Using Technology to Transform Healthcare Delivery Models with Matthew Fenty, Director of Innovation, Strategic Partnerships at St. Luke’s University Health Network

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: Welcome back once again to the outcomes rocket where we chat with today’s most successful and inspiring health leaders. I have an amazing guest for you today. His name is Matthew Fenty. He’s a director of innovation and strategic partnerships at St. Luke’s University Health Network in Philadelphia Pennsylvania. He brings passion and perspective to the dynamic intersection of health systems, life science and technology with a focus to transform health care delivery models through an innovative use of technology. A system search approach to design thinking and iterating on legacy business models. His perspective stands from a significant experience with healthcare and life sciences sectors spanning end to end healthcare delivery including translational R and D scientific informatics and analytics, due diligence corporate development product operations strategic planning and execution technical product management and digital health technology and adoption. I had the pleasure of meeting Matthew at a health care meeting and I was just blown away by his passion for health care and I thought man I’ve got to have this guy on the podcast and he was very generous with his time. So now I have the pleasure of welcoming Mr. Matthew Fenty to the podcast so Matthew welcome.

: Well thank you very much. Not a physician that I wasn’t playing early on but nothing more. On the technical side kind of behind the scene is the way to go.

: Matthew you have a doctor and results in my eyes and that’s why I wanted to call your doctor you know. But definitely a pleasure to have you on here. Matthew is there anything that I missed in your intro that maybe you want to fill in.

: No I think you covered it quite well. Just one other comment. So we are actually based in Dublin Pennsylvania. It’s about an hour north of Philly. But we do span this entire area. So you know one little while OK. Yes.

: Now good clarification. Appreciate that. What got you into health care to begin with Matthew?

: Yes sure. So you know health care has really been kind of a passion of mine you know going back to a grade school, elementary high school. I think a lot of the folks in your podcasts have always had that passion for health care either kind of behind the scenes or frontline medicine. It’s always been a big focus of mine. And you know think about it in my undergraduate days very much focused on bench science kind of more analytical behind the scenes. I think you know kind of you or other some of your other guests thinking about going into medicine seeing where that takes and kind of taking a step back and say you know on the provider side kind of boots on the ground isn’t the right path but there’s a lot of opportunity a lot of I think work to use my skill set to kind of think about how do we improve operations and how do we improve the business and the kind of the nature of health care and medicine and care delivery and that’s kind of really my passion. So kind of what you alluded to. I’ve been in the translational R and D side, at wet lab, pharmaceutical operations strategy. Now on the provider side and really I think there’s a lot of opportunity to take those different perspectives and I think how do we fix and how do we improve this entire beast of healthcare delivery and medicine within the country.

: Matthew that’s such a great summary and appreciate you sharing that. Some meandering road that got you to where you are but very focused in your case. What would you say today is a hot topic that needs to be on every medical leaders agenda and how are you guys addressing it?

: There’s answers I can think of you know easily hot topics and precision medicine you know makes things like that early. I think one of our big focus and you know a big focus of mine is adoption and changing management and kind of supporting our clinicians, our leaders for change that’s happening regardless of if it’s new models of care delivery, new economic models of care delivery ways that we engage with our patients in a remote or virtual setting but it ultimately comes back and stems to how do we get people to adopt change and how do we get patients to think differently and help them manage their own health care. How do we get our physicians and our clinical teams to redesign what they’re doing and how they deliver medicine. And a lot of it goes back to change management, education workload change, engagements by and support. These are health care types of issues. It’s really you know there’s a lot of change happening some mandated externally through policy but a lot of it is you know we need to prepare for how do we go back to care delivery and how we go back to the human touch of medicine. And it’s a big effort. And you know I think if we focus on those outcomes like precision medicine and genomics et cetera we always need to go back and say How did we get this to work and how do we scale this within our health system?

: Now that’s really interesting Matthew. And what do you think is at the center of change management. How do you move the needle on that?

: Yeah. It’s a trick and it’s really kind of it takes a team you know a lot of it goes back to organizational readiness and thinking about engagements of the people that you need to work with. And so it’s communicating, its understanding and translating why change is happening. Think about why successful EMR launches have been so successful but is it because of the technology. No you can look at and read in the news a billion dollar or 500 million dollar failures in a very public launches. Mars, they think about the ones why things were successful and why things were not in my perspective my point of view a lot of it doesn’t have to do with the technology or the systems. It has to do with engagements by and and communication. And if you can get your frontline staff and you can get your physicians and your administration and patients all kind of thinking about why change is important and health benefits them in a way that it makes sense in a way that they can kind of pull it in themselves. That’s the only way that I think that you can really have successful adoption of new processes new technologies new ways of evidence based medicine protocol delivery. It’s been able to articulate why something is changing and why say impacts me versus why it impacts you.

: That’s a great call out Matthew. And you stress that the beginning of the interview the importance of operational excellence and you know the theme that keeps coming up is just communication rank communicating the relevance of this the why and then the how. And you’ll get to that end result that you and your organization are looking for.

: I think you know we are it’s an industry that we’re in that you don’t go into lightly and you’re not. It’s a very self-selective industry to be in healthcare and we’re all in this to really improve patients. Now I want to improve experience. When my mother goes to the hospital that she has both the best care as well as the best experience,.

: Yes.

: And that her care team are physicians and her nurses and support staff. They feel part of the team are compassion and kind of the human touch is back in the healthcare. It’s not a machinist on an operation it’s not a process or checklist that this is really how do we get people to go back to the practice of hand touch, human touch medicine and you know we can do that with technology but a lot of it has to do with educating and get people to really think about compassion and empathy. And it’s a lot of work and it’s a lot of things that we all want to do and this is why we’re in the industry.

: Yeah it’s a really great call and you know a lot of people talk about Matthew like hey you know what. Why can’t health care be more like hospitality like when you walk into a hotel. The front line staff smiles at you and they receive you they take care of you, their service. Why can’t it be more similar. Like what’s the gap?

: Well that’s the million dollar question I think if you ask is you’re going to get wildly different answers and you might ask a physician say a trauma doc in the E.D. his job isn’t to make you smile, his job.

: That’s true.

: Her job is to keep you from dying on the table and then they can think about there is the inherent difference of a sort of a pure service industry where at the luxury of that organization that they’re getting that customer with think about the job and the goal which isn’t really highlighted as much as it should be is to treat patients who are who are dying. It is to find the best care to support patients at the end of their life. There’s ways that we are interacting and working with our patients and their families that is in a hospitality type of relationship.

: Right.

: Now with that said, we do need to think about how do we put the human touch and how do we make it more empathetic. So when patients are calling us and they’re concerned about their bill, they could be thinking well you know maybe they lost her job or maybe their parents are dying or have recently passed away or maybe their kids you know just got diagnosed with something. And so ends up being you have to put that and retrain staff and retrain some of our any frontline persons to think about this is the most intimate point of relationship that you have with your customer with your patients with their family. And they don’t necessarily want to be working with you. When I go to the doctor, that’s one of the least happy things that I want to do in my day. Something’s wrong. I feel sick.

: I agree.

: I or my parents in the hospital. It is a high stress, high type of emotional environment. So we need to make sure that our people are ready and equipped to deal with our customers and our patients in a high emotional type of setting. And I think kind of go back to your point, it’s not going to be a hot the pure hospitality type of mindset. But choice how do we put empathy back into health care for anyone who interacts with patients or their families. Or you know with anyone who’s part of the care team.

: Now that’s a really important distinction Matthew and I’m glad you brought it up. Definitely not a place where you go to get a smile. You get at a hotel right if you’re broken they’re going to fix you the bones or whatever you know your heart. So I think that’s very very great distinction to make. But let’s find the empathy. So can you talk to us a little bit about some of the things that you guys have done and maybe some examples or things you’ve done to create results or improve outcomes as it relates to this?

: I mean sure, as you know as it relates to empathy you know a lot of that is. I wouldn’t say that’s that’s innovation that’s education. That’s things like how do we get our patients to be able to speak with our staff in a non-clinical environment? It’s having a patient centered forums and bringing in patients who talk about their experience to talk about their patient journey so that our staff can understand holistically what’s going on when a patient either say a newly diagnosed patient with cancer or maybe someone who’s recently pregnant. We want to know kind of what is what’s going on and what’s your journey and what’s your experience like so that we can help reshape what we do retool what we do help kind of meet your expectations and exceeding expectations as well as provide the best clinical care and services that we can offer you. So when we think about things that we’ve actually done so you know we’re really focused on our key patient populations ones that have very complicated patient journeys. Not your come in rate fixed types of things so could be things like your maternity or obstetrics types of patients oncology pediatrics states that are high super high stress and super ambiguity in terms of what’s going on. So we’re putting in technology we’re putting processes we’re putting in kind of people to help support patients in these care journeys in these kind of these pathways that they go through. So that could be from outside of technology innovation or profit innovation that’s where managers and nurse navigators and kind of people helping you navigate all the different paths that you have to go through to come and see our physicians to see our care team. We’re also technology enabling a lot of those services. We can think of patient journeys in unstructured in prenatal planning a lot of it is how do we ensure that we’re providing digital access as well as physical access to our care teams so that when our patients need to access our services or have questions or have general anxiety about what’s going on, they can reach us on the phone, text message, e-mail, chat, video-based. So providing multiple points of digital access to anyone who has a question or concern about their condition, their parents or themselves have a way to reach out to us.

: Now these are these are definitely important, right? You want to make sure that you feel like you’re not on an island as a patient. Sounds a yes I’ve been very mindful about how to give patients more than just one way of getting in touch digitally and physically. In your journey. Matthew have you had any particular setbacks that you’ve learned like key learnings from that you want to share with us?

: You know I would say key learnings is the upfront education the upfront diligence the communication and with your end users and stakeholders, whether that’s you know having focus groups of patients. Or having focus groups and kind of workflow sessions with your clinical staff or operational staff. It’s thinking and being very mindful of what solutions you want to deliver as it really impacts and aligns with what is currently done now and how should we redesign that workflow in the future. We’re then engaged into the future and if we don’t have that by and if we don’t have that strong operational engagement from whomever that end user is and there could be patients or it could be our clinical staff or frontline staff or back office staff. Having that by and up front as early as possible is the only way that you know be successful and we’ve had some the projects initiatives and pilots that now haven’t been successful. And it’s not because of the technology it’s not because of the idea it’s because there hasn’t, there wasn’t a clear expectations in the beginning, there wasn’t clear operational buying. Now we might give a tool to a patient but if they don’t know why or they don’t see why it aligns with what they need it’s going to sit on the shelf. And I think that’s similar. You know regardless of industry, our job is to provide the best way that we can help deliver services in our physicians or our staff to our end users and our patients that we don’t be very mindful. Be very empathetic and have those discussions with the entire value chain and people and things are going at work. And you know we’re going to say well the technology didn’t work or we didn’t hit our end goals and our objectives. But really it goes back to the beginning, engagement, communication, by an acceptance of change.

: Matthew great lesson that you shared with us there. And listeners and you know it’s a great point and you can’t throw technology on top of a broken process or a misaligned interests or lack of by-in you get to achieve all those first. And that takes time and I think a lot of us want to hit the easy button and just throw some technology on top of things and it doesn’t work that way. And this message is really poignant message for not only providers but also technology companies and device companies life sciences companies, you can’t just throw your solution on top of broken process, you’ve got to work on that. Get the buy-in first. What a phenomenal lesson to share Matthew, really appreciate that. So what would just say one of your proudest medical leadership experiences has been to-date?

: Well it’s really I think getting our organization thinking about change and thinking about what’s possible and thinking about how do we collaborate and how do we make sure that when we’re looking at change or we’re looking at putting in systems or technologies that we’re thinking about it holistically kind of enterprise wide or organization wide and not just individual hospital or individual service line or individual practice because you can think about where the majority of health systems were maybe 10 years ago. Smaller, fewer hospitals many more private practices kind of individual decision making and lack of coordination. And so where we are in our maturity of critical coordination. we manage you know 10 acute hospitals with more than 300 physical locations in our area and our patients are very tightly within our scope of clinical care. So by our very nature there has to be significant collaboration and coordination between all of our locations, Family Medicine specially allied health. And so having our clinical leadership as well as administrative leadership thinking about scale and how do we take a piece of technology or service or product and have that scale to multiple patients, multiple service lines and really you know one of our big wins. I would say is that recently we we’re putting in a secure communication capabilities within our clinical staff that ends up just being secure text messaging and you can think about you know this is a market mature capability and this is the things that have been around for many years. But what we haven’t done is really think about how do we look at communication and clinical communication as a network or as an enterprise type of function. You can think about where we were in many health systems where they are now of having individual points of communication routing messages to operators using pagers, being on hold for hours in a day trying to track down providers. And you’re kind of your care team. What we did is say hey let’s do a small pilot of 2500 people a base of a size and say we’re going to put a piece of technology and we’re going to get people thinking about what’s even possible. And so going back to innovation, adoption. Sometimes it’s it’s very difficult to understand the value of a piece of technology or innovation until you start playing with it until you stop using it and the boots on the ground.

Then you can start getting people to say hey this is really important but if we tweak it this way and it’s even much more important ten times as valuable so what we typically do with our with our pilots who are kind of we call Phase 1 deployments or phase of launches it’s to get a very narrow core group of individuals checking out a piece of technology and saying here’s why it will benefit our organization. And then they’re going to be the champions. They’re going to be the stakeholders and they’re going to be the ones buying and selling it through their peers across the organization. So from a communications perspective we realize that this was a significant opportunity within our organization to improve all communications. Things like console’s a critical page alerts like rapid responses in codes and milers Sroka alerts in a way that our clinical staff at the functions that we have are physicians cover all of our facilities. So you can think of a much larger system or even a smaller system where physicians are only deployed at one hospital. The nature of our area that our physicians cover all of our hospitals and all other services. So we need to be very tight and very nuanced in how we do communication especially when we do things like Kotzer alert. And so we are completely redesigning with support of our entire clinical leadership staff and operational staff. If we could redesign this in the future let’s forget everything that we do now. What would it look like and it takes that level of buy-in innovation kind of help perturb the pot and kind of say here’s what’s possible. Then they going back operations say this is a great idea. This is how the ancient run with it.

: That’s interesting. So in your vision Matthew, what does it look like 10 years from now if you guys could build it.

: That’s a million dollar question. You know things are changing so quickly so you know you can think 10 years from now in terms of value-based care or provider rates contracting things like that that you know the economics of healthcare is incredibly going to be different. I think the way that we engage as a provider network, engage with our patients outside of the four walls of our facility is going to be drastically different. Now there’s a lot of adoption of telemedicine, types of capabilities within health systems and in my view that’s kind of table stakes at this point. So that’s like Telad stroke, telecom faults, Kelud behavioral health and just the way that we think about the point that it helps us scale our physicians to hit a much broader patient population especially if you’re thinking of things like stroke or.. Now we need to have that diagnosis instantaneously and maybe our patients and our way are two hours away from a physician but we need to make sure that we’re doing eye care. So I think the way that the technology’s becoming more mature that helps us scale are impact and our reach to treat and manage patients wherever they are either within our facilities or outside. And I think kind of lastly, there’s a lot of technologies and lot of things that we’re considering to improve just basic operations. So how do we streamline care delivery. How do we streamline documentation. How do we make sure that the encounter with your physician. You know it’s not a permanent encounter whether it’s 9 1/2 minutes of them typing on a piece of paper or typing.

: Yeah, that’s a great point.

: We want to put that human touch in that connection back into the visit. And so what can we do from a technology perspective to streamline that to do as much of the behind the scenes as possible to let our physicians be physicians and let our clinical staff do what they’re trained to do and what they want to do.

: Now beautifully said Matthew you’re asking all the tough questions and tackling some really pertinent issues. I’m excited to even continue the discussion outside of this podcast with you and because there’s no doubt in my mind that you’re thinking about these very difficult issues. Tell us a little bit about an exciting project or focus that you were working on today?

: Yeah I mean I think I’ll go back to the communications one because it’s a valuable project. Really thinking about this is not just communications. It ends up also looking that if you’re a physician, imagine a scenario where you’re the E.D. trauma Doc and you need to find the on-call or the you need to do a consult with orthopedics and consult cardiology and consult with the behavioral health.

: Yes, okay.

: What we currently do and what most physicians do is what we call the operator they find who is on call and they might track down people. But what we’re doing is saying can we blow up the entire thing and make communications completely self-service for staff. And so it ends up being how do we blow up our operator call center. How do we make all of our encore schedules easy to view.

: Like a dashboard of who’s available. Yeah.

: So what we do now.

: That’s cool

: So we have a dashboard also linked within our text messaging system. So right now you can text the hospitalist who’s covering the 5th floor in a main hospital. You don’t need to know who they are. All you needed knew as a physician I needed to reach the hospital who is covering the patient on the fifth floor. And so what we’ve done is redesigned the workflow to allow our clinical staff and support staff to be able to outreach and communicate directly with those types of clinical roles.

: That’s awesome.

: So that thing is like our patient transport center or care management or behavioral health toxicology. So if you need to rapidly communicate with the One toxicologist who we have working within the organization, it doesn’t matter where they are. You can send a text message to toxicology on-call and they get that message instantaneously wherever they might be.

: Amazing.

: So that allows us to completely redesign how we do things that console and patient transfers and transition of care between their hospitals and it’s gold message, so it be. It allows us to shrink that time that it takes to make that clinical decision seconds or minute versus hours. So we don’t think about this as an enterprise function or holistically. What are all the nuances of communication. And you just put in a texting system, you’re only going to scratch the surface. So ends up being you need to get significant operational engagement from all of these different functional areas from different clinical areas that say hey, we need to be managing this and look at this big picture. And I think that’s something I always push back to your listeners and to any of the innovations that we want to put into place. Is that how do we get the capability to scale enterprise wide? And what will it take operationally technically as well as boots on the ground and who’s going to own it and how is it going to be governed. Because what we want to do is make sure that we have significant impact with the technologies or process that we put in place not just at the good presure release. Or it’s interesting technology but there’s no adoption there’s no long term value. So we always want to push back and say operationally who’s going to own this and how we’re going to maximize the value of some of these technologies that we put in place. And without that buy-in that operational engagement stakeholder management that things are going to sit on a shelf or do nothing to be used to the fullest potential.

: It happens so much things sit on the shelf so often that the words of wisdom that you’re sharing with us today Matthew are just hitting home with me as I’m sure it’s hitting home with a lot of listeners. Listeners, don’t worry we’re at the end of the podcast here. Matthew will share the best way to get in touch with them. It’s something that he said resonated with you, maybe you want to collaborate with him. We’ll give you the best way to get in touch with or follow him at the end here because we are getting close to finishing up today. I always wish I had extra time but these 30 minute slots are are short of that sweet spot and listeners, time frame commutes and all that.

: They did go by quickly.

: They do man. I mean it’s amazing. So let’s pretend you and I are building a medical leadership course on what it takes to be successful in medicine operations, the 101 of Matthew Fenty. We’re going to write a syllabus. I’ve got four questions for you lightning round style followed by your favorite book that you recommend to the listeners. You ready?

: Sure, sounds good.

: Awesome. What’s the best way to improve health care outcomes?

: Connection. connection with your patients, connection with your peers, connections with patient’s families. Because it’s a team effort and if you don’t fully engage your clinical team and your patient’s family and personal support team then things aren’t going to work well. It could be things like did the patients get to the appointment on time. And so maybe it’s you know it’s their children or their parents are helping them doing that. So having that connection with everyone is part of the patients care team needs to be a part of it.

: What’s the biggest mistake or pitfall to avoid?

: I guess the opposite going rogue. But really it’s thinking that the patient knows what’s going on. So you know personally I’ve been to the hospital before they get discharged in the emergency room when I’ve been to the emergency room. And you walk out the door and say what did the doctor want me to do. What would happen next and a follow up, when the next step, what do I need in terms of medications and going back to what I said earlier this is a high emotion, high stress type of environment that we put patients in. So thinking that the patient is a type A person who is completely literate know medically literate who is only focused on what is my next step. That’s a big pitfall. So you have to be very empathetic of what’s going on in the patient’s head. Now maybe they don’t understand, maybe don’t speak English well maybe there’s other things going on behind the scenes so not being able to sit in the shoes of your patient is. No I think going to be a major downfall.

: Great point. How do you stay relevant as an organization despite constant change?

: It’s relevancy is I think a couple of different areas it’s you know you have your clinical relevance and you’re not seeing evidence based practice in medicine. And I think you know that’s something that people takes for all health systems to have to do. I think from a from a technology side and innovation side here that’s kind of the bread and butter within our organization working stage 7 organization most wired. So from an organizational readiness perspective and technology and how do we leverage technology is really in the minds and culture of everyone within our I.T. organization. So relevance, you know that’s going to conferences that’s listening to podcasts like yours that seeing what other organizations are doing and being able to think about how do we adopt that here? And it could be something for another sector to be from a consumer CPG, from end it from insurance from the hospitality and say you know that’s a really interesting way of doing business. And that’s a really interesting capability. How do we get that type of thinking internally? And I think that relevance is that always push for learning is relevant. Whether you’re a provider or even if you’re on the IT side.

: Interesting, that’s a very interesting point. What would you say is one area of focus that drives everything else in your organization?

: Well from an organization perspective I think quality quality and access. So we very much focus on 3 pillars within our organization. Quality, access and cost. And so when we think about either technologies or clinical processes, there’s a big laser sharp focus on how this is impacting or improving our patient access to our system. How improving total quality outcomes, long term outcomes, short term outcomes. How are we looking at value-based care and value-based contracting as well as how do we ensure that we are providing the appropriate cost. How are we ensuring that we’re managing those costs. Because we do realize that I think as an industry that health care costs are going up and it is in our interest to ensure that we’re providing a service that our patients and our customers continue to use and afford. It ends up being costs and price transparency as well as quality and clinical goals as well as access to services as always everything that we do either from a process or technology or innovation, always aligned to one of those goals.

: Outstanding. What book would you recommend to the listeners?

That’s a hard question. There’s a lot of things I read that actually aren’t books so a lot of like blogs from physicians, articles blogs, a lot of blogs from the venture space who have interesting perspective on healthcare. So you know I was always for an education or learn and read those types of blogs I can share with you some of the ones I check out weekly or monthly. It’s a really interesting book. I really like the Google Ventures design Sprint book because a lot of it what that does is get people to think about problems and opportunities. And how do you articulate what you’re trying to tackle and not trying to identify solutions. So a lot of what we do internally is exercises and discussions to really identify and need the value of a business processes to change versus what’s the value of a new tool or new piece of technology. So that book really helps us kind of get that frame thinking and then I think on the other side I really like The Martian that’s a fantastic book. It’s really funny. I think it’s a lot funnier than the movie with Matt Damon that anyone who has you know a couple hours to kill. You can blast of the Martian pretty quickly.

: That’s a good one. Matthew great recommendations. Listeners, you don’t have to write any of that down. You could find our entire show notes the transcript today’s interview as well as all of the Q&A and links to the resources that Matthew just shared with us. Just go to outcomesrocket.health/fenty, F E N T Y, it’s Matthews last name. You will find all that there. So this has been so much fun Matthew. So glad that you made time to do this if you can just share a closing thought with the listeners and then the best place where we can get in touch with you?

: Of course I appreciate the time on your show. I would always, regardless of where you are within healthcare either pharma, in a provider research. Think about we’re in this for for us and our parents. Think about how does what you’re doing is going to improve the experience for your parents or for your children. And so I’m putting empathy and putting that personal experience and personal touch in research or drug discovery or surgery or behavioral health or care management. At the end of the day we are treating our family and our friends and our neighbors and our community and healthcare is such a local type of industry that we’re going to see people that you know work that come in. Are you their services on a daily basis. So we want to make sure that we always put that human touch a human focus back into what we do and that every decision should be based off how is improving our community and how this improving our neighbors.

: Great message Matthew. And what would you say the best place for the listeners to follow you or reach out to you is?

: E-mail me directly. I’m pretty accessible. I don’t tweet a lot. I follow a lot of people who tweet a lot but my social media it’s, also in LinkedIn or e-mail or just a phone call would be always the best way to reach out to me.

: Beautiful. Well this has been a ton of fun. Matthew really appreciate the words of wisdom you’ve shared with us the tips on operations, the tips on just putting empathy first and some of the examples that you guys are doing there at St. Luke’s, really inspiring. So keep doing what you’re doing man. This has been a really fun episode. And we’re looking forward to staying in touch with you.

: Of course. Glad to help.

Thanks for tuning in to the outcomes rocket podcast if you want the show notes, inspiration, transcripts and everything that we talked about on this episode. Just go to outcomesrocket.health. And again don’t forget to check out the amazing healthcare Thinkathon where we can get together took form the blueprint for the future of healthcare. You can find more information on that and how to get involved in our theme which is “implementation is innovation”. Just go to outcomesrocket.health/conference that’s outcomesrocket.health/conference. Be one of the 200 that will participate. Looking forward to seeing you there.

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