AH054 - Judi Health™: Going Beyond Pharmacy and into Medical Claims, with AJ Loiacono and Dr. Sunil Budhrani

Transcript

Lightly edited for clarity.

[00:27] Justin Venneri: Hello and thank you for joining us for this episode of the Astonishing Healthcare podcast. This is Justin Venneri, your host and Director of Communications at Capital Rx, and I've got AJ Loiacono, our co-founder and CEO, and Dr. Sunil Budhrani, our Chief Innovation and Medical Officer, in the studio with me today. And we're going to be talking about unified claims and Judi Health™, which is now live for us here at Capital Rx.  

We're going to be reviewing what it means for the US healthcare consumer, plan sponsors, and other payers. For those of you who've been listening, Ryan Kelly, our Chief Technology Officer, foreshadowed this about a year ago. And then shortly thereafter you, Sunil, talked about the importance of unifying data on episode seven and how we're going to achieve value-based care once we have that. We'll link all this in the show notes as well as the Judi Health press release (Capital Rx Unveils Healthcare’s First Unified Pharmacy and Medical Claims Processing Platform); so, this is truly an industry first.

• AH007 - There’s No Value-Based Care Without Considering Pharmacy, with Sunil Budhrani, MD
• AH009 - Modern Technology in Healthcare: Enhancing Efficiency & Security, with Ryan Kelly

I'm going to stop talking and get to my guests here. AJ And Sunil, thanks for coming back on the show.

[01:18] AJ Loiacono: Oh, thank you for having me, Justin.

[01:20] Sunil Budhrani, MD: Yep, as well. Thank you. Looking forward to the conversation.

[01:22] Justin Venneri: So let's start off with you, AJ. Nobody's done this before -- this meaning unified claims and pulling all the benefit workflows and processes together on one platform. I’ve spoken to plenty of people over the years that have tried or have pulled some different things together for limited scope but not scalable.  

Can you walk us through the background and how you and Ryan and the team realized this would be possible, what problems we're attempting to solve for, and then we'll get into how with Sunil?

[01:48] AJ Loiacono: Yeah, I mean, I often joke we were raising our Series C fundraising, and one of the things that you do is you share your pitch deck or your presentation with your existing investors. And I showed it to them, and they get about 2/3 of the way through the deck with me and they're just like, what is this unified claim thing? Because up to this point, Capital Rx was and still is known to many people as this successful transparent PBM that doesn't make money on drug spend and is leveraging technology to create the efficiency to achieve that goal. But no one knew what unified claim processing was.  

And I start to spell it out in a series of six or seven slides. Now, time is precious when you're doing a pitch deck for finance. And so existing investors are like, what are you doing? Like, what is this? I've never even heard about this. And the second thing is this is impossible. Like, what you're describing would take seven years and an infinite amount of money. You know, so many companies have failed on this journey or attempted to do it, couldn't find the right product-market fit, couldn't execute on the plan or the vision, whatever it was. But I felt so strongly about it. And, you know, I often say there are times when you gotta dig your feet in and you're gonna use your political dry powder with your board. And I did. And I said, I believe there's a trillion dollars of administrative waste in healthcare. So if someone says, you know, whatever number you want to pick in total healthcare expenditure, $4 trillion, $5 trillion, whatever it is, I definitely believe there is at least a trillion in waste. And why do I say this is? We do everything twice in the current system of healthcare.  

You know, you go on one journey for prescription, one for medical. So, this means two underwriting teams, two call center teams, two clinical teams, two network teams, two billing teams, two reimbursement teams, two lettering teams. I could go down this list all day. When you do two of everything, already, you're twice as expensive. And oftentimes you might be more expensive on the medical side because claims are not paid with the same efficiency. So velocity wise, you may have fewer claims, but the complexity of it and the duration of the payment and reimbursement process is an extraordinary burden.  

And so one of the things that I want us to focus on, you know, when I was having this discussion with my board, is I believe so strongly that this is the future of the standard of healthcare. This is an imperative. And so you start out with allocating a budget, you know, and you have to defend that each year because there's no ROI on it when you're building long-term enterprise software. So, you're on this multi-year journey where you're saying ROI on this may not come until year four. And people are like, whoa, okay. But you bank a level of trust.  

And I talk about conviction all the time, that you as founder, CEO, need conviction. You need to have your management team agree with your vision and build conviction with you. So, Ryan, Sunil, others on the team obviously involved in the program. And that feeds through the organization. Also, a lot of what we're doing is in stealth mode for an initial year or two because one, you don't want to necessarily tip your hand where you're spending your R&D. Also, if you fall flat on your face, you don't want to publicize that fact.  

But these are things you just learn. You know, I've been doing this now for, hard to believe, 25 years. And so you put all of this together and you have this one moment in history that I talk about, which is if not us, I don't know who could do this. And I think that's where we were in that this is the imperative I keep talking about.

And more importantly, I believe very strongly in the evolution of healthcare that none of this will be achieved without unified claim processing. And just so you understand, no one has ever attempted this. And Sunil, I'm sure, is going to go into this in his segment. These systems have been separate. No one has ever devised a way to create these systems or this synchronized on one platform, this single source of truth in an enterprise setting. For me, this was a once-in-a-lifetime opportunity because the other thing we talk about is competitive pressure. The example I give all the time is if the three of us on this call were starting a new company and we wanted to create a new CRM, you're going to run headlong into this little company called Salesforce and they're going to eat you alive, and it's going to be extraordinarily tough to carve out market share against them. Or if we were to do it, you know, enterprise resource planning, you are going to run headlong into Oracle and SAP.  

But when I looked at claim administration, something weird was going on. There was no established, successful modern software company. There was no Google, there was no Salesforce, there was no Oracle, SAP, Microsoft, take your pick. There is like this hodgepodge of PE assets that have traded hands a few times with limited to no R&D, and they're not focused on this next generation.  

And unified claim processing -- just put this into perspective, one last point -- is such a new concept. We coined the term “unified claim processing.” In fact, we trademarked it. And this is important to remember because you're creating a category that has been overlooked but is responsible for the administration in some way, shape, or form for close to $5 trillion of market space. This was the conviction I had to build -- my team, my board, everyone -- to do. And this is hard to do, because you're raising money for as we talk about a Mars shot. Not a moon shot. Forget the moon, we're, we're going to keep going through the solar system. Let's pick the next celestial object in the sky to visit.  

And so this was the mission; this was the journey. And I think it's so important for, you know, everyone to recognize not just the technical side of how hard this is to do, but to get your board, your funding, your finance for something that has never existed.

[07:57] Justin Venneri: Yeah, it's for such a huge market. It's just such an amazing glaring gap with the benefit of hindsight. I mean, we're doing it now, so it's like, oh, cool. But not having this together does explain a lot of the problems we've been talking about for years and years and years.  

So, Sunil, thanks for standing by here. You're overseeing and managing this, and your background's unique in that you're, A, still a practicing physician, B, have digital health/telehealth experience, and C, you spend time at a major carrier and working on population health initiatives. So, what are the key two or three things that you're most excited about as you operationalize this and why?

[08:30] Sunil Budhrani, MD: Yeah, it's a great question. Thanks.  

You know, I think, you know, the best way to kind of address your question is Capital Rx, and the extension into Judi Health, is almost like the culmination of my career in the way that you put this.  

As you mentioned, I've spent my entire 25 years in different parts of healthcare, but different parts of healthcare than many of the incredible talent, like AJ, on the team. And what I think what makes this company so amazing is you have so many different folks that come from different parts of healthcare that we've all culminated together in this organization to really change the future of the way things are going. And what I mean by this is the following.  

As I've been a practicing physician for so many years, one of the pain points that I've always had and seen is the administrative burden, the paperwork, and the process that's gotten between me and the patient. More specifically, if I take care of a patient in the office, or the ER, or in an urgent care, or so on, I spend a lot of time and resources in my office just trying to make sure that claim gets through to the right place and that my ability to be able to track that claim and then get paid for that claim is not interfered in any way so that I can keep my business open and continue to see patients.  

So pain point number one in my career that many providers, health systems experience is the administrative burden and the cost of just taking care of a patient in their office and not letting that delay the care that that patient needs.  

Now, the second part of my career that kind of has made me realize what an amazing wake-up call Capital Rx is, is when I was in the digital health industry, it is very hard to do what Capital Rx has done in such a short span of six to eight years. Again, let me dive deeper into that.  

When you build any kind of digital health healthcare technology, the first hard part is building a chassis to be able to do what you needed to do. In my case, it was telemedicine pre-pandemic. Building a chassis is one thing, and that requires a lot of effort, resources, time, and talent. But then putting lives on that chassis is a whole different difficult space to go into. You have to convince others that have been used to a legacy system, no matter how bad it is, that your system is better from day one. What Capital Rx has achieved in the pharmacy space, in this short period of time, is not seen in any part of digital health, let alone the PBM or health plan industry. It is very difficult to build a de novo technology that puts thousands of lives but, not just even what we're talking about here, millions of lives.  

And then here's the key point I always say in meetings. It's one thing to onboard lives, and we've all heard about one-hit wonders in health care. But then it's another thing to sustain the lives. And it's an incredible testament to this company to be able to keep these lives on a platform at the rate that we do with an NPS score that's unprecedented in the healthcare industry.  

So understanding that we've overcome a challenge to be able to do that part is amazing. So I always say now being here and as we thought about, I remember first meeting AJ and the leadership team, the incredible foresight -- and people have to really digest this. We started off as a pharmacy technology platform chassis, built an incredible PBM/PBA business out of this technology chassis with the incredible expertise of folks like Ryan, and the development team, and the product teams and so on here. And then with this book of business and satisfied customers -- again, that's a testament of NPS scores, customer satisfaction scores, and the number of awards that many people know that we won over the years -- we had the foresight, the fortitude, and the support as AJ mentioned from a board for us -- I don't even think this is a pivot. This is an extension to expand the chassis of health care so that we can go beyond pharmacy into medical so we can deliver the true value, unlock the true value, of a healthcare infrastructure known as Judi® to, what I always say, our point in existing is to empower and strengthen the relationship of the provider and the patient. But we knew the legacy systems could never do that because those systems sit in different islands.  

So fortunately, we are the first company in the United States to think about and continue to build on a single chassis to really deliver on that value prop to our stakeholders: the providers, the patients, the employers, and everybody that lies in between. So very exciting point for us in healthcare.

[13:11] Justin Venneri: AJ, back to you. Can you just walk us through how Judi actually -- you know, you've described how these workflows are duplicative across pharmacy benefits and medical claims, potential for vision, dental. How does Judi actually support and empower Judi Health being like a one-stop shop if you will, for the HR professional, solving for the disparate systems. But also, in a way, we launched Never Move Again™ last year, and when I think about it, it's the malleability of it that makes it really interesting and attractive to kind of talk through all the options that are available because of this chassis.

[13:47] AJ Loiacono: You know what I always want to start with is we talked a lot about the “why.” You know, this is kind of the product and vision, you know, question always like, why are we doing this? Why unified claims? Why would we endeavor and add so much time and resource into a project like this?

One of the things that we also overlook is the how. You know, the engineering side. And this is my co-founder Ryan's world, which is okay, you know, I have bought into your “why,” what is the how? And you know, I think Ryan and I have been working together for 14 years and he's heard me say 100 times because I learned this from a mentor years ago, which is, “begin with the end in mind” - this trite little saying, which is what do you observe or believe to be a potential, the most complex end state, for your product and solution?  

And you, in mid-course, are making an adjustment. We had a platform that we thought would be infinitely flexible: Judi for pharmacy benefits, and that's across Commercial Medicare, Medicaid, from customers that are 50 lives to over a million -- millions, plural, you know, large health plans. And that is the ultimate level of complexity. But mid-course you're saying I'm going to add to that end state. That end state now is unified claim. But thankfully we had adopted a lot of architectural, what I would say infrastructure, decisions that would benefit us in the long run. How we think about managing down to the lowest N, being the patient, not a group level. How we think about integration of eligibility and accumulators and patient records on the same platform. How we think about the scale and efficiency and where you get bottlenecks in that database. And this is where Ryan and his team really were shining.

And so, you know, getting back to your question, when you begin to think about, it's not just pharmacy, and when you say medical, you start to kind of pick up its cousins. To your point, vision, dental, and sometimes lab work embedded or outside of medical in many ways. But what we understood is it doesn't matter. I talk about the four pillars of healthcare insurance in the United States. And if you do these things, and you create a flexible architecture around these four pillars, you can unpack everything.  

So the mission statement that we've stated many, many times in this company -- to give the country the infrastructure it needs for the health care we deserve – and I believe that. That's a mission statement that I literally developed for that fundraising effort all the way back in 2022, 2023. And the point of it was, I can't tell you how many times we would think of really cool ideas, but we had no chance of implementing it because the medical side was just woefully inept, incapable, whatever, of actually executing on that idea. And this is everywhere.  

So when you begin to expand your vision into these other areas, you need to create the platform that's going to be able to handle this. Because what you want Judi to become, and how has evolved into, is whatever your benefit is -- pharmacy, medical, dental, vision, I don't care. Commercial, government. The key is Judi is ready to unpack as much or as little. And it's not just the claim processing. It's these four pillars that I talk about.

The first one is eligibility. This is this binary mythical state, are you in or out of a benefit and some plan design, grace periods that go around that for or against in that workflow. But I can tell you this little file is the alpha. It begins the entire journey of insurance coverage. But it's wrong all the time. And one of the reasons why I joke about this is time is the biggest sin of health care. The moment a file moves from system A to system B, if it's not unified, it's already wrong. People are eligible, ineligible, people die, people are born, claims are paid, claims are reversed, claims are upcoded, recoded. Whatever it may be, it has already changed. And I used to believe when the file came back to the original system, someone would spend lots of time auditing and making sure it was accurate. No. We wait for mistakes in this industry, or “good enough” is the rallying cry, which is, hey, unless I'm audited, who the heck cares? And that's what I think so much of the industry became overly comfortable with. So we go to eligibility.  

The next one is plan design. This is both financial and clinical rule sets. I don't care if it's a prescription or procedure, it doesn't matter. There is a rule set to get to what you need to do or achieve or receive.  

And then there's this concept of billing and reimbursement. And under these trees, obviously are subsets, things like network management, fraud, waste and abuse, or you could say even lettering and information, and customer care, call center support. But the four pillars stand.  

And I go back to the why and the how.  

The why we need to do this: we need to reduce costs, we need to create a better experience, we need to unlock value-based care and contracting. And I'm sure Sunil will go into this more in a moment.  

But the how, the engineering, and it goes back to if you build these four pillars with the end in mind, the end state being claim is a claim is a claim. Because what we have lost sight of in this country is, remember, it's the same plan, it's the same patient, the same eligibility, it's the same accumulator, it's the same patient record. There are just different workflows that I have to add into this and unpack these services based upon different rule sets.  

And that could be everything from plan design to regulatory oversight, both state and federal, if it's a government claim. But if you do this, you have the industry standard for the next 100 years.

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[19:43] Sunil Budhrani, MD: AJ’s on point. When you have the right mechanical infrastructure to support a health care system, we can start talking about value-based care meaningfully. I can't tell you how many conferences over the last two decades I've been to where we have these experts speaking on value-based care and what we need to do to get there. But we haven't really made any progress towards getting to that value-based care world. And I'll tell you what I mean by that.  

We mostly live in a fee-for-service world. That means as a physician, I do more to you the more I get paid, and I don't necessarily need to do all of those things to you, but that's how I run my business and that's how I'm incentivized to take care of you. Now there's a reason why that's occurred. Doctors And I've seen this many, many times over years, both as a provider, but also when I was with one of the major payers, is the only way for doctors to have trust in a value-based model -- in other words, for me to do all the things I can for you as a patient, to keep you healthy and prevent disease -- I always say the U.S. health care system is a reactive health care system; it's not a proactive health care system.  

When you get sick, unfortunately, when you get diabetes, cancer, or have a heart attack, I'm going to throw the kitchen sink at you. I will save your life. We're an amazing system when it comes to saving your life. We are a horrible system, as noted by numerous ranking systems, when it comes to preventing the diseases that will kill you. And that is because of our financial and incentive infrastructure. We don't have an efficient system to send claims back and forth so that you can actually visibly see what is happening to the patient. And therefore it is so hard to get to a value-based model.  

Let me give you a couple tangible examples of what I mean.  

So, when patients come in with unfortunate conditions, like prostate cancer, there's a process where there's a medical component of it and there's a pharmacy component of it. And when I'm trying to dictate and put together treatments for a cancer like prostate, there's modalities like radiation, there's chemo, there's surgery. And many of these different treatments require different diagnostic tests. And often doctors experience a denial in this process, not because that test wasn't warranted; it's because they're missing ancillary information. It could be information about medical claims or medical aspects of that person's care. So, if a drug has been ordered to treat that patient for that cancer, it is held up because you're waiting on diagnostic tests or medical evaluations that were not coupled with that experience. But they're there.  

So think about this. If we have a chassis where we can have medical and pharmacy data together, the member experience -- and it's funny, we use this word a lot in health care -- but it's really the customer or the stakeholder experience, I like that word better, because the physician is part of that stakeholder experience. You got to prove their experience to make this a better system. The patient, of course, is part of that experience. You've got to improve their understanding so they're not caught between the doctor and the payer as the courier, or the messenger, of the information when they're going through an illness, which happens all day long.

There's this third stakeholder, the employer. So, the employer has a responsibility in this triad of health care.  

So what makes Judi so special in my mind is that we are building a system right now that is supposed to support all the stakeholders so that we can make sure all the parties have transparency, and in the end the patient gets the best care they need.  

I want to give you one more example of where you can unleash the power of a combined medical pharmacy unified claims platform that ultimately will include vision and dental, as AJ mentioned.  

We talk about personalized care a lot in healthcare. How do we do targeted precision care on patients? But think about this, also populations? It's also about population health. Many times people have talked about plan designs. How do we create creative plan designs for populations so that we can better manage their disease?  

So there were discussions, but we could never execute on something like this of a diabetic plan design. In other words, you create a plan design for a health plan and a pharmacy PBM, that's combined, that looks at patients in specific categories and provide $0 co-pays for visits to dietitians, endocrinologists, primary cares, and drugs related to diabetes. It could be something like a diabetes plan design. You can't do that, a personalized population health plan design, in a legacy health plan PBM model because the systems don't allow for that.  

But if you could deliver that with a system like Judi, all of a sudden we can encourage people to go to the right venues of health care with a population health personalized strategy through technology that allows us to deliver the care in a specific manner that steers people to behave in a certain way.  

These are a couple examples of how we can unleash technology's power to deliver better population health and stakeholder member experience.

[24:51] Justin Venneri: That's awesome. And in a way, you kind of stole one of my questions, which was my quote unquote million-dollar question, which is how does Judi Health improve care for the everyday person? So it sounds like the expectation is for better, more personalized care and a better experience.  

Thank you both for sharing your thoughts with me so far and kind of pulling back the curtain on what's going on with Judi Health. I'm going to get right to the last question here. AJ -- most surprising thing or most astonishing thing you've seen or learned leading up to or since the launch of Judi Health, making it a reality?

[25:21] AJ Loiacono: Well, I mean, I think one of the most astonishing moments is it, it works! You know what I mean? And it is a great experience. I mean, so I have a question for you, Justin. Your family is on this plan, the same as my family and Sunil's family. So let's start with your experience with Judi Health.

[25:40] Justin Venneri: I -- so far, so smooth actually had a really interesting experience that I shared with Sunil when we were up in New York. There's an out-of-network provider, and the way the network set up was just super flexible and friendly and they said you know what, we're going through their credentialing process, don't worry about it. The whole thing processed is in network and there was no issue. And obviously the call center is phenomenal. I called in to try to figure something out with a pharmacy claim and Will's team took great care of us. So, you know, so far, so good.

[26:10] AJ Loiacono: Yeah. And I think this is the astonishing part. My family's on it, you know my kids. I've used it already. Obviously we're at the start of the year with flu and cold season and everything else. I've even had some, you know, emergency visits with the kids with break falls, the usual stuff, but it works.  

I think it was this funny moment where the card arrives in the mail. My wife is like where's the other card? And I'm like it's just Judi Health now.

[26:36] Justin Venneri: Just one card.

[26:37] AJ Loiacono: Yeah, one card. You know, and be like oh and, and it works? I'm like well that's the goal.  

And I think this is the astonishing part is not just that it worked but also it's working on the same exact teams and infrastructure we have for pharmacy. We didn't create a new call center, we didn't create a new client management, client care team, clinical team. I do want to be fair. We did hire two individuals -- the payment and what I would call the TPA side of the process -- and that was just more for experience in governance. But I always want to make this very clear -- extraordinarily lightweight for us as an organization to just take on this role.  

And so, you touched on the last part of this, which is Never Move Again™ and the evolution. Complex payers -- complex payers being our largest payers, not just health plans which are naturally sophisticated. They already pay their own claims and do their own administrative support and workflows using technology as Judi does support them. But even self-insured payers, a large, self-insured payer could do what we're doing in two seconds and leverage our infrastructure of both services and technology depending upon their appetite and ambition, you know for these things.  

And I always want to make this clear. And Sunil and I have talked about this, and Ryan, is our goal isn't to be a carrier or a TPA. Let me make that very clear. You know, the same way that we built Judi, by being a payer, and observing these workflows, and getting our hands dirty.  

And the example I give, and I'm going to give it for the 110th time now, is if you ask me to make a croissant and you give me a great French recipe, I'll be okay. But if you allow me to work in a French bakery for a couple of years, I'm going to tell you every mystery, every workflow friction point, every magical moment of this recipe and improve it and make it better. Because I am actually doing the workflows, observing them in a repeatable process over and over again. And you know, through repetition, I still believe that is where you create perfection. And it's understanding this through repeated practice and discipline.  

And this has been a huge part of our product development and our engineering -- you know, the why to the how. And you're constantly in your shakedown crews. Even though we're like, hey, this is amazing from a front-end user and our family's using the benefit, the back-end teams are like, you know what’d be better is if I got this file format in this way, if it contacted this other team, if it already generated this report standard for this other entity in a workflow.  

And this is the magic of, again, being in the French bakery. And then I think instead of just writing software to spec, you're writing software through experience. And that's the love part of this, the passion that comes through, and what makes Judi such an unstoppable platform.

[29:35] Justin Venneri: And Sunil, you have to follow that. [Laughs]

[29:38] Sunil Budhrani, MD: Yeah. I always say this company, the passion is contagious. The fact of the matter is, it is incredible what has been built and what continues to evolve in all this time.  

Like AJ said, all of us were biting our nails, December 31st at midnight, hoping it was going to work. A lot of work, a lot of talent, and a lot of energy went into this over the last several months from numerous teams, and it worked. And we still have a good amount of work to continue to build. This company doesn't stop, and we will continue to refine and get better and better.  

But I always say the not so secret sauce of Capital Rx is our incredible talent and our incredible will and mission to really become the infrastructure for healthcare, to be able to do all those things I talked about earlier. And I would say there's a confluence of stars happening right now in that, people, all stakeholders -- I go back to patients, providers, and employers, the key stakeholders in healthcare -- are not happy with the system. It is now becoming louder than ever that they've had it with the current US health care system. And so I think there's a confluence of stars here for Capital Rx and Judi Health to be able to thrive in an industry where people are fed up with the existing status quo and are willing to take a calculated risk on something new so that they can bring better care to themselves and to the people they take care of.  

So very exciting time. I can say, you know, I'm astonished, but in some ways, the team, the talent, and the passion make sense as to why we were able to accomplish what we were January 1st and onward.

[31:24] AJ Loiacono: I have one last astonishing observation that I just thought of, being is, I first met Sunil probably the tail end of 2017 into 2018 when we were doing our initial seed round of investing, and he was one of the investors through one of the people I know. And I met this, you know, very intelligent doctor who understood not just the provider/patient workflow, but the entire mess of insurance and the workflow of the payer side. And we struck a bond, I want to say, in our conversation. And you would then go through this quiet period where we're continuing on our path with pharmacy benefits. Sunil is continuing in his career working in the health plan side, or the payvider side. And our paths would cross again in 2023 where he was like, “Hey, like I'm exploring opportunities.” And I'm like, “It's funny you should be saying this because we're thinking of expanding on this concept called unified claim processing.” And who better than someone who -- I always feel like, you know, this is very Marcus Aurelius, Meditations. It's a book I recommend. And one of the things that they talk about is celebrate the people that come into your life. I do believe there's a reason you are introduced, and I'm not saying it's fatalistic like this must happen, this is how things happen. But I am saying you celebrate the people that come into your life, and you find that purpose eventually, where you will do something great together. And I believe this is it.  

And so here we are these years later celebrating the launch of Judi Health, unified claims, together. But think about that journey. That in itself is astonishing.

[33:14] Sunil Budhrani, MD: I very much appreciate that. And this is the job and career time with Capital Rx that culminates my career. I think this is the end after this one because it really puts the people I'd want to work together with and the mission I'd want to achieve together. So, I very much appreciate that.

[33:32] Justin Venneri: Well, thank you both for taking the time today and hope you have a great rest of your day. We'll stay in touch on this one for sure.

[33:37] Sunil Budhrani, MD: Thank you.

[33:37] AJ Loiacono: Thanks Justin.

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