Educational Webinar: Health Equity: Overview of CMS’s Priorities

Hello and welcome to today's Webinar. My name is Brandon Martin. I'm the customer engagement manager with medical surgical. Uh We're excited to welcome today to speak with us about health equity and provide an overview of C MS s recent priorities today's presentation is being recorded uh and I'd also like to direct you to the Q. And a feature at the bottom left of your screen. You're welcome to submit questions to our speaker and we will respond as soon as possible. Today's presenters are health care policy experts, Robin Duddy Bruel and Nia Barrow from Avalere. Robin provides policy analysis and strategic advice to health care stakeholders. She holds an Mp P. From Georgetown University and A. B. A. From Tufts University. Nia supports clients with a focus on health economics and outcomes research and holds an Mp H. From Northeastern University and a Bs in Biology from Spelman College. Please join me in welcoming Robin and Nia. Good morning everyone. So we're gonna uh discuss health equity and uh topics that relate to health equity and post acute care. Um So we just wanted to give a first and brief overview overview of health equity. Um and some of the terms that are often spoken about in the health equity space. Um And just wanted to provide some clarity to not get confused. So, health equity is the means or attainment of the highest level of health for all people. And this is where we think of, you know, no matter where you live, what race or gender you are, you have access and you are. Um you can set yourself up for positive health outcomes. Uh Health disparities are differences in the incident prevalence, mortality burden of disease and other adverse health conditions or outcomes that exist among specific population groups in the United States. So, health disparities can be geographic. They can be specific to race or gender. And there's so many different ways to go about looking at health disparities based on the current uh health care landscape that we have today. uh Health inequities are the differences in health statuses or the distribution of health resources between different population groups arising from the social conditions in which people are born grow live and work. And this is driven and caused mainly by social determinants of health, which are health conditions in the environments in which people are born with learn work, play worship and the age that affects a wide range of health functioning and quality of life outcomes and risk. So just high level here. Um there's definitely a difference between health equity, health disparities, health inequities and social terms of health and it's really important to understand the small differences between each um term here. So the distinction between each of these terms have important implications for the selection of interventions, programs or policies with which health equity is addressed and how we seek to address any gaps. And um No problem. next slide. Thank you. So, health equity has been something that has been around for quite some time. It may seem as though it has just spurred up as of coviD-19, but it has definitely been um a topic that the health care world and C. N. S. Has been um discussing for quite some time now. So in two, the year 2000 healthy people had a framework and it laid the foundation for future health equity efforts and it continues to be updated every 10 years. Um then their Office of Minority Health Equity plan from C MS. The Office of Minority Health Release the strategic plan to reduce these health disparities and continues to report on progress. So another way that policy is looking to take action and address the health inequities disparities, all that we see in um health care today. The Executive Order 13 90 85. Um diversity equity, inclusion and accessibility in the federal workplace directed health related agencies to focus on addressing health equity by seeking to create a government wide initiative. And this is really important because it just shows another way that um the government and policy makers are working together to make um decisions and policies and programs that actually affect them system wide. Uh 2022 to 2032 C. M. Framework for health equity is currently where we are. And this is the Office of Minority Health 10 Years Strategic Health Equity Plan to promote and protect the health of diverse populations. So throughout this we will share more about how um policy is starting to lay the landscape of the direction that will be going in in the future, whether it be data collection, whether it be um cultural language barriers, um you know, nothing is off limits here. So This is really important just to show that we have been working towards um an equitable health care system for quite some time now. Thank you. Next slide Thank you. Thank you. um So I think we're going to do a bit of a deeper dive now. So was starting to mention um about the C MS framework. So we're gonna talk a little bit more about that. But before we do, was there anything else that you wanted to add on that big picture stage of what's been happening in the government? Focused on equity? Sure. I think like you know, one of the things that I would add and and I would hope that everyone like could really understand is that This is a system wide um change for the government and a lot of different policies from a lot of different um entities within the government. So that's one thing that I would like to add that this is not like a one um one government entity mission. This is a mission as a whole. So that's really important in trying to address um inequities that like result from an inequitable health care system. Thank you. Exactly right. Um So we're gonna transition a little bit here to talking about um the C MS framework. Right? And this is as was saying a bit of a a react or a response to that executive order that we saw from the biden administration, now it is not that there were no activities going on at C MS uh prior to that Executive order or the strategy related to equity or addressing disparities or trying to understand more some of the inequities that we were seeing in the health care space. But rather this strategy and framework is an opportunity for the agency to pause and coordinate across those efforts. And think bigger picture about where those policy efforts are going to be headed over the next 10 years and we'll talk about in a minute uh some of the shorter term uh goals as well So to pause here on this framework, so I would think of this as a bit of kind of the guiding principles of where C MS is going to focus and we'll see a lot of goals and more specific policy actions related to these broader pillars. So we're gonna spend a minute and just talk through these as a bit of a high level, so you have a sense of the lay of the landscape, because as I'm sure you'll quickly realize we could spend and an entire webinar talking about any one of these. Um But so the first one is around uh expanding the collection, reporting and analysis of data, right? And that's kind of understanding that for us to really think of policies or to meaningfully impact disparities, we need to have a really good understanding of what is happening right? We need to have good measurable information. and that's an acknowledgement that, you know, while we do have some information right across a number of different areas that we might look at here as we think about disparities. Right? So race, ethnicity, income geography, you know, there are gaps in that information and there is a lot of opportunity to think about how to uh really improve that data collection and how we are using that data Also the second pillar here is around assessing the causes of disparities within C MS Zone program, um and trying to address those inequalities in the policies to close operation in operations to close gaps. Right? So that thinking that we're gonna collect the data, we're also gonna be looking at from C MS perspective, you know, the existing programs, where is there anything on the that might be or rather on the books. Now that could be exacerbating or causing disparities furthering inequities. Right, Or are there areas where there aren't current policies um where additional policy action might help right to advance equity. The third pillar is around uh building capacity of health care organizations and workforce to reduce health and health care disparities. Right? So that's thinking about who are the people who we have on the ground, the providers, right? Who are working with patients. And Thinking about, you know, areas where we have provider shortages, so maybe there are challenges with folks getting the care that they need in a timely way, or in other areas, there might be, you know, a provider workforce that doesn't really reflect the community, right, Which can cause sometimes also barriers in care. So taking a systematic look at that workforce and how we are thinking about building capacity in a way that is going to help advance equity. The fourth pillar is around uh advancing language access, health literacy, and the provision of culturally tailored services. Right, So we're building this workforce, you know, we're looking at the data, we're addressing gaps and thinking about, you know, how can we as a system, how can policies really focus on uh meeting patients where they are right? Like making sure that, you know, people are able to engage with the health care system in a way that they understand what their providers are saying to them. You know, they are you know able to uh access services in a place that they feel safe and comfortable. Right? So thinking about policies that could really address those types of gaps um in health coverage now. And then finally, the fifth, uh or rather, the fifth pillar is around increasing forms of accessibility to health care services and coverage. Right? So thinking about the populations that might be struggling to access health care services in some places or other reasons that, you know, there might be things about the way that we have organized the health care system that could be preventing folks from seeking care. So, those are all very big picture, high level pillars. Right? So, these are, you know, big goals, they're ambitious areas. And so this is looking over a 10 year period, Right? And C MS has defined this so very broadly, they say this is in every program across every community, right? And we'll talk a little bit about, you know, the different programs where C MS is addressing this, but just to keep that in mind, here's kind of the bigger picture that C MS has put out of the direction they would like to head in. So looking a bit more specifically, uh into 2022 kind of paired with this broader framework. EMS has also put out a number of more specific goals around health equity, right, Which are some of those shorter, you know, these are also uh I will say very ambitious goals, but they are, you know, things that C MS has got more concrete concrete steps towards in the next year. Right? That map up to those bigger picture pillars. So there are nine different goals here for 2022. Um and we are, you know, not going to do a deep dive on all of these, but just to give you a sense, you know, C MS has put out information and reporting around, you know, what steps they're taking in the near term towards these goals. Um couple of ones that I'm just going to highlight here that I think may be relevant um for this audience. Right? We talked a little bit already about this first one here at the top left around closing the gap in health care access quality and outcomes for underserved population. Right? The C MS is taking steps to say, where are we seeing, you know, sort of disparities that are the most acute and how can we target to help folks who for example, don't have insurance or? you know, are not able to access services in their language, what steps can be taken there. Um Another one I'll highlight just quickly here is this middle one, right, which is ensure engagement and accountability to the community. So I think, you know, while we're focused here on what C MS is working on, it's important to to know that these things can't happen right in a vacuum. And it's very important to have successful policies to engage the communities themselves, right? Like to ask folks in the community, what do they want, what do they need? You know, what are the barriers that they are experiencing? And so here is an example that, you know, for example, C MS has taken some steps to uh ask, you know, that patients be included right in more sorts of, you know, more meetings around with health plans and other developments of guidelines, right to really get that patient voice into some of these efforts to advance equity, Um I'll also note here uh that there are goals more specifically around expanding and and standardizing the collection of demographic data. So, C MS has taken a look at that across a number of programs and we'll talk more about that in a moment. Um Also they are focused this year on evaluating policies to determine how C MS can support and partner with safety net providers. Um So I think that's one in particular to think about in the context of the public health emergency and looking towards the end of the public health emergency. Um and then finally, I'll just highlight uh this goal over in the uh bottom right of your screen around promoting culturally and linguistically appropriate services that are responsive uh to preferred languages, health literacy and other diverse communication needs. So we've seen C MS across a number of programs, you know, implement new requirements around the number of languages that materials need to be printed in and take a look at other types of switches and communication that might make language and the way that uh folks are engaging with uh patients a bit more patient centered. I'll pause here from it and I'm curious, is there anything else that you would add around these goals that you think is important to highlight, Yeah. And I think that, you know, expanding and standardize the collection and use of demographic data is a very important goal for C MS and um this is something that they're rolling out, you know, across many different entities and will be very beneficial or can be very beneficial to understanding um disparities and share access. So that is one that has been um you know, kind of out there for a while and and and we've been needing to collect this very very meaningful data. So really excited for C MS to uh start to strategize, you know, the collection of and the use of demographic data. Excellent. No, me, as well as someone who who spends a good bit of time looking at data on these subjects. Um so, you know, we'll be we'll be keeping our eyes peeled from where to come on that front. Um going to switch over here. So we've been talking right about C MS is big picture pillars, some of their more specific goals for the next year. We wanna give you just a little bit of a sense, we've talked a little bit about like, well, what actually has happened, right. What has C MS actually done so far or thought about doing more specifically? And so as I mentioned before, right? Like C MS is defining this across pretty much all markets for all people. So as we know, C MS. you know, has uh some of the greatest roles to play in Medicare, Medicaid and the exchange market. So what I could just give you this is by no means an exhaustive list of the things that have so far happened. I wanted to give you just a little bit of a flavor of some of the activity that has gone on across these markets. Um So on the Medicare side, uh C MS has been looking at uh equity as they think about their payment rules, right? The C MS every year issues these rules that define payment for the Medicare program. And they have been using those as an opportunity to collect more information around equity and try to address some of the disparities that they see around sort of the systems of payment, um also thinking about Medicare advantage, right? They've been thinking about how to more systematically incorporate equity into some of those systems. Right, so Medicare advantage has quality measurement systems and risk adjustment systems and a number of other policy levers. And there is a bit of a focused effort to think about how can equity be built into those. Um We also note that the Center for Medicare and Medicaid Innovation um is looking across its demonstration to think about how to incorporate an equity focus and in particular that's something that we have seen uh related to accountable care organizations. So, Ac Os, thinking about the requirements for those organizations. Thinking about Medicaid, uh C MS has also released a proposal around looking at, you know, as I was mentioning uh data. Right? So thinking about how can through the Medicaid program data that is being reported be stratified, so we can better understand some of the differences that might be happening based on demographic factors such as race, ethnicity and disability. They're thinking about, you know, I would say across Medicare and Medicaid, how can that equity lends be brought to some of the existing systems. Um And then also thinking about the exchange and employer market, you know, similarly, um thinking about requiring health plans to have more information or do some thinking around how to address inequities um and how to identify disparities that are ongoing and take steps. um great, so that's just a little snippet of some of the things that C MS has been doing. Um one thing to highlight is that there are some broader, uh sort of regulations and laws that govern across these markets? Right. So one in particular, just to flag for you all, where there's been, you know, perhaps a bit of buzz about this in the last year or so, um around the Ac a section uh, 15 57 rule. And that is the tax that prohibits discrimination based on race, ethnicity, gender identity, and sexual orientation um So that is also a bit of a framework right for how C MS, you know, can perhaps evaluate how, you know, programs are not meeting some of these goals around um you know, ensuring there is no discrimination and also advancing equity. Um, so those are some of the things where we've got to see more concrete action, but also, you know, there's, as you might imagine with some of these bigger picture goals, there's a lot that we don't yet know. And C MS has been trying to take some steps uh to gather more information. I will turn it over to to chat a bit more about those Thank you, Robyn. Yes, so since 2021 C. MS has issued numerous like related to health equity to inform future action. And this just goes once again with what Robin has been um speaking on is just their plans to understand the health care landscape, to collect meaningful data, to understand the communities in which it's trying to serve and um advance health equity for all people. So the first thing that C. MS has released um they raised over 20 equity focus including through the S. MS and H. And H. H. And Hospice rules. Um and they wanted to gather input from their stakeholders across the care continuum, but most importantly they also wanted to gather what was important to their patients. Um The first one is understanding existing disparities and barriers for specific populations, This is really important when we think about health equity and you know, who are we trying to serve and how do we serve them and what are the best ways in which we serve those populations. So really getting a better understanding of how do we understand the population in which we're trying to serve more specifically so that we can have targeted programs and approaches to address health disparities and number two evaluating the impact of current policies on health inequities. So are there any policies currently in use that are actually contributing to um health inequities in our health care system? And if so, how do we address them? And course correct? number three, identifying gaps in data collection and strategies for improvement? Um This is one that rob and I both share a lot of passion about uh there are lot of gaps in the data. Um You know one of C MS S. Rules is to our goals is to advance the collection of demographic data. And it speaks to number three here in identifying the gaps in data collection because there's so much information but yet not a lot a lot of data collected on certain populations that could allow or would allow C MS to make um better decisions for those populations um and their health outcomes. uh so the number four determining how and when to target policies to assist specific communities, so what works for a community, you know, what may work for rural community may not work for urban community, what may work for male population will may not work for a female population. So really understanding how to look at programs and policies and make sure that they're specifically targeted and crafted so that they're addressing um the issues of the population. Number five, identifying opportunities to to advance equity through policy change C MS has really been looking at this care continuum, but also across all of its stakeholders to understand how can we all best work together to change the policy that we're currently operating from and course correct so that they can be more equitable for the folks of this country that we're trying to serve. So these are like really interesting RSI S um and they all seek to advance equity in a specific way whether that be health equity, overall social determinants of health inequities are disparities just advancing or identifying the gaps and drivers of of all those um outcomes. So I think here C MS has Pretty much set the foundation for how it would like to look at um community health and health overall through policy in the future. Robin, is there anything there that you would like to add, No I mean I think that's exactly right. I mean I think that I would just emphasize again the volume of R. F. I. S. That have been released. Um So there are a number of areas where you know, C MS has been in this information gathering mode. Um So it'll be interesting to see, you know, what their next steps are from there. Totally agree. And it's really, it'll be really interesting to see what they get back in response to their um this is a space where It's not uncharted territory for C MS, but this is like one of their first of many action plans that they've actually put together to address the inequities in the in the health care system. So this is really exciting um so we're gonna go on to talking about um some examples of C MS post acute care Health Equity Initiative and these are um services that folks receive receive in a post acute care help setting um and how it relates to health equity so the S. MS rule. Um C MS arrange and classified measures in nursing home quality deployment programs that indicated the social risk factors um which will help to identify gaps in care across different demographics. This N. S. L. S. MS rule is really interesting in that looking at different measures across nursing home in an additional postage care settings is really important to understanding. which population can we better serve, which populations are we? not meeting the needs up and how to best meet those needs. So the collection and reporting of this data is really really important. Um And understanding. this um program and it cares so next is the hospice role. Then would you like to pick up here Uh Yes, definitely. Uh So thinking of that, um So I think this is again looking at, you know, through the hospice rule, there's no there's been, you know, from data that we do have right that there are inequities that do persist in hospice care, right? So black and hispanic populations are less likely to use care um through hospice than our uh white beneficiary. So, this is an area where C MS is focused um to try to develop measures to understand better what is happening here. Right? And thinking about, you know, how can they be making changes that might incentivize differences going forward. Um Right, and this being, you know, just kind of one of those areas sort of throughout the world where, you know, that that that that data has enabled them to identify where there could be changes. Um but similarly, we would expect, you know, ongoing effort and focus in this area. to create there? Um Next we have the Home health rule. So C MS is considered ways to stratify health outcomes and is developing new strategies to address disparities to improve data collection. So once again just going back to their priorities and um how do we evaluate, how do we understand communities? How do we understand populations um that may be experiencing um Inequities in health care or access or um prosecute care settings And they're really interested in collecting data and understanding the data. Um which is something that C MS has been Um implementing across all of their um their different services and and policies. So here considering ways to stratify essentially, really important to understand what population do we need to understand better? Do we need to provide meaningful programs for and how do we provide those programs and what do those programs look like? So all the data collected through whether it be the N. S. F. Rule, the hospice rule or Home health rule, all of these different measures and data collection. methods are definitely set to advance equity and advance understanding of the population of interest in which C MS is serving Ok, next we're gonna talk about addressing disparities and some post acute care settings um which requires a multi stakeholder approach, Um Robin, So we have a few here. Example of disparities, and post care includes both geography based and outcomes race, ethnicity based and discharge patterns. Impact of culturally competent care. And Robin is gonna explain just a little bit more about, you know, some of these different places in which we see um disparities and post care settings and how it relates to C MS overall um plan. Absolutely. So I think this is one of those areas, like, you know, I think a number of others we've touched on, where we could easily spend a whole hour talking about any one of these issues. Right? We wanted to flag them here just to give you a bit of a sense of some of the areas where it's possible there could be focus um in the post acute care space based on some of the information, right, that has already been collected, but again, and I'll just preface before jumping in here, we we keep mentioning this point about data. And that's because I think as we think about these complex multi stakeholder approaches and how to engage, you know, there is, you know, a focus on getting it right right, like designing the right policies, identifying the right interventions, trying to really tailor things by population, you know, is the goal here and that requires, you know, a lot of information gathering and sometimes that means, you know, things are are in that information gathering phase for for quite some time. Um So a couple of things that we wanted to highlight here if we think about on this, you know, sort of on the uh starting from left to right here, the geography based differences in outcomes. Um there have been some studies looking at uh post acute care in rural settings compared to urban settings and noticing some differences there. Right? And thinking about what happens to folks post discharge. So that could be an area where we might see more activity, you know, to try to really dig in and understand what is driving those disparities and what steps could be taken uh to try to mitigate them. um similarly, you know, across a number of different types of conditions, there are some differences that the data has shown um in discharge patterns based on race and ethnicity. So that's, you know, in terms of utilization of post acute care, you know, is different um across uh racial and ethnic groups, Right? And that's looking at certain conditions. Right? So for example, here, you know, congestive heart failure, we see some substantial variation. that's another area where we might see some additional data collection and focus and perhaps some policies to try to uh you know, uh lessen those disparities. Um And then finally the other thing and we have touched on this in a couple of different places but wanted to bring it up again here um in terms of where some of the policy attention is focused really from that provider perspective really has been around uh culturally competent care, right? And that, you know, is that broader point of ensuring that patients when they're interacting with their provider you know, are being, you know, spoken to in a way that is you know comfortable and meaningful for them and that they are able to you know, sort of really engage and ask their questions and understand next steps and really thinking about what is the provider role there, right in asking questions in a way that patients feel comfortable answering and explaining things in a way that is gonna resonate with patients and making people feel confident right in their next step. Um So I think that's a bit of a place where we will continue to see that focus um from C MS and other stakeholders as we think about the provider space more generally. um Right and I think across a lot of these areas, so within a care but also more broadly, you know, there's sort of the the bigger C MS efforts, right? As we think about some of the payment rules that we mentioned and the goals and like those efforts to address disparities. Uh There's also we mentioned right, the Center for Medicare and Medicaid Innovation. Right, so some of those models and demos that are being piloted, you know, we might start to see an equity focus there. um as well as what we would expect in terms of how that is hitting post to care and where there are opportunities for stakeholders right to engage and work with C MS as it thinks about how it should be. Thinking on designing some of these programs. Oh, So, you know, I think we're you know, going to be wanting to take some questions here in just a moment. Um I will, you know, up to say, you know, kind of across what we've said, right, this is not a new space, right? This is, you know, we've been talking about what C MS has been focused on recently and their goals and their pillars and some of the specific activities, so really work has been done in this area for a number of years. And, you know, a lot of what we're seeing right now is an opportunity to organize that work um and put metrics around it and think about where are the gaps? What are the next steps, How can we continue to advance equity, Uh Yeah, any final comments before we take some questions here? Uh No and I think definitely like making our audience aware that the cultural competence portion of care and the collection of new data and demographics is really important to see MS overall equity um play in their policy. So it's really important to look at communities individually to address um care and to provide interventions um so that they can be culturally competent. So it's really good to see C MS I really kind of like own these goals and um use them in in future policies and future interventions. I'm really excited to see what's next, what comes next. what the brand and I think we'll we'll turn it back to you here. Excellent. Thank you so much. Um That was a perfect segue for a question that is uh that we have here. How can C. M. S's goal to expand and standardize the collection and use of demographic data, Advanced health equity and post acute care settings. Thank you. Um So I I definitely believe and think that the collection of additional demographic data allows C MS to um identify groups uh that may be experiencing poor health outcomes or um are not getting the proper post acute care, and by studying groups individually and people individually. C MS can create more tailored interventions to address um those gaps in care. And this is just really really important to advancing your entire equity position because as we mentioned earlier, in order to advance health equity or to advance positive outcomes in different populations, we need to first understand them and we we need to also be able to measure what's happening so by collecting new data, demographic data is gonna be really important um when it comes to stratifying and looking at what are the causes and drivers who's being impacted and how do we help? So, C MS can definitely increase or advance health equity um for all people, once we can standardize data collection across different policies and across different Um health care industries. This is gonna be really really important to addressing any types of of care or gaps in access for people. Thank you. Excellent. Thank you. Um It's also a great segue uh to a question, I'll I'll direct this to Robin. How can providers address disparities through their engagement with patients? Mhm. Yeah, so I think we we touched a little bit right about, you know, some of the aspects of culturally competent care, but there's something I don't think we didn't touch on that, I do wanna highlight here, um which is that providers have, I think an increasing role as a bit of a connector in care for folks, Right? So I think, you know, providers are of course meeting with patients and you know, they're having those conversations with patients and thinking about how to have those conversations with patients, you know, in a way that is, you know, demonstrates, you know, both awareness and respect for that patient's culture and that patient's needs, I think is really crucial. I think another piece of that, right, As we think about, you know, a system where we wanna be addressing social risk factors is what role can the provider play in connecting a patient right, with other services that might help them? Right. So thinking about in those conversations with the patient perhaps You know, it could is a patient who could, you know, use some additional support uh with nutrition or a patient who might be struggling to get to the appointment and you're thinking about, you know, are there ways to connect that patient with other services in the community that can really help support their care Excellent. Thank you. So as we look at um uh multiple touch points here. Uh Mia I'll direct this question to you. How can multi stakeholder initiatives work to advance quality of care in post acute care settings? Yeah, so I I stakeholders are really important, right? Like everyone needs to be at the table, everyone should be speaking the same language, understanding, you know, what the measures of interest are and when stakeholders all work together, um you build a stronger intervention, you can build a stronger policy because you're attacking or addressing the issue from multiple different um position? And this is really important when we think about, you know, like the inequities that we see in our in post acute care settings or in health care in general are not just like from one set from one um setting or one. Um my setting, like they're not just in post acute care settings, they're not just in like oncology spaces, they're happening everywhere across the different care continuum, um in health care and it's really important for all stakeholders to understand what is happening, understand their role and what is happening, how they may be contributing to some outcomes and address them and working together to address the inequities are extremely important to. driving change. Uh So Robin, I'll direct this question to you. Uh Will the biden administration continue to prioritize equity? And where might it focus in the coming year? Is a great question and yes, yes, the short answer is yes. Um I think we should definitely anticipate that the Biden administration is really going to continue to focus on equity. Um it's an area where they have been quite vocal across, you know, we've been focused on health care here, but really across a number of different areas um in terms of where, you know, we might see action in 2023. you know, I think there are a couple of couple of places I would start to look or think about. Um you know, we've we've talked a lot here about the data, so I think that's definitely an area to watch for the upcoming year. I think also, you know, thinking about the variety of R. F. I. S. We've seen in some of the proposals, I might expect us to start to see more action around how to better incorporate. equity into kind of current systems. Right, so that's thinking about, well, what measures do we have right now for quality that we could stratify? You know, what trainings are we having for providers that could include more about culturally competent care. So thinking about what exists and how to layer in that sort of equity focus is where I might, you know, think we could see more activity in the next year. Right. And then I think there's this other component of our f I have asked, you know, these sort of large big picture questions about more systemic change. And well, I think we could see, you know, more activity on that front. I also suspect that some of those larger changes, you know, might be further down the road as the administration continues to collect data and think about what kind of policy interventions might work. Excellent. Excellent. Thank you so much. And uh as we uh near time here, I just wanna take a moment to uh thank you, Robin and Mia both for your time and expertise today. Uh This has been a uh a uh great presentation uh on a a very important topic, so I I really appreciate you taking the time for us today. Uh If we did not get a chance to uh answer your questions, we will definitely submit those to Robin and and have them respond to you. Uh You should receive uh the next day or so, uh an email link with a uh uh well a link to the recording of this presentation, um and uh the uh Pdf version of the slides as well, Um Thank you all so much for your time today and for joining us for uh our presentation with a, I want to give you a second to uh read over our disclaimer And also I'd like to invite you to view our upcoming webinars by visiting our website, uh M MS dot dot com slash educational dash webinars. Uh there you will be able to sign up for uh uh any of our upcoming presentations, uh and also uh join our list. So you do not miss any notifications in the future Once again, I thank you to Vallier Robin and Mia. I really enjoyed your presentation, Thank you so much for joining us today and also to our audience, Thank you so much for joining us today. Uh We will see you next time. Have a great day, everybody.