, company, um, would be a ticket to a stable future for other people in Akron, Ohio. And over a three-year period, we made that come, um, made that transition come to life. Yeah, I mean, I think that private equity, at least in the Health care space It sometimes gets a, a bad rap. Um, you know, oh, they're just buying up practices, and they're, you know, it's all about profit maximization, just like they'd be buying the, you know, the roofing company or the pest control company down the street and aggregating that. Right. But my sense was, from the very beginning, that that, at least how I viewed it, and I, maybe I'm, I'm wrong, other people in media or whatever, saw this as being something different, that you were going to be leveraging that availability of capital and investment in a for-profit system, um, for, with, with much bigger goals. And may- I, I, I feel that you wanna say something, so I'll, I'll- No, I- … I'll stop setting it up. What were- First off, um, one of the promises that, um, HatCo made to the Akron community is that we would be there to stay. Um, and, um, that this is not a short-term investment that, I think the phraseology we used was that the Health care changes over years to decades, not over, uh, months to years. And that in order to create something that was really meaningful, um, that there needed to be a, a long-term commitment, and that has remained in place. Um, I, I will say that the, um, to some extent, the lines between venture capital and PE become somewhat blurred in this era, as, as you know. Um- But the very best companies on both sides of that, those sort of investment philosophies and, uh, deal construction are long-term propositions whereby management teams get worked with so that they can be really successful over the long run, and that social good, um, comes of things as well as, um, just financial, um, financial gain. And I've been really lucky in that I think that General Catalyst, um, and their portfolio companies really lived up to that and continue to live up to that with the Hatco team in Akron. And then I'm super fortunate to be working with, um, the folks at, uh, at TowerBrook, um, at this point, and more on the PE side of things, um, we're able to both address social good as well as financial health. I will point out that TowerBrook was, um, the first, uh, PE firm that was a, a B corp, so t- uh, took those social imperatives into account as well as financial, uh, opportunities when doing, um, when doing deals. And, uh, I, I, I find that they live up to their commitment to society every day. Uh, and you're right that there are a lot of, uh, financial services firms, both VC and PE, who've actually justifiably earned not great reputations. Um, and I've tried to be really careful to make sure I work with the right kind of people, and I've been rewarded thus far. Yeah, I mean, it does, it obviously comes down to the philosophy, right? And, um, you know, what is it that, what is it that you consider a good return, right? I mean, the typical- Well, it's a philosophy, but- team… uh, uh it's also, you can only judge their time and their money and, and the people that they interact with. And I think looking really carefully, and I think this comes up as we sort of segue into what, what needs to change in the Health care system writ large is, um, you know, as incumbents in Health care choose to work with, uh, financial services, um, companies, they, they really need to be awfully careful, um, in parsing out who the good guys are and who the bad guys are. And I'm not here to name names, but I think that the principles of how have they managed themselves in the past, um, what kind of work do their companies do? Uh, do they hang in there with their, do, with their portfolio companies over the long run? Do they make sure that when it's time for an exit, it's done in a virtuous fashion, um, that makes society better as well as in, uh, rewards the investors? Let's get to sort of the, uh, I, I didn't wanna spend a ton of time on this, Marc, because I feel like I've been asking these questions definitely for the last few months, uh, around value-based care. Um, but you've been in the thick of it, and, uh, uh, and my sense was is that at least in the early years that Intermountain had kinda like their own, we'll call it their own thing going with, um, value-based care. They weren't jumping on the, you know, the Medicare ACO train, um, at the level that, I mean, I think in- initially at all. But you were doing things with SelectHealth and there were obviously you had this sort of a mindset around outcomes and finances. Um, but today, as we're, I don't know, pick your number, 20 years into the experiment-ish, 15 years into the experiment, how would you assess where we are? Give us a, give us a grade, uh, on our scorecard with value-based care as a nation. As a nation, um, I'd maybe give us a C plus or B minus at the very best, um, with some real bright spots. If anything, I think we've had a bit of a degradation over the, um, over the last several years, maybe the last half decade. And I know we're gonna talk about AI, um, later, but I've seen a sort of a bilateral weaponization of digital tools that pit payers and providers against one another. So on the one hand, you know, the providers are using-- have, have used tools to maximize, um, appropriate coding. On the other hand, the payers have used, uh, digital AI-powered tools to deny um, care as, as quickly. And there's just this like, um, digital AI arms race that is just incredibly frustrating and wasteful. And the people who really, really suffer are the patients who get ping-ponged ball back and forth between the payers and the providers, and are often left trying to navigate a really difficult system. And, um, I remain incredibly optimistic that, um, with the right set of incentives and the right collaboration, and I b- that I believe that, um, payers and providers can work together. Um, and there are a number of companies that are beginning to really talk about this, um, on both sides of the equation, and I remain hopeful that, um, we'll, we'll see a resurgence of activity in value-based care. And I think some of that may be powered by, um, some of the changes that we're seeing on the federal level, which is really pushing folks towards outpatient care and, uh, pushing people towards, um, more holistic solutions. But I'd say C plus, B minus at the very best. Well, just a couple of weeks ago, just briefly, I wanna go back to Hatco because, again, we wrote about it, um, announced the Health System Command Center, and there were eight, uh, GC-backed tech vendors, uh, under a single operating layer. And as you go through, and I'm not gonna name them all, but as you go through the list I got the sense that what you're talking about, not just those two elements, the, the, you know, the provision of care and the, the payer side of things, that, that from all of these different angles that at least conceptually trying to get these different tools to talk together, work together, and work under one, um, I guess a, a common goal. Am I getting that right? Or, or what is your sense of, of that? So absolutely, and what you're seeing is an animation of, um, our concept is starting to come to fruition in Northeast Ohio. And, um, toes get stubbed and things are difficult at times, but, uh, the team drives forward, um, to, to make this st- to make this come to life. Yeah, I get the sense that if you're in this space and you're succeeding in this space, you kinda have to be a little bit of an evangelist. You know? Um, you have to believe in it, live it, you know, just like what you said. Um, it's very important- Well- … to, to have that level of belief. So I, I, I think, um, what you're seeing is, uh, Clay Christensen's innovator's dilemma really supercharged at this point in time. So I was really lucky to have Clay as a board member at Intermountain. And, you know, as you know, at times of cha- change, the innovator's dilemma says you need to run your A category, your old cate- your old strategy, um, uh, uh, and run it as well as possible even as you get ready to switch over onto a new growth curve and a new innovation curve. The problem is, um, the new innovation is happening so fast right now that, um, I think a lot of systems, uh, both on the payer and provider side, are having a hard time, uh, holding both things in their mind at the same time is- which is an absolute necessity at this, uh, uh, you know, period of lightning-fast change, particularly on the technology front. Yeah, and we're, we're gonna get to that in about, about two minutes. Sure. But before we do, um, you know, when I, when I look at, at TowerBrook Institute, very, um, uh, admirable institution, I would say, uh, overall just in, in the little bit of research that I did looking at, at, at the work that you guys are doing. What makes, in your mind though, you know, because I think about like the think tank model, and of course there's the private equity side of it. But in your mind, what makes it different as an institution? What is it that- Yeah … you know, you kinda hang your hat on and say, "We're something else"? Well, I think there are a couple of differentiators. One is, um We're taking an explicitly non-commercial approach to, uh, convening folks in, on the, on the institute side of things. And the second is that, um I guess tied to it is we have a firm belief that there are about 150 people in Health care who drive the vast majority of change and control the vast majority of the capital associated with Health care. And we're lucky in that we work with over 90% of those 150 folks, um, and have deep relationships with them that have been built over time, and, um, a lot of trust is built up. And we have the ability to convene the right people at the right time to talk through sticky problems and well as huge opportunities, and then, um, have a point of view about what the future might look like. And at the right time, um, to then be able to connect portfolio companies, um, uh, uh, with the right, um, operators, uh, and strategics to really make a huge difference in how Health care is delivered. So right time, right place, right people, but mostly, um, predicated on building trust over time that we care about making money, but we care about doing it in the right way first. And it's absolutely about the relationships, right? Hundred percent. This is- Um, when there are only 150 folks, um, if you act like a jerk, no one's gonna wanna talk to you ever again. Um, or if you actually leave somebody in the lurch, uh, and declare war, that's not, um, that's not forgotten, uh, quickly. So, um, I think that, uh, you know, I, I came over to TowerBrook very intentionally to do the kind of work that we're doing right now. Um, I love the fact that, um, TowerBrook, uh, and the institute is really predicated on this idea that if you put the right people in touch with the right technology in an environment where they can be vulnerable and ask questions and learn and teach at the same time, that great things can happen. And then I think finally, um, I think one of the lessons that we're sharing with some of these 150 folks is that given their strategic importance to their communities, to their industries, uh, to regions of the country, um, that they should benefit along with the portfolio companies that they work with, um, and, um, come to bolster their balance sheets by working with the right companies and having the right investments in the technologies that they're actually using. And I think there's a virtue for everyone involved in that. Sure. Sure. Well, I'm not… I'm familiar with the, the Health care 150 and the AI 10- Mm-hmm… which is where we're going next. Right. Um, I have to say So I, you and I talked, uh, several months ago, and I was-- I, I had done, uh, my, my share of research at that time as I try to prepare for these conversations. And, and then time passed, and then as I mentioned before we started recording, I went on vacation for a couple of weeks, and I was back in the office yesterday and a little bit, little bit groggy from the, the coming back from Kauai. You know, there's a just a little bit of time difference. Yeah. And, uh, so I settled in in the afternoon after lunch and started going over my notes and, and one thing led to another, which comes to the second person I want you to make an introduction to for me, and that's Eric Larson. Um, I ran across, uh, Health care's Oppenheimer moment. Yeah. Brilliant, right? Un-freaking-believable. I mean, talented writer. Um, uh, I, I didn't use my thesaurus as much as I do with, say, David Foster Wallace, but it was pretty close. Pretty close. It's got a lot of, uh, a lot of SAT, um, words on there that I know that I should know. But Marc, I'm not kidding. 30 yesterday until almost 6 o'clock, I was reading that paper. And I think I got maybe a third of the way through it. Um, absolutely extraordinary, um, thinking, processing everything that's going on. Um, and we can certainly, you know, again, if I can get him on, I'll, I'll, I'll pepper him with the questions about his very long essay that's close to 400 pages, I think. But, but you know, one of the themes that I'm getting, and I know you probably have a lot to say about AI, but one of the themes that I'm getting is this sense of abundance, and that Health care is in a position where a lot of these tools we're, we're, we're running shortages in so many different ways. We're so effic- inefficient in so many different ways. There's so many places where AI can make things better without displacement, shall we say. Um, and so coming at it from a, a position of abundance rather than we're gonna be losing, you know, half a million people in the Health care workforce in the next couple of years. W- what is your sense today where we are, and, you know, where do you see meaningful change that's, that's already happening in the world of AI? I know a lot has been said about it, but I wanna get your perspective, Marc. Well, I think you've really, uh, uh, I like the term abundance that Eric uses. And by the way, he is the most hyper-fluent, um, evangelist that I could ever imagine. I will be hap- I'm happy to make the introduction to him. And, um, I, I fully commend the Oppenheimer moment to anybody who's listening who would really like to get a sense for the art of the possible. So I think there are, there's, um The National Bureau of Economic Research, um, just has started to circulate a draft of a paper that compares, um, actuarial predictions for growth in Health care spending with what has actually happened between about 2010 and about 2022 And, um, turns out that there's a pretty big gap between what we were-- how much we thought we were going to spend and how much we're actually spending. And sort of there are three big things, um, that account for this gap, and we m- it may actually, in fact, be the beginning of bending the cost curve for Health care. The first is, um, drugs that were formerly on patent are moving over into the generic space. So big changes in some pharma spend. Second is big changes in, um, um, care moving from the inpatient to the outpatient setting. Um, and you know, I'm, I'm privileged to chair the board of Regent Surgical, which is an ambulatory surgery center, uh, company that, um, is, is doing some of that work, but it's happening all the way across the industry. And the third piece is this idea of abundance, John. And, you know, I, I think we probably all know people who have struggled and continue to struggle with finding help for their medical conditions, and certain specialties are particularly bad. Neurology's tough, rheumatology's tough, nephrology's tough. Um, a lot, a lot of these are cognitive specialties. Uh, physiatry is hard to find. Our son is a, um, maternal-fetal medicine, uh, fellow. Um, there are about… the country's between five and ten thousand MFM short. And if we can use AI to help close that gap and go from scarcity to abundance, the good in terms of public health, um, and cost savings and improvements in quality is going to be absolutely enormous. And, um, I, I like to remind people who are scared to death of AI, um, and not always, um, without reason, but often in a hyperbolic fashion, that American Health care is pretty dangerous as it exists right now. So around two hundred thousand Americans per year die in our hospitals, uh, because of medical errors. And if we can add a layer in there that would, um, change that for the better, um, I think all of us would be much more comfortable. So it's not like things are so perfect now, right? Um, in fact, they're far from it. So I, I look forward to moving holistically from scarcity to abundance and, um, you know, we'll have to deal with some of the negatives that inevitably are gonna come from the new operating model in Health care. You know, as I was driving home last night At the same time that I was, I was running through all of these, these ideas that I'd just been reading through for the last four-plus hours, um, I think people around here thought I was a little bit, I don't know. They don't, they don't usually see me that focused for, for that length of time But I, but I also had a little bit of a pit in my stomach. And not just because-- Well, I guess largely because Darwin Research Group, we're in the intelligence business, right? And when you talk about multiplying intelligence as the, as the paper talks about, right? The really what's going on with AI. So I started wondering about, not that this is the first time I've thought about it, but, you know, what are we gonna be doing around here? What, what is the nature of work? And we're doing those things as a company now. But, but, but, but also, I kinda came back to the flip side of the coin and said, again, maybe selfishly, these questions that I'm asking around value-based care and value-based payment models, and what is CMS gonna do, and blah, blah. Like, uh, it, I w- I, I wonder if these questions in five years are gonna be sort of irrelevant, not for the reasons that you would think, that some of these models have, have, you know, kind of worn out their welcome and other models have replaced it. We've got this sort of bifurcated system of, you know, fee for service and value-based care, and we're gonna live with it, but it's better in some way. But, but that AI is going to tackle and address some of these gaps. And I don't know where I'm going with this question Marc, other than to say I did have that same hesitation, even though here we've been living this world for, I don't know, 18 months we've been thinking about this and working on it. And, and, um, so I, I don't know. I'll just leave, leave it at that, that it just … I, I, I wondered if we're not even the average person, the average doctor out there isn't really seeing the massive, massive change that could come to Health care through these tools. Well, I think you're spot on. Um- I think a couple of things are gonna happen. One is, um, if you're like, like me, your friends are already using AI as a integrator around their Health care experience. They're asking for second opinions. They are integrating their wearables with their medical record. They are, um, asking for second opinions and reinterpretations of laboratories and X-ray reports. It's, it's happening right now. I, I think I'm accurate when I say that OpenAI is seeing about two hundred and thirty or two hundred and fifty million queries per week on the Health care front. So I think that the l- the large language models, whether we like it or not, are in the wild becoming the glue for, for many people's Health care experiences. And, um, I think that if this is happening, we should lean in as quickly as possible to make sure that, um, quality, um, and the right values are in place, um, as this happens. But it-- I think the genie's kinda out of the bottle. Um, I, I would personally be shocked if with Health care as eighteen percent of GDP, if some of these big tech companies weren't looking really hard at how they might begin to knit together payers and providers into one large health system and maybe have aspirations of their own around how Health care is delivered. Um, and I don't know enough yet to say whether that's gonna be a good thing or a bad thing, or it might be some of both. But I think that, um, AI is a set of technologies that transcend frontiers, and we both know that the Health care industry is a set of these competing priorities that if they're knit together right, we can actually get a really virtuous outcome. The question is, who's gonna do it? While we wrap this up, Marc, um, I just wanna kind of give the microphone to you and just say- Mm-hmm … you know, as we're looking out, I'm not gonna ask the 10-year time horizon, that's ridiculous, but as we're looking out over the next, say, 12 to 24 months, what are the things that we should be looking for? What are the, the major areas of change that may be AI-enabled and may not be, but that, that are kind of ringing in your crystal ball that we should be looking for? Well, what I'm hoping we're gonna see is, uh, use of AI to, um, steadily improve quality and access, um, for, for, uh, for our friends and our neighbors. Um, Health care is too dangerous. Health care is too expensive. Um, Health care is too inconsistent in terms of the quality, uh, that people get. And I think there are some pretty big holes in, um, our Health care ecosystem as it exists right now, particularly for people who are, um, are economically disadvantaged. And, um, I'm hoping that some of the disadvantages that they continue to bump up against will be addressed, um, potentially by, um, our colleagues at CMS by using AI to begin to close some of those health and care gaps, um, for some of our most vulnerable, um, uh, citizens. All this work is actually happening right now. Um, I think you're gonna be in an incredibly interesting seat, John, to interview, understand, um, gain intelligence, knit together, uh, some important people to, uh, to help, uh, move this transformation quick forward, quickly, accurately, and as safely as possible. Well, I'd like to think that I'll have a seat at that table. Um, it's a fascinating time, uh, more so than I can ever think of in my career. The, the, the pace of change that is going on now, even compared to what we thought in twenty fifteen and twenty sixteen, twenty seventeen, mergers and all that, the pace of change is just extraordinary. And if there's-- I guess that was one of the biggest takeaways as far as I've gotten on the paper. Um, one of the biggest takeaways that I have is just absolute speed of change that if we're not out ahead of it, because the old rules, the old ways that we slow things down, the old ways that we gum up the works of committees and everything else, in the face of AI, um, we're gonna-- the machines are gonna leave us behind. Maybe that's a, a little bit dire way of putting it. But John, I think this is really… You, you're, you're absolutely on target. But I think this is why this Towerbrook model of, you know, health systems and payers need to do what they do, and they need to run their A strategies as effectively as possible. And I think they're going to need to partner with the right, uh, financial services firms who can connect them with the right technologies to actually run their B strategies. Because the idea that everybody can do everything all by themselves, that's old thinking. It-- This is really gonna be about virtuous partnerships. And, um, um, you know, like you, I just feel incredibly privileged to be in the mix at this point in time and look forward to making as much of a difference as I can, um, in the best interest of, um, my friends, neighbors, and family. Well, Marc, thanks again, uh, for taking- It's a pleasure … the time out today to, to speak. I really do appreciate it. Hope you can come back, uh, at some point in the future. And, but I hope, uh, you and I get a chance to talk more even before that. So again- My pleasure … uh, thanks, thanks, Marc. Thank you. And, uh, thank you all for joining us on Health care Rounds. If you enjoyed this episode, please forward it to a friend and rate, review, subscribe on your favorite podcast platform. Positive reviews help other people find the show. And remember, if you have a question you'd like me to answer in an upcoming mailbag episode, or if you just have a comment about my conversation with Dr. Harrison, please send it to Health care rounds@darwinresearch.com. And if you're not receiving Our Take, Darwin's Research Group's weekly newsletter, you can subscribe at darwinresearch.com. I'm John Marchica, and we'll see you next round.