Rae Woods (00:02):
From Advisory Board, we are bringing you a radio advisory, your weekly download on how to untangle healthcare's most pressing challenges. My name is Rachel Woods, you can call me Rae. Healthcare is getting more and more technologically focused. It's not a matter of if technology will intersect with healthcare, it's how. I bet all of you know, the promise of technology doesn't always match with the reality on the ground.

(00:30):
That's why I've invited Health System Expert, Paul Trigonoplos, and Digital Health Expert, John League to this episode of Radio Advisory. You're going to hear each of them take on the persona of one half of the provider/vendor partnership, and be pretty brutally honest about why most of those partnerships fail. Hey, Paul. Hey, John. Welcome back to Radio Advisory.

Paul Trigonoplos (00:54):
Hey, Rae.

John League (00:55):
Hi, Rae.

Rae Woods (00:56):
John, you always have some hot takes when you come on the pod. I think you may have been on the first podcast where I actually cursed. I think you did too. I feel like that might happen again this time.

John League (01:10):
Well, that's very on brand for me.

Rae Woods (01:13):
No pressure, Paul.

Paul Trigonoplos (01:14):
All I'll say is that, if we do, it will reflect the word choices that came through in the interviews we had.

John League (01:21):
I believe that.

Rae Woods (01:37):
Let's get into it. So Paul, you work with Global Health Systems. John, you lead our Digital Health Research Team, which means that you end up spending a lot of time talking to vendors. We know that these two stakeholders have to work together, but what do they actually think about each other?

Paul Trigonoplos (01:53):
Overall, I think there's some mixed feelings, if I'm putting it politely. At the end of last year, I did a project where I interviewed around 25 health system execs and tech vendor execs. When I say tech vendor, I'm mostly talking about software as a service. I'm not talking about EHR stuff, or big enterprise firms.

(02:18):
Honestly, everyone was upset and pretty frustrated with how the partnerships they have with the other side are going, a lot of feelings of pain, a lot of feelings of frustration, of missed opportunity, of "Why did we even go down this road?," et cetera. These interviews were confidential, so we have some pretty brutally honest takes from each of the sides.

Rae Woods (02:45):
You don't have to name names. We probably shouldn't name names, 'cause that's a essential part of our research process. But, what were some of the things that you heard?

Paul Trigonoplos (02:54):
From providers, there was just a general frustration at how opportunistic, we'll say, most tech vendors are. Providers, rightfully so, are sitting here with 11,000+ tech vendor options, and they want to be able to say no without having to deal with 50 sales pitches per week. One person literally told us, they wish that vendors would understand how many valid reasons there are behind saying no to a sales pitch.

(03:21):
They said they felt like they were sitting in on a multi-level marketing sales pitch by the end of the week, it just kept going. There's some other sentiments too. People wanting to just have a good vendor, versus enter in completely from day one into this 10-year transformative partnership. There's a little bit of, "Prove yourself as a good company to begin with," because I think there's some skepticism around what actually are good vendors out there, what's worth their weight, because there are so many?

Rae Woods (03:50):
But, you said both sides have negative feelings.

Paul Trigonoplos (03:52):
Yeah.

Rae Woods (03:53):
What did we hear from the vendors?

Paul Trigonoplos (03:55):
From vendors, the real takeaway I got was that systems don't do a good enough job at vetting out all of the noise when they pick a product. We can get to this a little bit later, but the vendor market is driven on pursuit of growth. They're never going to say no to someone that wants to buy them. It's up to the health system. They blame a lot of the failures behind, "Well, why did the health system even come here? Why did they get us if they didn't know what problem they were trying to solve?" So, there was a little bit of blame on that side.

(04:28):
Then, there was some frustration on the change management side. "Health systems are a thousand points of no," was one of the quotes that came through. When you're dealing with a rollout, especially at an enterprise level and a multi-regional system for instance, the amount of, this is another phrase, "Shadow IT departments, that you have to jump through, just bureaucratic hoop, one after the other, that was a huge, huge pain point for them.

Rae Woods (04:53):
Look, there are lots of examples of these finger pointing partnerships in healthcare. I don't want to be brash here, but why is it even important for us to understand how both sides of this particular partnership think? Why is that important for us, as researchers, to share with the industry?

Paul Trigonoplos (05:13):
There's two things I'll say. One is that technology vendors and health systems are tethered for the foreseeable future, and I don't see that changing. There are competencies that tech vendors have that health systems just are not going to do in-house, especially when you consider how fast technology progress is. When you think about things like AI, and things like telehealth. So, they're tethered.

(05:37):
Then you look at the data on success rates, based on whatever surveys you're looking at, between 50 and 70% of partnerships fail, and that's just in business at large. But, health system is by no means safeguarded from those risks. So when you combine those, it creates this high risk, often painful partnership environment, because these two sides just don't talk to each other.

(06:02):
On interviews we ask them, "You have all these honest feelings, why don't you just tell the tech vendors you're talking to? Or why don't you tell the health systems you're talking to all this stuff?" They said, "Why would I do that?" One guy who literally said, "Doesn't the Advisory Board do that? Can't you tell the other side for us, so we don't have to?" I think that's indicative of where the postures are right now.

John League (06:24):
The thing that I hear so much in the market, is folks wanting help with, "How do I actually get value from my investments?" There's a lot of, "Help me figure out what the new thing is. Do I need it? Should I invest in it?" Probably not.

(06:46):
There's a ton of untapped functionality in a lot of the existing systems, and a lot of the needs are extremely basic. There was a class survey at the beginning of 2022 that said that the thing that patients struggled with most, and was the most important thing in the patient experience, was an easy way to communicate with their provider-

Rae Woods (07:10):
Oh my God, yeah.

John League (07:11):
Before and after a visit. It just doesn't exist. That is not a generative AI solution, where we've got to be on the bleeding edge of technology. What they really need is to be able to get value out of the most basic investments that they have to make, and they're not doing it. That's why this is a problem. This is not just a vibe. This is not just Paul out there trying to stir the pot and trying to figure out, "How do we fill in the missing piece or give the secret bit of intel to the other side?"

(07:45):
If the things we're going to say today sound incredibly basic, they are. But I think that is where we have missed, especially with technology, when we think about chasing shiny things and, "How do we keep up?" And, fear of missing out. That is true, both on the health system side and on the vendor side.

Rae Woods (08:06):
Yeah. I feel like there's this acknowledgement that, to Paul's point, a good chunk of these partnerships fail. Even the ones that don't completely fail aren't necessarily getting enough value out of them, like you said, John. But we also have to keep in mind that we can't just blame the product. You said this to me at one point, John, that technology keeps getting better, faster, cheaper, and yet we still aren't able to actually get what we want out of these technologies.

(08:39):
At some point it has to come back to the partnership. I feel like we're going to have a little bit of a therapy session here. If the solution is to understand each perspective of the partner here, the health system needs to understand where the tech vendors are coming from, and vice versa. At a basic level, are these parties even operating on the same definitions of success?

John League (09:01):
No, not at all. As Paul alluded to, tech vendors are, I don't want to say entirely but I feel like I have to, entirely focused on near term growth, because that is the way their incentives work. Growth is oxygen for many of these companies, especially ones that are not huge incumbents. So they need as much revenue, certainly in the near term.

(09:25):
They also need to try to get these long-term contracts that Paul was talking about, to demonstrate to investors that there is runway in front of them for their service down the line. Those incentives will not change. That is true whether it is a publicly traded company, or a VC backed company. All of those things are true, and it is a matter of existential importance to them. It is about survival in a way that even very challenging initiatives are not existential for health systems. The hospital will continue to stay open even if this technology rollout is not successful.

Rae Woods (10:09):
So then what are health systems focused on? What's their definition of success here?

Paul Trigonoplos (10:12):
At a broad level, it's growth. But I think, when you drill down to why a health system is seeking out a potential tech partner, we want to assume positive intent, and assume that they are doing all the necessary due diligence to identify the core problem at hand that's stopping them from doing whatever version of success they're chasing. Finding that problem, and then trying to fill it with a tech vendor. We want to assume that they're doing that.

Rae Woods (10:45):
Give me some examples of some specific problems that we would want health systems to focus on. Not the shiny object that John was talking about, but some specific challenges.

Paul Trigonoplos (10:52):
Sure. You can think about core, age-old business problems, network leakage. Do we have technologies that give a better understanding of where the opportunities are. Primary care access, top of funnel. Where the cost centers are, if you're trying to standardize care across a few facilities. This is not revelatory, it's core operations.

(11:13):
I say assume positive intent because, in reality, I think a lot of systems are making decisions on which tech products to partner with, based out of FOMO, reactively, because another system that they compete with did it, because they're trying to play catch up. So there's a fallibility to a lot of the decisions out there. The other goal that health systems are pursuing here is just a focus on minimizing risk.

(11:41):
When I say risk, risk of failure in the partnership, that could lead to financial loss, loss of resources and time, political problems, like lowercase p political problems, pissing off people in your system because you botched a rollout. They are really risk averse, and I think that's part of the reason why you see health systems skew towards short-term discreet projects, as opposed to these giant transformative things, because the risk involved with that is really high.

John League (12:08):
When you think about the limited resources that most of these health systems have, a high functioning, high performing good market organization, if they have a 1% margin, that is outstanding. But keep in mind that, if you're talking about a 1% margin, that is what you have to reinvest in the entire business. So nevermind the fact that, if that investment does not go well, that is money wasted.

(12:43):
But to Paul's point, it is also an enormous expenditure of internal political capital and goodwill. You picked this instead of this other priority, it failed, and now there's a question of leadership, and hurt feelings, and all of that, that snowballs. The risks are not just about the technology and the implementation.

Rae Woods (13:06):
John, you're starting to get at where I wanted to go next. What tension comes out of the fact that the core purpose of these two stakeholders in healthcare aren't necessarily the same?

John League (13:18):
I'm going to take the perspective of the vendor, and I will tell you about the things that they are doing, and the behaviors that they show. Then Paul can take the other side because, again, this is a two-sided issue, and there are behaviors that are maladaptive for the success of the relationship just in general. So the first one that relates directly to all the stuff we've been talking about so far is, selling to anyone good or bad.

Rae Woods (13:47):
Because they want to sell.

John League (13:48):
Exactly. Emphasizing both the near term revenue dimension that is there, "We need to sell this, we need to get it on the books," but also as a way to shoulder out competitors. However, many thousands of vendors there are out there in the market, it is always going to be easier for a customer to buy from you again, once they have the first time. So clearly, there's a lot of market share dynamic that goes into that.

(14:15):
I think that is probably one of the biggest ones that leads to a lot of down-the-line issues, because we don't take a lot of time, on the vendor side often, to really evaluate, are we going to be able to deliver? Is this going to be a good relationship? Is this an organization that we want to build a relationship with? Do they really seem to understand where we're going, and how our product, or our vision for our product, could grow over time?

(14:51):
Now that's not the health system's responsibility to do that. I think it's the vendor's responsibility to understand how the health system is working. So much of communication, we think it's about what we say, but it should be about what the other person hears. I don't think we approach it in that way in a lot of these things, and I think that is the basis of this selling to anybody. I could keep talking, but that's the biggest one.

(15:21):
There are other very important ones as well. Certainly, every health system would tell you how, during the sales process, a vendor embellished what they were able to do, or what they could do in the future. Certainly, there's a lot of emphasis from vendors on becoming a long-term partner to the health system, that is usually not aligned with what the health system is looking for, or the way they orient themselves to the sales process. But again, the biggest one is selling to anybody.

Paul Trigonoplos (15:51):
Before I jump in with the health system side, I just want to say that is, by and large, the biggest thing we heard from vendors themselves admit on calls.

Rae Woods (15:59):
Oh,

Paul Trigonoplos (16:01):
We talked to multinational telehealth corporations that said, "In an ideal world, we would pick really good partners, we would only partner with them. But also," and I'm quoting, "We are like squirrels, and we will chase anything we can, and that's just the reality we live in." So, this isn't health systems blaming. This is vendors saying, "Yeah, this is just the market we operate in."

Rae Woods (16:20):
Were health systems that self-aware?

Paul Trigonoplos (16:23):
I don't think so. No. There's an irony that comes from all of that coming from vendors themselves.

Rae Woods (16:29):
So what behaviors is this resulting in from the health system side?

Paul Trigonoplos (16:32):
There's a bunch. The one or two that I would focus on is, health systems tend to skew, because their goal is to solve discrete problems, towards a more discreet gap filling approach when they're looking for vendors and when they're scanning the market. There's a certain value to this. There's so many tech vendors in the market that exist. How else are you going to filter down all the options into something that makes sense for you? But on the other hand, we talked to one system, their C-suite has a list of 40 functions that they're trying to fill and they're going one by one-

Rae Woods (17:08):
Oh, God.

Paul Trigonoplos (17:09):
To try to find tech vendors for it.

Rae Woods (17:10):
That's probably on top of already dozens of vendors that they're working with for other point solutions.

Paul Trigonoplos (17:16):
Right. Right. Yes, sometimes they might find a vendor that does two or three at the same time, which that's a win. But in reality, play that forward. In the best case scenario, you have a ton of noise. Somehow, if they're all giving you value at the end of the day, there's still a lot of devotion you're going to have to do, wrangling all those partnerships.

(17:36):
But more often, you're going to have a cost consultant come in and just hatchet all of those contracts at some point, because there's just this log jam of partnership buildup. It's a bit of a reality that health systems are living in, because there's not really a consensus out there on what tech capabilities health systems must have. Everyone's charting their own course, so they're just making their best bet on here's the 30, 40, 50, depending on what our footprint is, depending on what our problems are, let's just go one-by-one.

(18:07):
Part of that is because they also use RFPs for this, and there's a point here around using RFPs, which is generally, in the past, been done for hospital beds, for enterprise solutions like an EHR, for medical equipment, these big single item tickets. Using that RFP for something like AI is a bit anachronistic considering, there's just data published last year on this, it takes health systems 23 months to go from identifying a solution to fully implementing it on average.

Rae Woods (18:42):
Wow.

Paul Trigonoplos (18:42):
Do you know how fast AI changes?

Rae Woods (18:44):
Yeah.

Paul Trigonoplos (18:45):
Do you know how slow an RFP process is?

Rae Woods (18:48):
Yeah.

Paul Trigonoplos (18:48):
There's a different world out there that needs to happen.

Rae Woods (18:52):
You said 23 months is the average, I'm sure there's plenty of listeners that have examples of rollouts that have taken a lot longer than that. I can tell you, with confidence, that in eight years of being at Advisory Board, I am still talking to medical groups who are in the midst of rolling out a unified EHR, right now, in 2023.

Paul Trigonoplos (19:11):
It's not just EHRs, it's also tiny point solutions. This goes into the second point, the second behavior I want to focus on for health systems is, they rush through the change management portion of the purchase. When we talked to health systems, and especially vendors, we heard that a lot of teams that sign the contract, they might communicate the value of this thing to a select few leaders, but they usually overlook the end users, the patients, especially if the tool they're buying actually changes the way access occurs.

(19:50):
Very few systems actually incorporate all this feedback into the purchasing and partnership decision, because it's slow, and it's political and you don't really want to go there. It's better to just make the decision and then hope for the best. But in reality, it doesn't really happen. There's a lot of wrenches that can get thrown in if you don't get all the finance people, all the nurses, all the docs into something.

(20:12):
That's the other behavior, when you make decisions out of FOMO, and you want to catch up, there's a tension that comes from trying to act fast but also skipping. We like to say, "You should probably slow down to speed up," and it's hard in this environment. But in reality, it's probably better than just outright failing and wasting time.

Rae Woods (21:35):
There's this central tension that results in all of these different behaviors that the other side doesn't necessarily like, or agree with, or maybe even totally understand. Is the right answer, is the purpose of your research, to point this out so that we can change those discreet behaviors? Is it right for us to disagree and say, "Selling to any partner, good or bad, is wrong. We are going to change the way vendors sell?"

Paul Trigonoplos (21:58):
Not really. There might be some self-awareness, self-realization that comes from any of these entities reading our reports on this. But I think, more often than not, the goal is to just understand the other side. The theory that we were operating on, and what we heard in interviews, is that I need to get to know the under-the-hood dynamics that are going on, on the other side. With that, I can better anticipate hurdles. I can better identify red flags that come up in the sales process. I can ask hard questions during the sales process to negotiate. I can call them out for selling to my market when, in reality, they have no business doing that. They're just trying to make money. That is the take the research pointed as being the most valuable.

Rae Woods (22:44):
So then if we need both sides to take a step back and understand, so that they can adjust their approach to partnership, let's look at each side. John, how should vendors adjust their approach to partnership with health systems?

John League (22:59):
I would start this off by saying again, this is not going to sound revolutionary. This is probably not even going to sound particularly counterintuitive to anyone who has done this work before. The reason we are calling it out is because it's not being done, and it is absolutely essential. So the first thing that vendors have to do is, they've really got to focus on, who is the ideal sponsor for this, within the health system? Usually, only a handful of people with the influence to steer and approve this.

(23:31):
But what we're really looking for is someone who understands all of the workflows, how they connect, where do the change management surprises live, and how can we address that proactively? That's the person that we need, not just the person who can sign the check. The flip side of that is owning the work of actually vetting, identifying, who a vendor partner could be, that could be helpful for the health system. The health system would love to be able to incorporate a lot of different stuff. They have lots of different vendors for lots of different problems.

(24:13):
Often, vendors don't want to partner with each other. There are reasons for that, that go along with their incentives that we were talking about, about growth, and market share, and trying to shoulder people out. But vendors can be much better as partners if they know which other vendors are actually complimentary to what they have, because the health system probably does not have that view. That is something that the vendor can bring to the table, that really could be a value add. I don't think the health systems have the time or the resources to fully evaluate, not just what an individual vendor says they can do for me, but what combinations could be most valuable.

(24:55):
The last two, I think the one that is just an echo of what I said before is, stop selling to everybody. I know that's hard to hear. That is especially true for organizations who have huge ambitious goals. They need to meet targets, I get it. But this is a threat to that sort of long-term growth trajectory that they all claim to also want to be on. Then finally, when you do find a partner as a vendor, we've got to make it so that we aren't bending over backwards to clients so that we build this island of our solution that is so unique and so embedded specifically in what this one organization needs, that we have created an enormous point of failure potential with that partner.

(25:48):
If for whatever reason, the rest of the market outgrows that product, or needs something else, or as a company we need to shift away from that, if we have customized the crap out of this one offering for this one customer, we are really setting ourselves up for a problematic relationship if we can't sustain that. I think that goes back to not selling to everyone, not saying yes to every health system, being sure that we're aligned with what the partner actually needs, all of those things. I think those are not new things to hear, but they are absolutely essential if vendors want to do their part to make these relationships, not just more valuable, but just easier to have.

Rae Woods (26:39):
Paul, how do you want health systems to adjust their approach to partnership?

Paul Trigonoplos (26:42):
The biggest recommendation I'd make to health systems is to focus on building internal consensus about the problems that they're trying to solve, when they go out to the market to find tech solutions. There's some language in that that is important, building internal consensus. One part of that is, you should identify the problem, as opposed to make fear-based or FOMO-based decisions because, if you're really grounded on the problem that you're trying to solve, it's a very easy vetting process to say no to vendors that don't solve that specific thing. So, that's one.

(27:15):
Two is, consensus around the problem. Communicating the why to, especially clinical and IT teams way up front. We heard in calls that most partnerships that happen, there's some unsaid expectations around who's going to actually do the change management. Often, after the sign contract is signed, the health system calls the tech vendor and says, "Oh yeah, you guys are doing this, right?" The tech vendor says, "We did not talk about that. Also, we do not do change management." I'm making fun of that, but that scenario happens time and time and again. So I think it's more of the health system responsibility to sort out their own bureaucratic quagmires, and get everyone that's going to be affected by this tool on the same page.

Rae Woods (28:00):
Our listeners can't see that we're all laughing in the background as you're talking about this, not because it is objectively funny, but because we're internally going, "Yeah, that sounds about right."

Paul Trigonoplos (28:13):
The third thing I'll say, is that health systems really need to push tech vendors during the sales and negotiation process. We heard in calls from one health system, that partnered with a tech vendor to solve some access problem on good faith, and after the contract was signed, they found out that the tech vendor had actually trialed whatever the tech product was in beta twice, and that's it. The health system did not know that they didn't have the scale, and it's not because the health system fell for it, it's because the vendor put up this front that said, "Oh actually, we have really good ROI. We have really good data."

Rae Woods (28:47):
Embellish the sales process, maybe?

Paul Trigonoplos (28:48):
Embellish the sales process.

Rae Woods (28:49):
As you were saying. Yes.

Paul Trigonoplos (28:50):
Yeah, check your footnotes if you're a health system, pretty closely. But the further that vendor was operating on a burn rate, they were supposed to run out of money in three weeks after the contract was signed. They didn't tell the system any of this. They don't have to. That is on the health system to push for. Then the last one is, along those lines, pushing the vendor to figure out if you, as a health system, are actually in their market of who they can actually serve.

(29:18):
We heard from systems that were dealing with sales pitches from vendors who 90, 95% of the business from some vendor was in urban AMCs. This system we were talking to was like a semi-rural standalone community hospital. They had to sit the vendor down like, "Why are you selling to us? We are not your market." The vendors said, "Well, yeah. We're growing here." Which actually what they're saying is, "We need more money." There's an element of communicating internally, and figuring out the problems you're solving, and then there's an element here for health systems to really be annoying to the vendors that are coming to them.

Rae Woods (29:57):
Clearly, there is tension and a lot of negative feelings on both sides, but we started off this conversation with a very important point, vendors and health systems have to work together. Do we even have an example of what an ideal partnership looks like between these two stakeholders?

Paul Trigonoplos (30:16):
Ideal? I'm not sure.

Rae Woods (30:18):
Wow.

Paul Trigonoplos (30:19):
There's a few reasons why I'll say that. One is, on paper, unicorn partners exist. I'm sure in the market they do too. These tech vendors that have their ducks in a row, their long-term value prop is so clear, and so impossible to disrupt, that they are going to be here for a while, they're who you go to for this problem. That's fine. You have a few health systems that are really strong at enterprise vetting of tech vendors, and looking out eight years in advance to figure out what they want to be.

(30:50):
Northwell is one that comes to mind. They had a partnership with Teledocs that was announced last year. They kept that secret for like two, three years, because they were building the partnership from scratch. That's the type of thing that, it might be pretty strong, but I go back to the word ideal. I don't know what the under-the-hood dynamics of that partnerships are. They could still be really frustrated at each other, and any other name brand partnership that's going on. The reality is, most entities keep everything close to their chest.

John League (31:18):
I think the thing that stands out from all of this research, and Paul has done a lot of work, and it's all available on the website, so you should definitely check it out. Rae will drop it in the show notes, I'm sure.

Rae Woods (31:28):
Can do.

John League (31:28):
But the thing that stands out to me is just how these organizations are talking past each other. That seemed to be the vibe in all of the conversations that I heard Paul have with these leaders, is that everyone is relatively clear about what the problem is, but has not made any moves to actually address those challenges. Now, part of that is, as Paul has said, a lot of these orgs keep a lot of that stuff close to the chest. A lot of that is simply that, and this is true across healthcare, we don't like to talk about misaligned incentives. Everybody talks a good game about patience first, and all that stuff. When it comes right down to it, everybody's got a quarterly number they need to hit, or they've got a KPI.

Rae Woods (32:12):
Yeah. By the way, we talked about how the purpose underlying these two stakeholders are misaligned. I don't think anyone would actually say that out loud.

John League (32:19):
Oh, no.

Rae Woods (32:19):
They would say, "We are both trying to solve these operational inefficiencies, or make things better for the patient, or make things better for the clinician," et cetera, et cetera.

John League (32:27):
Exactly. If we can't even acknowledge that, if that conversation cannot exist, then we can't solve this problem. If we can acknowledge what the other side is dealing with, and we can see it, then we can start to think about how we can do it differently, and maybe take a different action.

Rae Woods (32:45):
Well, John, Paul, thanks for coming on this episode of Radio Advisory.

John League (32:50):
Thanks, Rae.

Paul Trigonoplos (32:51):
Anytime.

Rae Woods (32:56):
I know we spent a lot of time in this episode talking about the problems between health system and vendor partnerships, and that we might not even know what the ideal partnership looks like, but that doesn't mean that there's not work that can be done right now. Paul has done some pretty extensive research around the behavior changes that we need to see. I've added those links to the show notes because, remember, as always, we're here to help.

(33:27):
If you like Radio advisory, please share it with your networks, subscribe wherever you get your podcasts, and leave a rating and a review. Radio Advisory is a production of The Advisory Board. This episode was produced by me, Rae Woods, as well as Katy Anderson and Kristin Myers. The episode was edited by Dan Tayag, with technical support by Chris Phelps and Joe Shrum. Additional support was provided by Carson Sisk and Leanne Elston. One more thing, the podcast team wants to know how we can make the podcast better for you, so we created a quick listener survey at advisory.com/podsurvey. Please take it and let us know what you want to hear on Radio Advisory. Thanks for listening.