Beyond The White Coat | Dr. Zwade Marshall & Zack Fox | The Business Of Staying Independent

Zwade Marshall: Mm-hmm. Hey everyone, welcome back to Beyond the White Coat. ⁓ I've got a very special guest with me today and look forward to this conversation that I think many of our physicians ⁓ and allied health professionals that are entrepreneurial will really care about these topics. Now, in this world of medicine ⁓ becoming in increasingly more complex and evolving at a rapid pace with declining reimbursement, a lot more pressure on business owners within healthcare. ⁓ to find solutions for staffing shortages ⁓ and the overall economic and margin erosion that happens within the health environment today, that there's been this consolidation. And it's becoming increasingly hard for doctors to remain independent in this world. And so there are a couple of models that have been evolving over time to help us remain independent and autonomous while also doing a thing that we love to do, which is caring for patients. Today's guests, Zach Fox. chief growth officer for redefined health. He is someone who's grown ⁓ a practice from 14 million in revenue to north of 200 million. ⁓ the odds of being able to do that are so incredibly small. ⁓ and Zach is someone who has the mind of ⁓ an executive but the heart of a clinician as well. ⁓ Zach, welcome to the show. Yeah, I appreciate that, Doc. ⁓ yeah so if you want me Give me a little background about the essence and kind of how we got to be here. started my career as a med device rep, was a striker for for two, two and a half years, and then eventually went to Nevro, spinal cord stimulator rep. And while I was there, it's so interesting. When you're in the STEM business, you really get into the nitty-gritty of what it looks like to work with a medical practice, right? Sure. You're seeing patients all the way through the care cycle. You're helping them get scheduled for their psyche valve and their imaging. It's not as transactional of a sale. As selling a total name, right? You're really more involved in the operation. It's longitudinal health care. Correct. So I get into that. I'm one of the top reps in the country. I'm doing very, very well. Really enjoying my job. Really getting to interact with patients was a ⁓ cool shift in kind of the mindset that I had been in prior to ⁓ at Stryker. And then unfortunately, my life gets rocked. ⁓ my father asked to wait for this this morning for COVID. He was a provider. He owned a ⁓ 14 provider mental health clinic. And he passes away December twenty-fifth. December twenty-sixth, I take over as the CEO of his practice. And I know nothing about running a medical plan. Had he been sick ⁓ for a bit? So you were getting geared up and prepared for this or was it suddenly Yeah. So unfortunately, and I and I always say, ⁓ to kind of preface, you know, why I'm so passionate about what I do, we will all be recipients of the healthcare system at some point. Sure. And my father is definitely a recipient. He he had his first heart attack when I was sixteen years old. And I had seen kind of the ups and downs of his health over the years and he had really kind of ⁓ started to deteriorate in certain ways towards the end of his life, but unfortunately got COVID back when it was really, really bad. Or was put on a ventilator December tenth and then he ended up passing Christmas morning. ⁓ so yeah, it just totally rocked my world. and I taken over to the CEO as his practice. While you were still at Nevro. While I was still in Nevro. Got it. So you're doing double duty. Double duty. And knew nothing about running practice, sure. ⁓ we had taken an audit way after I become the CEO. ⁓ he had he did corporate therapy. So if you've ever seen billions, but he was on the board of a bunch of companies. He did a lot of ⁓ what are called EAD programs, emergency assistance programs for large companies. Sure. His clients are freaking out because he really was the business. And ⁓ I had to So with billions, he is ⁓ Axe's whisper that the the woman was missing about. Yeah. Yeah. Yeah. Yeah. ⁓ so I take over this business and ⁓ my largest client when I was at Never was a group called Redefined Healthcare. They were a small single specialty pain practice. And my father and I for a long time had talked about the fact that pain management and mental health really should be married to each other. There's so many synergies between the chronic pain patient and the patient who's also because of their chronic pain experiencing. Anxiety, depression, suicide abstract. Yeah. It's comorbid. Yeah. A hundred percent. ⁓ so I called the CEO of their practice, who was a young guy who had actually grown up ⁓ probably three miles from my house, who I had become friendly with from working at their practice. I said, Will, I've got this practice. I have no idea what I'm gonna do with it. Can you just help me out? She came in, we converted to an EMR system, we really just professionalized the business. And then about 12 to 18 months later, we sold the business after doubling the revenue. So this is early 2021, January of 2021. ⁓ He then comes to me and says, Zach, I'm forming an MSO. And I want to totally shake up how healthcare is done. I want to form the first outpatient healthcare system that really empowers providers to have the resources of being part of a hospital system, but allowing them to stay independent, allowing them to keep their profit, and allowing them to To really grow and thrive in what is healthcare today. I said, I'd love to be your partner. I'm gonna help you do this. He goes, Awesome. I don't have any money to pay you. So I spent the next two years ⁓ basically jogging back and forth between working for Nevro and being a rep and helping to grow the business. ⁓ 2021, we formed and started the care center model where we started ⁓ bringing out other groups. Fast forward to now, we have 110 locations in New Jersey. ⁓ we operate about 40 medical clinics. Between 2021 and 2026. This is now being filmed in in July of twenty six. Yep. So so a five year time frame. Yeah. ⁓ a lot of bones and bruises in the beginning. Sure. ⁓ because we had essentially been going to providers, pitching them on this model of we're gonna take a value-based care concept and overlay it on top of the fee for service payment model to prove. Because it was really our north north starred, what we wanted to do, that better quality care could be delivery at lower cost. Sure. And we were able to succeed in doing that. And that's really what made this thing grow. So we have 110 locations. We're have either involved with ownership or management of nine surgery centers. ⁓ we have about 200 providers in New Jersey. And we really spanned the gambit. ⁓ we didn't do the traditional private equity approach of being single specialty. We had their Of pain. We really wanted to prove that by controlling the patient ecosystem of pain management, orthopedics, neurosurgery, spine surgery, mental health, chiropractor pain, cardiology, interventional radiology, and vascular, that we could keep patients in the ecosystem that allowed them to go to outpatient labs, outpatient surgery centers, see and network outpatient doctors, and really help lower the cost of care for both the patient and the payer. And the cost savings come because you're keeping them out of the hospital. We're keeping where the cost is a little outside of anyone's. Exactly. So it it's funny. I've had this conversation with so many people over the years. There's this what I think misguided ⁓ concept that cost and quality are directly correlated to each other. Sure. You need to have high cost to get a better quality. And I think healthcare is actually the only place that that isn't fully accurate. Sure. It's not accurate in a lot of places, other places too, I think. But I think healthcare ⁓ breaks a lot of the rules that economists will talk about, you know, like for instance, ⁓ this concept of supply induced demand, where usually you say a market's saturated and so you don't want to build another center there. ⁓ but in healthcare, you can have ten MRI scanners in a small town. You build an eleventh one and that one's busy as well. Yeah. Because the supply of it in terms is demand because there's so many what will be called perverse incentives to get busy. And so I think a large part of what you're describing here in a value-based care system, overloading a fee for service, removes some of the perverse incentives that will motivate folks to kind of build things, do things just to go ahead and generate revenue. And and I want to take I want to go a little bit deeper here because a couple of things you just touched on a moment ago. ⁓ And we've discussed this already in the entrepreneurs journey of most of our doctors who are contemplating starting their own business will oftentimes struggle with do I keep doing my employed role and then start my thing on the side or do I leave it? Because it's so much burning frustration. Yep. Clearly you said I'll stay with Nevro, I'll do this double shift until it was time to jump. I don't want to go there too much longer, but talk to me a little bit more about What motivates somebody like you that's that's been doing well? You were top sales rep at Nevlo, clearly the pinnacle of your career, clearly earning well, to then take on the risk, the hardy, the bumps and bruises, and begin on the journey of building your own thing? You know, I I think it's twofold, right? So I think there there's a a certain level that people have, and I I think a lot of providers have this too, where they want to be entrepreneurial. They want their name on the wall, they want their logo, and I definitely have that. ⁓ I've always wanted to. strive to do something that I felt was ⁓ above and beyond what the average person kind of wanted to do. But I think tying that directly to financials isn't necessarily the best way to do it. Sure. For me, it was I want to do something great. Like I I I money is in the motivator. Money keeps score. Exactly. Yeah. So money to me like can be the motivator. Yeah the way that I look at it is actually I want to break the wheel. I really want to try to change healthcare in a positive way. I think that there's my grandfather owned the last physician-owned hospital in the state of New Jersey. And his hospital was so great back in the heyday because it was owned by doctors and he had great administrators who were part of it. And there is certainly a place for administrators and a place for providers in healthcare. Sure. But I think what we have today is this like very strange divide where it's either physician owned where there's no resources or it's administrator owned. And there's no input from the clinicians. Sure. And we're in the healthcare business, not the business of healthcare. I know you've heard me say this a million times. If you take the healthcare out of the front of that sentence, it becomes about the mind. Right. So for me, when Will had approached me about this idea and kind of went through his vision of what he wanted the business to look like, it was let's change the paradigm on how things are done. And I think the biggest example of that. is our group purchasing organization. So are you familiar with how GPOs I am, but I think we should explain for the audience. So GPOs are group purchasing organization that helps you to get economies of scale, right? So you purchase together within this group and then you drive the cost down because you're getting your suppliers to negotiate in earnest to get your business because you're now instead of being a single practice buying your epidural kits, you're now fifty practices buying them all together. Hence you get some ball discounts, right? A hundred percent in theory. So ⁓ there's about three large GPOs that are out there. And a lot of them are hospital system owned. One of them I believe is publicly tr ⁓ publicly traded, one of them is private equity owned. And there's so much misalignment with group purchasing organizations because the way that they get paid is they basically hold contracts and they become the contract aggregator for their members, which are surgery centered hospitals, provided practices, but they get paid from the vendor. A percentage of the spend for giving them access to the facilities that they manage their contracts. Sure. So if you're one of these large GPOs and you have a hundred million dollars of spend with Stryker, you have zero incentive to to actually argue to get that down to seventy-five strikers. Because it hurts your pocketbook. It hurts your pocketbook. So I think what we wanted to do was we wanted to create an ecosystem where we were able to strategically say, we're gonna form our own group personality organization. And we're not going to care about making money on the GPO because we own such a large breadth of the infrastructure. Surgery centers were involved in the medical clinics, were involved in the MRI facilities and the labs. We care about keeping the money and the profit in the hands of our providers and in the hands of our surgery centers. So the GPO did what group personal organizations were always designed to do, which was lower cost. When I was a grep and I would walk into a hospital and they say, ⁓ you can't come in and unless you're on our GPO. I would be thrilled because my pricing was no exaggeration, double sure what we pay. Sure. Because they they don't care, right? Yeah, it's enough to sit in the price as possible. So to answer your original question, when Will came to me and said, Zach, I want to form this company and I really want to try to make a positive change in healthcare. The GPO is an example, my goal was to take what had been done wrong in the past and kind of break that wheel. Sure. And start to create it the way that it was designed to be created, which was to lower the cost of care for the patient, lower the cost of care for the payer, and create that dynamic between us and the payer where they want CLP successful. Sure. And be able to make sure that patients aren't burdened with very large healthcare bills. And I think that's why this thing has been able to grow as quickly as did. Sure. So ⁓ in transparency, we meant because I own a ⁓ a multi location practice, ⁓ and I'm struggling with the challenge of scale. ⁓ like Like most of our our listeners, ⁓ I want to retain autonomy. I think I've built something that's been good. ⁓ but I'm struggling with ⁓ labor stuff, the turnover of early employees, ⁓ the declining reimbursement and being bullied by the payers ⁓ to get contracts in my surgery center. And then you start to feel the strain of patients complaining that when they call the office, the fold lines are always busy. Or Referring doctors saying that they sent a referral over and they were told they can't see me for seven weeks. And but I'm not that busy in the clinic or in the UR, yeah, to have my staff tell external parties that I'm I'm I'm a seven week wait. So I'm feeling the pressure and the strain of a system that's not keeping pace with the scale that I've currently accomplished. So I know I need help. And I've heard pitches from several private equity based groups. And larger groups on the private equity model. Mm-hmm. As a physician, I think I speak for my peers and we say that we're very leery of what private equity is. Explain to me why what redefined is doing is different from private equity. It's an awesome question. ⁓ so I think for the viewers who don't know kind of how private equity makes their money in healthcare, because of CPOM corporate practice medicine ⁓ in most states. ⁓ non-physicians can't own it in medical practice. So what they do is is they stand an MSO on top of the medical practice that they purchased, right? And they use the MSO by levering the company and then also charging an elevated management fee to scrape the profits from the practice up to the MSO, right? So if you're a provider of practice that has a million dollars in profit and you're running a 50% margin, right? You exchanged your practice for a check. Usually that check that you get from private equity is on a multiple of your EBITDA, right? So you get you have a million dollars of EBITDA, you get a six times multiple, you get six million dollars of which And for simplicity's sake, we're using EBITDA and profit interchangeably right now. So a million dollars, but you give us a million of profit. Six times profit, six million is the check the doctor gets. Usually the doctor is gonna get anywhere from fifty to seventy percent of that in cash, and thirty percent of that is gonna roll into equity in the private equity MSO. And the hope is is that they'll be able to grow that NSO and be able to grow that platform and then sell that sometime down the road. Sure. So I think we're different on a lot of levels, but there's two main fundamental levels where I think we've really differentiate ourselves. The first being we don't charge a high management fee because we're not buying the practices. We're not trying to scrape their profit. ⁓ we have what's called a care center model. And to be honest, the OIG calls it a profit center model, but I didn't think it sounded healthcare enough. So you change it to care center model. ⁓ By which we roll groups under a single tax editing. And when they come on, we create a new class of stock for all of the groups coming on. And that class of stock is just a representation of the EBITDA, the revenue, the profit, the expenses associated to the practice that's joining. So it's one large medical practice with multiple groups that own shares of that medical practice that all run on their own set of books. Sure. Because that they all have their own profit, they all have their own expenses, they all are. operate as their own practice on their own little island within the eco the larger ecosystem of redefined. Through that transition, they keep what I have felt ⁓ is important and what a lot of providers have told me is important. I still feel that healthcare is local. So they keep their brand, they keep their phone number, they keep their website, they stay their practice the same way that they've always been their practice before. So marketing isn't changed. The way they're presenting to their community is the same as it was before they joined the MSO. A hundred just the back end operations now have the infrastructure of what we define offers. Exactly. And instead of us sucking all of the money up to the management company, we allow the providers to keep all of their profits. And quite frankly, our goal is to make them more profitable, right? We're completely aligned with them that the more they grow, the more that our MSO grows. Sure. And to be clear, Garrett, this is not a benevolent ⁓ kind of a charity thing. The the MSO in your instance does better. the better the practice does because you're getting managed percentage of revenues your management management fees. Correct. So the goal is to ensure that that practice does as well as possible because your payments come from the fees associated with correct growth. Correct. But usually when we factor in what we're providing on managing services to the groups, it typically ends up being a cost neutral and a lot of times a cost saver for the groups. Sure. For a lot of reasons, ⁓ staff allocation ends up being spread amongst multiple groups. Office location sometimes gets consolidated when need to be. So a front desk staff who you're paying twenty dollars an hour could be split amongst two different provider groups. So there's a lot of ways that we're able to help reduce that cost. I think even a more stark example, as I looked at your model, is EMR fees. If you're paying your EMR company ⁓ four percent of of collections within the redefined system, that fee comes down to two point three percent. Correct. And so it's the immediate cost savings off the top line of Expenses you're currently paying. Correct. Being a part of the GPO, if you're buying spinal cord STEMs for twenty two thousand dollars per STEM, now you're ordering through your GPO, you're paying sixteen thousand bucks instead. Correct. So you're offsetting what you're paying in management fees with cost savings. The practice gets directly at Daisy. Correct. And and and we don't take any of that. All that profit goes directly to the providers. Sure. So the first fundamental difference is opposed to private equity where they buy your practice and they give you a check and you become a salary employer, ⁓ employee. Where unfortunately what I've seen in private equity is a lot of these providers become disincentivized to work because they got their check and now they have a theoretical sale down the road that they don't know if it's ever gonna happen. Or and no offense, I heard a private equity guy say this, but they've told me that they buy good doctors and they get back offers. And and that's been like the joke that that I've heard some from some private equity guys. ⁓ with that being said, I think the the other fundamental difference when it comes to a capital event, because we are going through one in New Jersey, like I talked to you about, which is different than what private equity has done or a hospital transaction is most times when these provider groups get ⁓ purchased, they get ⁓ what I would call ⁓ they're kind of like a plug-in sale, meaning there's a private equity MSO that's already there that Is rolling up painting groups as an example. And they're gonna buy your group as an example, and you're gonna become a plug-in to a larger MSO platform. Sure. Where we essentially skipped that stick. So with our transaction, we basically got to the point where we were on like our the time frame horizon revenues associated with what would be like the second or third sale to private equity. Because we're not selling a single provider group. We're not selling a a a plug into a larger platform. We're selling a whole platform. We have all the infrastructure. We already have HR. We already have switched to accrual accounting. We've already done all the things to take a medical practice and turn it into a real business healthcare system. Sure. So we're offered a bunch higher multiple. Of which our providers get to reface right. Sure. So to be clear here, I think this is a key differentiator from what I'm accustomed to hearing. Usually, ⁓ within these MSO models and these PE models, they're rolling up pain groups, they're rolling up GI groups, they're rolling up orthopedic surgery groups. This model is multi-specialty, where we're saying that we're good, you're gonna be managing the entire musculoskeletal pipeline, ⁓ and creating this ecosystem in which these doctors that are caring for these patients that have pain ⁓ complaints outside of the hospital. It then creates this network effect where because there's all referrals back and forth, we're all doing ancillaries as well, that the entire tide rises so all ships rise together while simultaneously creating more enterprise value because now you've got a multi specialty group. So the multiples are by nature just higher because of what comes along with having these groups continue to thrive and grow together. Correct. And I think from a ⁓ a clinical workflow perspective, and like let me put my ⁓ my payer hat on for a second, because I think that this is other ⁓ another really differentiating part of our model. And not to say that the traditional P model rolling up single specialty groups and selling them hasn't worked. It has, but I don't think the concept of going to the payer and saying, Hey, I have two hundred pain doctors or two hundred orthopods in my medical practice, I want to bully you into rates has been proven to be successful. Sure. So we have very advantageous rates that we've been able to negotiate in New Jersey and we've just helped with our Utah group and we've obviously started helping you guys. And I think the reason that our story resonates with the payers on a multi specialty level is because the payers work on budget neutrality, right? So they say I have a $20 million budget for orthopedics, right? And if you're in Georgia and you're just rolling up orthopedic groups and saying, I want to take your $20 million budget to $25 million, or it's not a compelling story for that, right? Where with our model, having a multi-specialty approach, we're basically going to the payer and saying, hey, like let's look at the totality of your MSK spent. And like let's track how our patients are doing on a total cost of carriages. And we don't do the the term value-based care to me, it's so broad because it goes everywhere from shared savings to like true capitation and population healthcare. Sure. Where I like to say that we do value-based care, stupid simple, which is just we have an ecosystem of providers. The payer has a budget. What we're going to do is we're going to say, okay, we have all these provider groups. And if a patient sees you as a in-network pain physician with your own POL, your patients are going to be seen in your practice. You're going to do the the procedures at the appropriate site of service where a lower cost of care. You're going to send the patients to your POL opposed to coming to the hospital system. You when you send for imaging, you're going to send to one of the imaging facilities within our ecosystem. When you send your patient for more ⁓ interventional surgery like spine surgery or orthopedic surgery, they're going to go to a patient within our network who's an orthopod or a neurosurgeon or a spine surgeon. Who's going take their patient to an in-network surgery center opposed to a hospital who's going to get the imaging done at their imaging facility? So when when we go to the payer, we're not saying we want to bully you into better rates. We're saying we've taken this value-based care approach to look at the totality of episodes of care and how we could systematically reduce that cost for you. And I think that has been such a a great part of what we've done because it's really resonated with the payers. And I think I think the other side of all of this is. ⁓ what many of us fear as doctors is losing autonomy and decisioning and becoming the instrument through which private equity guys make more money at the expense of our patients. Yep. So the worst thing that can happen to me in my practice is that I then I get a check of some sum, sell to a private equity group. I'm now still employed, it's an employee in my practice. Yep. And I'm being questioned about the KPIs for why did I not do more epidurals this week? Yeah. And it becomes like you've gotta hammer Dr. Marshall. Yeah. Like I want you to hammer these nails. Yeah. And so it's it regardless of what the patient's content is. So so many of us feel the ick. Yep. From totally becoming becoming told by suits what to do for the thing that we've been trained to do and care for patients, that being able to retain autonomy, being able to outsource the parts of this business that we weren't trained to do. So I have an MBA and I've been a organizational leader for some time now. But I've realized that I am now at my limit on how I can appropriately manage an organization of my current size and scale and also do good medicine. I can't do both. Yeah. And I want to just do the good medicine part. And I want to have trusted partners who are not telling me what to do. Manage the parts of this business that I don't I don't want to keep having to hire front desk employees and medical assistants. I want to have a system that can vet them, screen them, post an ind.com, check their credentials, make sure that no one's hiding drug history, any kind of bad outcomes that have been in the past before they're in my office, because today I'm the one doing all that work. And I don't I don't enjoy that work. Yeah. So I think what there is an opportunity today because of where healthcare is going and because of how poorly private equity is viewed with good reason by my peers and by myself as well, that having an organizational process that better cares for the management. And also keeps autonomy with the doctors where we then get to decide how when, how many, ⁓ is certainly value that needed today. Yeah. And and to be quite honest, that's why we we push you to be our CMO because I think you ⁓ you kind of see both sides of the business ⁓ bet better than most. But ⁓ yeah, I mean to that point, the I think we're in a really interesting time in healthcare where margins used to be so good in healthcare. Yeah, you could do everything wrong, sure, it's still make money, guess they'll make money. Yeah. And The last like decade it's been the opposite. Correct. Do everything right and you definitely will lose money. You'll lose money. Yeah. And I think now, and I I hate to use the the you know trigger word of ⁓ of AI, but there is a lot of operational efficiencies that we've been able to build through AI in our our ⁓ in our care centers. But you as a provider do not have time to do a two hour demo with an AI fall center. Short. You don't have time to kind of vet all of these different opportunities or probably even the resources to hire a good engineer to build them, of which we built most of ours on our app. So we we kind of have the luxury with we have great provider partners who give insight into the business. They keep 100% of their clinical autonomy, they keep their brand, they keep their phone number, they keep their website, they operate as they've always operated, with us being the ones in the back end doing all the things that they don't have time to do. Right. We're the ones who are vetting the new processes. We're the one and then we're coming to you to say, does this make sense for your practice? And you could say yes or no, but at least you have the option to pop up. Yep. So that the idea is massive today. And we had these conversations deep behind the scenes because as we begin to digest the myriad of kind of information inputs that we get for patient care, the biggest pain point for me with the new patient is painting specialists are tertium specialists, meaning Our patients have gone to their primary care doctors first. They've probably seen orthopedis, probably gone to physical therapy. They've probably got some x-ray or scan done somewhere else. By the time they get to me, there's probably a thousand pages of records. Yep. That that patient ex expects me to know as I see them for their first consultation. I have no way of digesting that appropriately. I agree. And as we discussed the inclusion of AI within my healthcare environment, I wanted to have a bot that can scan the records and give me a summary for me to digest that shows me exactly where that patient's been and what are the highlights relative to their current pain complaint. But I to your point, I don't have the bandwidth to vet which companies do it well. Yep. Like where we are within the healthcare regulatory compliance space to have those kinds of ⁓ bots within a health record. Yep. ⁓ and so it's transformative what AI can do for us now. It's incredible. Yeah. But then Who does the work to to do the diligence? Yeah. I source it to you. And then I get to demo it, I get to pilot, I get to test it and say, Yeah, this works or does it? Or tweak it this way. So awesome example of that. ⁓ and this is where like our provider partners, they're the ones who are coming to us saying, Hey, this is the problem, right? Like sure. So, you know, we grew in scale incredibly fast. We had four locations in New Jersey in two twenty twenty one. We have a hundred to ten right now, right? So in five years, there's a lot of locations that have been added. But ⁓ Well, we ⁓ a constant question from our providers is, hey, we have all these doctors and we do the networking and we get everybody together, but they're like, I don't know the specific provider in our care center network who's closest to me that offers a swap for stimulator or the one who does a reverse total shoulder. Sure. So we just hired an engineering team who's actually creating a lot of our AI platforms. I've had this cool idea to build out this software where any of our providers, it's right on their ⁓ desktop. They could go right into it and they have a patient in front of them that says, You need a reverse total shoulder. Who might have sent you to? They go in, they put reverse total shoulder total shoulder in. It brings up all the providers in our care center network by location within a certain geography around that. Sure. That they could schedule directly within that software. Sure. Right for the patient right then and there. And this is all end network. We know that the peer will approve this payment and it's all done in an outpatient center. Uh-huh. Exactly. Exactly. So so it it hits the operational side of it and then hits the patient need and pay repeating. Zap, I think ⁓ I want us to have a follow-up to this conversation shortly after we launch together. And I think ⁓ we're announcing that RSPS my practice is gonna be a part of the redefined health system. ⁓ and we're in the earliest phases right now of legal diligence. ⁓ and so ⁓ once we get live in the course of the next several weeks, it'll be cool to do an update on the lumps and bumps scars of starting together. ⁓ what's gone well, what's not gone so well, ⁓ so we can kind of expose our audience to what does it look like to go from from a practice to an organization. A hundred percent. ⁓ I wanna thank you for your time. No, appreciate it, man. And thanks for flying in. Thanks for having us in in Georgia. Love coming down and Super excited for we're gonna be able to build here. Fantastic. Pleasure to have you. Awesome. Looking forward to talking more. Thanks, guys. Only thing was I just moved to CEO, but besides for that, I not should have big enough. So ⁓ let me let me do this real quick. So ⁓ Jared in the ⁓ in the ⁓ intro for Zach, ⁓ I want you to cut and splice where I said chief growth officer from the Run sheet to I'm thrilled to have Zach Fox here. the chief executive officer of redefined health. Here with me today from New Jersey. And we're gonna talk a lot about physician practices, MSOs, and private IP within healthcare.