AH044 - Searching for Answers – Understanding Transparency, Alignment and Incentives in Healthcare with Andrew Gordon

Transcript

Lightly edited for clarity.

[00:27] Justin Venneri: Hello and thank you for listening to this episode of the Astonishing Healthcare podcast. This is Justin Venneri, your host and Director of Communications at Capital Rx. And joining me in the studio today is Andrew Gordon, who has been doing a ton of quote unquote primary research via an NSF grant and a pretty unique program, I-Corps the Hub, but I'll let him explain that. All of the work is focused on understanding certain problems in healthcare. We're talking about transparency in the healthcare system, talking about misaligned incentives, and a few other things. So let's just jump right into it. Andrew, thanks for joining me today.

[01:00] Andrew Gordon, LSW: Happy to be here. Thanks for having me, Justin.

[01:02] Justin Venneri: So the backstory here quickly is you had interviewed our co-founder and CEO, AJ Loiacono, and I'll link that in the show notes for listeners. But this piqued my interest as my background is in investment research, mostly the qualitative stuff like expert interviews and surveys and the stuff you're doing. So I thought it'd be fun to have you on and learn about your work. How about you start off with a little bit about your background, Andrew, and how you got into this project that you've been working on?

[01:30] Andrew Gordon, LSW: Sure, yeah. So I think to start off, my career really began in the startup space. Right. I was wearing multiple hats across sales and strategy and business development, predominantly in the advertising industry. And while these roles were certainly fun, what I came to realize over about a year or two in the space is that it wasn't very fulfilling. So I decided to sort of reorient myself and ended up actually going back to school to get a master's degree in social work, specifically realizing the importance of mental health for myself and friends and family members and others, just how important that was.  

And so when we look at the core of what social work is, it's really being able to advocate for those who are either marginalized or at some sort of a disadvantage. And so that's really been a lot of my core tenet and pillar when stepping into healthcare is really how do we advocate for the underdog. I'm usually either watching the World Series or the World Cup or anything like that. And when I'm doing that, I'm asking folks if my team's not in the game, "What team has gone the longest without winning this title?" Right. And then I'm putting my energy and my efforts behind that. So I think when we talk about the underdog and really standing up for people that haven't had a chance at the title or fame or anything like that, being able to be advocated for is something that's super important.

[02:36] Justin Venneri: Makes sense and that certainly in healthcare there's a lot of folks that can use some help, education, resources to find the right path, to get on the right journey, to get the care they need. About how many people would you say you've interviewed over the last two-plus years? And can you take a step back here? The program you're in, the NSF grant, the folks you're interviewing—give us a high-level overview of what you've been doing here.

[03:01] Andrew Gordon, LSW: Sure. It all started off actually with an MRI. So I'll kind of set the stage for people where I was employed by a really large health system. I was also insured through my employer. I went to one of the radiology facilities that my employer owned to actually receive an MRI. And so I was thinking to myself, right, the stars kind of align. It's likely that I'll probably have a super low, if minimal to none, out-of-pocket in this regard. And then I ended up getting a bill for about $700. And so I was really shocked that not only could the MRI originally be billed for like $3,600, but then I'd be responsible for paying so much out-of-pocket. And that just started this insatiable curiosity to learn and to call folks from the insurance company to talk to people at that radiology facility, just to understand how the money flows, how does the billing get done and things from there. So that was about two years ago, as you had mentioned. And then this kind of curiosity eventually led me to secure some grants on a regional and national level.  

So the I-Corps program is essentially focused on primary interviewing. And so it's getting out into the marketplace and the industry and talking to suppliers and vendors and hospitals and insurance companies, which I'll get into a bit more later. But just talking about all of these different things, asking these questions, we're about to go over into transparency and some other key topics. And so that was something that I was able to on a regional level, I think the requirement was you had to interview about 30 people in a month. Then you could use some of the insights and other learnings from that to parlay yourself into the national grant, which I have now. And that's doing about a hundred interviews over seven weeks and so completed about 300 interviews in that seven-week timeframe that was earlier this year. The interviews just continue to go on every single week. So that number climbs. And so it's been super rewarding. And the grant funnels through Princeton, which has been fantastic as a support system and mentors and a great network there. And so really, really excited to be continuing.

[04:57] Justin Venneri: That's awesome. Okay. And yeah, I think a lot of people out there have similar stories about getting that hospital bill and trying to understand, wait a minute, what's this code? What's this cost? Why is this in network? Why is this hospitalist out of network? Like, what am I responsible for? I think the word "transparency" in the context of health here, and in particular in PBM land, has been thrown around quite a lot over the years and I think it's generally lost its meaning. It's kind of been abused. You're working primarily on price transparency, is that correct? Maybe just go into it a little bit. What does it mean to you? What kinds of questions are you asking and so on.

[05:34] Andrew Gordon, LSW: Yeah, I think "price transparency" is a good way to put it on where I started. And then I think when you think about that, going beyond just price transparency, it's understanding some of those other elements that patients really care about. So you've got price, you've got quality, you have availability and location, some of those things there. Right. And so the way that we derive value is using price and quality. Of course, price was an important and sort of first starting point for me, but this kind of comes down to just helping people understand what their out-of-pocket cost is. Right. You can look at so many different areas of the supply chain, but I think at the end of the day, when I was going about doing some of the work that I'm doing, it's really saying to folks, "Hey, this is what you're going to be responsible for paying for this service."

[06:14] Justin Venneri: And you obviously were digging around on the pharmaceutical supply chain when you were talking to AJ. What other areas of the system have you been working on over the last couple of years? What are some of the things that need to be fixed in your opinion most in healthcare?

[06:29] Andrew Gordon, LSW: Sure. I think three things come to mind when you ask that question. Right. On different fixes. I think it's misaligned incentives, misplaced expectations, and then also the lack of transparency, which we've been touching on a little bit.

[06:41] Justin Venneri: All right. I guess in my experience when you're having these conversations, you're digging a little, you're trying to figure out. I try to triangulate around issues, really try to understand what people are saying from different seats and where is their alignment? So with misaligned incentives, it does seem like all across the supply chain there are misaligned incentives. What comes to mind first and foremost when we say there are misaligned incentives in healthcare?

[07:08] Andrew Gordon, LSW: I think a great starting point here would be that payments are expected to occur regardless of an accurate or proper diagnosis and set of treatments. So I'll give a patient story to illustrate this example here. There was somebody that went into a dermatologist and they were having irritability and itchiness in their fingertips, and they had given some information to the doctor like that their older sister had suffered from eczema in the past. And so it was like a three- or four-minute telehealth visit with not too much curiosity spurred throughout. And initially, the diagnosis was eczema. Medication was prescribed; it was like an ointment and a cream. And so they ended up spending like $60 on the meds and then it was like a $150 office visit after the adjustment. And they later found out that not only did none of the medications or the creams or ointments work, but also the diagnosis wasn't correct. It actually wasn't that it was eczema. It was that this individual was using nail polish that their fingertips were having an allergic reaction to. And so when you think about this, right, you really notice that the incentives are to see, not solve, or to focus on volume as opposed to value.

[08:17] Justin Venneri: I think in other areas you have different stakeholders. The source of their profits, if you follow the money, how do they actually earn relative to the client or the member they're supposed to serve? That's a patient story there. How many people have you interviewed and what is it? It sounds like you do patients, you're talking to executives all throughout the supply chain.

[08:38] Andrew Gordon, LSW: I wanted to cast a wide net. The number is well over 600 at this point in the game. And in terms of the different stakeholder groups, these would be folks from insurance companies, patient advocates, policymakers, health system executives, and folks in the revenue cycle. You've got the patient experience people, you have the employers and HR leaders and CFOs that I've been talking to, right. Fully insured and self-insured to understand the dynamic and changes between those two audiences. It's really a wide net of folks that I've been talking to. And I think it's important because especially when we talk about transparency and the patient experience and being able to have these positive interactions with the healthcare system, anyone can talk to that, regardless of the hat or the role that they sit in when they show up to work every day.

[09:25] Justin Venneri: Got it. On the insurance side, where we see a lot of issues historically with just education, understanding what's covered, what's not, who makes money, how—any areas you've looked into recently there?

[09:37] Andrew Gordon, LSW: Sure. On the insurance side, and this is something that has come up, I think, in a couple of recent discussions is, terminology can be confusing. Right. So when we think about insurance as well, it's well, hey, this service is covered or this thing is being. You know, we take your insurance, for example. I think when people hear that, it's sort of this natural understanding of, well, hey, maybe I don't have to pay anything. But what we don't realize is that we're not free from financial liability. When we hear that, hey, we accept your insurance, it just means that it could be right. An in-network provider. And so I think it's not that we're not literate or intelligent as a human species, but I think when you put the word medical in front of that, are we medically literate? Are we medically intelligent? And I think the answer there is that for a lot of us, we don't need to be until we have to be. And so that's kind of something that I realized as well.  

And so on the insurance side, too, I'll just sort of dive into a little bit with the misaligned incentives that we were talking about earlier. I mean, there are people that when you're selling insurance to employers and groups, you're making a percent commission on the premium spend of the employer group. And so, I mean, I don't know about you. Right. But for a lot of us, we end up answering to whoever is cutting us a check. Right. Whoever's paying us. And so I think that there's some inherent misalignment there that really needs to be sort of unearthed and focused on and just get an understanding of, like, where is the money coming from, who's paying who and for what? And then also to what amount. Right. How much, as AJ had pointed out in our interview together, how much self-interest is baked into each area of the supply chain. And with these payments.

[11:09] Justin Venneri: That makes a ton of sense. And with the Consolidated Appropriations Act, which we kind of covered ad nauseam at this point, but it's really important because it's the source of lawsuits, it's the source of some confusion, and it's the source of what should be help for the employer, plan sponsor, or plan fiduciary. To get their data and really understand what they're paying for. And the trick, right, is is it reasonable? Have you asked, does that come up in your discussions?

[11:34] Andrew Gordon, LSW: Yeah, absolutely. The CAA has been a core focus when we talk about fiduciary duty and procuring services in a very, you know, a very meaningful way and intentional way. And I think part of the example that I give for that too is like, you know, when there's these entrepreneurs that I meet and they're talking about how they limit their client base because they need their objectives to align with the customers or clients they choose to bring on, this isn't just a money grab. This isn't just, hey, we've got a product and we're happy to work with you no matter who you are. It's a sense of you align. We align together in what we're looking to do. And I think that we need some more of that thoughtful interaction in our system, you know, among the partners and people that we choose to work with. Right. Is will they actually genuinely understand and use the dollar in a very, very smart way and make sure that they're delivering value?

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[12:19] Justin Venneri: I'm curious what you've seen on the buyer side since you're talking to these folks. You know, you mentioned the seller offering a service to a limited number of buyers because they, to concentrate, they want to focus, they want to deliver value. When you're speaking to the buyers across industries, especially healthcare, of course, what are they saying?

[12:37] Andrew Gordon, LSW: Yeah, I think a lot of them are starting to realize how important the RFP process is. So that's come up at many different conferences and even in just direct conversations with folks is sort of understanding that when you're in that RFP process, that's where the expectation setting is done. And so to be able to have a refined RFP that really looks at and sets forward these parameters of this is what an ideal partner would be. I need you to look through this and make sure that when you're submitting, you're aware of a lot of these things, right, that may have changed over the last couple of years in those expectations. I think that's a lot of where that focus is turning. Right. Is that upfront and allowing yourself to not waste your time. Right. In vetting different people and to put it out there and allow them to show you how great they can be.

[13:20] Justin Venneri: Makes sense. Okay.

[13:22] Andrew Gordon, LSW: So another thing I wanted to point out too, is that society today is lonelier than ever before. And so I think when, when that comes to mind, we also have siloing of different business operations. And the way that I've been able to see this, right, is when you're calling folks and they're saying, hey, I actually don't have access to that information or you know what, Andrew? That really doesn't fall into my department. And so when there's those different comments that are being made, you kind of think to yourself, I mean, when we're in those patient facing roles, aren't we better off giving more information than not enough?

[13:53] Justin Venneri: Yeah. Silos in healthcare are a whole separate discussion. We've had a couple of them regarding trying to get to value-based care and breaking down those walls so that it makes the continuum of care smoother, if you will, and allows for better information exchange across it. Any other points you'd like to make on misaligned incentives before we move on?

[14:12] Andrew Gordon, LSW: Sure, yeah. I think that for entrepreneurs in general, right, they see this massive multi-trillion dollar pie, right. It's a really, really big industry. And I think sometimes what happens with that is we can get stuck in this mindset of, well, you know, it'd be great if I could just get a piece of that. Right. It's sort of this notion of like anyone going into the Shark Tank, right, or they're pitching and they're like, we could capture 1% of this massive industry.  

And I think when that comes to mind, it's sort of how do we go back and understand we've got this big pie. But I actually am really curious to know how is it being made, right? What are the ingredients that are going into it? How is it being cooked versus hey, I just want to take a slice or I'm just really hungry. And so I think that that's something that's really important to understand. The payment structures and the contracts and a lot of these other things that make healthcare the way that it is that sort of sit under the water, if you will. Right. Not necessarily these tip of the iceberg things to get a good understanding of the flow.

[15:07] Justin Venneri: Got it. Okay, the second part of this misplaced expectations. What are some of those that you've seen or heard over your course of doing your research?

[15:16] Andrew Gordon, LSW: Sure, yeah. On misplaced expectations. I mean, I struggle to grasp the notion of hitting specific volumes of patients in any given service line because I do know how unpredictable healthcare can be. I mean, outside of annual visits and other routine care operations, we might be able to predict volumes. But I mean, the question that I would have for people is, should we be expecting it? Right? Should we be expecting that level of predictability. And I would hope that in medicine, we aren't encouraging any patient to do something that they wouldn't want to do just to hit a quota, right? The patient should have the final choice, but this also means that they need to be presented with an exhaustive list of their options, you know, regarding treatment.  

So the cancer patient, where surgery and other interventions aren't an option is probably weighing on, you know, their quality of life. Do they want to spend their remaining days, weeks, and months seeing hospital and healthcare walls as they go back and forth for more and more testing and treatment interventions and beyond? I think that we really need to take a step back and remember that patient desire and choice is one of the most powerful things in healthcare today. Doctors recommend and work with patients, but ultimately depend on patients to make a choice that ultimately needs to be respected. And so I think also as we talk about misplaced expectations, another thing that comes to mind is this fee-for-service atmosphere that still predominantly is the framework that healthcare has defaulted to when it comes to payment and understanding of value, which is that, you know, we have a volume-focused mindset with fee-for-service as opposed to a value-driven one. But as a doctor or physician, I think the question we should have is, right, am I being valued by the number of patients I see or the outcomes that I create? And I do think that management can focus on both, right? They're both incredibly important, but their narrative on priorities does have to be clear.  

And I had mentioned just going back, I had started my career in sales, right, wearing multiple hats. And there were some managers I had who were just obsessed with how many emails I was or wasn't sending out per day. There was others I had that may have been more interested in the quality of my communications and the time being put into each email. So should we be looking at how many emails, how many visits is somebody doing per day? Or what is the messaging? And how are those emails engineered to land more of those calls, to land more of those meetings, to make those patients feel more heard? That's kind of what we need to apply that framework to healthcare, is that we need expectations that are closely aligned with treating patients, right? Listening to these different stakeholder groups and just making sure too, that we're empowering physicians and nurses and social workers and other critical care team members with the utmost level of respect and autonomy. And so with insurers and employers looking to steer toward healthcare services with quality and outcomes in mind, I think there's a lot of win-win opportunities that we can explore going forward.

[18:09] Justin Venneri: Yeah, I think we talk a lot about the drive toward value-based care and the potential it has. Assuming you have all the data to pull everything together, run the analysis, then to your point, present the patient, the member, with the options they have so they can choose what's best for them. You know, maybe they do want to go to a specific doctor over someone that's in-network and maybe it'll cost them a little more, but they can be an educated consumer, right?

[18:36] Andrew Gordon, LSW: Absolutely. And another aspect I'd like to bring up too here is appropriateness of care.

[18:41] Justin Venneri: Okay.

[18:41] Andrew Gordon, LSW: I think it comes down to a few possible aspects. Where are we delivering this service in the optimal environment, the proper medical authority overseeing it? And has this service been deemed the most fitting engagement for this patient at this point in their treatment journey? You know, there are some health systems that will send a patient to get an MRI or scan done again a second time, even if it was already done at another facility. This could be particularly true, Justin, in scenarios where the scan was done in a facility that was external to that health system.  

So you ask yourself, right, the reason for the repetition here could be liability, could be not knowing what has changed since the first scan. But I think we also should be asking the question of, is the likelihood of uncovering new information high enough to warrant exposing that patient to the elements of another scan? Whether there's some exposure to radiation or other things with the imaging process, it's just being mindful, once again, holistically of the patient and the objectives that we're seeking to achieve.

[19:39] Justin Venneri: Can you share a little bit before we get into the last couple of questions about some of the processes or methods that you've used that you think may benefit listeners in some way as they go about doing their own due diligence on whatever topics they may be working on?

[19:53] Andrew Gordon, LSW: Happy to. So deeply rooted in my methodology is a passion for understanding. And so one of the things I tell people is that I'm obsessed with this problem, right? This problem of a lack of price transparency and transparency in our system. But I'm not necessarily married to any solution. I genuinely believe that we can all learn something important and useful from one another if we're willing to just spend the time engaging in thoughtful dialogue like you and I are doing here today. And so I focus on primary interviewing and real-time collection of insights. I'm attending conferences, I'm going to a ton of in-person events. I'm absorbing knowledge from different books, right? Specifically healthcare, finance books and other things that are really dialed into the healthcare space we find ourselves in. And I'm also reaching out to people mentioned in them. If I'm reading a book and I see that somebody's mentioned in there, that's usually a really good sign that I want to speak with them. Right? And they've got some amazing things to share outside of even just what's been summarized in that book or in that chapter. And so following up on names that I get either in the books that I'm reading or that get sent my way in discussions that I have in person or on Zoom, that's been a really meaningful pathway for me to pursue.  

And then I would also just say, right, like listening to healthcare podcasts with executives and other thought leaders, right? People are so willing to be helpful. And I remember that when we first connected, you were also incredibly, like, willing to just say, hey, is there, you know, are there folks I can make introductions to? Or is there anybody that would be a great discussion, you know, in my network that I can help with?

[21:16] Justin Venneri: So, yeah, referrals were always awesome. So love that. What about just in general, like, how have you found access to leading executives? Obviously, you got to AJ and that was cool. I'm just curious about the overall level of receptivity to the ask for a discussion about, quote, unquote, transparency these days.

[21:38] Andrew Gordon, LSW: As it's becoming a more common topic to pursue. People are absolutely engaging in that dialogue more. They're willing to take some calls or set some meetings, or it's coming up at conferences more. But I think that when it comes to the access to the executives, it can be tricky because it is based on your approach. Right. And I do think that you need to be really dialed into, hey, like, what's my mission? What's my position? Why am I reaching out? What am I looking to get? But then also, right, as we know, it takes two to tango.  

So what do I have maybe to offer, right? And have I been doing a lot of this work, or is there some perspectives that might be worthwhile for me to introduce as part of our discussion? And so I think that you've got this ability to reach out to folks and really be thoughtful about what that outreach looks like? And I found, too, that when they sense that passion and they understand your position, they're willing to open up some time on their calendar. Right. Or they're willing to spend that 20 minutes with you while you're at a conference, in person, together, Things like that.

[22:33] Justin Venneri: All right, so I'm not going to get to the last question yet, but I am Curious. What have you been seeing more recently regarding the lack of transparency as you've connected with these people based on how you described. Do you like to get in touch with them? And I love the conference angle and meeting people in person. I don't get out enough.

[22:53] Andrew Gordon, LSW: Sure. I think I'll start with the most obvious one, which is that very few people know how much their healthcare will cost before they schedule their appointment. Right. It's one thing to say, hey, I've been seeing this therapist, I've been seeing this physical therapist or what have you for weeks at a time. And so I know every time I go and it's this amount or this is my co-pay. Right. But I think genuinely understanding for these occasional interactions with the system how much it's going to cost me as a patient out-of-pocket is a major, major challenge and still a black box. And so there's definitely this need and desire that I've sensed among people to have that kind of information. And a lot of the times, right. It's going to take weeks or months. I mean we look at the average adjudication period for a claim being around 45 days. It can take a long time. And even then there's some inaccuracies that could be in the chain of how that gets submitted and some corrections that have to be made. So I would say that's probably the biggest and most obvious one I'd like to highlight.

[23:48] Justin Venneri: That's an interesting one. Just because I was always surprised about the lag there on the medical side relative to pharmacy.

[23:55] Andrew Gordon, LSW: Yeah, yeah, there's, there's also. Right. This sense of like, quality is very misunderstood and you've got, you know, entire companies that dial into quality. And so because I think also, you know, outside of transparency, it's can I understand the information that's being presented to me? And there's a lot of things that are very hard sometimes. Right. This explanation of benefits looks like the matrix, right?

[24:14] Justin Venneri: Yeah.

[24:15] Andrew Gordon, LSW: So it's, it's really challenging. And so I think that it needs to be a combination of transparency but comprehensibility. Right. Like the ability to get this really easy understanding of what you're consuming. And so that's another big thing here. But I would say probably another huge challenge is the lack of visibility and I would specifically say around employers gaining insight into their claims data to understand where their money is going and how it's being spent. If I'm a CFO, I'd be curious to know what is the average expense for each service in my geography and how much on top of that am I paying? Have I historically paid? Competitive advantage in business can come from cash flow.  

So you know, really being able to dial into these expenses and figure out right where there could be some ways to optimize that will allow you to retain top talent as a business, grow into new areas, improve existing product offerings. I can improve my cash flow, right, If I, if I more tightly manage these expenses. And I would say too like healthcare is routinely in the top three biggest expense items for an employer. I would say I only hear it fall second to maybe third to payroll expense and cost of goods sold. It depends on the company and where they sit and what their orientation is.

[25:34] Justin Venneri: What feedback have you heard from employers that have been able to control their cost? Is it really we're using it to retain our employees for compensation purposes, for reinvestment in the business savings just war chest, what are people doing with the ability to control if they do understand and can control that cost line?

[25:54] Andrew Gordon, LSW: I think that there are a lot of different benefits coming from folks who are dialed into really wrangling in understanding, addressing the somewhat opaque, right Healthcare costs or the line item that comes up on the balance sheet. And I would say that it extends into retaining talent, it extends into having more capital to be able to give back to people like give them bonuses, enhance their pay in some regard, but then also figure out how do we further enrich our benefit design plan and our structure to separate ourselves right from our competitors and to do things that even though we know patients do value access and they do value choice and having a big network, maybe that might not always right? Like where can we set up some narrower and more focus benefit opportunities. But then also what healthcare-related things based on our population can we include that help to separate us, right? Ultimately help to separate us, but also help us to grow closer to our people and our employees and these folks that we just know are responsible for being at the core of our business and our growth and value delivery makes sense.

[27:02] Justin Venneri: So last question and I ask everyone, and I'll kind of twist it a little bit instead of the most astonishing thing you've seen or heard relating to our discussion today, because I'm sure you've heard a lot talking to over 600 people, what are some of the most interesting sort of tidbits or an interesting takeaway or two that you can share with the audience, I'll bring up two.

[27:20] Andrew Gordon, LSW: Things here that come to mind, right? The first is that I've never met somebody who genuinely said like I don't want Price transparency, you'd have a greater chance of probably winning the lottery than running into an individual who disagrees with the need for it. But I have met plenty of people who have told me that hospitals and insurers don't necessarily want it. And so perhaps entities don't want it, but I know that every patient does. Right. And patients, when we think about it, right, they're people, which means that all of the resistant entities employ them. And so where is the core issue? And I think it does sit with the entity that has been designed and operated by a series of agenda items, financial goals, and other incentives that we know aren't always aligned with perhaps the greater good of patient care. Right. And the public. But I also want to highlight something that's been a theme over the last year or two for me, which is that I cannot overstate the power of in-person events.  

As our lives get more and more hectic these days, I want to just take a moment to explain what I mean by this, which is the value of getting anyone's attention is climbing at an exceedingly high rate. And healthcare conferences do have some amazing perks. Right. The food could be delicious, you could imagine dragons on stage, you could have some world-class speakers. Right. But for me, the price of a ticket and going to these events is always justified by the understanding that when I'm in a room at an event, I have the ability to grab anyone's attention. Why? Because they expect it. And most of us come into these events not only being open to meeting new people, but also desiring it. And as we know. Right. There's a lot of the themes that we've unpacked today. That thread back to those hour-long, two-hour-long, spontaneous discussions that could come from an event and just really being thoughtful around a certain issue.

[28:59] Justin Venneri: Nice, Andrew. Well, this has been a great discussion. I love all the insights on networking and gathering information and trying to understand what's going on in and around price transparency and the healthcare system. I'd love to stay in touch with you, hopefully maybe have you back on the show when you've got some. Will you have data to read out or how can people get in touch with you, learn more about what you're doing, maybe share a little bit before we sign off here.

[29:21] Andrew Gordon, LSW: Sure. Yeah. I would say the best way to reach out to me would be on LinkedIn, which is just my first and last name, Andrew Gordon. And then I have LSW standing for Licensed Social Worker after, just to kind of separate myself from the other folks that share the same full name, so I would just say LinkedIn is a good way to reach out and get engaged and then happy to go from there. But thank you so much for having me on and I also appreciate all the listeners that have made it this far.

[29:42] Justin Venneri: Awesome. All right, have a great rest of your day.

[29:44] Andrew Gordon, LSW: Thanks. You too.

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To learn more about his work, LinkedIn is the best way to get in touch with Andrew.

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