The Value-Based Healthcare Podcast: Vivek Garg

Reveleer welcomes you to Episode 7 of  The Value-Based Healthcare Podcast. Our guest on this episode is Dr. Vivek Garg. Dr. Garg is the Chief Medical Officer at CareMore Health. 

This series aims to assist health plans become more successful through shared experience and best practices used by their peers in the industry. We interview executives at all levels within Risk Adjustment and Quality Improvement groups to share various perspectives. 

The Value-Based Healthcare Podcast is about sharing inspiring and real-world solutions from the people who are questioning the way business has always been done. We aim to educate across the spectrum of healthcare so that managed care organizations, providers and members alike are more successful in navigating and operating in this complex and ever-changing landscape. Subscribe today to ensure you receive the latest episodes!

Podcast transcription: 

Jay Ackerman:
Hello, and good day! I'm Jay Ackerman, CEO of Reveleer. We're a software and services company committed to providing health plans with innovative technologies, to maximize their return from quality, risk adjustment, and compliance initiatives. It's a must in the value-based care world we operate in. 

I'm back again with another installment of our podcast series, The Value-Based Healthcare Podcast. This is truly one of my job highlights, is I have a regular opportunity to engage with thought-leaders and visionaries in the healthcare arena. Through our podcast, we aim to widen the visibility and voice of people working to change how healthcare is provided, and the impact it has on all those who participate in the care delivery chain.

I'm thrilled today to be joined by Dr. Vivek Garg. Dr. Garg is a Chief Medical Officer at CareMore Health System, and a practicing internist. CareMore Health System is a national care delivery org, an integrated health plan serving over 150,000 high risk members in 12 states across Medicare and Medicaid. In his role, Dr. Garg leads gross strategy, product development, implementation, and learning development nationally at CareMore. He previously led strategy, performance and clinical care for CareMore's expansion markets, including diversification to Medicare care delivery, and home-based primary care.

He is dedicated to the goal of humanizing healthcare, and achieving a triple aim through patient-centered care delivery redesign. He also serves as an advisor to early-stage healthcare startups. Previously, Dr. Garg was the Director of Medical Operations and Medicare Director at Oscar Insurance, a high growth consumer-focused and technology-enabled healthcare company focused on redesigning the health insurance and care delivery experience. He was also clinical assistant, Professor of Medicine at Weill Cornell Medical College. Prior to Oscar, Dr. Garg was Medical Director at One Medical Group.

Prior work experience spans the public, private and non-profit sectors, including positions with McKensie & Company and the Medicare Payment Advisory Commission, a leading congressional advisory body on payment, innovation and Medicare. He trained in internal medicine at Brigham & Women's Hospital, where he practiced primary care at Faulkner Hospital and was a Clinical Fellow at Harvard Medical School, where he received his M.D. and M.B.A. from Harvard Medical School and Harvard Business, respectfully, and graduated summa cum laude from Yale.

Well, Dr. Garg, I'm delighted to have you here with us today.

Dr. Vivek Garg, CMO CareMore Health:
Thank you, Jay. It's great to be here.

Jay:
Why don't we begin with a few questions regarding your career journey? First, how did you find your way into healthcare?

Dr. Garg:
Great question, Jay. So, when I think back, it really all started with my father. My father is a practicing pulmonologist and primary care physician in New Jersey, and I grew up going with my dad on rounds. That's really how we spent time together. I would go with him to visit patients in a nursing home or at home on weekends. I would sit in the doctors' lounge or the ER if he got called in. And I really thought how fundamental his role was to his identity, and how he thought he could contribute to the world in his life. There were patients and family, and those were the two things that he continues to rank around today.

So, later in my life as I started to go through the educational process, I'd have to say I found myself as a more introverted person, and as I started to explore healthcare, I found that working with patients and working with other clinicians really led me to a better version of myself. To respond to a higher professional call around trying to contribute something very meaningful to people who are going through a very hard journey. And so that's ultimately what led me down into a formal career in healthcare.

Jay:
It's fascinating, with a number of the podcasts that I've conducted, that it has to be at least 80% of the people that are in healthcare were led there by a parent who was already practicing in that space. Why don't we talk about how you found your way to CareMore? So, a fascinating health system was having a tremendous amount of success in Medicare and Medicaid. What caused you to head on over to CareMore?

Dr. Garg:
So, when I left my medical training, I was really looking for an opportunity to make the healthcare that I thought people should be getting now, a reality. So, I wanted to be at a place or places that weren't waiting for that. I had done some work in healthcare policy with the Medicare Payment Advisory Commission, and pursued a joint degree through medical school and business school. And ultimately, I just felt a lot of impatience. And so, when I was graduating from medical training, I went with the job that was the most different, and that was joining One Medical. And when I visited with the team and I saw how they approached patient care, it felt like things were different. It was different enough that actually I was counseled against joining them, because it was too different. They employed different types of clinicians. 

My father actually told me, "Why would you need 30 minutes with a patient? You should be able to do it in five if you're clinically astute." And so... but what I saw was that patients weren't getting the attention that they need or that I would want, or that I would want for my family members. So, I started down this path of essentially working in new models of care and clinical programs in healthcare; that progressed with Oscar, which really rebuilt health insurance from the ground up, and paid a lot of attention to the member or patient or consumer voice. And then as we built clinical functions, we intercepted them with member service, with data science, with intersections back with provider groups in our network.

And then after that I decided, hey, I want to take the skills I have and actually work with the patients with the most needs. And that's when I talked to Sachin Jain, our CEO, around the work CareMore was doing. And CareMore has been going through a very interesting transition of scaling and diversifying our clinical org, and taking our history as an integrated care model for seniors in designing for purpose. And there are many purposes with patients in healthcare, and we had started doing some work in Medicaid, and we needed to rethink it. We were interested in going into more virtual care and more home-based care, and we needed to go down that path. 

And so really, the opportunity that I saw initially at CareMore was to be at an organization that had built a culture for over 20 years that was grounded around patient care, and a holistic sense of patients, and that was set up to do new things from a place of putting the patient at the center and bringing more clinical rigor and services to their needs. 

Jay:
Thanks for sharing that journey. So, now that you have a new role, or expanded role inside of CareMore's Chief Medical Officer, can you share a little bit about what your top two or three objectives might be as you look out over the next 12 to 18 months?

Dr. Garg:
We are focused on doing better for our patients right now, as well as building the capabilities we need to be better for them in the future. And so, one thing we're starting off with this year is actually looking back and saying what is our clinical philosophy for healthcare? What has guided all the decisions we've made around patient care? And the reason we're doing it is we now have many generations of clinicians and team members of the company, and we need to reframe both who we're becoming with who we've been. 

And so, we're planning a series of on-site discussions, really to take a step back and say if we're going to deliver more care in the home or through virtual means, or work in commercial populations, or the east coast and not just the west coast, what are those core principles that really guide us? So, one exercise we're going through is around clinical philosophy of care, and really codifying that and using a wealth of expertise our team members have and all the different windows of perspective they have. 

The second thing is to really care for more of our patients. In any healthcare organization, there is an ongoing challenge to meet more of your patients, to develop relationships with them, and ultimately understand their clinical needs and work with them. And so, we're making a major push around patient engagement. It's a very broad term that's often loosely defined, but at the core of CareMore's relationship with our patients individually, where we deeply understand them and they deeply understand us, and we can be first doctor and supporter for their needs across the whole ecosystem of care.

So we want to do better. So, we're focused on clinical initiatives and operational initiatives. We're focused on changing our model of care where needed, to be in front of more of our patients on their terms, and therefore engage more of them so that we can support them better. And just a few other things are around really deploying these new modalities of care. And so, we have been doing a lot of experimentation around virtual care. We actually have a virtual care center, we call it, in our headquarters in Cerritos, with some initial clinical staff. 

But we want to deeply embed virtual care as a modality that's available for our patients, and also for our clinicians. And so, we're focused on identifying two or three areas to aggressively expand, and really sink into the day to day care that we provide our patients so that we can provide more behavioral healthcare, for example. We can provide 24/7 clinical coverage if people have a symptom or issue. They can call us first and we can really help guide them, because ultimately we have many different ways we can support them, and people don't know unless they call us first.

One other area is around care in the home, and so that's part of a national shift. There are a lot of organizations looking at bringing more care to people where they reside, and we've been doing this work for a long time. In the last few years we've made a lot of changes to actually embed a mobile care team as a core component of all of our markets and services, and we're continuing to expand and deepen that, including bringing hospital level care to the home. And so, we have a pilot program here in LA and Orange County where one of our medical directors is actually working with two nurse practitioners and caring for hospital level issues in their home for a small but growing group of patients. 

Jay:
Dr. Garg, that's a pretty ambitious agenda. You're talking about modality of care and trying to do more through virtual care. Anything you can share in terms of what do you think has to happen to really cause that to expand rapidly, and its use both by patients or members and the care providers? 

Dr. Garg:
We think about outcomes we can support patients in achieving over time. And so, I think there's one framing of virtual care which is there are a lot of low complexity transactional issues, runny nose, allergy medication, things that telemedicine services handle now. And when you look at what they're doing, a lot of it is these quick, urgent care-like, low acuity issues. I think the next frontier is really using virtual care as part of the comprehensive longitudinal care of patients. And that means that virtual care is a part of a relationship with patients, and comes from a team that's oriented around their needs holistically. 

And so that's where we're focusing, which is because we're set up under a clinical framework where we work towards patient outcomes at scale and individually, we inherently think of virtual care as not a substitute, additive technique that's a part of the continuum of care we provide. And sometimes it could be the first thing, sometimes it could be the third. Sometimes we trigger it, sometimes the patients trigger it. 

From a technology perspective, I think the technology is already there. You can FaceTime with a patient. The dull joke I used to have with some colleagues is physicians and nurses have been doing virtual care in telemedicine forever. It's called talking to a patient on the phone. And so, to some degree, we need to just recognize that that's real, clinical work. That patients want it, that clinicians can do a lot of meaningful interaction and support of patients through very simple modalities. So really what we need is people to actually design these things into their health systems or program, and also for them to be supported financially for actors that work under fee for service. And so, we do have liberty that many healthcare institutions don't have because we work under capitation.

Jay:
That's actually a great way to frame it, as virtual care not being the thing, but integrated in the care continuum. Perhaps you can share what you see as the biggest industry trends that are beneficial to providers and perhaps to health plans.

Dr. Garg:
One of the major trends is really an inversion of the healthcare system relative to hospitals. And so right now, the front door for many people's healthcare is the hospital or extensions of the hospital. ER, affiliated urgent care sites. And what is happening now is high degree of openness, mergers, new program development around bringing services to patients. And so, I think the major trend we're seeing is the construction of an alternative healthcare system where the center point is around the patient and where they are, and clinicians come to them. And we use the hospital or other facilities when needed. And so, you can look at that, whether it's bringing care to the home like we talked about before, we also have clinical programs where we bring care to people who reside in assisted living facilities, nursing facilities or residential communities for seniors. And I think virtual care wraps into this. 

So, I think one of the major trends is around really inverting that and then getting to the point where… really to do it well, you have to be able to do multiple things while outside of a hospital. So, it's not a transactional framework. It's in bundling those clinical services so that you can care for a population. And I see payers are much more interested in it. Payers have now looked to providers to do more innovative things, and really the great limiting step I feel is process clinical organization and providers, it's our pace of change. Because you can go to payers and propose a framework where you're paid a capitation fee, you can design the clinical models, you can hire the clinicians, and then it becomes about how fast can we do it, how well can we do it, and how much of it can we do. 

Jay:
Thinking about the trends that you just shared, how do you see CareMore benefiting from that, but also CareMore being a leader in driving kind of the market?

Dr. Garg:
I think there's huge benefit in that. We're building the healthcare system that we want to see and be a part of five years from now, but we're acting like it's needed now because it is needed now. And we do have some flexibility that not every healthcare organization has to make it a reality now. So, our effort around virtual care, of bringing care to the home, working across populations, incorporating more integrated behavior health, it's all part of this inversion or flipping of the system to be patient focused, where patients are, but longitudinal and comprehensive. And then to reach into the traditional systems when needed. So in a good way, there is a lot of openness to discuss these opportunities and these programs and models so that we can build for health plan membership who have complex needs, and we're engaged in many of those conversations now.

The downside, although I wouldn't necessarily think of it as a real downside, is that it's becoming competitive and others are moving towards this place as well. And so, the pressure is there, the urgency is there, and every day, every week, we see announcements around different clinical models being introduced under managed Medicaid framework for Medicare Advantage. Also, plans are doing partnerships for our physicians. And ultimately, we want to be leading the charge here, and we are. So, we have to keep up, and really, through all us, we're here because there's a national change to help happen. And so, in some ways, we also welcome the competition because CareMore is a place where we have come to build a healthcare that we all think is needed for America, not because we think we need to be the only player in it.

So I'd say there's a healthy sense of competition that has emerged. It's different than 5 or 10 years ago. There's much more movement going on. I don't think there's any clear winner or dominant actor, but there's more and more convergence. 

Jay:
No, I appreciate the comment on competition. I think we'd all admit that ... I mean, there are moments when we'd prefer not to see a competitor in our space, but competition makes us better, makes us smarter. What do you see as the greatest barriers or challenges that will affect your success in today's environment?

Dr. Garg:
Clarity of vision and managing the pace of change. So again, to think about where we should be five years from now but act like it's where we're going tomorrow or this year. We need to lead from a vision and philosophy of care, and so that's why we are spending time on that at CareMore this year. If we don't start from there, everybody is not aligned and everybody has their own interpretation, because ultimately, we have to continuously shift our structures to meet patient needs. And to incorporate these new modalities to react to data we get, to really uncover what are those additional spaces where there are patient needs we could serve better and we're not there yet. 

And so, this cycle of continuous change and using data to create feedback loops, it's a different level of agility than most clinical organizations are used to. And so, we're very fortunate that we have care team members, clinicians, leaders who are here for that, and so it's really about scaling the ability to create a vision to align people to it. And there’s the pace of change, because change is fatiguing. And so, we are constantly changing as an organization, and that is a challenge we have because we are restless about addressing the needs of our population. 

Jay:
Any insights that you can share regarding how you try to balance that pace of change? That must be a challenge to keep the organization moving at a rapid pace, but also allowing people to stay fresh and to stay sharp around adjusting the vision.

Dr. Garg:
I think creating intentional time for it is a part of the solution. So, we're creating off sites, we're asking different teams to come together to really spend time thinking and talking. That space is very much needed. It's needed because patient care is hard. It's hard because people empathize and they want the best things for their patients, and we often work with people with very challenging health circumstances. And so, there is caregiver burnout as clinicians and care team members from that. So, we need to give people time and space to revitalize. And then you need to shape it into something, and the something is where do we go from here? And so again, giving the time and space allows people to reset and re-center around those core principles that led them into this field.

There is skill development that supports that, so we're looking at building out more leadership support and training, really around change management and leading teams through periods of change. We have amazing leaders who are impatient for the future to come and want to drive us towards us it for our patients, and they need more support and skill development. So, we're building, through our CareMore Living and Development Team, which is called The CareMore Academy. We are more focused on supporting them and leading teams through change.

Jay:
It's impressive to see that level of internal investment for a company that's growing at the pace that you are. A lot of companies just wouldn't be able to find the time, the energy, or the leadership space to do that. So, I applaud you and your colleagues for all that you're doing. What technology do you think will have the biggest impact on the payer-provider relationship over the next three to five years?

Dr. Garg:
That is a great question. I think... okay, a couple thoughts come to mind. I think real-time data will be the most fundamental kind of organizing dynamic. Real-time data from patients, real-time data from clinicians, and really, real-time data to other actors who could be supportive of patient needs or clinician needs. When we look back at where we fail our patients, in some cases it's because of delays. It's delays of this data point or decision sitting here and not going there, and things not coming together well enough. 

So creating a real-time data enabled healthcare infrastructure is critical to the future vision we have, and I think we'll support payers and providers in working better together for patients. Because nobody wants to have a case management function that is trying to call people five months after they were pregnant and could have been in a high-risk pregnancy. Everybody wants that support to happen in real time because everybody wants the best outcome for that member or patient, or whatever their vantage point is. And so, this is one of the core frustrating elements for everybody who works in healthcare. Is the fragmentation and how it manifests, and delays in data to people who can actually do something with the data. 

Jay:
Let's shift the questions a little bit. What advice might you have for healthcare executives in navigating our industry during these rapidly changing times?

Dr. Garg:
I would go back to the framing and the level of urgency. And often when I'm in conversations with partner organizations or just industry events, everybody is talking about what's coming. They're looking around, they're identifying the trends, they're now even asking the question, "What should we do about it?" But the urgency is here-now. And so, I think if the industry could find a way, or other executives could find a way to call that out and to maybe use a framing like plan as if... what is the vision you have for five years? And then act like it needs to be true this year. That's personally one kind of framing I've taken away, which is there's no time to waste. There's no time to waste from a patient perspective, there's no time to waste from a competition perspective if you look at all of the different parties that are now engaged in healthcare, modern technology companies, utility companies, UPS. It's everybody because it's a huge part of our economy and it's a huge part of our human experience. And so, I think tomorrow is today, and whatever leadership teams can do to change their typical pace of action would be beneficial. 

Jay:
A bit of a side question, but your focus on urgency, is that something that's always guided you, or perhaps was that built-in being an executive in three early stage and rapidly growing companies, being One Medical, Oscar, and now CareMore?

Dr. Garg:
So, I do like working in a place where we can create what we think should happen soon. And so, you're right to point out those other experiences, Jay. What those other experiences taught me is that it's all possible. And so, you don't need to have a data science team in SoHo. You can contract one from Nashville. You can change how your member service team works with your care management team. You can think about a different type of partnership with the clinical groups in your network of your health plan. You can help them hire resources to work with their patients and also members of other health plans, and then think of a shared framework around it. 

And so, the urgency is a personal framework I have, which I think actually matches more and more people's real desire in healthcare. There is a growing wave of talent in healthcare that is impatient. They've worked in other settings that may be more traditional, and they don't see the change that is possible happening. And so, we actually find a lot of those people and bring them onboard. And I think so are other organizations that are creating more of the momentum that more and more people want to see. 

Jay:
Kind of continuing on, on the broader industry, what regulatory change would you like to see from CMS that would be most beneficially impactful to your members?

Dr. Garg:
There's two or three areas that come to mind. Overall, I think the more that the regulatory framework can be simplified, the better for patients because the incremental energy and resource will be used to do more of this other area of work that we talked about earlier. So, the more consistency and simplification that can happen are around the regulatory burden, assessment of quality, risk adjustment, all of the core underpinnings of fee for service and managed care, kind of government infrastructure, the better. 

Secondly, we really need to accelerate the development and adoption of alternative payment frameworks. And I'd say it's less about the payment framework and more about the modality of care, or clinical model, or program that's being supported. And so, under capitation, of course you can reconfigure a resource to develop the arms, and you have more of that framework to deploy yourself. But for other players, which is most of American healthcare, we need a specific reimbursement stream. So, there's been a lot of positive progress around payment frameworks for telemedicine, payment frameworks for integrative care, payment frameworks for home-based care. I would love to see that continue, and the more of it the better, to the earlier conversation around, ‘this is a place where competition is morally right.’ We need more people doing things like this, and so all of us are responsible for creating a system in which more alternative methods of care can be deployed because it's what patients need. 

The third would probably be around risk adjustment. And here I think there's a very robust framework under Medicare Advantage, and different state frameworks under Manage Medicaid. And then on the exchange, there's a version of the Medicare framework. But there's an opportunity for CMS to remove friction and variation in how all the different actors in healthcare size and allocate resource relative to the complexity of patients. And so, the more uniform we can have an opt-in option or framework that the government has done technical assessment and work around, the more players I think would adopt it of their own volition, and the more we might be able to see more uniformity of focus on these other aspects of healthcare delivery. 

Jay:
Yeah, well, I can tell you on that last point, that would certainly simplify our life and our ability to support health plans across risk adjustment. Kind of moving on, what recommendations would you have for the public or for members, regarding their empowerment and ownership of their own medical care?

Dr. Garg:
Two thoughts come to mind. One is to trust. Form a trusted relationship with a clinician. It could be through telemedicine, it could be through somebody down the street. Often what people don't realize is that continuity really matters, and it's for your benefit. And so, if you can form a trusted relationship with a clinician who resonates with you, share with them more than just your immediate clinical needs. Share with them some of your hopes and dreams for your life. Actually preserve time to see them on a periodic basis. The care you get will be fundamentally better and more aligned with who you are.

Clinicians are there for the patient. We're there because we want to advise, guide. We become very aware of our own foibles as mistakes people can make. There really is a strong orientation towards not judging people because we've seen it, we've been a part of it. So, the compassion aspect of the profession can be very strong, and that can be said by sharing some of these other aspects and creating continuity. So, really to summarize, I'd say continuity is in your interest as a human being relative to your own healthcare. Continuity with a trusted clinician.

The second thing is around verify, so, trust but verify. So, for any significant clinical decision, whether it's considering a surgery, whether it's making sure the right diagnosis is in place for a potential cancer diagnosis, just these very critical decision points that come up, it's worth getting input from somebody who is not directly involved. A second opinion, but not maybe a third or fourth opinion. There was just a paper published looking at the diagnostic yield that having a second opinion from a clinician for the primary treating clinician. And so, it was sort of if I consult more of my peers, does my diagnostic accuracy as a clinician increase? And the biggest leap up in diagnostic accuracy is from having just one other voice clinically. 

And so, to optimize your decision making as a member of seeking healthcare or a patient; for those really big issues, ask your clinician if they can consult with somebody. We all do it. We can call a colleague. We can call somebody we trained with. We can call somebody… refer people to, and just run the case by them. But maybe you don't need to hop around to five different places to get the same opinion. So, I'd say trust, and to build trust early before there are real issues, and verify for those big decisions that may come up. 

Jay:
Yeah. That's super advice, and really practical about asking for your clinician to consult with someone else. It makes it a lot easier, probably less imposing, and more practical. Something that certainly makes sense, right, for big, critical, life-impacting issues. Dr. Garg, you've been fantastic, and I appreciate all the insight you've shared. We're going to move to bring our podcast to a close, and I'd love to wrap it up with about five quick questions. So, we're going to move through them quick, top of mind. I'd love to hear your thoughts. So, what keeps you up at night?

Dr. Garg:
I'd be lying to you if I didn't say the urgency issue. I just feel it in my bones. It does keep me up at night because I have family with health issues. It's personal, and it becomes personal for everybody at some point.

Jay:
When those life issues are keeping you up at night and your restless, what book might you grab from your nightstand, and can you share why you're reading it?

Dr. Garg:
I have a book called India Calling, which actually our CEO, Sachin, gifted to me. It's by an author named Anand Giridharadas, a South Asian heritage writer. And he writes about experiencing India as somebody who grew up in the US as a teen and then early adult, and then professionally. And really kind of re-integrating his cultural sense and somebody who's part of a diaspora. And so that really resonates. It's very kind of therapeutic, it's eye-opening, it's aligned with who I am, it's aligned with my family experience. And there's just beautiful stories, experiences, that he tells around just thinking through what it means to be a part of this world and having these two different cultural touch points. 

Jay:
Thank you for sharing that. This one is a little deeper, but hopefully you'll indulge me. If you could re-do one decision in your life, what would it be?

Dr. Garg:
I've been very fortunate. I feel luckier than I ever thought I could be in my life. The one thing that came to mind is, I would propose to my wife sooner, and I'll tell you why. Because we were both in medical residency, and our schedules are mapped out for 6 to 12 months ahead of time. And she knew that, and I didn't think through it. So, to me, I did end up finding a way. We're married. We have two kids. We're very happy. I hope she's happy too. She wasn't happy with that part of things, that it took a little bit longer. And there was no reason for that. And for me, that was just a lesson around actually acknowledging that some things take planning and big decision making, and you can't let life's inertia get in the way of the things you want to be true. 

Jay:
I think that was probably a decision before the urgency aspect really took hold in your life. We're going to go a little bit lighter with this next one. What's your favorite app on your mobile device?

Dr. Garg:
I really like Spotify. Spotify just I think recently added podcasts. So, I can listen to music, I play music for my kids when they wake up at night. They now make requests through the monitor for different songs. They say, "Daddy, can you put the song on through Spotify?" So, I play it through the Amazon Echo Dot in their room through Spotify. And then podcasts, I travel a fair amount. I commute. Just in the same framing as reading that book by the bedside table, I'm trying to spend more time thinking outside of healthcare as well, which is something during my MBA experience I had a chance to do. And just think more as a human being, and a part of society, and think about these other aspects. And podcasts have all of these lively voices in place, like this one.

Jay:
Yeah, that's great. I spend a great deal of time on podcasts. I'm sure it's already in your channel, but based on the impressive growth that you're realizing at CareMore and the challenges you're taking on, you might... if it's not already on your channel list, you might check out Masters of Scale with Reid Hoffman. I think a lot of what he talks about would be relevant for you and your colleagues.

Dr. Garg:
Absolutely.

Jay:
So lastly, if you don't mind, last one, how do you invest in yourself with all that's taking place?

Dr. Garg:
I'm trying to do a better job on that. So, my wife and I gifted to each other, a Peloton bicycle. And for me, it was a series of failures in being physically active enough, where I finally said I just need something in the home. And I'm a social being, which relates to why I went into healthcare because I'm a better person when there is people around me. And so, the tele-kind of virtual aspect of the classes is really motivating. So, we're committed to using it, and it's been a great tool in kind of our own family health.

Jay:
Well, great. Dr. Garg, thanks again for you time and your openness. You've been a fantastic guest. I really appreciate it. 

Dr. Garg:
Thank you, Jay.

Jay:
You're welcome. Thank you very much. This brings our Value Based Healthcare Podcast to a close. Please follow Reveleer on LinkedIn. You may also follow me on Twitter @AckermanJay. Over and out.