November 21, 2017
- Management & Marketing
Episode 1: Highlights from GSC's 2017 health study, "Come Health or High Water"
And now for something completely indifferent
Episode 1 Transcript
[0:00:15.0] SM: Welcome to the first ever and likely only Canadian health benefits industry podcast, aptly titled And Now for Something Completely Indifferent. I am Sarah Murphy and in this podcast we’ll be discussing the hottest topics and trends in the Canadian health benefits industry. You can think of it as the podcast that is filling a void that no one thinks exists, and it is brought to you by Green Shield Canada, or as we say GSC, for short.
Before we get started with Today’s topic, we would like to remind our faithful listeners that the views expressed in this podcast are those of the individual speaking and not necessarily the views of GSC, the company. We will likely talk about sensitive and possibly controversial subjects and we therefore reserve the right to potentially offend and are apologizing for it upfront.
You can download this podcast from our website at greenshield.ca or subscribe to it from wherever you get your podcasts. We also encourage you to read out publications, The Inside Story and Follow the Script, which you can also download from our website. Please be sure to follow the conversation on Twitter and LinkedIn.
That’s it for our introduction. Let’s get started with today’s topic, and leading us off will be David Willows.
[0:01:23.8] DW: Thanks, Sarah. I should say with us here in the studio are our colleagues. One; Peter Gove, who has responsibility for innovation around health management and impacting plan member health here at GSC; and Erin Crump, who has joined our product development and innovation team recently to lead our strategic innovation initiatives. Above all, Erin wants you to know she’s an actuary. This maybe the first instance ever where an actuary — Not that an actuary has been interviewed, but actually that we’ve asked to listen to them live and not edit them.
This is the first podcast. Sarah, you’ve been instrumental in organizing the organization so that we, actually an insurance company, can do a podcast, which is a little bit out of the norm. I want to set the scene for our listeners. I’m assuming we have listeners.
[0:02:19.7] SM: We have a few…
[0:02:21.8] EC: At least the four of us.
[0:02:22.8] DW: You’ve actually built a studio here, but tell the listeners where you’ve put this studio.
[0:02:29.8] SM: We were a little short on space in our office, so there was a room called The Wellness Room that is not that regularly used, and it’s also doubles as a first aid room and I thought, “That is a great spot to have a podcast recording studio.” And so asked a few people, put up a little bit of equipment, and here we are today in the wellness room.
[0:02:57.6] DW: Do you personally have concern that someone that may fall ill during the recording of this and a wellness room is now locked to them?
[0:03:05.6] SM: Personally, no, but I do care about people.
[0:03:10.9] DW: What is your advice to a GSC or who has fallen now on our Toronto office and is no longer of access to — I think we used to call them sick rooms, didn’t we in the old days? Those of us that are old enough where there used to be a sick room, now they’ve been rebranded wellness rooms. Everything has to be wellness. This is tough for other podcasts, absolutely.
[0:03:28.4] SM: That’s right. Next podcast. I feel like those people, there are four offices vacant right now as we sit in here recording. Perhaps they could go sit in there. Preferably not mine, or walk it off.
[0:03:41.8] EC: Most importantly, if the four of us fall ill, we can lay down.
[0:03:45.1] DW: Yeah, there’s a bed right next to us here, which is a little bit unusual. Behind Erin, there is an emergency defibrillator, which I’ve never been in a room with such a device. I’m curious that it’s called an emergency defibrillator.
[0:04:01.0] EC: Just to clarify.
[0:04:02.0] DW: Yeah. I’m interested when it would be used in a non-emergency. What are the circumstances where perhaps it has been used in non-emergency? It says in small print there, “Warning: For use by trained persons only.” I just want to let all of you know, I don’t think any of you had training.
[0:04:18.9] PG: I have had training.
[0:04:20.0] DW: Really?
[0:04:20.4] PG: Yes, I’m a certified first aider.
[0:04:22.1] EC: Actually, I have too.
[0:04:23.6] SM: Wow! We’re in good shape then.
[0:04:25.3] PG: If any of you fall to the floor in convulsions, you’re fine.
[0:04:28.5] DW: We’re safe during this podcast.
[0:04:30.5] PG: Yes.
[0:04:31.1] DW: I want to say generally to the GSC population, even if you’re not trained and you feel I need an intervention, give it a shot. I am providing consent right here right now in that sort of situation for you to try to figure out how to use a defibrillator.
Also, there’s a big orange bag with a stretcher in it. Ideally, over the course of the next few months, that will not come into use at any point during our podcast.
[0:04:57.7] SM: Proof that that we’re in here.
[0:04:58.7] PG: Basically, it’s in a few languages: stretcher, and camilla. Is that Spanish for stretcher? Excuse me. Sorry. Is camilla Spanish for stretcher? I guess it must be.
[0:05:07.9] DW: Or it may just be —
[0:05:07.6] EC: I’m guessing it’s probably camilla.
[0:05:09.2] DW: Maybe somebody is named the stretcher. It’s a lovely name.
[0:05:12.8] PG: It’s possible.
[0:05:14.7] DW: We’re going to talk today to Peter a bit about mental health, to Erin about decisions around benefit plan structure and design. These are two ideas that came out of our heath study that we’ve just finished taking across the county. You’re in about 13 or 14 cities between the spring and the fall. Sarah and her crack team organized some very large events across the country.
Sarah, what sort of stands out to you about our health study tour this year?
[0:05:47.2] SM: What stands out the most would be the booze that we were able to enjoy with our valued clients and advisers across the country.
[0:05:55.4] DW: Unusual for an insurance industry events, a large long presentation with an open park.
[0:06:01.9] SM: That’s right, but it was appreciated. People liked it. We also did a few morning events. I would say my reflections on that would be the audience was a bit more lively in the open bar event, versus the coffee event.
[0:06:12.3] DW: Yes. As the person that was at the front delivering that presentation, I can confirm that the audience was largely intoxicated. The morning sessions, I would say 50% intoxicated.
[0:06:24.6] SM: Definitely. All kidding aside, I would say my reflections on the event would be that we were able to bring some very powerful messages across the country and there were a lot of aha moments. A lot of people were really resonating with what we were saying, getting the conversation started. A lot of dialogue after the fact and we’re continuing to hear that dialogue, so I would say they are very successful events and we look forward to doing more in the future.
[0:06:53.6] DW: Like I said, we’re going to feature two particular topics from the health study. We are going to start by talking to Peter Gove about what he has termed the medicalization of unhappiness.
Okay, Peter. We’re going to talk about the medicalization of unhappiness. That was one section of this year’s health study, but you actually have a broader presentation that you created on this particular topic. I should tell our listeners that you are a psychiatric social worker by trade.
[0:07:30.8] PG: That’s right.
[0:07:32.2] DW: You’ve worked in AAP in the past.
[0:07:35.3] PG: Yeah, adult and child psychiatry for many years.
[0:07:38.9] DW: Yeah, but as far as with the AAP, because certainly when I looked around our team, when people need some level of support, I’m not sure they go to you.
[0:07:46.3] PG: That’s true. Yes, this is probably true. I’ve always called myself, “I’m a fake social worker.”
[0:07:53.6] DW: Okay. We’ll talk maybe more deeply about that in your performance review. Really, in our industry you are one of the foremost thinkers around disability management issues. You’ve run large disability organizations certainly. I’m sure that contributes to some of the perspectives you have on mental health.
The medicalization of unhappiness, it’s quite a provocative title. What’s your premise?
[0:08:21.7] PG: I think the title actually we kind of lifted from an editorial that was written in 2013 and published in the British Medical Journal, which is probably one of the preeminent medical journals in the world. The premise is that what we now concern to be mental illness, depression specifically, the definition of those expanded so much that we’re probably trying to capture all kinds of people who are in distress, but perhaps are not really ill in the traditional sense of that word and we’re labeling them as ill and a result prescribing them medications that don’t’ work and don’t need.
This came from a whole bunch of different directions we can talk about, but that was generally the concept. In our business, of course, we’re in the drug management business and this becomes a significant issue for us, because our biggest expense line actually these days is antidepressants. That was a big issue for us, and for our clients really, I think.
[0:09:25.0] DW: With your background both in healthcare and disability management, and now at a company that specializes in drug claims management, what have you seen in your work that led you to want to talk about this?
[0:09:41.1] PG: Well, in the disability side of things — It’s an interesting question. When you work in clinical settings, people come and get help because they think they need help. Disability, insurance-based disability settings are different and that people are paid to be sick, in fact. That leads to another kind of scenario where people, I think, are much more willing to present themselves as ill or perhaps aren’t as ill as they present, and that’s due to all kinds of factors. It can be due to the fact they want to be paid by the insurance company. It can be due to the fact they hate their jobs, etc., etc.
[0:10:18.2] DW: I’m sure that there are some legitimate mental illness.
[0:10:19.9] PG: Oh, for sure. Yeah, for sure. In disability, of course, we’re continually trying to understand whether somebody is truly ill or the kinds of psychosocial factors that are driving that situation.
In our situation, our concern is really for our plan members how they’re being treated or they’re getting the right kind of help that they need. Are they getting stuff that works or not? I think some of the research that we’ve done, sort of the research in the medical literature would suggest that that is not necessarily the case.
[0:10:55.0] DW: Who should be getting antidepressants.
[0:10:58.6] PG: This is really interesting. The editorial that I mentioned was written by Allan Francis. We’ll talk about Allan Francis a little bit later. He suggests that a whole lot of people who are not ill, in the traditional sense of the word, who perhaps are distressed are receiving antidepressant medication.
There are strong evidence in the medical literature that antidepressant medications actually work quite well for people who are very ill, moderate to severe depressions. The evidence suggests that these drugs really don’t work at all or at least no better than placebo for folks with mild-moderate depression. I think Francis’s concern is with the ever expanding definition of who constitutes being ill leaving lots of people medications who won’t benefit from them.
That becomes a significant issue, for sure. Especially considering — These are significant medications. They’re psychotropic medications, there are significant side effect profiles. They’re not necessarily good for you, for sure.
[0:12:00.2] DW: This population that is potentially receiving them that we put questions marks around whether they should be receiving them. What do they need?
[0:12:11.0] PG: That’s a good question. When you look at sort of the epidemiologic literature on the development of mild to moderate mental illness, we do see that there’s an upward tracking in young people, adolescence and young adults who are anxious. Rates of anxiety are going up and up and up. We need to understand what that’s all about and what we should be doing about that.
Probably, that has to do with many factors; parenting, social media, etc., etc. The approach for most of these people is not a medication approach. It’s probably some kind of a psychosocial interventions, changes in their environment, changes in their behavior and probably psychotherapists are much more useful intervention for these folks than medications.
[0:13:04.8] DW: Is that a psychologist needing to that, a psychiatrist, a social worker?
[0:13:07.7] PG: Well, all of these people do psychotherapy, some of them better than other certainly. Any of those kinds of folks maybe of more help than a medication prescription. I think the problem is in Canada, it’s very hard to get access to these psychotherapy, physicians — I believe when a physician is faced with a distressed person in their office, they have very few options, right? The easiest option for them to try and do something for this person is to write a prescription, and I think that’s probably a big part of what’s going on here.
[0:13:44.0] DW: Okay. We’ve seen in our industry, certainly, articles around some companies making sort of a bolder statement on this and then increasing allowances for psychology quite dramatically. Is that unabashed good thing or does it have other consequences?
[0:14:02.1] PG: Yeah, it’s really an interesting questions. We have seen companies that have increased the availability of dollars for psychotherapy to their plan members in the range of $5,000 to $10,000 in some cases. I think that’s a very interesting problem and it’s kind of a big dirty secret in psychology that the number of psychologists, social workers, etc., who actually do high quality evidence-based psychotherapy is much lower than you think. The difficulty with that approach is that if you provide people with all the money that you want to provide them, but who knows what they get for that money. This is significant issue, I think.
It makes me wonder if we need to do more about making sure that people can access good stuff rather than not so good stuff when it comes to psychotherapy, because psychotherapy does work. It works actually as good — It’s as good as medications. In fact, in many cases, better than medication especially for long-term outcomes.
[0:14:56.2] DW: For a late person, how would you explain what the good stuff is versus a not so good stuff?
[0:15:01.5] PG: Yeah, that’s a really tough question. When you look at the real strong evidence in psychotherapy, it tends to — The type of psychotherapy with the most evidence is called cognitive behavior therapy. There’s another kind of therapy called interpersonal psychotherapy with good evidence as well.
The difficulty is, especially with cognitive behavior therapy, known as CBT, pretty much everybody claims they do it. If you’re searching for a good CBT intervention, you can call up a psychologist and say, “Do you do this?” They’ll typically say, “Yes.” In fact, they don’t necessarily do it.
You really have to look pretty hard. You have to look for people who are members of associations, etc., etc., who are well-trained in delivering these kinds of psychotherapy, which are very standardized or manualized over structured kinds of approaches, and that gives you a best chance of success, really.
[0:15:54.8] DW: Okay. Famously, or perhaps infamously, the first time you made this presentation on medicalization of unhappiness, was at a large benefits Canada event at the Royal York and you were yelled at.
[0:16:08.8] PG: That’s right.
[0:16:09.6] DW: By an audience member, which you handled quite gracefully, I must say, but anybody who is there will not forget it. They objected to a lot of the content of that presentation and some of the things you’re sharing with us today. What is it about mental health that creates sort of these third-rails where we’re uncomfortable positioning some of these things?
[0:16:30.4] PG: You know, it’s an interesting question. On a particular situation, what I’ve learned after the fact was — So my presentation, I spoke extensively about how we really need to shift our approach to prescribing, and I did not — We certainly agree that these medications do work very well for who are seriously ill.
In that particular scenario, the person who stood up and berated me from five minutes straight, we learned after the fact it was somebody who had quite a severe depression that had recovered via the use of medications. We don’t have a problem with that. That makes perfect sense to us, and that’s not what we were saying. He objected to a number of things, one of which was a picture in our presentation. We had a Prozac pill dressed up as Superman or something like that. He thought we were making fun of him and drugs and stuff.
I think that one of the issues is — This is a tough one, because all the kind of, for lack of better words, marketing around mental health has been very good. De-stigmatization, people are willing to search for help in that kind of team, but you got to wonder at what point we’ve crossed the line into creating, if you will, an epidemic of people believing that they’re sick and need drugs. I don’t know what the answer to that is, but it’s a bigger issue, really.
[0:17:48.9] DW: With all of these, we believe there’s overprescribing happening. We are concerned about the quality across the board of psychotherapy that exist in the country and the availability. Where is balance here? What are the answers?
[0:18:04.1] PG: Yeah, what do we do? I think that — There’re a couple of things. One is we’re not the only people seeing this, choosing wisely candidates says what we’re saying, which is don’t prescribe medications, people with mild symptoms. CAN-med same thing. In both cases these organizations are saying the approach needs to be different for folks. It needs to be focused on lifestyle, diet, exercise, psychotherapy and psychosocial interventions.
I think that we need to do is somehow — Our job is to take care of our plan members, really. It comes right down to it, our plan members and our plan sponsors. We need to find ways to help make that happen in some way. How exactly do we do that? We’ve found a number of different things we could do in that venue, but I think that’s the direction that we need to be going.
In Canada, of course, family physicians are not good at managing these kinds of things. They see patients for 10 minutes, one problem only. Psychotherapy is not covered in the public health care system, so we’ve got some real challenges here in terms of making a shift. Yeah, we’ve got a lot of work to do in this arena for sure.
[0:19:18.7] DW: Okay. I’m going to stop there. Thank you for sharing all of that with us, and I’m sure we’re going to talk to you in the future.
Okay. Now, I’m going to talk to Erin Crump. Erin, just to level set for listeners, you’ve had a varied career. Is that a polite team, a varied career?
[0:19:44.6] EC: Yes, that works.
[0:19:45.6] DW: Okay. You have been a benefits adviser. You’ve had senior roles at reinsurance companies and you’ve actually been on the employer’s side as well leading a benefits and compensation team.
[0:19:58.4] EC: Yeah.
[0:20:00.7] DW: Last but not the least, you are technically an actuary.
[0:20:04.2] EC: Yeah. Please mention that at least three more times.
[0:20:06.9] DW: Okay. An actuary. In our health study this year in sort of the financial section where we sort of try to give a broad overview of where we think benefits plans are at and what decisions makers around benefit plans should be thinking of. We’ve said a couple of times that we believe that sort of many stakeholders, be it advisors, plan sponsors, carriers, PBMs maybe are avoiding some of the hard decisions that will need to be made to maintain sustainability of health benefit plans, specifically drug plans over the decades to come. In your mind, what are those hard decisions that are or are not happening?
[0:20:52.0] EC: Yeah. I think I’d love to be able to state that it’s something really sexy and forward-thinking and something that none of us have thought of yet, but I think a lot of the hard decisions that I’d like to see more plan sponsors making are things that have been around for years. We still see so many plans that don’t have managerial generic substitution. We still see a lot of plans out in the market that are still paying for the first biologic rather than subsequent entry.
We see clients turning down our narcotics policy. Really, really basic stuff, and I think it’s the hard decisions that are being avoided, but I think it’s really the conversations that are being avoided. We see a lot of plan sponsors making decisions because they don’t want to create noise. They don’t want to have those conversa — Having been in that position, I get you. If you can have kind of a renewal to through, get through another year without having to have any difficult conversations with your employees, I get it, because as an HR person, you’re dealing with a hundred other things.
Having those conversations with your staff about these are the drugs we’re going to pay for. This is why we’re going to pay for them. We want to make sure we can continue this plan. Those are difficult conversations to have.
[0:22:04.8] DW: Is the conversation around generic drugs difficult in 2017? Are we to believe that?
[0:22:11.0] EC: Yeah. I think for most people who the drug plan is one part of their whole job, yeah, I think it is. Maybe there’s ways that — I think we put out a lot of good content in trying to help plan sponsors in that conversation, but ultimately when they have an employee calling you complaining the thing that they were on forever they can’t anymore or their doctor recommended something and now you’re saying, “I can’t have it.” That’s a really awkward conversation, because people trust their doctor, and who are we in HR to tell you, “Provide other guidance than what your doctor have said.”
[0:22:50.5] DW: What are the numbers that you’re seeing in your work that should arguably scare people into having conversations they don’t want to have? I know you were in front of our executive team earlier this week as we’re doing our budget preparations for 2017, and maybe if you give our listeners a flavor of what you told us.
[0:23:11.5] EC: We did a full sort of stop-loss pricing basis review. If we look at our book of business since 2010 or sort of the last full seven years, the proportion of total health claims over $10,000 has increased by 60%. $10,000 are the very common stop-loss threshold.
If you look at that same number with claims over 25,000, another very common stop-loss threshold, most of our clients are at 10 or 25,000. The claims over 25,000 have increased by 130% over that period, so 2010 to 2016. Those are the numbers. When you see the increase, instead we’ve — Having to pass to our clients, that’s where the numbers are coming from.
At the same time, trend on claims under 10,000, because of generic pricing reform and all of that great stuff, has stayed relatively flat. Because we expressed stop-loss charges as a big claims over not big claims. That numerator has gone up. Well, that denominator has stayed relatively flat.
To keep having those cost escalations without having a serious thought or conversation around what’s the risk I’m looking to see here and does that star plus threshold still make sense for me and my plan and my situation, those are the conversations that we think we should be having more of and less so about, “Oh, it’s getting so much more expensive.” That’s the new reality.
I think the other scary thing is in part of our review, we purchased external data, because we know what our largest claims have been, but we didn’t know what was kind of happening in the industry. We heard anecdote about what the big claims were like, how much they were, but what was it actually? The largest claim in the industry was three times our largest claim.
We’ve had that experience in our book and those numbers I just gave you, but the potential for what it could have been or what it can be in the next few years is even greater. That’s scary.
[0:25:29.2] DW: Yeah. When we’re doing these health studies and we had a large contingent of advisers, consultants, brokers there, sort of in the aftermath of the presentation having said of chats on the side as we had a lovely beverage, I often hear from that community that there’s a mistrust of the carriers numbers that they don’t quite believe that these stop-loss increases are legitimate. Surprisingly, to me, they don’t feel that there’s been data presented to support it, and I sort of sit here and say, as an non-actuarial, non-underwriting person, “My God! We’re swimming our data.”
We talk about drug data all the time. Where is the disconnect between our world as a carrier PBM and that world? Isn’t there mounds of data to reflect what you just explained to us?
[0:26:28.8] EC: Yeah, there definitely is. We publish [inaudible 0:26:28.8]. We have a couple of years ago where we focused a little bit more on drugs. I know ESI does an annual drug study. I’ve seen advisers presenting Telus data on the same topic. It is out there. Data, like any data, could be overwhelming and hard to find exactly what you need, but it’s out there. CDIPC has — That’s the Canadian Drug Insurance Pool Incorporation.
[0:26:59.9] DW: The industry drug pool.
[0:27:01.4] EC: The industry drug pool has historically not made this information more widely available, but that’s the discussion we’re having now, because should we be making it more available? In the past, we only had just the pool of data, but now they’re starting to collect just more general data on large claims so that would be more available.
I think the reason I get where the advisers are coming from is because if you look at the way carriers are approaching stop-loss pricing and treating things like recurrent claims or whether or not they list certain large drugs, I think when an adviser goes out to get a quote, they’re probably getting a pretty wide range of quotes, and that’s probably where the mistrust is coming from, and I totally get that, because carriers are treating things in different ways.
In the old days where stop-loss was very straightforward, like it’s just claims over this level, those days are gone. Now, carriers are changing their treatment of things. They may be experience reading a little bit. They may not be. They might be removing recurrent claims from their pricing. They may not be. When an advisor gets a quote and they see this wide range of numbers, yeah. They’re thinking, “What the heck are these guys doing?”
We need to do a better job of being much more transparent about what’s in, what’s out, what the price is, what it covers, recurrent claims, all that good stuff, and we’ve talked about that a little bit as an industry.
[0:28:25.0] DW: Other noise I hear, and it would cause a criticism. Certainly, in the small to mid-market brokerage world, is that the industry drug pool, CDIPC, has disappointed. It has not worked. We should probably declare that you and I have both been sitting on the board of that, so we’ve been engaged in it. So we’ll declare that potential bias. What is your take on that disappointment and what were the expectations and what is happening?
[0:29:00.3] EC: Yeah, I don’t think it hasn’t worked. I think maybe the expectations of what people thought it would do were incorrect, and I think part of that is because — and CDIPC had conversation submitted it. We’ve relied on the carriers to do the education and maybe we didn’t do a good enough job educating what the purpose was, because CDIPC, that pool, was never going to get rid of large claims. Those claims are there. It was just a mechanism to share those claims and to make sure that no individual group would be burdened by having a large claimant. I think from that perspective, it’s done what it said it was going to do.
I think, admittedly, when CDIPC was created, the claims that have come through and the size of the pool has been much larger than any of us thought it would be. That was one thing. There’s been more claims than we’ve thought. We also see that the claims that existed that were inexistence, those were current claims when the pool was established. Those are creating the issues.
Yeah, I don’t think it didn’t do what we said it would do. I just think the issue was much larger than that. The issue is the pipeline. The issue is the cost of these drugs that are coming to market. They’re still coming. They’re recurrent in nature, and so we need to do more as an industry to pay for the right drug and have conversations around what the right price should be for those drugs rather than just sharing it.
[0:30:38.0] DW: Okay. To finish; if you were an adviser today sitting in front of a client, what would you be telling them?
[0:30:50.9] EC: In front of a client. I think the first conversation I’d be having with a client is what’s the purpose of your health plan? What is it that you’re wanting to do with it? Is it just compensation so that your benefits package can be competitive with — Or your full compensation package can be competitive with your — Or do you really truly care about protecting your employees and impacting health outcomes?
It would be the answer to those questions that would help me to guide them in what their plan design should be, because I think we’ve talked a lot about the drug caps that we’re seeing in the market and that a lot of advisers are talking to their clients though and they view it as a way to de-risk their plan. Of course, you can never de-risk anything. You can change risk, but you can never get rid of risk.
By putting things like drug camps into plan design, you’re ultimately kind of just kicking that ball down the road and eventually someone’s going to have a high cost drug, and how are you going to deal with that situation when it arises? If you’re comfortable saying to that employee, “No. No. This was just — It’s in the compensation we were giving you. We didn’t —” That’s their call.
If you really want to play a role in protecting your clients and making sure that they have the right drug at the right time, then let’s look at the plan and decide what we should be paying for and what we shouldn’t be paying for.
[0:32:30.6] DW: Okay. Great. Thanks, Erin.
[END OF EPISODE]
[0:32:40.4] SM: Okay. I would like to thank Peter, Erin and David for their contributions to our first ever edition of And Now for Something Completely Indifferent: A Canadian Health Benefits Podcast.
As a reminder, we talk about these issues consistently in our publications, so in case you missed it we encourage to check out our website, greenshield.ca, where you can look for editions of the inside story as well as follow the script. Specifically for today’s topics, you can look for our September issue of the inside story.
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Thanks for listening, and we’ll talk to you again.