Season 1, Episode 3: Independent Home Care Alliance Industry Insights with Kunu Kaushal

www.indhca.org 

IHCA is on a mission to further professionalize the caregiving industry! 
There are many validators showcasing the ever increasing importance of non-medical care services. 
Who should own the relationship with the care recipient? 
Be the care navigator for families.
Home Care can "be the hub" for care resources in addition to their service offerings.

Transcript

Sarah Barker  0:01  
Good afternoon everyone. This is Sarah Barker with the independent homecare Alliance. And today we are doing HCA industry insights with canoe Cushaw, the founder and CEO of Senior Solutions and independent non franchised home care company, and also the founder of the independent homecare Alliance. As a reminder, HCA is a membership based organization only for independent non franchised home care companies. And we are looking to level the playing field through best practices, improving efficiencies, offering education and various other aspects to really empower and elevate independent caregiving agencies in their growth goals. So, we are looking forward again to hearing from canoe on what he is noticing in the home care industry.

Kunu Kaushal  0:52  
Great. Well, thanks, Sarah, so much for having me. And, everybody, thanks so much for any time that you ever give, for those of you that are giving us some of your precious time live today. Thank you so much. I mean, you know, right in there in the chat, we will try to answer some questions as they come up. For those of you that are new, this is maybe your first one attending, you know, the generally we're just giving you some perspective on what's happening in the industry. What are some areas to focus on right now. And then, generally, it's one of those ways that we can make sure the independent agencies are focused on some of the biggest news that's been out there, I am fresh off of a trip to DC in which we attended a conference. And it was really focused around strategy and, and investment inside of home health, home care, hospice, and all of that. So I want to, I want to start with probably the greatest, the biggest piece of news that everybody should pay attention to, which is it was announced less than 24 hours ago, that you've seen LHC be purchased, or have a purchase agreement in place for over $5 billion by optim, slash UnitedHealthcare. And, you know, it's great to see some movement there. I have my own thoughts on I'll give you just a quick perspective, which is wishing them very much the best. There right before this announcement, there seem to be some regulatory concerns of optim and united even getting together. So the fact that now they're putting this proposed acquisition of a one of the nation's largest home health companies that's also publicly traded, is kind of a big question mark. So I hope they work it out by q4 of this year is when things are supposed to actually close if they can get regulatory support. But regardless, here's the major point, I don't know that there's anything you directly need to do in your marketplace. You know, business as usual, as far as it's impacting any of us. Here's the major point, though. I think the biggest point is LHC does not have a very big personal care market. They themselves are very much focused on home health and hospice. But if you go back and this is, you know, put on my my nerd hat for a minute, if you look, listen to the kind of open investor call that was done, if you ever want to fall asleep a little ways, and then waiting for the sentence, that's powerful listen in on some of those the investor calls that they're required to do as public companies. But the one that came out from LHC, not so long ago, before this deal was even announced. They were talking about the growth in the personal care market, and how important that is for them and their strategies. Here's the thing, when you have a large organization that is very focused on governmental pay, you know, Medicare, Medicaid, ma plan, so on, they're not necessarily very focused on private pay. And so for a lot of you, which is the far majority of independent homecare owners and operators, you know, private pay homecare is meaningful. Here's the point, if it's meaningful enough for a publicly traded company, through the many millions of people that need the care to be out there, and to have a segment in their business where they do think personal care has a huge future. We all know this, these are validators, and it's very important for you to find that out. But if you think about what the customer at the end of the day is going to be looking at, so your customer could be your referral source home health companies, hospice agencies, ma plans that you know, whoever, primary care physicians. An important aspect to think here, though, is now you're going to have groups that were already setting a bar have access to certain resources and expectations that are much higher. So what is expected of how personal care operates, I think is something that we need to really think about at this point. And so some examples All of that would be, you know, challenging ourselves around elements like, you're gonna have to do better care planning, right? The data that you're collecting with an individual and your private pay homecare agency needs to level up. The main reason is people who are private or government pay or whatever else, the systems are going to have to try to respond to that I think this wave of integrations or interoperability between home health and personal care is only going to get that much bigger. I think the MA plans are going to just get that much more powerful in their way. And today, I think if I had to say, what's the greatest opportunity that might live out there, I think it is building that relationship of being the care navigator for an individual and let me explain what that means.

You know, at this recent conference, and for gosh, the last five years, there's been a lot of discussion around who should own the relationship with the care recipient. Okay. I, if I could just take a second and rattle off a bunch of alphabet soup to you, I'll do my best. But the managed care organization wants to be that person, the case manager from the Medicare Advantage plan wants to be that person, primary care physician wants to be that person, the Geriatric Care Manager wants to be that person. What really blew me away, and then the list goes on, right? Like we as independent homecare agencies, we want to be the personal care agency wants to be the person because we have the longest length of stay, or at least we think we do. Let me throw something at you. That's very interesting. You want to go like little Google happy, and we'll invite them on as maybe a guest in the coming weeks, I had some recent dealings with a group called village MD. And a while ago, years ago, someone gave a physician really a gift, I'm trying to figure out where they get these gifts from, they gave him a gift of $15 million to stand up a home concierge physician business, and the idea was physician comes to you, they come in the home and they do a bunch of stuff. And you know, now that's not quite as new. Right? So we know visiting physician, concierge medicine and all that exists out there. Many of you are probably working with a physician like that in your area. What is more interesting is Walgreens recently bought village MD. And that movement really signals what Walgreens health really thinks that they ought to be. If you think about the total number of Walgreens stores that are out there. They are there on many corners, they're in many communities, and they're looking to open clinics, or they want to be community clinics in some way. To give you a sense of the volume at which they're doing, they're converting two to three clinics every single week, for the next five years, in order to have that capability of they want to have that deep relationship with the people who come in and get their, you know, meds filled. Walgreens has this philosophy right now, which I think is interesting is they want the pharmacist to be the care navigator. I laugh a bit because obviously they're biased. They liked the idea. I'm not saying it's a bad idea. And you know, there's been plenty of times where I was shocked at ideas that worked out. But I think it's an interesting plant. And this is the lesson in what I can tell you is the person who owns the relationship with the client, right? The care recipient, they have more power and control than we realize today. I mean, some of you know it inherently, but we're not leaning into it. So if you're an organization, I would be really I think at this moment focused on the idea of do a self audit, like how much do we know about our clients? How routinely do we get notified about changing condition? How often are we hearing about, you know, something with their care is changing, that isn't necessarily when our caregivers there, but just in general? In some examples of this where the details get lost? It's just a quick test. How many of you know that Mrs. Smith is now walking with a walker?

As a maybe a week or two ago? You might know most of your owners operators that attend these. So that's really good. I mean, it's pretty high level, but that's okay. I mean, bring it down a level how many of your schedulers or supervisors or your care manager or your you know, nurse know that and how quickly were they notified? And so the question always is, is Mrs. Smith thinking oh, I have to call my homecare agency and give them an update or did their physician or their PT right or their rehab Did they say Think to let you know from a coordination standpoint. So to sum up this point is be the expert. I think being the professional is going to be really key as time as moving forward. Clearly, lots of people want to own that relationship with the care recipient. They want to be the care navigator. And I think the more that we put ourselves in that seat, we are going to serve our client better and better. And I think it's meaningful, right? In the sense of what are you use your purpose, I think most of us have wanted to create a health care oriented company in which we're professional, we're high quality, right? All the things our brochure says all the things that our website says all the things that the stock photos as whatever it is, we all are competing to be in that state. So you know, being a professional homecare agency, I think, is evolving very rapidly. I think COVID taught us a lot of that. We've seen through COVID I want to make this another COVID call. But you know, COVID forced us right? How many of us were going to have our EMR system was going to be able to track things like Do you have a fever today? I mean, that was not in our world before and it is there now. We weren't thinking about personal protective equipment before and you are now some companies didn't even they were arguing do I need to provide gloves for my caregiver. So when you think about the the large scope and variance of what professional home care looks like today, and I will tell you that we as the independent Home Care Alliance, continue with our mission to try to educate you and help you and bring you whether it's vendors resources, you know, workshops, anything that we can do that's going to continue to help you professionalize. I think that's really important. We're not in a space where, you know, our mission is not to be a really big membership organization. That's, that's not the mission. That is one of the ways we do that. But you know, what do you get from membership? Or what are you getting out of this whole thing I would tell you is to be surrounded by a community that wants to be the best. And the best is defined as the most professional version of homecare out there. So you know, if you need any more why I would tell you because someone is looking at Mrs. Smith, right that Mr. Smith in your marketplace, and is trying to make you one of the spokes and not the hub.

I think many of you know as well as I do that, you know, you've all experienced a physician visit in which they come in, they spend five minutes with you, you know, a really good physician spends a little longer with you. But they have a support team behind them. And you don't really hear from the physician. And there's a bit of a mechanical thing that happens there. I kind of laugh about Walgreens, you know, the pharmacy model. I can be convinced right, I'm sure that I don't have a deep relationship with my pharmacists. And maybe I will when I'm 85 and on 57 meds, right. I don't know. But I think you know, I think I understand where they could get there. It's really hard to be a pharmacist today. I mean, just imagine if you've been into a Walgreens, the pharmacies running pretty slow. The pharmacy tech is like non existent and can't find them. And then they're stopping to try to give people COVID shots and flu shots, right? There's not always an NP nurse practitioner available. So will they be successful? Sure. I mean, you know, they may continue to evolve and things get better for them good. I think we have the best opportunity because nobody's saying you need to go out and be able to diagnose you know, a UTI. I think what you have to be able to do in the care navigation space is be able to have enough complexity that you can recognize Mrs. Smith isn't feeling well, and then kick off some additional steps after that, right. It's like, oh, let's call this person let's get you checked in let's let's do a telehealth visit. Let's call your primary care physician or nurse practitioner with a click of a button, whatever that might look like. So enough about that. I think that was a major, you know, area, I think a takeaway. The other piece that I think is worth talking about is if we're being very forward looking here for a moment, and you think about just generally where the money inflows are, I want you to just kind of put your mind around the idea that someone out there major entity from a health side, even though multiple companies are, you know, Optum united, and LHC were all public. They still felt that there was a valuation enough to not only put in 5 billion, but to purchase a company that was already at the top of its game. They weren't trying to go out and find you know, some small company that has a lot of gumption, you know, like they Oh, they'll really make it one day, what they did was they took one of the top performers in the industry in this space and brought them

in, because they feel like there's more opportunity strategically for them in that way. So I want to take a moment and talk about just generally, you know, what your goals are, as an organization, it doesn't matter, you know, to us, like whether you are building it to continue to grow, you want to have a lifestyle business, you want to sell it one day, you want to, you know, hand it down to your, your, your family member or somebody else, some other executive in your company, doesn't matter. What's important is that you continue to be in business, because you're a high quality provider. I do think though, it matters if you are a strong player in your marketplace. So marketplace domination. Sounds like such a tough, like, non sensitive thing, but gotta get competitive. And it doesn't mean you have to be the biggest, I think you have to be certainly really good at the things you're saying you're good at. So you want to be really good at dementia and the best dementia care expert possible in you know, XYZ state, some city and some state good, be that person and lean in and be known to be that organization that does that really well. And will tell you that sometimes Simplicity is the thing that we're we're messing up the most. So it's okay, if you don't like short term clients, or short shifts, or whatever. Beyond just the workforce crisis, I think you should say, well, that's part of my identity. We don't want to be a sitter service, we don't want to be a band aid, we don't want to be something you use for the weekend, right? Or for the couple of months. If you really want to get integrated into their life, my recommendation to you is put yourself in a space where you are the provider of choice, but you're also something that's become integral to that family and to that individual as a part of their continuum of care. So what I mean by that is, think about your competition. I mean, whether it's, let's say, you know, there's such a thing as respite care. So for those of you that are going to jump in on a technicality, that's okay. But you know, like in assisted living, when they sell their services, they're selling it as this is your forever, or they're obviously some emergency could happen. They could end up in rehab. I mean, yes, but that's not what they're talking about. They're saying, and they're making people feel comfortable with this decision is a long term fix for your issues. What they don't do, by and large, is that yeah, just move in for a couple of weeks, and then you can move out. So yes, I know, there's respite care. But the idea is they're making it now it's not only the model, it's the reality. And you have to find individuals that are, you're going to say, don't say things like Oh, and if it doesn't work out, then you can go to an assisted living, I would say, you are the kind of preferred model of aging in place, right, or just aging, you'd have to say in place. Aging in Place is not you it's kind of an old metric, you know, too much. I'm talking to every single body that's probably listening to this, you know, way too much about this space, you have to remember at some point, put yourself back in the shoes. The family who doesn't like talking about aging, they don't like thinking about death, they don't ever want to hear the word hospice, they don't want to hear you know, someone's becoming dependent on care. The word bed bath or standby assistance for a shower is like, absolutely the most horrifying thing that they've ever thought about. And you got to make this, you know, put yourself in that headspace and realize what you're saying to this person is, this is what you most people want, right? This is what is preferred. This is what every survey shows. And the reason is X, Y, or Z and you got to figure out their persona, what's their driver, most people it's very simple, they want to be at home, they want to be safe, and they want to have dignity, right? They want to have they want to have some level of agency in their life, your personal agency. So beyond that, most people don't know the difference between franchise non franchise independent, you know, GCM back, Nurse back, not back, you know, former finance person that thinks this is a good business. The reality is the service is the service. Right? And I would tell you, in most scenarios, everything's a sales pitch on the front end. But the execution is what's going to be you know, the the win or fail along the way. So, knowing that there is capital at the $5 billion range is an example that was poured into the industry. We know that aging home health care in the home is a major focus area. And obviously, it's signaling the fact that there's much more growth to be done. On. So at this point, although we've all been kind of excited by some personal care deals that are out there, you know, whatever's happening, I would just tell you think about ultimate valuation, right. There's some strategic buyers, there might be some whatever your plan is downstream, you need to be running your organization in developing it to a point of you got to think like, Hey, we're, you're barely getting started. And that's not to make anybody get stressed. Right? Don't be worried. I think that the core key there is, what do we need to do with operations? What do we need to do with sales or recruitment? What do we need to do with payroll? What do we need to do with some of these areas? In order to not make this so painful? There was a great question that was asked of you recently that I thought was really interesting. And the question was, hey, can you just, you know, imagine you're me for a minute, and you're staying up at night? And you're not, you know, you're losing sleep? What are the things that I need to do? And I think my comment back or kind of, in a response, easiest way to say this is, if you're at this point, post COVID, right, or like, towards the tail end, let's hope or at least after COVID, phase three, whatever this is,

if you're still at a point in which you're losing sleep, it's already something's terribly wrong. Meaning you're a survivor. Like if your agency's open right now, regardless of anything else, right? Yeah, it's fine. It's okay. You lost some hours, you know, recruitment is tight, whatever. But oh, my gosh, rollover, go to bed. I mean, you know, it's gonna be right now is better than it has been in a while. And you just have to say that, you know, these are going to be the challenges that you're going to your face over overall. But what are you going to do, I can say is, it's more important to say what you should not do? Okay. I don't think you should still be talking about last year, I don't think you should be talking about, you know, oh, back when the government assistance was, you know, in full flow, we just, we're gonna have to look forward, right. And if your teams are experiencing that, if you're experiencing that, you're going to have self limitation just because your mindset is in the rearview mirror. So it was there a lesson to be learned? Yes. Great. Let's move forward with it. Right. Have you already tackled for example, minimum hours, as far as you know, per visit? Good, because those short hours are going to be really tough. Have you already tackled minimum hours per week? Great. You know, that's gonna save you on your your caregiver client matching issues. If you already dealt with, you're getting your pricing, right. Fantastic. And pricing will obviously lead caregiver pay rates, you know, operationally, it's what are you still doing on paper? What are you still doing that's inefficient, you know, quit trying to only solve one problem. And the reality is, there's other places in which we can, you know, have less of a headache. Think like customer service. When's the last time you do a survey? When's the last time you heard from the caregivers in math? You know, a lot of us are like, Oh, I know what the caregiver is gonna say they want more pay. They want to, you know, we can all be a little sarcastic. They all want to sit at home, they all want to get paid. Nobody wants to actually do anything. I think the best thing we could do is go out and listen. Right? So if you're already doing customer satisfaction, caregiver satisfaction things, you know, like through through partners like home care, Paul's are great resource.

You know, are you reading those? Are you really trying to catch a trend? I, I've never heard of anybody doing anything perfectly. Right. Like, there's always a nugget there. And maybe we need to change up some questions. Maybe we need to lean in, you know, certain areas. If clients are generally happy, pat yourself on the back. I mean, don't just only think about the negative, maybe you guys are doing some things well, and you just share that with the team. It's like, Hey, guys, no matter what we do next month, let's not lose the fact that our clients really like when we answer the phone and we communicate well, so let's not forget that and keep those kinds of things going. So reinforce the positives along the way. So there's there are a lot of I think items out there generally from an industry perspective that are ongoing. I don't think that any of this information is earth shattering at the moment. The the biggest thing that I can tell you is happening for most agencies is they are resting on their laurels, right, like they know the things that they should be focused on and working on where Getting kind of this ongoing, while I'm just catching my breath, right, like I'm still recovering from cocoa. It's just been so hard lately. It's not even burnout. I mean, candidly, it's not burnout, you're just in low gear. And I know, you know, no better way to say it than that. Whatever you need to do to re Energize. I think this is something that Sarah's much better at talking about than I am in fact, I'm not as good as executing about it. You know, you got to find pathways for yourself of how can you get plugged in again. So some of us are, you know, if you're in your homecare organization, and you went to this, like work home, work from home, and remote, and whatever else, in your feeling that that's somewhat been a drag on you, because it's hard for you to focus and devote time whatnot, you just need to get back to normal work hours, some of us are saying we're busy, and we're starting to like drag time, right? It's like, wow, I'm gonna take an hour lunch, or hour and a half, or like, oh, yeah, you know, this remote thing is great, whatever. Think, leave the way that you want. And, you know, own the level of dedication that you should have. Use some features, you want to find a really exciting thing, find your how to like pause your notifications inside of your iPhone, and just have it to where you got big chunks of times where you don't, you're not that, like, add individual that's like, oh, alert here, oh, there's somebody posted, oh, there's an Instagram thing. I mean, sometimes it is just as easy as if you could do certain things at that takes you typically an hour and a half, you might be able to knock it out in 45 minutes with no distractions, right? Time block for yourself. If you enjoy the flexibility, that's okay. I mean, you know, that's perfectly fine. But make sure you're putting in the work. I think being under resourced is not about money. It's not about people, sometimes it's also things that we're just not prioritizing correctly, or building a plan and path. I'm seeing tons of opportunities without just people gotta get re re energized and reengage. I will tell you, tech continues to be a major focus area for a lot of companies just in their capabilities. We're not in a space, like, you know, I'm saying you know, you need to go buy new software and all that. But do you think you need to reevaluate some of your systems, you know, we've got some great vendor partners is not a pitch by any means. But my point is there's there's options out there. So if you're not happy with your phone system, or your CRM, or you know, your supplier for gloves, I mean, there's all kinds of things, the point is, don't get to a point where you just didn't quote unquote, have the time because sometimes the time is as easy, especially for our members just going into the vendors tab, right and looking for that information, we're trying to make that a lot easier for you as well. So in the next, maybe a few weeks, you're going to start seeing better usability in those areas. The other that I've just, you know, put a plug out there is for those of you that are on ClearCARE, you probably got an email about care forum 2022. And for many of you, you know, clear care was really bought by well sky inside of COVID, maybe a little bit before, and their integration wasn't totally done, meaning there kind of transition to the well sky brand and all that stuff. This is really going to be the first time to do an in person care forum. So it's a very dedicated industry conference that will have home health and hospice and other players, there's a big Continuum of Care type piece, just check your email. And the only reason I say that is, you know, there's some earlybird pricing for that event, we'd love to see some of you there, we're going to try to organize a kind of a buddy on event with it so that you know, we can get maybe some independent homecare agencies together, do like a VIP room or something, we'll figure it out. But between now and then if nothing else, put a little placeholder on your calendar. I believe it's in September. So you got plenty of time for the year it's going to be in Kansas City. So you know, it's fun town to be traveling to as well. And, you know, it's it's like two or three days. So enough about that. I think you know, that's a conference from just for those of you that are in clear care. It'll be the first time in over a decade. That clerk is doing kind of like a structured User Conference type thing. So that'll I think that'll be a fun one. Other things just generally in the industry to be kind of looking at, do a plug for the homecare Association of America. Many of you know I'm a board member there as well. They're launching out some great webinar type content out there. So for those of you that are there, it is a paid content. But you do get a member discount if you are a COA member. And if any of you are out there on the fence about becoming a homecare Association of America member, the only thing I would tell you is, this is my bias belief. I think the thing that HCA does at the best is advocacy. And that's an area that I HCA as an NC we don't do, we don't want to march in DC, you know, we don't want to do Day on the Hill. And not because we don't want to we think that H COA does an excellent job with that. And I think that's an area where we can buddy up with the franchise's and the corporates and you know, all these other people, that is our biggest bang for your buck is not only in DC, but I also at state at the state level. So, you know, please consider membership there as well, it's a, it's a steal of a deal, you know, for the banning that you're getting there. And then, you know, in general, as far as any other events, I have a request and plea for the group, I hope that some things that I say and deliver to your group, and then ICA is helping us really good, we would might ask or request currently is if you know of a industry conference, a conference something in your area that is, you know, where home cares gather,

please, you know, send that our way and recommend us maybe to do like a speaker, session one, it gives us an opportunity to go there and meet and greet with votes. But to if you don't have a state associated, you don't have those kinds of meetings. That's okay. Recommend the independent homecare alliance to a friend, I you know, we do a lot of things, obviously for the industry in a positive approach, but we want our network to grow. And let me bring you full circle before I hand it back to Sarah. Wouldn't it be nice to go to optim, United LHC and all these other people and say, Hey, guys, we know you don't have a very big personal care play today. We would like for as you guys are doing all these other things, Medicare reimbursed Ma's and this and that. We'd love as an industry for you to use our director directory for members and refer your personal care services as people would need it. And that's what we're talking about, right? Like don't get lost with the 5 billion is spent here by this public company doing this thing to solve this problem, whatever. We have to be the champions of the best homecare agencies in our marketplaces. So if you know another excellent homecare agency, or one that wants to work on being an excellent homecare agency, please send them our way. We right now are kind of a best kept secret. And we're trying to change that. But Sarah, thank you so much for giving me a few moments and some time and I'll turn it back over to you.

Sarah Barker  32:57  
Well, it's always a pleasure to hear the insights that you have, can you and I know that our members in the larger audience really enjoy hearing from you as well. So I just do have a couple of comments to make about what canoe has said and shared, which is professionalizing. The industry right? For years, I've been saying that homecare agencies, the owners, the staff, everybody needs to start looking at themselves as an advisor, because it's really important to understand that these families truly do not know what their options are. So even if your area of focus is homecare, because your caregiving agency, make sure that you're knowledgeable of the entire continuum of care. So you can be that overall elder care resource for these families, right, own that relationship and be that advocate for the care recipient and their family. Because as a reminder, home care is not just for the care recipient. homecare is a service that supports the entire family. And I think too often caregiving agencies, and everybody employed by the agency is not valuing themselves enough, right? Understand your importance and the value that you are providing to these families. So there's that. And then another comment on something that can do with sharing. So getting plugged in, right, it's been very trying two plus years and what it's caused, and you know, I'll break it down like this. And there's actually an article that was written about this. So in the military, right, people are used to this, you go on a deployment and you come home, there's sort of this transition phase. And really, you know, I don't want to say trauma as in don't think combat veteran, really, but it's just trauma can come from a fear of the unknown, right? And you can get stuck in it and it has a lasting impact. And so what I'm noticing is that it's been a traumatizing experience for many homecare owners Not knowing what to expect not knowing how things were going to end up, right. And of course, then the stress from the labor shortage, all of these things are really traumatic experiences, right? And so sometimes people can get stuck there, right. And so that's part of what we want to work with these agencies on. Yes, there's the operations. There's all the technical aspects of the business, but really helping the individual right, helping that individual owner and their operators, right, get past where they're stuck. And also out of a place in a place of complacency. Because going through a period, like what we've gone through over the last two plus years, eventually people get kind of stuck, they get complacent, you know, oh, there's no caregivers, recruiting sucks. There's no caregivers, okay? It is what it is. So what are we going to do about it? Right. So we're really working on things such as that focusing on the positive though, still working through issues in our performance level memberships, we do have cohort number one that is filled, cohort number two at our performance level is almost full, and then we'll be launching number three. So that's all the benefits of the membership at the network level, the growth level. And then at the performance level is where we're bringing together independent caregiving agency owners, into the sessions of 90 minutes once a month, where they're learning from each other, we bring in subject matter experts, it's facilitated by HCA. But there's also elements that we've developed Incorporated, right, that address the needs of the individual, right, personal accountability to make sure that that owner is carving out time for the relational aspect of their lives, family, friends, you know, financial, looking at the financials of the business, really understanding that, can you have this presentation that speaks to if you don't understand your financials, you don't have a business, right? Spiritual, whatever that means for people, your physical well being all of these different areas are incorporated into our performance groups, on top of the business aspect of things, because if you're not taking care of yourself individually, how can you expect to take care of your employees and take care of your agency as a whole. And then there's some accountability tools and stuff. Additionally, we do have another HCA executive workshop coming up, we are going to do a day and a half this time versus one day, it'll be May 12. Starting at 1pm. There'll be a couple of sessions followed by a dinner where it's networking. And then the next day check in May 13, at 730. And it's a full on workshop with educators on various subjects, followed by a cocktail hour after the workshop. And the feedback that we've received from these workshops is very, very positive people walk away with these aha moments that they have. And sometimes it's issues that they knew they had. But they're just so inundated every single day in their business, putting out fires doing this doing that right that even if they know in the back of their mind, it's an issue. They've not stepped away to really see perhaps how big of an issue it is. And they certainly haven't taken the time I stepped away to contemplate what possible solutions there might be for that issue. And so through these workshops, we go through that process through education and this guided audit process. And so owners walk away from the experience with a clear plan a clear vision of what they need to do to move their agency forward. But to really make it impactful, we tack for strategy sessions on after that. So any aha moments that were had during the workshop, then we come together as a group all of the attendees in four separate sessions. So that way, we can be there to help hold their hands and implement the necessary changes so that way they can grow. So that workshop is coming up may 12 and 13th. The link is in the comments. And as you can see, it's on the screen right now. And as I mentioned, our performance cohorts are growing at a great rate. And you can find that link if you're interested on our website as well. So I appreciate everybody tuning in today. If you have general questions about official registration in the independent homecare Alliance about anything that we offer all the way from the in network membership up to our power partner shared services level, please reach out to me at Sarah dot Barker at IND hca.org. I hope to hear from you guys soon. And we look forward to our next IFC industry insights with Keanu next month. I hope everybody's having a great week and you're taking time to take care of yourself and your business.