Key Insights Into Medical Group Transactions & Alignment Strategies

In this episode, host and VMG Health Chief Commercial Officer Jen Johnson talks with Valuation & Transaction Advisory Managing Director Clinton Flume and Strategic Advisory Managing Director Cordell J. Mack about the world of medical group transactions and alignment strategies.

This month's dose of practical insight on the business side of healthcare involves a conversation about the current trends in the physician practice sector and insights for helping clients better align with physicians. Flume and Mack also focus on cardiology, a sector that has seen a lot of activity in recent years.

Topics covered in this conversation include:

• Recent M&A activity trends such as who is doing the buying and selling
• Background on the types of financial pressures and industry challenges clients are facing specifically focused on medical groups
• Advice for health systems needing physicians to help lower costs
• Transactions perspective of trends happening today related to value-based care entities and partnerships
• How to form a strategy around specialty physicians
• What is driving current trends in the cardiology space and how to create a strategy in the space

Read Flume and Mack's recent article on cardiovascular medical group strategies (written along with other VMG Health experts Colin McDermott, Tim Spadaro, and Christopher Tracanna) linked here: Strategic Options to Strengthen Cardiovascular Medical Group Affiliations.

Read Mack's recent article written with VMG Health's Scott Ackman linked here: How to Assess Medical Group Performance.

Learn more here about VMG Health's service offerings for Medical Group Positioning and click here to access the 2023 Healthcare M&A Report.

Transcript

Intro 0:06
Welcome to the Healthcare Download with VMG Health. We are the leaders in strategy and transaction advisory dedicated to finding solutions for the healthcare industry. In each episode, we will leverage our expertise to provide trends and timely updates about what is happening on the business side of healthcare so you can move your strategy forward.

Jen Johnson 0:34
Hello. In this episode, “Key Insight Into Medical Group Transactions and Alignment Strategies,” we will be interviewing two of VMG Health’s leaders focused on the physician practice sector. Clinton Flume is a managing director in VMG Health's Valuation and Transaction Advisory Division, and part of his practice includes valuing and guiding clients through medical group transactions. Our other guest is Cordell Mack, who is a managing director in VMG Health's Strategic Advisory Services Division. Cordell advises healthcare clients on strategy, which increasingly includes physician alignment and optimizing medical group performance. I'm Jen Johnson, VMG Health’s Chief Commercial Officer, and I'm ready to get us started with a dose of some practical insight on the business side of healthcare. So, Clint and Cordell welcome, as you know, we want to provide listeners an overview of what's happening in the physician practice or medical group sector today. I'd like to explore the transaction environment trends you're seeing and how you guide your clients to better align with physicians, both primary care and specialists. And we'll go ahead and spend a little bit of extra time on cardiology. Now, obviously, there's been a lot of activity with this sector and it remains a hot transaction space. I mean, we've got interest from private equity groups, health systems, health insurers, and others. So while all this is going on, we're seeing both deal structures and alignment strategies continue to evolve. So, since VMG Health works on hundreds of physician practice deals each year, I was hoping you two could provide listeners with a solid overview of what is happening out there. First, I'd like to set the stage with Clinton and get a little insight on the transaction environment with medical groups. So Clinton, what can you tell us about the recent M&A activity? For instance, who's doing the buying and what trends are you seeing?

Clinton Flume 2:23 
Well, thank you, Jen. It's great to be here. It's awesome to share this podcast with yourself and Cordell. You know, when we start thinking about physician medical groups, and we think of 2022, it was such an amazing year, honestly. You know, we look at a lot of transactions and sourced some data from the Irving Levin 2023 Healthcare Services Acquisition Report. And that report, you know, stated in 2022 there was 600 physician medical group transactions. And that's truly amazing in the sense that, you know, 2021 was a banner year in the first place because 2021 had a lot of carryover transactions from 2020, which was a COVID year. So, it was already buoyed up in 2021 and 2022 just blew it out of the water. A lot of those deals were completed by private equity, private equity has gotten into the medical space. 70% of those transactions that we saw were driven by private equity, what we saw was a continued focus in certain sub-specialties, primarily dental. We also saw continued increase in ophthalmology or eye care type transactions. And in orthopedic obviously, it is picking up and that's a space that we're seeing a lot of interest in. And just those three deals in and of itself is about 50% of the total transactions. I mean, these sectors are really high reimbursed sectors from the private insurance market and they have really great out-of-pocket payment strategy. So, it's natural to see there to be continued evolution in terms of the investment in those industries. So, other things that we're seeing in the space are health system transactions. And some notable transactions that we've seen, and this is just to name a few because of course you can go to our Healthcare M&A Report and check out all of them. But in June of 2022, United Healthcare, United Health Group’s Optum acquired Healthcare Associates of Texas, and that was a primary care practice that had over 80 locations in Texas. They had a focus in value-based care, and that's an item that we'll talk about a little bit later, but that acquisition had a total consideration over 300 million. So, pretty big transactions that we're seeing in the medical group space. And then the second largest deal that we saw in 2022 was a physician-led buyout of GI Alliance and that was driven by Apollo Group Management, LLC. And that was valued at almost three-quarters of a billion dollars. So, you can see that there's still a lot of interest in the medical groups. You know, obviously, those two organizations benefited from large-scale platforms. And obviously, those are really attractive in terms of investment opportunities, but the entire state of the medical group transactions that we saw in 2022 is extremely robust. And even our hospital and health system and community hospital partners, they're still extremely active in this space.

Jen Johnson 5:30
Perfect. Wow, that's a lot of activity and some enormous deals. I know that's just a snapshot of what's happening out there. You mentioned the M&A Report, this is our biggest report of the year, it just came out. So, you guys need to go to the website and download that, it not only covers the physician practice sector but there are eight entire sectors. So, there's a little plug for that guy. I’m going to go ahead and switch back and highlight based on Clinton's comments that there is a growing focus on value-based care and primary care. So, I just like to highlight, these two things are giant because there's a big focus on lowering costs in healthcare. Everybody knows this, if you look at it in the two buckets, we've got primary care, this movement makes a lot of sense because physicians have always been considered the gatekeepers for care, they have the best chance to lower costs. So, there's a movement to get those guys. And then we've got this other focus around value-based care, which is a huge theme as market participants are now seeing that there really is a value-based care reimbursement environment that's happening. And folks are making more money if they're doing it right. So, these are two great trends on the positive side. But we have seen financial success from these, normally from larger players, however, it's putting some pressure on the health system. So as we know, these guys are struggling financially, a lot of them. And they've got all these competing buyers coming in, whether it's for primary care or the value-based care space, which is making their strategy for physician alignment a little bit more difficult. So, speaking of strategy, I want to move that question to Cordell. So, since you work on strategy with health system clients, could you provide a little background on what types of financial pressures and industry challenges your clients are experiencing as it relates to medical groups specifically?

Cordell J. Mack 7:19 
Thanks, Jen, happy to. And I echo Clinton's comments, it's good to be here and talk about what's facing our clients today. We've had an opportunity to spend a lot of time with many of our traditional hospital health system clients, and the pressures that are facing medical groups really aren't all that different from your traditional hospital or health system. And medical groups are not immune to different pressures as compared to just traditional hospitals and health systems. So, we still see the fact that, you know, revenues are being outpaced by inflationary trends on expenses, whether it be staffing, whether it be supplies. A lot of the same drivers that are occurring with our hospitals are really, you know, filtered down to impact our medical groups as well. We went through in 2021, a really big change with the Medicare Physician Fee Schedule. And the implications from that are still impacting a lot of what we see, you know, just longitudinally as we think of medical group performance. There are, however, though, some things that are just unique to medical groups that are probably a little different than maybe what a hospital or a health system may think of. And as a health system, you know, has financial challenges, there is this constant renewed visibility on operating losses of a physician group, and focus on trying to get to optimization of how do we best organize that medical group from a stewardship perspective. We came into COVID, and the better part of 10 years prior to COVID all we heard was challenges that were related to driving forms of asynchronous care and telehealth, and why those strategies really wouldn't work. And so the care model has really been impacted in medical groups since COVID, in that inboxes are getting filled up with different kinds of patient inquiries. And we're seeing providers, physicians, advanced practice professionals that are working at levels probably well below the top end of their license. So there's all this pressure to try to find ways in which we can redesign care, that really kind of gets the care to the right individual inside of that care team. And while we have these mounting financial pressures, we still live in this world of scarcity of doctors. And so in many markets we're seeing call pools that are shrinking, we're seeing the medical group where physicians are working either in just the inpatient space or just the outpatient space. And so, you know, the challenges inside optimization, and more frankly, strategies for medical groups, they continue to mount day after day.

Jen Johnson 10:09 
That's a lot to tackle and I know that this is pretty much at the top of every health system leader, is how do we optimize our medical group performance? You know, I know you've got some ideas on this. I mean, when folks come to you, and they say, “Hey, we need physicians to help us lower costs, we need to align with them.” What is your advice? What strategies are you proposing at it just a very high level?

Cordell J. Mack 10:32 
Thanks, Jen. You know, it's an interesting and it's a broad question. I'd say most times when we’re with clients today we're starting with maybe broader scale ambulatory plans, just what sites, what services, what locations? And how are we going to begin to think about transforming or advancing our strategies related to value-based care? And we take that broad-scale ambulatory plan and we have a need to though drop down and to become more finite in some of our strategy work. And as an industry, we’ve just not done super well in measuring performance. And what I mean by measuring performance at a medical group, we have relied heavily on some antiquated measures around medical group loss per position. And it's just measurement that has got us into some challenges relative to devising really kind of forward-looking strategies. At the same time, we live in this evolutionary world where value and value-based strategies continue to come in. And oftentimes our clients today are asking, how do we develop incentive structures that are really going to work in order to align with the types of clinical end and or financial and strategic outcomes that they're looking for? And we've seen, really for about the last 20 years, since this most recent wave of employment has occurred throughout health system environments, that the organizational strategy has often been to try to build these large, integrated multi-specialty group structures inside of health systems. And when we've done that, we're now faced with these challenges around equity and fairness, and building systems that really have primary care physicians and hospital-based physicians and specialty physicians all at the table together. And the reality is, physicians are really, you know, pointed towards probably a single area of affinity that they can best produce success with. And what I mean by that is, if I'm a specialist in a neural sciences area of clinical focus, or I'm a specialist in an orthopedic area of clinical focus, I may be really akin to trying to make sure that specialty area is working really well for me as compared to just simply this broader medical group, multi-specialty orientation. So, we're seeing a lot more organizations that are trying to do deeper dives into various kinds of clinical service line, institute-type models. And finally, I'd say, at a broad level, there's a lot of work on the care team. And so, the scarcity of doctors that we talked about previously, as well as just getting the incentives to be able to drive more advanced practice professional integration inside of doctors' offices, inside of specialty clinics, inside of even primary care offices. We're seeing that happen increasingly more and more.

Jen Johnson  14:07 
Yeah, that's a lot to unpack. I think I want to take two things from that. I think super helpful insight as it relates to the old physician practice losses and looking at loss per FTE, like I completely agree with you. That's something everyone's looked at forever and I just don't think it makes as much sense anymore. I mean, they're integrated teams, there are different ways to look at and assess medical groups. So, I'm going to go ahead and plug your “How to Assess Medical Group Performance” article because you guys do a lot of that work and take a deep dive and you look at it differently if it's a primary care group, or if it's a specialist group. And I think that's a really important thing for listeners to pick up on when you're looking at a practice strategy. Now, Cordell brings up value-based care strategy. Now, this is obviously a huge topic these days. So, now I'd like to turn back over to Clinton, who works in the transaction space. So, what are you all seeing as it relates to value-based care strategy, and just overall what's going on out there?

Clinton Flume 15:04 
Yeah, thank you. And I think all the points that Cordell had articulated are very salient to this conversation that we're exploring value-based care. So, you know, when we think about value-based care transactions, obviously, the main thing that I think is that most of it's being driven by the payers, right, a lot of the transactions that we see out into the market are heavily focused on the payer side. There's a ton of hospitals that have the infrastructure that's necessary to complete value-based care type transactions, whether we're talking about ACOs, or clinically integrated networks, those are the players that we're starting to see really make advances in this space. And I tell you the main reason that is is that, you know, everything that Cordell was saying, that takes a lot of time, a lot of energy, and more importantly, a lot of money. There is a multitude of factors that have to come into play, its strategy, its cost, its people, there are a ton of people that have to go into reporting and ensuring that quality initiatives are accurately assessed to be able to take advantage of value-based care payment models, that a lot of people don't think about the overall cost that goes into creating these models. And the folks that have done it successfully have invested in the infrastructure that's necessary to do it. So, when we think about the transactions, yes, a lot of our hospitals and health systems are going out and trying to build and improve their overall value-based care initiatives by acquiring, solo medical groups that maybe they're bringing some more MA lives into the portfolio. But it's really, the large transactions are being driven either by public organizations or private equity, that really have the resources to dabble into the value-based care world. Most notably we had a transaction that is featured in our M&A Report, you know, it really at the tail end of last year, in November, CareMax closed on their acquisition of the Medicare value-based business of Steward Health Care System. That transaction in and of itself created one of the largest independent, senior-focused value-based care platforms, and gave them access to almost 400,000 Medicare Advantage fee-for-service beneficiaries. And so, you look at transactions like that, and why do those transactions happen, right? I mean, that's exactly what we're saying is like, you got to create scale for these to actually be profitable ventures in the value-based care space, and, really, the opportunity to transfer all those lives to risk is really what they're going for. You have to have enough infrastructure, you have to have enough scale, to be able to make these value-based care transactions actually worthwhile. So, while we do see a lot of transactions on a smaller scale with our organizations, the ones that are really going to shape and move the environment in the value-based care world are really going to be led by our hospitals and health systems and their equity partners.

Jen Johnson  18:27 
That's a lot. So, it sounds like getting into the value-based care strategy is going to be a big lift, no matter who does it, there's a lot of resources involved. I'm also hearing primary care strategy is critical, which we all know has been forever. And overall, we've got a lot of transaction activity, we've got new PE participants, we've got mega deals happening, lots going on in the medical group sector. So, really great overview. I personally, as I stand here, I think that we're going to see all sorts of buyers move more and more into the primary care space, which is going to give health systems who are trying to acquire these targets even more competition, which is just another struggle for them. Which brings me to another area for strategy in the sector. So, I asked, you know, what about focusing on specialties such as orthopedics and cardiology, and all the other ones out there, you know? There are a lot of high-dollar specialties that bring a lot of revenue to hospitals and there have historically been some interesting strategies around working with specialists. So I bring this up, I did a lot of physician compensation work here at VMG Health and it really can be an excellent strategy for health systems. Our little comp division does a lot of the co-management deals, which is a way to align with specialists. So, if you're not familiar with these, co-management deals are structured as contractual arrangements with specialists where the physicians are incentivized to improve quality and/or lower costs of a service line of the hospital. Now, these have been around forever, and we do continue to see more each year and we've seen a lot of success with them. But what we've seen recently is strategies going beyond co-management, we're seeing even more innovative strategies with specialists. So, that's what I'd like to talk about a little bit. And I'm gonna go ahead and switch over to Cordell. Just if I could get a little more insight from you on this topic, how do you guide your clients through strategy around specialty physicians? I'd like to hear whatever you think is most helpful to listeners.

Cordell J. Mack  20:25 
Agreed, Jen. I think the specialty space is evolving, it will likely continue to evolve and I tend to think of it in two different kinds of categories. I think there's a group of specialists that have this very high degree of alignment with what occurs inside the four walls of a hospital. And the hospital needs the specialists and the specialist really needs the hospital to be successful. And there's another group of specialists that, honestly may be more community based, and that may be like your rheumatologist or your endocrinologist, and they're much less apt to really need the alignment with the hospital to be successful. But that latter group, and I'll start with that latter group, we are still seeing integration where health systems are being asked to step up and fill a void in the community. And if not for the health system or the hospital, the likelihood is we wouldn't have some of those services and we'd have restricted access as a result of that. But if I think of that former group, that group that really this high affinity, the specialists have a high affinity towards a hospital or towards the health system, that's where the innovation is really kind of coming from an alignment perspective. And I referenced previously this kind of migration in thinking a bit differently about a multi-specialty group orientation inside a health system. And so if not that, then what? Right? And so, at the specialty level, specifically with areas around orthopedics or musculoskeletal or cardiovascular, we're seeing people organize to where that specialty, or maybe a grouping of special specialists, have an opportunity to think about governance structures and management structures and facility designs and compensation systems that are really more geared towards what's applicable for their individual discipline. And that level of thinking is affording kind of that traditional not-for-profit health system partner, an opportunity to try to grow and kind of differentiate what their services are. And they're doing that without this burden associated with this multi-specialty kind of grouping that occurs in the background. And then, as part of that, as a delivery model, we're seeing more and more of that care that's moving towards the ambulatory environment. And so we can't think about specialty and specialty strategy without thinking about how that migration is impacted either through ambulatory surgery center, or just different ways in which consumers are able to access care at really convenient, off-campus type locations. And so, previously, when we had all the integration around employment, we had very few of our clients that were thinking about syndication opportunities on the ambulatory surgery center front with employed physicians. In the last 24 to 36 months, that's really fundamentally changing. With changes that have occurred in Medicare and how they're viewing the migration of care out of the hospital onto an ASC eligibility list, we're seeing more and more health systems that are kind of driving towards what it really means to think about being in partnership, even with their own unemployed doctors, Jen. And then I think, finally, I agree with Clinton 100%. The increased migration towards some value-based definition, that can vary significantly market-to-market or community-by-community, but even carve out niches through value-based enterprises with specialists, and what the changes that have occurred in the Stark Law have afforded traditional tax-exempt hospitals and health systems, more comfort in their level of aggressiveness in pursuing new different levels and different forms of value, and how those benefits can be shared back with their specialist physicians.

Jen Johnson  24:47 
Yep, that's all very helpful. It makes a lot of sense, and it's always good to hear there are so many avenues to navigate this space, opportunities to align with these specialty physicians. You know, I see it as like little mini businesses, you know, whenever you specialize, it's always a good idea, you can focus on what you need to. So I like where it's going. Lots of good opportunities out there. So, what I'd like to do is end by touching on a major specialty that health systems have been focused on for years and years, which is cardiology. Our Physician Practice, Affinity Group actually just published an article titled, Strategic Options to Strengthen Cardiovascular Medical Group Affiliations.” And now both Cordell and Clint, you guys both participated in writing this piece. And I'd like to give our listeners some salient points from the article. Starting with you, Clinton, can you provide a few takeaways from this piece to help demonstrate both what's driving current trends in the cardiology space and what types of affiliations and transactions you're seeing here?

Clinton Flume 25:48 
Absolutely. Yeah, cardiology is very interesting. I mean it's been one of those sub-specialties that obviously has been integrated within the hospital for so long, right? I mean, you have, you know, for employment trends for cardiology, like 65% of cardiologists are employed, right? There's still independence out there, there are still opportunities for investment with independence, but a lot of cardiologists have found safe haven in the confines of a hospital and a health system. I mean, it's a very technically robust service line that requires a lot of infrastructure. You know, it's one of the biggest sources of revenue in service for community and local hospital systems. So it's going to be naturally a very important sub-industry that would be focused in on. The things that we started to see over the last couple years, is really the shift to the outpatient setting for cardiovascular procedures, which Cordell touched upon, and then the continued trend in reimbursement. And when I think about my clients, and I have a lot of ambulatory surgery center clients, I have some private equity clients, that all deal in the surgical space, and the one thing that they're very keen on and interested is, “Okay, how do we monetize, or how do we affiliate with cardiologists?” Because now that CMS is opening up additional procedure codes that are allowed to be performed in ASC, how do we go out there and be able to service and provide a return on investment for our stakeholders? And cardiology is an awesome opportunity to dive into. So, in terms of strategy, obviously, for cardiology we're starting to see a proliferation of ASCs and OBLs coming online. You know, the recent MedPAC Report that we were going through, indicated that the single specialty cardiology ASC has increased, I think, almost double over the last three to four years. And that's just single single-site specialty cardiology, and that's 100%, related to CMS releasing additional codes, and then additional investment into that space. So again, aligning with independent cardiologists through medical group affiliations, and then helping them understand what are those alternative investment strategies, so that they may be able to participate in sort of the surgery side of their practice is really what's driving these transactions in the market. So I would say, above and beyond, it's the shift to the outpatient that has led to the increased transactions that we at VMG Health have seen. But you know, the other thing too, is that there's going to be continued pressure on these medical groups internally within the hospitals because we're starting to continually see reimbursement pressure. Coming out of COVID, cost structures are so out of whack, labor is super high, operating costs, drugs, medical, there's continued pressure across the entire system. And whereas cardiologists continued to see increase in their overall compensation year over year under those hospital models, I mean, introduction of value-based care and other initiatives within these health systems, those days are, maybe they're not completely gone, but they are certainly slowing down. And so naturally, you're going to start thinking, “Well, are there opportunities outside of an employment model? What does it look like maybe going back into private practice?” And that's where the PE firms get you, they start showing you all these different opportunities in terms of investment with ASCs. And then there starts to become a little bit more interest and that's where we start seeing the activity. So, I think that's a pretty good idea. And that kind of gives you an overview on the reasons why, but the article also focuses a little bit more on the strategy too.

Jen Johnson 29:59 
Perfect. Thank you, Clinton. It's good to hear there are a lot of choices out there to succeed in the cardiology space, almost too many it seems like. But even with all these transactional strategies, we still do have a ton of employment of cardiologists. In fact, according to the Physician Advocacy Institute, we've got approximately 67% of cardiologists are employed by hospitals or health systems. So, I'd like to go ahead and ask Cordell, when advising your health system clients about the specialty of cardiology, what are some of the major strategies or points you'd like to get across?

Cordell J. Mack 30:32
Yeah, I think this is a specialty that really is at an inflection point. Jen, what you said is really spot on and Clinton, he raised the same point as well. Cardiology 10-15 years ago, a lot of the employment that occurred, hospitals provided a safe haven for cardiologists seeking kind of an alternative way of organizing the day-to-day delivery of cardiovascular medicine. But we now fast forward, and we fast forward to where clinically, we're in a different place. We've gotten to, where we've bypassed, we're seeing vascular procedures that are done in an off-campus ASC environment, we've migrated to now having ICDs and pacemakers being done safely in an off-campus, you know, ASC-directed. OBL environment. And you know, more recently, we've now gone into things that were traditionally only done inside the four walls of a hospital, and we're seeing coronary diagnostics, and we're seeing coronary interventions that are occurring in this ambulatory environment. The horizon is next to probably think about some of the ablation-based work that our electrophysiologists are doing. And so, the inflection point for a health system today thinking about cardiology, is really going to be directed towards, “Can I build this service line institute-like framework and be so compelling that cardiologists are going to want to maintain that type of environment for their day-to-day practice?” Because what Clinton said is right, there's a lot of external noise to say, “Hey, maybe with the advent of all these new procedures that are available to you, maybe the time to think about private practice is really ripe.” And so that inflection point for health systems may be to really, truly evaluate, “Do I really need to employ those doctors in the way that I once thought that I did? Or is there really a community-based strategy that would allow those doctors to be independent, to partner with me on an ambulatory framework, and actually be maybe a first mover on trying to capture some of that ambulatory market share, if we really honestly believe that that's going to occur with us or without us in terms of that care migrating to an ambulatory setting?” So, you know, I summarize it, you know, if we could repeat this same conversation in five years, I think it'd be fascinating to see the way in which it plays out. I think, Jen, your 67% statistic, I think we're likely to see some of that actually occur in a downward fashion. I think we're going to see more independent cardiologists, I think we're going to see the proliferation, as Clinton said, of these independent, cardiology-only ASCs. I think for health systems, all that complex work is still going to come to their hospitals. The question is really more of, “Is it better to partner on that and to migrate and drive that ambulatory framework? Or do I feel like I can build such differentiated service that really cardiologists want to retain and maintain their employment with us to be able to kind of drive what happens across the entire kind of care delivery spectrum?”

Jen Johnson 30:32
Yeah, I tend to agree with you. I think it's gonna drop. I hate to say that on air because it'll live forever and I could be wrong, but I just feel there are so many choices out there that there might be even stronger partnerships. But if I had to bet, I would think employment might go down a little bit, but who knows? So, it is comforting to know there are a lot of ways to succeed out there. That's what I like hearing, there’s a lot of choices. So I'd like to just first thank Cordell and Clint for their insight. You both have done a fantastic job outlining innovative and practical strategies to work with this medical group sector which is just, you know, on fire right now. And I always like to recap our episodes. So, first, let's go ahead and just start with one, we know that medical group transaction activity is hot. We've got competing buyers, including health systems, PE firms, and other giant buyers. Second, we've got primary care and value-based care as big themes in the medical group sector, but specialists continue to have their place in strategy and can really move the needle on financial performance for health systems. And then third, be mindful of new strategies for both acquiring and aligning with medical groups. There are great opportunities out there. Although complex, VMG Health can help you navigate them. So, please feel free to reach out and think about what we can do to help. So, to finish this up, I want listeners to know that VMG Health is always looking to find solutions for our clients in this environment. I know we all hear a lot about the financial pressures, and it's a bit of a grim outlook sometimes, but I really don't think it needs to be. The key is to understand the industry dynamics and reimbursement environment so you can make thoughtful decisions toward a successful strategy. So, Clint and Cordell, again, we appreciate you both for the excellent insight and want to make sure listeners know they can reach out to either of you anytime, and that we have a ton of content around this topic on the VMG Health website. Lastly, I hope everyone tunes in next month for your dose of the Healthcare Download, where we will be discussing strategies and the behavioral health sector. We'll speak with two of VMG Health’s experts who work with clients on innovative transactions and strategy in this ever-growing sector. Everybody take care.

Outro 36:14
Thank you for listening to the Healthcare Download with VMG Health. Make sure you subscribe to the show wherever you listen to podcasts to receive new episodes when they release the first Wednesday of each month. You can also go to vmghealth.com or visit the episode notes to follow VMG Health’s monthly newsletter and to learn more about this conversation.