Jennifer Colamonico: Welcome to HMA Vital Viewpoints on healthcare. Concise conversations with experts that identify practical solutions to make health care and human services work better. I'm your host, Jennifer Colamonico, and I'm thrilled to be your guide as we explore new ideas for solving challenges that confound our uniquely American systems. Charged with delivering health and health care in a world that has far too much information and far too little wisdom.
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Jennifer Colamonico: Subscribe now and together we will explore the hard earned wisdom that could change the way you think about your professional challenges. Today's guest is Erin Russell. Erin is a dedicated harm reduction expert and a Principal Consultant with H.M., where she leads a portfolio of projects that expand the reach and acceptability of harm reduction practices. She's been immersed in harm reduction for over a decade with experience in advocacy government nonprofit organizations.
Jennifer Colamonico: Before she joined HMA, she was the first chief of the center for Harm Reduction Services at the Maryland Department of Health. She led statewide naloxone distribution, syringe service programs, a harm reduction grant program, and capacity building initiatives. Erin's really been at the forefront of integrating harm reduction into larger behavioral health. Opioid response is prevention programing, which improves state government's capacity to meet the needs of people who use drugs.
Jennifer Colamonico: Erin, I'm really glad to have you with us today. It's been fun getting to know you as we've worked together. Let's start with a basic question. What is harm reduction mean? I know that you work in this space, and it's a common phrase, but some of our listeners may not be familiar with what this means. So talk us through a little bit about what it includes, and then I'd love to know how you got into this space by reduction.
Erin Russell: As you mentioned in my bio, has that a part of my life for 15 years. I've seen it manifest on three different levels. Harm reduction describes tools that reduce the immediate harms of using drugs. Then harm reduction is an approach. So by providing those types of services, we're acknowledging that people use drugs by removing judgment from that experience.
Erin Russell: And we're asking people what they need right now to be as healthy as possible, as safe as possible, and to determine for themselves the quality of life that they want and what they would like to pursue. And then finally, a reduction is a approach to policy thinking about policy. And I'll talk a lot about this when I talk to people about stigma of drug use.
Erin Russell: I believe a lot of the stigma stems from the fact that drugs are criminalized in the United States Army action as an approach to policy is trying to shift some of that focus away from criminalization and towards treatment, compassion and kind of trying to maintain a sense of share for people rather than a punishment or.
Jennifer Colamonico: So how did you get started in this space?
Erin Russell: Yeah. I got started volunteering at a syringe service program in Pittsburgh, Pennsylvania. I went to college at the University of Pittsburgh and was trying out a lot of different fields. I always had an interest and knew I wanted to get involved in public health but didn't know very much what public health was at the time. I took classes in a lot of different fields to get a feel for where I might sit in.
Erin Russell: As part of the Social Work 101 class, I was required to volunteer. I knew I wanted to do public health, so I asked around, looking for volunteer opportunities and public health to kind of meet that requirement, thinking it would be a short-term box for this class. I got connected to the local exchange program, and once I started volunteering, I just then never stopped.
Erin Russell: I got so fascinated by this intervention or by this, like, program challenged me and a lot of ways. I think that's one reason I stay in this field, is because harm reduction turns upside down everything you think you know about drugs. and it was surprising to me, the people I met, the people who came through those doors, I realized I was not much different than anybody there.
Erin Russell: And I just was amazed when I learned that that program only existed because of the emergency declaration and the city that allowed for the program to exist in response to the HIV crisis. So there is no still, to this day, no state law in Pennsylvania that allows for certain service programs to operate. That shocked me because I just saw how affects this intervention was, you know, everyone once a week.
Erin Russell: So the needle exchange program, sometimes twice a week to volunteer, I would sit down with people who came in and ask them what they needed that week. We had a checklist of supplies. I would talk through, their patterns of drug use if they injected drugs. How many times a day? What types of drugs they were using.
Erin Russell: And then I would have that conversation with them, check off the supplies, get that check list to another volunteer who would bag the supplies up for the person. I'd also ask the person if they wanted the locks on, and if they did, I would connect them to someone or I would provide the training myself and give them that kit.
Erin Russell: It's very simple and some people come in and they just want to tell you that they need 100 syringes and this type, and then they're on their way. Some people want to sit down and say they've been struggling with a wound on their arm, and they're not sure what to do about it. Certain service programs are now in a lot of places offering their services, and they are often like that first line of interaction someone has with like talking about their health and their needs.
Erin Russell: So anyway, it did. The length of conversation and the type of conversation depends on the person and what they want to talk about that day. And then I saw lots of people get connected to treatment, connected to tested for hepatitis and links at the tightest treatment. Again, all realizing that that's only existed because of a very, short term response, as you know, or not, a permanent, a lot.
Erin Russell: and so for me, from a human rights perspective, that just seemed wrong. And it has continued to motivate me. I mean, a needle costs $0.10 and it saves our healthcare system a lot of money, and it saves somebody a lot of pain by not getting HIV or other infectious diseases that you can get. so there's a huge return on investment in these programs and then just wanting there to be, more equitable care for people who use drugs.
Erin Russell: That's really motivated me. So we hear a lot in health care this idea of meet people where they are. This seems like the kind of the ultimate version of that, right? They come in for one thing, but you have the opportunity to engage them and perhaps identify all sorts of other needs that, you know, that they may have, health or otherwise.
Jennifer Colamonico: What is it you think people least understand? I think maybe you touched on it, but, you know, if you had to give people the 92nd version of, like, what they need to really get about this, you know, what would that be?
Erin Russell: I think what people least understand is the impact of drug policy on drug related harms, that connection, because we tend to fixate on the harms of drugs, that drugs themselves are the problem in our.
Erin Russell: What's that? When really drugs are molecules that have an impact on our body, in certain doses, they have different effects. People use fentanyl in a healthcare setting for anesthesiology, for the treatment of pain, particularly like cancer related pain. and those are really important and valuable pain management tool. But when it's in an illicit drug market, when it's bought on the street, it's not regulated.
Erin Russell: It is unpredictable. The dose that you're going to receive that relationship between making drugs illegal and the unpredictability of a dose that people can then purchase, I think, is one thing that is least understood. I often say it's bad drug policy and it's like kills people more than bad drugs. and every overdose is a policy failure because we have not.
Erin Russell: But into statute, but into practice and really codify services and programs that support and care for people who are using drugs. The legal drug market creates a lot of risk for people who are involved in it, and that risk is expensive. The other thing is like affecting the price and then the quality of drugs, that make their way into people's hands.
Erin Russell: And there's studies showing the enforcement of drug policies has an effect on the quality. And then the overdose risk associated with the drugs that you can purchase when there is a drug bust within a one mile radius. Overdose rates increase within the seven days following that drug. Plus it has an immediate impact on the quality of drugs, people's ability to predict the drugs that they're using and kind of anticipate the effects.
Erin Russell: People are really good at identifying how much strength they need to use based on their tolerance levels. All Ahrens plays a big role in overdose rates. So when the supply is unpredictable and they have to go to a different source and that source is unknown, it then puts them at extremely high risk of overdose. So I find myself explaining a lot, that connection between the macro level policies and then the drugs that people are buying the street and trying to show that a lot of the deaths we're seeing is because of an unpredictable, volatile drug market.
Erin Russell: And the introduction of new types of substances that people's tolerance is not ready for. I think the other thing I want people to know is that, yeah, harm reduction really is the only evidence-based way to stop overdose deaths that we could really end the crisis, the overdose crisis, if we invested in harm reduction, to expand it to its full capacity.
Erin Russell: Those evidence-based interventions are the expansion of on the lock zone that I mentioned reverses opioid overdoses. Getting it at arm's length of anyone who is going to witness an overdose is effective at decreasing overdose mortality, increasing access to medications for opioid use disorder. We've seen that dramatically decrease overdose rates in cities that have really invested in low threshold access, reducing all barriers, particularly to buprenorphine and then finally supervised consumption.
Erin Russell: That is where we have a center that people can go to with pre obtained drugs. When they use drugs, they're being witnessed. There's someone there who can immediately respond if there's an overdose. so those are the ways that we were able to expand access to those three interventions. It would have a tremendous effect on our overdose rates in a given area.
Jennifer Colamonico: Thinking about the stigma, as you've talked about it, I mean that that sort of threads through everything that you're talking about, right? I mean, you know, you talk about supervised use and, and, you know, obviously, I think it raises hackles even among people who might otherwise support or you might be able to, like, intellectually get the data side, but like, well, you know, it just makes me a little uncomfortable.
Jennifer Colamonico: And I'm sure that kind of gets to why our policy framework is more punitive. but I feel like we're tackling stigma in so many ways right now. Right. The, the broader mental health, issues. People are talking about things more people are putting more of a human face on it. you know, I feel like the opioid epidemic itself, and forgive me if I'm using that word incorrectly, but you know, just where we are with, this kind of crisis level, has been very humanizing, right?
Jennifer Colamonico: We've all probably experienced loss of people who have died, you know, related to overdose. And so, it's not sort of those people. It's our people. Right. And do you see that changing? Do you see that the in your work in harm reduction, is it kind of benefiting from, perhaps a little bit less stigma on these issues more broadly?
Erin Russell: I think we're reaching a tipping point. I mean, 40% of Americans have been directly affected by the overdose crisis, and the majority of those have felt that their life is forever altered as a result of loss or the trauma associated with this crisis. so you're right. It's affecting more people than ever. And we have more awareness. People know what of our reduction is in ways that they never did.
Erin Russell:And it's being talked about at the federal level in ways that it never has. SAMHSA just released a harm reduction toolkit. There's harm reduction being mentioned in the president's address earlier this year. So there is definitely an environment of unprecedented buy in and, resource allocation to harm reduction. Fortunately, I don't think we're at a point where we are fully embracing harm reduction.
Erin Russell:And I think that meet action interventions will always be limited in their impact in a context of criminalization of drugs. I can give a couple examples of how I've seen people be held back. I mean, I have a friend who served as an EMS supervisor, was looking at run reports and looking at notes and evaluating the call records and response records of this teen.
Erin Russell: And when EMS treats an overdose, it's too much. Naloxone is given. Someone can who is opioid dependent can experience acute withdrawal, and that is extremely uncomfortable. You feel nauseous. You feel like you have the flu, you feel really sick, and it can motivate people to try to do whatever they can do to feel better.
Jennifer Colamonico: Well, counterproductive.
Erin Russell: Yes, yes.
Erin Russell: Counterproductive. And it's not compassionate to put people into withdrawal. I personally think that could be one of the keys to ending the crisis is paying more attention to withdrawal, and that if someone isn't in withdrawal after an overdose, they're going to be more likely to accept post overdose care or be interested in learning more. And that can include getting in the locks and kit for themselves, talking to a peer recovery specialist, getting inducted on to it.
Erin Russell: buprenorphine regimen, things like that. But one thing I noticed when I looked at those reports was that they would code for withdrawal and then not go for it and sign some medication, and he asked them, like, why are you not treating the nausea? You're not treating the withdrawal. And they would say, no. And he's like, why not?
Erin Russell: And then they did it to themselves. And there's this thought that like, people deserve to feel bad, after they experience one of the consequences of drug use as if it's their fault. So it's the thinking that drug use is someone's fault. Thinking that experiencing overdose is someone's fault is like baked in to our yeah ness, and has been a years of a war on drugs, and it is perpetuated by our media, by articles that talk about people as zombies, the latest zombie drug, the latest flesh eating drug, or, even, you know, associating some scary events that happen in society to drug use and kind of, conflating the drug with what we're
Erin Russell: seeing as social problems. That has been our tendency for many years. and I think it's very, very difficult to undo while we're still in an environment of criminalization. You know, the other example I've heard recently about a patient at an opioid treatment program with cancer had showed up at the opioid treatment program seeking care and was experiencing some symptoms of a psychosis.
Erin Russell: And she had just purchased drugs from the illicit market and felt like she had no other option because her doctor would not prescribe her pain management because of her history of drug use, because of the cancer patient experiencing cancer related thing. And she was not getting adequate care because of the doctors judgments and or risk analysis for himself somehow.
Erin Russell: What might happen if prescribing these medications? So, the opioid treatment program then carried the burden of trying to manage this person's care and figuring out next steps. There is a difference in the way that people who use drugs get treated.
Jennifer Colamonico: Well. You've talked about kind of decisions that are made at the point of care that, negatively impact people in ways that are, you know, maybe intended, maybe unintended, but maybe kind of go up a level to the policy framework.
Jennifer Colamonico: What are the, you know, what are the areas that you are focused on in terms of changing policy? Perhaps your time in Maryland? what were you able to do at a policy level that kind of change the environment around these issues?
Erin Russell: The approach I took to policy was thinking that going back to kind of that three levels of harm reduction tools approach and, and policy.
Erin Russell: So one, because for me, option is underdeveloped in many parts of the US, we need first authorizing legislation for reduction programs. And then the investment in the establishment of just brick and mortar services. So, we need more, the fixed site syringe service programs, more, more drop in centers that are providing permeable and wraparound care case management, like its, other services, low threshold treatments, infectious disease testing and treatment, etc..
Jennifer Colamonico: are those kind of new sites or are those things that are sort of co-located either with like community clinics or opioid treatment centers, or is that sort of bringing the services to places that are already interfacing with the community, or do you are these kind of distinct standalone, separate bricks and mortar boats?
Erin Russell: Yeah. So initially I think we need authorizing legislation.
Erin Russell: I mean, Maryland, I worked on the naloxone access law that allowed anyone to get, prescription for naloxone, eventually a standing order that allowed anyone to get on the locks, without an individual prescription. Naloxone is now available over the counter. And so that prescriptions not necessary for some formulations, but not all. I worked on legislation that removed those barriers for anyone in the public to get access to this lifesaving drug.
Erin Russell: And then I also worked on legislation increasing access to syringe service programs. So previously in Maryland, only the Baltimore City Police Department operated a syringe service program. Now there's over 20 across the state. Because of the law passed in 2016 by the Maryland State Assembly that allowed any organization or health department to create a program. So again, this is legislation that allows for the establishment of new programs, new services, and creating access points for those lifesaving tools.
Erin Russell: And then kind of what you're talking about and, and what I think is a blend of the two, both new standalone sites, a syringe service program, we really should take the word syringe out of them, that it is a hubs of care for people who use drugs, and they offer much more than access to sterile injection equipment. especially as we see trends across the country, way from injecting and then a lot more people who are smoking or inhaling drugs.
Erin Russell: And there's other routes of administration for which we have tools to provide people those hubs of care. Again, I've mentioned over and over the infectious disease prevention component, but there's also case management getting people enrolled in insurance, identifying coverage opportunities for them. Education is a big thing, again, because we don't talk practically about drugs and we don't provide transparent, clear, useful information about drug safety.
Erin Russell: Often that is provided at a harm reduction program. And there's resources and educational materials for people to learn about drugs in order to reduce their risk of overdose and reduce the transmission of disease. So and then there's policies that help to integrate that into other places. So we do see existing service providers integrating these services. I worked with health care for the homeless in Baltimore City.
Erin Russell: They're doing a great job operating a co-located. They integrated syringe access into their behavioral health treatment service area. And there's a lot of other examples about, kind of the integration of these reduction services into existing places and how they've worked that into their, workflow and system of care. Yeah.
Jennifer Colamonico: I mean, that gets back to sort of the meet people where they are.
Jennifer Colamonico: I mean, it seems if you're trying to reduce stigma bringing these services to the people, along with other things that can help them, you know, be healthier or make better choices, it seems that that would as opposed to, you know, oh, you have to go to that separate place if you need that thing. Right. And it's not it seems to me in the work we've done around just opioid treatment centers and getting the medicines, there's a little bit of that right?
Jennifer Colamonico: We've bifurcated like you have to go over there to get that stuff. And over here we take care of your health, but, you know, it's really all about your health. So, but that's a policy choice as, as you've said. Right? How do we, wrap that in to our public health system, in our health care delivery system?
Erin Russell: Absolutely. And offering harm reduction tools sends a message to people. It tells people that you care about whether they live or die, tells people that you are here for them, regardless of their drug use status that day. And that's a very powerful message when people have been turned down, pushed away, incredibly marginalized because of their drug use. And we have seen over and over that service providers, you know, providers that embrace the harm reduction approach, they see more patients, they get more foot traffic, they are trusted more by the community, and it leads to better patient outcomes, and it leads to better business overall.
Jennifer Colamonico: Well, and I'm assuming also crime and, you know, public safety I mean there's seems like community benefit, right. If people are being better cared for I mean that there's all sorts of other upstream benefits for that.
Erin Russell: Yes. Yeah. There's harm reduction interventions from other countries that are not yet implemented in the United States, such as offering different opioid agonists as forms of treatment.
Erin Russell: And that includes, long acting hydromorphone, diacetyl, morphine. These programs are called prescription heroin in other countries, and they're offered like alongside methadone. So in a very regimented treatment setting. But it's diverting money out of cartels and diverting money out of that, system. And people also engage in less crime because they're not having to, you know, we see that behavior, that that negative behavior that often that it's a signal of addiction, and accompanies addiction.
Erin Russell: We see that reduce because people have a stable, predictable supply of drugs. So it reduces overdose rates, it reduces crime. And that's true too, even for the services that we implement in the U.S., such as syringe services and overdose prevention sites, of which we have to in New York City right now.
Jennifer Colamonico: Talk about funding a little bit. you know, there's sort of like a there's obviously the public health element to this.
Jennifer Colamonico: So, you know, is this coming out of public health programs to an extent, is this coming out of Medicaid programs? Obviously, the correlation perhaps, although not exclusively right, with poverty. I mean, we see increased opioid, addiction problems in the Medicare population, right? So it's older, it's more it's not really only about poor people. Right? It's that it goes back to the everyone problem.
Jennifer Colamonico: But how are these services being paid for right now, even though it's affecting probably a wider swath?
Erin Russell: Again, the harm reduction is under resourced. Traditionally, most of our reduction programs, syringe service programs are funded through philanthropic means. They're nonprofit, grassroots organizations that are fundraising and that are getting the majority of money from a foundation or other type of organization.
Erin Russell: There is a federal ban on using federal funds for the purchase of syringes. This is extremely limited and only recently in the, you know, very, very recently, has the federal government allowed federal funds to be used for the operations. may harm reduction, certain service programs. So anything but the syringe, so to speak, and the funding that's currently being used, that's federal funding is mostly the state overdose response grants.
Erin Russell: that are congressionally allocated for states to respond to the overdose crisis. So they fund a variety of things. So it's not long term sustainable funding like Medicaid. there's a few harm reduction programs that have the infrastructure to bill Medicaid, and they do for certain services. But that is a pretty high threshold for a lot of the grassroots, nonprofits, smaller organizations that are really embedded in the community and reaching people at high rates.
Erin Russell: There needs to be an investment to integrate harm reduction services. I mean, there could be reimbursement and coverage for more harm reduction services by providers already established and reimbursed by Medicaid. But then we need kind of an alternate, sustainable way to cover on the ground more grassroots services. The funding landscape for harm reduction is precarious. The hell is the Taylor?
Erin Russell: you know, I was very involved in HIV Aids activism. was a major donor through Aids, United for a lot. We used. So when her health declined, it was a scary time for harm reduction programs. and, you know, it's only a few of those types of philanthropic organizations that are really funding the bulk of syringes. There has been more state investment.
Erin Russell: I was part of that in Maryland of establishing state investment in services and and braiding funding to cover all types of harm reduction services. We use a couple different funding sources other than federal to pay for syringes for programs. It is possible, but you have to be really innovative. You got to be really ambitious. You got to get a lot of by and support.
Erin Russell: I think that there are probably more sustainable ways that the federal government and state governments could work in partnership to ensure that local programs and on the ground programs are really supported over the long term.
Jennifer Colamonico: Do the opioid settlement funds create any opportunity here. I mean, obviously, those are one time funds. So we know that's not sustainable. But does that provide an opportunity to at least get something off the ground, perhaps
Erin Russell: considering that those funds are only here because so many people have died and as a result of just this, we are experiencing continuing to experience an overdose crisis now, which we lose over a hundred thousand people a year in this country.
Erin Russell: I think that money needs to go directly to grassroots and local initiatives, and I really support the delivery of services that makes sense for community by reduction. As I've mentioned over and over, it works at a cost. So the fact that it's lifesaving, but it's not a one size fits all, you know, community really needs to be involved and designing and implementing and evaluating the harm reduction programs that make sense for their community.
Erin Russell: It's a very community driven. I often say that the best response to drug related harms in a community is one that's hyper local. The drug market can vary block by block. I mean, especially in a place like where I live in Baltimore City. You know what's affecting the life of someone who is using drugs can vary city by city.
Erin Russell: And so it really needs to be driven by people who know the community and trusted by the community.
Jennifer Colamonico: A bottom up approach, a grassroots kind of policy approach.
Erin Russell: Yeah. And I think that it's only right that that funding goes to support people who have been directly impacted by this and to try to create an environment where we are simultaneously stopping overdose right now.
Erin Russell: And like I said, our reduction is the key to doing that right? While we invest in the building of a more prepared and stronger and sustainable behavioral health system of care. And I think the behavioral health system was unprepared for the level of demand and then the burden that has been required of it during the overdose crisis. I mean, we talked about, with memory, that option being a way to engage people who, again, are often like not involved and care very marginalized.
Erin Russell: Many people who use drugs are also experiencing an unstable housing conditions. And when we give someone a harm reduction tool, we're saying we care about them. That can help them to stabilize and think about what's next. It can help them to consider talking to you about what their needs really are, and it can help them get engaged and care evaluations up.
Erin Russell: Certain service programs have shown that people who are regularly going to a syringe service program are five times more likely to seek and stay in treatment and seek long term recovery. They have this touchpoint. And then when they want to make a major change, you know, they're they do that and they're more ready for it and they're more ready to commit to it over the long term.
Jennifer Colamonico: That's powerful.
Erin Russell: Yeah. So I think, to really make the most out of opioid settlement funds or reduction from that perspective, it's not just like a Band-Aid on the issue. You know, it's really building capacity for community and building connection to, individual health system that can support people over the long term.
Jennifer Colamonico: Yeah. It's like a mindset change that, you know, the policy, the funding has to flow from that.
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JENN
But there's a bit of a it's a culture change, really hearts and minds. I think that we're talking about
Erin Russell: Absolutely. And we've seen from reductions kind of like niche activity. you know, approach and, and certainly harm reduction. Us are angry at the system. I am yeah. There's been a lot of heart from the way the drug war has been enforced.
Erin Russell: We say it's a war on people. It's not a war on drugs. It's a war on people who use drugs. People are the ones bearing the brunt of it, and mostly people of color. You know, we disproportionately enforce drug laws in communities of color, and it has led to mass incarceration of people of color, particularly men of color.
Erin Russell: And that has dramatically changed our society. So, there are rightfully angry harm reduction that's out there. And I think it's a combined, you know, some of the stigma where people see harm reduction as enabling see it as you know, we just wanted to be a free for all, for everyone to just use whatever drugs they want and it will increase fire.
Erin Russell: We do that. That often leads to harm reduction being seen as this one thing we do over here on the side, you know, I hope through that perspective that people see that harm reduction. And it's just the way of thinking about things that can really induce a transformation of our system of care, or can really inform a transformation that just makes services more equitable and more effective and makes people's lives better over time.
Jennifer Colamonico: So if you had a magic wand, you've talked about a lot of different solutions, but if you had a magic wand and you could wield it to change one thing, just one, that would have the biggest kind of ripple effect on this whole area. what would that be?
Erin Russell: My goal is to end the war on drugs.
Erin Russell: I could see the ending of the war on drugs in my career. That would be wonderful. The regulation of drugs so that people who use them have a predictable, understandable and safe supply of drugs, and that if drugs speak their lives unmanageable, they can seek treatment and not feel ashamed about that and not feel this. The level of stigma and shame that we see now.
Erin Russell: I'm a person who is in a 12 step program. I consider myself in recovery, and I understand how that shame all people back from seeking care. I had to go through that myself. But I do believe the criminalization is the root cause of a lot of the issues we see, with access to care and stigma. And so if I could wave a magic want, that's what I would change.
Jennifer Colamonico: That makes a lot of sense. Well, in your work is your way to give back, right? And continue to, to make, hopefully make the world a better place for people, the actual human beings that are experiencing this part of their lives. So, so thank you for being with us today and talking about your story, your experience, your commitment, your vision.
Jennifer Colamonico: I know there's a lot of, interest and curiosity, and, you know, increasing data behind these issues. So it's good to know that you're at the helm here, and helping people make some better policy choices. So thank you.
Erin Russell: Thank you. Really appreciate being here. And thank you for listening.
Jennifer Colamonico: Thank you for tuning in to another enlightening episode of HMA’s Vital Viewpoints on Healthcare.
Jennifer Colamonico: We hope today's discussion has sparked new insights and perspectives. To learn more about our esteemed guests, please be sure to visit Health management.com/podcast. Until next time, stay informed, stay curious, and keep searching for the wisdom that will help to transform our healthcare landscape. This podcast was produced by myself, Jennifer Colamonico along with Tiffany McKenzie in collaboration with our guests.
Jennifer Colamonico: The content is the property of Health Management Associates.