Things You’ll Learn:

• Innovative healthcare solutions are helping to improve patient care and increase equity in access to services.
• Technology integrated with telemedicine, is essential in reshaping healthcare delivery, especially for underserved populations.
• Addressing social determinants of health is critical to improving health outcomes and reducing disparities. 
• Collaborations between healthcare providers, community organizations, and policymakers are driving more inclusive and effective care models.
• Data-driven approaches are empowering healthcare organizations to create more personalized and efficient care strategies.

Resources:

• Connect with and follow John Gorman on LinkedIn.
• Follow Nightingale Partners on LinkedIn.

Transcript:

Rachel Schreiber: 

Hello and welcome to the Spark, a view of innovation in healthcare. I'm Rachel Schreiber, your co-host, and in this episode we're speaking with John Gorman, founder and chairman of Nightingale Partners, the first venture fund to invest in early stage companies in the social determinants of health ecosystem. John and I both worked in a Medicare advantage space, and I'm excited to speak with you, John, about your work in SDOH. I'm also joined by Stuart Hanson, CEO of Avaneer Health. 

Stuart Hanson: 

Thanks so much, Rachel. I'm so excited, John, to have you on the show. Thank you so much for taking the time and thanks for all you're doing in the health equity and SDOH space. 

John Gorman: 

Thanks. Thanks, man. 

Stuart Hanson: 

Yeah, really intriguing. Would've never even known where to look to find the first venture firm to invest in SDOH, but I'm really excited that it's you. So yeah, really looking forward to our discussion. 

John Gorman: 

Me too. 

Stuart Hanson: 

So I know you've got a ton of experience and really great perspective just in our prep. I know we could go one of five or seven different directions, but before we get started, I want to ask you a question that we ask all our guests, which is really, we all recognize how complicated and how hard and how difficult and how much you have to grind to change anything in the healthcare system. Not only is it huge, but it's also really, really complex. It's really laden with technology debt, as I'm sure from a lot of your investments and companies you've helped along the way. And it's not easy to persevere in this industry as an investor, as an entrepreneur, as even an executive within a health system or a health plan. So it seems like everyone who gets to this stage of their career and they're actively working and making the impact that people like you are, they've got a unique spark and that's how we named our podcast. But I would love to hear a little bit about your source of passion for what you do in healthcare and what gets you out of bed and what gets you excited about what you're doing. 

John Gorman: 

Well, for me, probably my biggest motivation and spark, as you guys like to say, would probably be my mom. My mom was a legendary primary care physician in her day. She passed two years ago, but in her time, she was the first woman er chief in the United States back in 1967. She came to run the biggest primary care group in Massachusetts, which is a very mature market, and that was a big accomplishment of hers. But her real passion was humanitarian relief. And so she was in the first wave of helicopters into Chernobyl with the first wave of medical personnel. And she ran refugee camps in Macedonia during the Bosnia war. And she was in Sean Penn's camps down in Haiti after the earthquake. And her, she was in the first wave of clinical personnel in Fukushima after the meltdown. She loved being needed and she loved helping people in some of the worst circumstances imaginable. I mean, her idea of retirement was to go run the biggest AIDS orphanage in South Africa for six years, and she was like 75 at the time. 

Stuart Hanson: 

Wow. 

John Gorman: 

So she was just an animal when it came to her passion. And she always said service before south. 

And that really rubbed off on me, my dad too, in a different way. My dad also an ER chief, but his idea of residency was to go do two tours in Vietnam as a field surgeon in the cavalry. So he was riding around on tanks and army personnel carriers patching up guys in the field, and he came to be New England's foremost gunshot wound expert, and he ran his own ER for 35 years without a hitch. And he was really the one who just kind of hammered into me always do the right thing, especially when there's money on the table. So they're two of my huge inspirations. But my younger brother Todd, is actually a huge inspiration for me. Todd is one of the most accomplished internal medicine docs I've ever met. He actually renounced his citizenship, moved to Quebec Reboarded in French, and now is the chief of internal medicine for the entire province of Quebec. And his wife is the chief of infectious disease for Quebec.  

Stuart Hanson: 

So you're surrounded by slackers is basically 

John Gorman: 

It’s an ambitious and driven family and I'm actually the only one in my family that's not a doctor, and they all say I was the smart one. I like doing this work around the edges of healthcare rather than actually getting my hands dirty in the way that they do. 

Stuart Hanson: 

That's awesome. What a great inspiration 

John Gorman: 

For me, this is my 35th year in my career, and I spent the vast majority of that time so far cleaning up health plans and insurance companies that hit the rocks trying to get into Medicare Advantage or in Medicaid and turnarounds of health plans was a big focus of career when I was running Gorman Health Group. 

I just kind of wanted this last phase of my career to be about something a lot more meaningful. So social determinants that just always fascinated me. This is where the majority of healthcare spending comes from is from poverty and racism 

Stuart Hanson: 

What a great family of service that you're part of and really exciting to see you applying that in a different way. I wonder if your father and mine maybe crossed paths in Vietnam and one of those tours. So dad's definitely one of mine as well. So hey, I know we could spend a ton of time talking about that. Let's save it for the next time.  

But we'd love to hear, especially given your active roles in a number of companies and the investments that you all are making and things that you've looked at and things that inspire you, we'd love just your take on. There's so much changing. I coined a name for a business maybe eight years ago, inflection Healthcare. Oh, that's good. I thought everything was changing then, and it's been in this protracted inflection point. Because there's so much opportunity. So I'd love your take on what's hot, what's not, what do you not, where do you think things are going from here? 

John Gorman: 

It's almost dizzying the amount of innovation that's now going on in this space. I got to say in 35 years of doing this, I've never seen so much stuff that's just coming out of the woodwork that 30 years ago we never would've imagined. And it's a really exciting time. It's also an exceedingly frustrating time because so much of the hype that's out there around things like ai, I think is just dangerously overblown and we got to come back to earth on some of the stuff that we think is actually going to result from these kind of innovations in the next five to 10 years. Well said. But for me, as a guy who's focused on SDOH in this phase of his career, the thing that I think is at the top of my list of what's hot, and maybe I'm just a hammer looking for a nail here, but it's the health equity stuff. 

And when you consider that health equity is really about eliminating disparities in care, that's very much an extension of the passion that I've got around social determinants of health, which let's face it, are just four fancy words for poverty and racism. And so this administration's unrelenting focus on health equity has been a real wind in my sails, certainly around these issues of really improving access to care for vulnerable, making sure that expensive new therapies and technologies are available to people who can't afford them. I mean, I think that's actually the real next frontier of health equity.  

But one thing that you can certainly count on is that that commitment to health equity will continue even greater in a Harris administration. And so I'm very excited about that because that really has the potential to move the needle on or to bend the curve on costs in our healthcare system, which yeah, 

Stuart Hanson: 

Such an important needle to move. 

John Gorman: 

Absolutely. I mean, when 60 to 80% of what we spend in healthcare is directly attributable to poverty in healthcare, wow. I think this is absolutely the battleground of the next decade, and that's my top priority. But man, if you look at all the innovation that's happening elsewhere, I mean, look, in just a short five year period, telehealth and remote monitoring have gone completely mainstream. 

I think we're still trying to figure out what's the best way to pay for some of these things. I think it's especially useful around mental health and increasing access in a specialty that we know is dramatically understaffed in this country, and the need is very great. As I mentioned, I'm a skeptic on a lot of the stuff in artificial intelligence and in machine learning. I think there's a long, long way to go there. Similar in digital therapeutics, I mean, I think we still have a lot of work to do. I'm encouraged in starting to see AI applications in diagnostics that I think are very helpful around breast cancer. We're starting to see some amazing breakthroughs there, but I think that's really where AI needs to focus and not on some hot new hospital marketing auto emailer, if you will. And so I'm really hoping to see more breakthroughs around AI in clinical care and in diagnostics in particular. 

And I think that could have a real impact on preventive care in particular. I mean, we're now seeing AI capable of detecting cancer before it even really manifests itself as a tumor like five years before it would become a tumor. So that's the kind of stuff I would get excited about. The rest of it is just a lot of noise right now, and I think I want to sit back and wait and see where some of these things come through and the folks out touting these solutions can really prove that they do improve care. I think what's hot and what is going to be either the biggest help or hindrance in this next decade is interoperability and data exchange. I mean, we just have to make this stuff a lot easier. One of the things that worries me a little bit is the dominance of Epic in electronic health records and whether or not that could be a help or a hindrance as we try to get the stuff to work better. Of course, value-based care is on the tip of everybody's tongue. 

I think this is as what I'd say to the things that aren't hot right now is this is evolve or die time for providers, for insurers, you name it. And value-based care isn't just a mantra right now. It's a business necessity. Yeah. They have to. I think the more we can support, especially physician groups, and I would go even further and say especially minority physician groups, to be able to have the access to liquidity and technology to make this giant leap forward into a value-based care environment is absolutely critical. There was just a great study out in the annal of family practice yesterday about the importance of diversity in the physician workforce and that Asians represent 15% of primary care docs, African-American, 7% Latino docs 6%. We've got to get those numbers way higher because it's very well established that minority physicians directly reduce disparities in their communities. 

They're more willing to accept Medicaid beneficiaries as patients, and they tend to have a much better grip on the needs of a lot more in tune. Yeah, for sure. So I think a lot of that will come down to it, genomics and personalized medicine. Those are the ah whizzbang stories that we all love to see on social media and some new giant breakthrough for some obscure rare disease or all that stuff is wonderful. What concerns me about that is that so many of these new next gen cures are going to be cost prohibitive for most of the folks that need them. And I think the next frontier in health equity is going to be around the affordability of these new therapies and drugs that are coming out that are heinously expensive 

You would imagine, a rare therapy that might be, but say the ability of lower income black patients to be able to get an Alzheimer's drug, I think is going to be a real Alzheimer's insulin. Some of those things are getting addressed, but GLP one, I mean, there's a lot of things that need to be addressed as the landscape evolves. 

I think that's the big next frontier in health equity iIs the affordability of so much of these next gen solutions that we're coming up with. Mental health is certainly going to take prominence here yet again. And I think again, this administration, Joe signed an executive order last week. Again, recommitting the administration to mental health parity. Certainly in a Harris administration, you're going to see a lot more of that. I think you'll see a lot more emphasis around the supply of mental health providers and the ability for telehealth to extend their reach so that more people can be served so needed. So those are, for me, the big ones in what's hot. 

And what's not. Again, I would preface this by saying everybody needs to recognize in times of rapid innovation like this, the mantra, the code word, the North Star has to be evolve or die. And folks who are resisting a lot of the movement into the technologies that we're seeing right now, I think really got to get past that or they got to stand aside and let somebody else lead the way. I think what's not hot right now are still outdated EMRs, EMRs that aren't keeping up with data exchange or with interoperability. A lot of these systems are just not user-friendly or interoperable, and they're actually hindering effective communication and coordination of care. And I think a lot of those are going to get thrown out the window real fast in this next couple of years and give way to more systems that have a better track record and actually ease of use for the end user. 

I would say the same with overhyped technologies not hot, and I don't think this flood of AI startups that we're seeing right now. I mean, I don't go to health conferences and I don't go to HIMSS anymore because man, when you just walk in those exhibit halls, it's like all I see is dead men walking. It's like 98% of those companies are not going to exist five years from now. And I don't concern myself with a lot of the stuff that we're seeing now, which is just me too stuff, and let's do a cheap knockoff of somebody else's solution and try to carve out a little bit of market share. I think crappy user experience in digital health is definitely not hot 

I just think I see so many of these technologies that are coming across my desk now just as an investor in this kind of stuff that absolutely were not designed with the end user in mind, and those systems are just designed to fail. You've got to design this for the doctor or the nurse or the social worker or the nurse practitioner that's going to actually be using this information in these communication tools and not what's designed by some really sharp designer, but who has no idea what managing a clinical workflow it looks like. 

So those things are dead regulatory barriers now. Everybody loves to complain that the big bad feds and state governments get in the way of innovation. I have to say this administration has been very forward looking on these kinds of technologies, certainly trying to drive interoperability even further. I think the innovation center over at CMS has been doing some really groundbreaking work, especially in this administration. And I think they are very much aware of how regulation can get in the way of innovation, and I think they're legitimately interested in hearing about where those rocks in the road are and what they can do to lighten the load.  

So again, hat off to this administration, and I think we can expect to see even more of the same from a Harris administration. I mean, you certainly cannot expect that from a second Trump administration, a second Trump administration on stuff like this. They wouldn't even think about it. I mean, for them it'll be letting brokers and agents and Medicare advantage just off the leash. Again, that's the kind of regulatory stuff a Trump administration would want to do. Okay, great. And the one thing that I think is worrisome and what's not hot is what we're seeing in terms of limited funding for the startups that we need to see breaking on the scene here. I mean, 

These are the worst venture conditions I've seen since 2008. And I can certainly say that as a venture guy who raised his last one a couple years ago, it was brutal out there two years ago. It's even worse now. And when you consider that upwards of 40% of venture capital deal flow now are in deals of a hundred million or more, 

Stuart Hanson: 

Unless it's an AI startup and then you can get a billion dollar valuation right out of the gate. 

John Gorman: 

Yeah. Well, I think a lot of that stuff's going to continue coming down the road. But that does concern me because it's very difficult for some of these early guys that have very promising new solutions to bring to market, can't find 10 or 25 million where in many cases it's easier for them to raise 150 for private equity, 

Their idea doesn't merit that yet. And so they're in this funding rut that I hope will get a better in this next couple years. Now the fed's starting to cut rates again. 

Stuart Hanson: 

Yeah, we're starting to see start to loosen up. 

John Gorman: 

Yeah. Thank goodness. That's my great hope, because I think that lack of capital is going to suck a lot of the air out the room and innovation. 

Stuart Hanson: 

Thanks for the round robin on hot and not hot. You mentioned Epic and you mentioned interoperability and you mentioned maybe I'll try to put a label on it. Technology equity for small and minority physicians and just physician groups in general trying to keep up with the needs of tech investment, which is all hard.  

John Gorman: 

My family business, that was my first job was working in mom's practice. 

Stuart Hanson: 

Okay. So the pain of probably some ancient EHRs that are probably still around 

And just how costly it is for physicians at groups. Oh, maybe that's not around myself. Okay, fair enough. All right. We won't ask you to name the backend system, but even the Epics, even Cerner, Oracle, they still struggle with trying to unlock data for all these awesome use cases because everything you're talking about the ability to intervene and provide good care, it's all requires access to data in real time. And our systems are not built for real-time data access. So maybe we can just hone in really quickly on what you think the biggest risks or opportunities are around the industry tech stack. If I want to just kind of put a big label on it, because data silos, there's a big problem, right? 

John Gorman: 

Yeah, absolutely. But one that I think is universally acknowledged across the health system at this point. It took us a long while to get here, but I think that's very well understood at this point. I gave a speech to what AHS predecessor 30 years ago where I said that what we then called HMOs are going to become IMOs in the future or health information management organization, and that would be their primary revenue stream. And reason for existence was that look, health plans are ideally positioned to be the data repository and the one to really synthesize this data into actionable intelligence. And I think we see this from huge companies like United and Humana that are doing some really interesting things with roping this data into all kinds of solutions that can better improve care. And we're even seeing it in small and regional plans. Like one of the great pleasures of my career serving on the board at Health Alliance Plan and at Henry Ford in Detroit, and really being at the forefront of what small and regional plans are looking at. 

And I can tell you this is one of the biggest line items in our budget is in investing in large IT and AI initiatives. But therein also lies the risk. I mean, as soon as we saw that there was a rate cut coming in Medicare Advantage last spring, then everybody's big AI or IT project went up on the chopping block as an expense that maybe we could cut back on this or eliminate it altogether so that we don't have to change our benefits because of this rate cut. I mean, that's an enormously shortsighted view of things. I think there is a danger that these things get underfunded when plans belts get tightened. You certainly saw a lot of the Medicaid plans cut back on some of this stuff when the reconfirmation of people's eligibility after the public health emergency ended and 20 million people lost their Medicaid coverage. So a lot of Medicaid plans started cutting back on those 25 or 50 million IT initiatives. And that's the kind of stuff that I think has to get reinvested pretty quickly in these next couple years for these companies to stay ahead. Agreed. Makes sense. Everybody is aware of these silos and how it's hindering us, and I think there's been great progress made at every level of the industry around this. I tend to think it's, it's not happening enough among medical groups, especially those that take risk. And it's not happening nearly enough among the minority physician groups that we mentioned earlier that just simply lack the capital to make kind of investments without external help. 

Stuart Hanson: 

It's interesting because you're talking about data interoperability and the plans driving it, and I don't think that is a topic of discussion much. I think that's a really unique perspective. And you're right, they have a lot of the data and they could be sharing it 

John Gorman: 

Or using it. 

Have a lot of it. And there's a lot of folks out there looking at social health data 

And everybody can look at income. Everybody can look at race and ethnicity. That's not where the real action is. The real action in understanding social health data is in using claims from the plan. And I'm not just talking medical claims. I mean, in many respects, pharmaceutical claims data is a much better predictor of future disease and spending than medical claims are. You want to look at data that's coming out of your customer service department and factoring that into your analytics. When we at Nightingale did interventions, we did about a dozen of them. We were looking, our very first step data was always the tip of the spear. 

We were looking at 5,000 different sources of publicly available data. So we were looking at stuff like who checked into a food bank in the last two years who checked into a homeless shelter in the last two years who had a house foreclosed on or a car repossessed? Those are much better indicators of social health and the pressures of poverty that can result in exacerbating mental health conditions and exacerbating things like blood pressure and other comorbidities. So at the end of the day, the insurers have to be out in front. They hold a hundred percent of the data and they hold a hundred percent of the risk. 

Rachel Schreiber: 

So what's your perspective on how social determinants of health data and or just interventions can be more integrated or more a part of health care? 

John Gorman: 

I think it's starting to happen. It's happening slowly. And I think it's because so many insurers, and for that matter, capitated medical groups just never envisioned themselves as having to function like a social service agency. They pay claims and they're trying to make sense of just a load, a huge load of data, and to make sure that it's not noise that's getting pushed downstream to their provider network. And it is been very slow coming to this realization that, look, guys, if you're an insurer, you hold a hundred percent of the risk, therefore a hundred percent of the social health risk. If you are a capitated medical group, you're taking 80 to 85% of the risk on that patient, 

It absolutely has to be part of your responsibility to take care of their social health needs as a business imperative. If this is 60 to 80% of where your healthcare costs are coming from, if I've been baffled by anything in this last 20 years, it's that it's taken this industry so long to awaken to this fact. I mean, social determinant interventions are cheap and have absolutely massive returns on investment. And my big frustration in this last five or six years since these benefits have been explicitly authorized in Medicare is that we've got to get out of the plans, and to a lesser extent, the capitated groups worldview that these are marketing and sales and retention tools like a food security benefit or non-urgent transportation and not a clinical quality member experience and health equity driver. I mean, every intervention we've ever done shows that intervening on social health matters returns at least a four to eight x return on investment net of your costs. And in some cases, like food security or food as medicine, particularly for folks like diabetics who have very food sensitive conditions, you get as much as a 35 x return on investment and that you're just not going to see that kind of return anywhere else unless you bought Bitcoin in 2014, you sold that shit in 2018. You know what I mean? So this is where it's at as far as I'm concerned. 

John Gorman: 

Again, I may be a hammer looking for a nail in this last phase of my career, but this is where it's at. 

Stuart Hanson: 

Do you think the plans, broadly speaking, and I know there's some way better than others, we work with some of the best, but do you think plans in general really appreciate that opportunity and that ROI from a medical No, 

John Gorman: 

That's what I'm saying. They still think a long way to go. These are good inducements to get people to join your plan or stay with your plan, 

Stuart Hanson: 

So they're not intervening actively enough. They're using it more just to bring plans or members on. 

John Gorman: 

It's not a logical connection necessarily stew. That food will reduce the number of people going to the hospital. That takes a bit of an intellectual leap and some understanding of the research to see why that would work. 

And when you consider that these are in fact great retention tools that plans that provide these social health benefits actually have much stickier members and they have much lower infection rates. Once you start feeding somebody, or once you provide them with broadband internet access they didn't get last year, or transportation. 

Or transportation, they tend not to leave because those are benefits that they use every day, every week as opposed to a dental benefit or something like that that you use maybe twice a year. 

Stuart Hanson: 

Makes sense. 

Rachel Schreiber: 

So what about the dual eligible? What are some of the ways that the industry should be prioritizing that? I think that it's well interconnected with health equity SDOH. 

John Gorman: 

The dual eligibles in being qualified for both Medicare and Medicaid are really the last frontier for healthcare in this country. These are the most vulnerable and expensive and complicated patients that there are out there. And I think it's really important that we recognize that the duals are not homogeneous at all. There's two very distinct segments of the duals that have very different needs and priorities. You've got your 65 and older low income seniors who get both Medicare and Medicaid because they're poor, but then you've got the under 65 disabled, and these are folks with severe intellectual or developmental disabilities. And their needs and priorities are very different than older beneficiaries that also qualify. So for instance, 

Rachel Schreiber: 

Yeah, that's a good point. 

John Gorman: 

Older duals would tell you that non-urgent medical transportation is a very big deal for them. Whereas an under 65 dual who's intellectually or developmentally disabled may be living in a group home or by themselves with help. Their biggest thing would be help pay my utility bills. And those are, in many states, also allowable Medicaid expenditures. So you have to do patient specific care planning for every single dual because they just aren't, if you've seen one dual, you've seen one dual, but because of their disease burden and their complexity and they stack of their comorbidities, you have to be a lot more focused. You have to have a lot better data. You have to have much better and integrated outreach and intervention with these folks because they need it. And these are the folks that use the hospital the most. They end up in long-term care the most. They don't end up in hospice nearly as frequently as they should. And these are folks for whom a $5 copay on a drug means they don't get it. And so there are very few companies that are out there that get the duals. There are some that are excellent at it, but I just finished a year long engagement with Sync Care. That's Tony new company, relatively new company, started it three years ago. But Tony was the one who started the Medicaid business at UnitedHealthcare and grew that into a, what, 20 30 billion business 

Sync Care was Tony's answer to what we saw during the pandemic, which was that black and brown populations had massive health equity issues during the pandemic. They had worse access to care than anybody else in the country. And Sync Care was designed with two purposes. One was to take risk on duals from health plans with a direct care intervention model. So they have a direct care workforce of nurse practitioners and community health workers that try to provide 95% of what these members need in the home, which is the right approach. The other half of the company focuses on the formation of ACOs for black and brown physician groups and helping them make that giant leap over the technology and capital chasm. And they're doing great on both. And that was a really valuable experience for me working with them for a year on the inner workings of how this stuff gets done. And it's very complicated, and I think a lot of plans are aware that there's a much greater margin available in the duals, but they're scared shitless by the complexity of the population, and they're very slow to adapt their approach. 

Rachel Schreiber: 

You've covered a lot of ground, but are there any last points that you'd like to cover before we end? 

John Gorman: 

I think at least what I'm working toward guys, is that in this next decade that the word social determinants of health are gone. I'm trying to work myself out of a job, and I think that within the next decade, the market leaders in healthcare are going to integrate social health into their clinical workflows in such a way that we won't even have to talk about this stuff anymore, that it will be sort of de that. Of course, we have to deal with whether or not our patient is homeless or is couch surfing. Of course, we have to deal with making sure they can get to their appointments on time or to pick up their drugs at the pharmacy or have them delivered. Of course, they need to have healthy food if they have a food sensitive condition. And all these things are just been folded into what we think of quality of care and care coordination in this sense. That's my great hope is that, yeah, to be out a job, detect 

Stuart Hanson: 

All of that. 

John Gorman: 

Yeah, exactly. And then solve it. I can finally retire. 

Rachel Schreiber: 

So when you describe the vision of what you're creating and where you're dedicating your career, what is that vision for healthcare? 

Stuart Hanson: 

Or maybe more specifically, how do we get there? How do we get to your tenure plan? 

John Gorman: 

I would think if I got to come back with four words, like in SDOH, I would say responsive social health integration that's responsive to the need of the member or the patient that is responsive to the conditions in which these people live that affect their health. And that, like I said, all this stuff gets woven into what we think of as care coordination today. And it just becomes part of the wallpaper in 

Stuart Hanson: 

Yeah. How they do business. 

John Gorman: 

Exactly. Exactly. So that's my great hope and kind of what I'm working toward. And I hope we'll have others that will join us on this journey in this next several years. 

Stuart Hanson: 

God bless you. I hope we all are. 

John Gorman: 

Thanks. 

Stuart Hanson: 

Yeah, thanks. It's really cool stuff. 

John Gorman: 

Thank you. 

Rachel Schreiber: 

Well, thank you for joining us today, and we appreciate hearing your views and perspectives and your vision for a better, more holistic healthcare system. We do need more leaders like you that are working on it. 

And if our listeners would like to keep up with your thought leadership and your perspectives, they can follow John Gorman on LinkedIn. 

Thank you for joining us today. 

John Gorman: 

Thanks so much. Yeah, I look forward to having you back. Thanks so much for the time. This was wonderful. Thanks guys. Take care.