Introduction and Episode Overview
[00:00:00] Stacey Richter: Encore episode. "When Your Health Plan Is $9 Million in the Whole, Who Are You Going to call? A CPA and Tell 'em to Bring Their Spreadsheets?" Check out this conversation with the one and only Marilyn Bartlett about going from bankrupt to $112 million in the black in about three years.
Marilyn Bartlett's Achievements and Recognition
[00:00:36] Stacey Richter: Marilyn Bartlett is the real deal. I saw Marilyn get a lifetime achievement award last year at Rosetta Fest from Dave Chase, and then I actually had the pleasure of getting up on the stage with her and heard that rounds of applause.
But it takes guts to push for fiscal discipline and put patients over profits. So thank you so much to Marilyn for showing us how to get started fixing healthcare and for creating really true health value.
And that's why I'm encoring the show from last year. It's a great one. It's inspiring to revisit
Health System Pricing Transparency
[00:01:08] Stacey Richter: Plus as just one more reason for this encore, I saw a post from Katy Talento on LinkedIn the other day, link in the show notes, and it was about health system pricing transparency. But Katy referenced the NASHP pricing tool, which is under Marilyn's leadership, and the NASHP tool can be used as a starting point for hospital negotiations.
We've had tons of shows about direct contracting so this is really relevant, but I wanted to mention that version five of the NASHP tool will be out January 2026. So make a note to check it out.
And with that, here is my conversation with Marilyn Bartlett. Prepare to be inspired.
Yeah, I made a meme for the show with Marilyn Bartlett. You can find it in the show notes. My very first meme ever. I picture that Olympic silver medalist shooter from Turkey who showed up in a t-shirt and his hand in his pocket versus the others with all their fancy equipment that turns out may or may not be necessary, regardless of who might swear up and down that complexity requires even more complexity and plenty of expensive gear to shoot straight.
Point being, it's amazing what a dedicated CPA with a spreadsheet and their eye on the target can accomplish in the real world when they just do their thing and follow the dollar.
And with that, Marilyn Bartlett has entered the chat. Marilyn Bartlett isn't called the Queen of healthcare for no good reason, and nobody is joking when they say this. She was probably the first person or one of the first at a minimum to truly identify the amount of money getting sucked out of the wallets of taxpayers and employers and plan members, and into the pockets of the healthcare and insurance and consulting industries.
Let's start from the beginning here, but you'll have to listen to the interview that follows for the end. And most of Marilyn's really sage advice and words of inspiration for any of you, for all of us trying really hard to fix healthcare and any day of the week, taking two steps forward and or five steps back.
It's what Mike Tyson was talking about when he said, everybody has a plan until you get punched in the face. And yeah, I'd say, pretty confidently that everyone in the Relentless Health Value tribe trying to fix healthcare has been there at some point or another.
Marilyn Bartlett's Journey with Montana's State Health Plan
[00:03:20] Stacey Richter: So here's where I begin the conversation with Marilyn Bartlett today. One day in 2014 or 2015, Marilyn was minding her own business as a CFO at a regional TPA firm about ready to retire. When the state of Montana reached out. They asked if she would consider being the plan administrator for the state employee health plan, which was turned out headed for bankruptcy.
Marilyn took the job and she took the state health plan from $9 million in the hole, they were in debt. $9 million, to $112 million to the good. Meanwhile, plan members got better benefits. Think about that 9 million in the hole to 112 million in the good. In fact, the plan had so much money in 2018 when Marilyn left, that the state took some of it to pay for other things in the budget.
This is truly mind blowing. I mean, get a CPA with their eye on the ball, and this is the difference that is possible to be made in a state health plan. It also just needs to be said that this same state plan, the one that was going bankrupt, clearly had seen over a hundred million dollars of taxpayer money, exit stage left and wind up in the bank account of their vendors.
Now might be a good time to mention something that Chris Deacon wrote about the Federal Employees Health Benefits Program. This is a $55 billion program, once again funded by taxpayers as per an OIG audit, there is no written policies or procedures over approval and payment of funds to the carriers via ACH.
Wait, what? This is just one example along with a whole lot of other things that kind of make you go, Hmm. Can a CPA with a spreadsheet please get in there and do your thing.
Strategies for Financial Turnaround
[00:05:00] Stacey Richter: In the conversation that follows, I ask Marilyn to tell me what she did in roughly three short years to do her thing and save the state of Montana over a hundred million dollars while improving benefits of the state workers.
And she tells me, short version, she created a why. That's Step 1. Step 2, she looked at her spreadsheets and quantified the situation. She was able to identify a few big hairy problems, which she then hit fast and hard with solutions.
This is gonna accomplish a couple of things if you do this, find a solution for a big enough problem. First, it creates a quick win and quick wins are needed to get some momentum to get started. Second, she knew that by solving big hairy problems, the solutions would have an outsized impact given the scope of these original problems. This is kind of strategy 101.
And then Step 3, she dug in on assembling the right team with the right skills to make it through what amounts to a change management process, I'm gonna say.
What did Marilyn not do in those three years? She did not get captivated or sidetracked by any, I'm gonna call it transformational theater. Which is not easy because a lot of transformation theater has more glitter than a Las Vegas show and is really hard to look away from. It's as magical as most magical thinking.
Also, Marilyn stayed the course in the face of what I am sure were many opportunities for personal gain that would have not been a win-win for the state of Montana or its employees.
My name is Stacey Richter, and this episode is sponsored by Payerset and Aventria Health Group.
Marilyn Bartlett, welcome to your Relentless Health Value.
[00:07:05] Marilyn Bartlett: It's really great to be here Stacey. Really appreciate your invitation.
[00:07:09] Stacey Richter: Here you are happily eyeing up your retirement. You had the State of Montana employee health plan, $9 million in the hole effectively. What was it about the circumstance that gave you the confidence that you could fix this?
[00:07:27] Marilyn Bartlett: I immediately went to the website because the plan used to post their financial statements. I immediately dug into the data and I saw a lot of opportunity.
[00:07:39] Stacey Richter: As you were scanning those financial documents, what were just the things that jumped out at you?
[00:07:44] Marilyn Bartlett: The medical trend was out of line. Numerous point solutions, numerous little add-on vendors that I knew could be some quick hits. The pharmacy benefit. It was not a transparent pass through. I could look at the amount of rebates coming back compared to what they should be.
So there were a lot of metrics I was familiar with and I saw a lot of opportunity because the health plan was not meeting those metrics.
[00:08:15] Stacey Richter: You followed the dollar and when you followed that dollar just based on patterns you'd seen in the past, you're like, there's a lot of waste here that the taxpayers of Montana are currently funding.
And you know, those dollars are now not going to the state employees as intended. They are going to other parties.
[00:08:34] Marilyn Bartlett: That is well said. The state asked me to come for an interview. I prepared my analysis and some quick fixes, some longer term fixes, some novel ideas. I also knew that since it was the largest self-funded plan in the state and it also had government money in it, but that was going to give me some bigger leverage to make some changes needed.
[00:08:59] Stacey Richter: So you also realized that by taking this position, you would actually have enough power to affect the rates and the rights. And now I'm quoting Cora Opsahl who often talks about like you have to have amassed enough power in the marketplace to be able to pull certain things off that you might wanna pull off.
So you also made that assessment right up front. So you're like, let's do this thing.
[00:09:24] Marilyn Bartlett: Is exactly what happened.
[00:09:25] Stacey Richter: I definitely wanna dig into some of the quick stuff before we get into the longer terms, but before we even do that, and I guess massive spoiler alert here, but when you left, when you resigned your post, what had you achieved?
[00:09:41] Marilyn Bartlett: We started our efforts in early 2015 with that projection net reserves at minus 9 million, and by 2017 our reserves were 112 million to the good.
[00:09:53] Stacey Richter: Wait, wait, so you went from negative 9 million in the hole?
[00:09:58] Marilyn Bartlett: Yes.
[00:09:59] Stacey Richter: To 112 million in the black.
[00:10:02] Marilyn Bartlett: Yes, we did.
[00:10:03] Stacey Richter: What you're saying is just striking in about 10 ways. So I'm gonna attempt to contain myself and actually say one or two things cogently.
It's not like anything was fundamentally different from 2014 or 2015 when you began until 2017. Right. Like you could probably very credibly look back on 2015 and say that taxpayer funds being wastefully spent. You have all of this taxpayer money that it's probably going to for-profit entities or even not-for-profits, but basically that is not being used for the stated purpose, which is to take care of the state of Montana employees.
There's just millions and millions of dollars that are being wasted.
[00:10:49] Marilyn Bartlett: You're absolutely right, and our goal was to enhance benefits and still the employees have not had any premium increases since 2015.
[00:11:01] Stacey Richter: Let's talk about how you went about this. You had mentioned that there was a couple of quick wins and you also said medical trend, which I know is harder to tackle. And then you also said PBM rebates. So let's start with the fast stuff.
Quick Wins and Initial Steps
[00:11:12] Stacey Richter: What were those quick wins that you were just like, let's just take care of this, you know, this week?
[00:11:17] Marilyn Bartlett: And that's exactly kind of what happened. I immediately dug into the contracts and looked at the spend versus the results.
We had five wellness programs. I immediately terminated four of them. But we coordinated it with the members. So we did that really quick and that saved 5.5 million right off the top.
We analyzed it closely and reached out to the members. It went really smoothly. So that was a quick hit that we got rid of back.
The other thing I did was take in looking at the contracts was I fired the consulting firm we had. We were not getting the benefit for what we were paying. I also realigned a lot of things the staff was doing. We were overstaffed.
[00:12:04] Stacey Richter: And I could see that the stuff that you're just talking about when you see it in hindsight. It’s like, obviously we would not have, I mean, who would have five wellness vendors. It's just the chances of them not being overlapped and redundant in some ways is just, it feels very slim.
I will ask you this question though, as you were doing this, how could you have been so confident that you weren't in some way diminishing access to care? Montana is a large state, a lot of rural.
How could you be so confident that by removing some of these point solutions that you weren't accidentally diminishing access or quality of care?
[00:12:44] Marilyn Bartlett: What we found out was not many members were utilizing the services at all. Now one product was fully insured with a carrier for behavioral health and they would not provide us any of the information.
So we didn't know what members were using it. We just knew the fees that we were paying. So we were able to do mass mail to the employees and say, if you're using these services, could you please contact the health center or a nurse we had on staff, and they were able to help transition 'em and we didn't have one single fallout from that.
[00:13:21] Stacey Richter: First of all, you did a comprehensive analysis just where are we?
You followed the dollar. You figured out where a bunch of the dollars were going, perhaps wastefully, and then honed in on those opportunities as your quick wins. And anybody that has had anything to do with any sort of change management approach knows that that's how you start a change management approach.
In addition to figuring out what the why is and making sure that that is clear and communicated, and I think the why in this case, just, you know, the fund is gonna go bankrupt is pretty sufficient.
So yeah, identify the problem. You follow the dollar, you figure out exactly what the plan of action is gonna be here and what the quick wins are.
Then you vetted that solution. And you're doing that by actually communicating with members and working with them to ensure that there is no diminishment of access or quality. And they can largely tell you, I mean, it's easy enough if no one's actually leveraging the services for effectively nobody but the ones that are using those services, they know.
I mean, and probably a no other space of anybody's corporate discipline, would you go and ask the vendor how they're doing like you would go ask your employees. It's interesting how you vetted the solution as your third step. And then you had the power to put what you wanted in place.
[00:14:41] Marilyn Bartlett: Exactly. And it worked really well.
[00:14:43] Stacey Richter: So those, those I think are good examples of the quick stuff where the state was in complete control. You had the contract, you didn't need anybody else's cooperation.
Controlling Medical Spend
[00:14:51] Stacey Richter: You also mentioned medical trend was a little bit outta control here. So I know this is a very long story that has lots of, uh, twists and turns, but what was the plan there to control medical spend?
[00:15:06] Marilyn Bartlett: I think as a CPA, one of the things I did was what we call a split variance.
Was the trend based on utilization? Was it based on price? Most overall, it was price. I got information from the actuary to find out where our plan spend was. 43% of it were the Montana hospitals, about 20% was the pharmacy benefit. So I knew if I could hit those two areas, we would get the savings we needed.
[00:15:38] Stacey Richter: Total medical cost to a plan is gonna be volume times price. You did the assessment to determine like, is medical trend rising because all of a sudden our plan members are getting tons more services and what you determined was no, that's not the case. It's actually prices have gone up. And as you just said, medical costs are 43% of the plan. So that is a very relevant place to start.
[00:16:06] Marilyn Bartlett: I think so too. And that was 43% were just the Montana hospitals, but we had 48 critical access hospitals and 11 acute care hospitals. We looked at the acute care hospitals first because they were 87% of that 43% chunk. So if we could get those costs down, we knew that that would help.
That was our big effort. We compared what our claims runs were for those hospitals as a multiple of Medicare. Plus we were headed towards no longer basing reimbursement as a discount off of a charge master, and both of those being secret and can change at any time. To doing a cost plus. Now, that's an accountant for you. We like cost plus, so I wanted to do Medicare plus.
We did that analysis. We saw where the hospitals came out, and at the same time I was digging into the Medicare cost reports, the nine nineties, the audited financial statements, doing organizational charts, and developed the very beginnings of what is now the NASHP hospital cost tool to know what that hospital would need from me to break even.
We decided our approach with the hospitals would be data driven. We would have the data, we would share it with the hospitals, but we'd keep it to data driven. We terminated our contract with the carrier TPA we had. We did an RFP. We said exactly what we wanted, but then we left it open. If you have other ideas or a different approach, you can talk about that too.
And it was interesting because we had only, well, we had nine respondents and only one that they would do what we wanted.
[00:17:55] Stacey Richter: I just wanna point out that we do have a show coming up with Claire Brockbank, who digs in deep on how to do an RFP and shares a lot of the same kinds of thinking. So if you're really interested in RFPing, then please do listen to that show. It's, it's coming up in a couple of weeks.
I think the interesting thing that you're saying here, Marilyn, is you started out your hospital initiative by figuring out what you wanted the plan to look like, like what your whole strategy was. Like, you figured that out.
And then the next part is, you know what, I have to have a TPA, an ASO who's willing to work with me. You didn't just immediately go talk to hospitals. There was an intermediate step where you went and found your TPA partner as your first foray?
[00:18:41] Marilyn Bartlett: Well, we knew that we didn't have the negotiation skills that might be needed. So the TPA that we chose definitely had their provider relations department and we're on board with our strategy and could help us with the contracting because we ended up with separate contracts for each hospital and then some ambulatory surgery centers.
So we relied on their expertise. Once we had it we went to two of the facilities. We did not want to do price setting. I had a legislature that was very adamant. They did not want price caps and they did not want price setting. So we were doing individual contracts for no balance billing. And each contract was different with the rates, but the process was the same on every single one of 'em.
So everything would be billed at a multiple of Medicare. They were capped as far as increases, which were dependent upon the Medicare payment increase or CPI, whichever was the lowest for medical. We wanted it across the board, including the infusion drugs in patient outpatient. We wanted it across the board because we don't want to just carve out one little bundle and see the prices go up in other services.
We then started negotiating and we went to two hospitals that were already in that range. They were kind of called out as the efficient hospitals. And we started working with them. Both of those agreed to do it. One in Billings, a large city that has another hospital and one in Missoula, a large city that has another hospital. And once they signed on, we were able to then get some momentum started.
[00:20:28] Stacey Richter: I just wanna stress again that if we're thinking about how do you roll out a program and do the change management, which is required, we talked about quick wins in the context of just the whole program writ large, meaning let's find some quick wins to save money and just roll those out because we can do that quickly, which gains us momentum.
This is kind of another version of that. Alright, so for our let's save hospitals medical trend, which is 43% of our whole plan. Let's get a quick win by working with the hospitals that we know are probably gonna be amenable to working with us. And then as you said it, again, this gives momentum. We can say that we've succeeded, you know, so for any doubters that are in the vicinity, we can be like, look, this works. Don't say that it can't work with the hospital because we're already showing that it can.
I know this whole getting the hospitals on board is a very, very long story, which is fraught on a number of different levels because at the same time that you're lobbying to get a cost plus, you know, get a percentage over Medicare, they are coming in saying that they can't possibly do this, and also they're a major employer, so therefore they have their own power base and leverage.
Just really at the top level, Marilyn, is there any just kind of summary, word of wisdom that you might have for somebody who is trying, who might be in the middle of the whole, I need to work with hospitals and they have zero interest working with me.
Building the Right Team
[00:22:00] Marilyn Bartlett: Right up front once the idea was conceived and when I started assessing, I knew I needed to pull the right team together and I would need support. So we worked with the governor and real key to this was the budget director. So I liken that to a CEO and a CFO of the corporation. The director of administration, who was my oversight, totally on board. We brought in the union leadership because we needed their in support selling this to employees.
We also, I was required to report to the legislative finance committee quarterly while I was putting this in place and update them. So there were a couple of members of that body that we included in our group to really get the right team together.
So when I look at the right team, I think that I needed that support. And I'm sure every benefit administrator out there in HR person would probably echo what I said because I knew we were gonna be lobbied heavily and the governor would be lobbied, the budget director would, the legislature would. And I needed a support team to carry our message and have our back and help us.
And then the second thing I did was I knew that we needed vendors that were on our team. We needed vendors that were clearly loyal to us. So I did fire the TPA and we hired the one that agreed to work with us. I fired the PBM. And we found a good transparent pass through that would work for us, and then a new consultant company.
[00:23:45] Stacey Richter: Okay. So I think you just said something that was really powerful there. I said to you, you know, like, what is the one thing. What is the one really big piece of advice, word of wisdom that you might have for somebody who is trying to work with hospitals? And you said, get the right team around you. You ticked through who is so necessary to be on this team.
And if I was gonna sum it up, I would say you have to have, again, it's kind of this whole power thing. You have to have people that you know you need to support you, otherwise you're gonna get undermined and you've said the governor and, and important government people, which could be likened in the private sector to the CEO and CFO.
So you have to make sure that you're thinking through right, like, who do I need to have on my team? Because if they're on the other team, it's gonna be a problem. What you're saying, has a lot of really important lessons. You gotta set up the why. You gotta understand what your problem is. You gotta follow the dollar, you gotta do some quick wins.
But the one ring to rule them all, I guess, is get the right people around. And I might also just add to that people with a really strong sense of why, spines of steel, a lot of conviction because as you're kind of alluding to, you're getting hit from all directions with why we can't do this and just status quo, and there's money that's involved here.
So there's every dirty trick in the book that's getting tossed at you. So it does take a really strong conviction. And an ability to march through the maelstrom of attacks.
[00:25:21] Marilyn Bartlett: That's exactly right. And the other thing we did was when we had this right team together, we looked at where we may be needing some help.
And I think, you know, my strength is as an accountant and loving to reviewand do contracts, RFPs, follow the money, we knew that we needed help on the benefit side. The clinical side too. And I didn't have that on the staff at the time, nor did were any of the connections really viable to change, and so we hired on a consulting basis, a retired primary care doctor in Helena who really knew Montana, a new primary care, and knew the health side of it.
We also hired a communications consultant. We needed somebody that could help us and really support us through the change management process. Communication with employees, the media, and help guide us in that. And then I also hired an independent pharmacist as a consultant in Montana to help me understand a little bit better about the retail pharmacy side and the member impact.
So we rounded out our team with some of the, you know, specialty areas that we knew were missing within our key team. I think that was all very, very necessary.
[00:26:49] Stacey Richter: What I really like about talking to you, Marilyn, you're showing what the roadmap needs to be, which is inclusive of this right team and who should be on that team, making sure you have all those bases covered and, and real experts, because some of the attacks are going to be, well, do you know this to be true and, and try to undermine.
So recognizing that that is gonna happen, just put together the right team of your own experts. There is a playbook here. This can be successful.
[00:27:17] Marilyn Bartlett: I think you're right. And another thing is we did it quickly when you think of it. Because we really started this in 2015 and by, you know, by the time I left in July of 2018, we had reference based contracts in place with all of the hospitals we had moved to, uh, transparent pass through PBM.
I had kicked CVS out of the network because they would not match the pricing we needed. We got rid of those duplicate contracts, we enhanced our onsite clinics, and even, this was probably even bigger challenge was I wanted off of the state ERP system. It was big and archaic. We moved to a cloud-based benefit enrollment and administrative system, and that saved 1.5 million annually. I wanted the plan to always have access to their data.
Pharmacy Benefits and Final Thoughts
[00:28:14] Stacey Richter: So we don't really have time to talk about the stuff that you did on the pharmacy side of the house, but it does mirror, we have had guests on the show, like, Paul Holmes, we had Mark Cuban talking. We have had, I can put in the show notes, a list of shows that have been about curtailing and controlling pharmacy spend and, and as you said, that was also a whole initiative because it was 20%, what did you say? It was 23% of your overall spend?
[00:28:41] Marilyn Bartlett: It was about 20%. And when we were done, we realized that we had saved 23%.
[00:28:47] Stacey Richter: By all measures this was really successful. And I just wanna restate that you started out nine mil in the hole. You wound up with 112 million in excess with no diminishment of benefits to plan members. That is what is possible here. Like you, you think about how much money was sloshing around not going to its intended purpose.
So you can see why with the class action lawsuits and stuff, it's just, that is a lot of money. So you left, you go. And what happens?
[00:29:25] Marilyn Bartlett: Not to bore our group here, but there is a risk-based capital measure. It basically says, do you have enough reserves? The magic number for the state is you are doing really well if you can have 300%.
When I took over, the plan was well below that, but when I left it was at 822%. So we were very, very well funded. Now, when I left in 2018, I left behind the next steps for reference-based pricing, which were to go work with the hospitals. We knew there were some issues, we wanted lower rates. Possibly some shared savings, some different ideas.
When I look at what happened was my successors did not follow through with those particular plans. And they also changed the transparent pass through clinic model, which automatically cost 2 million more a year. They also started adding more point solutions back.
Even with that additional spending that went on after I left the reference-based pricing, the pharmacy, all those things we put in place, were holding that number down. But then I do notice that in 2021, the plan was still overfunded. So the, that RBC number again when I left was 822, but it was 669, so double what it needed to be.
So the plan was doing very well, very well funded. But in 2021, I think the direction came from the administration and governor's office to change the whole plan. They went ahead and did an RFP and ended up through challenges and stuff. They did end up moving to more of a traditional plan with a large carrier.
Most reference-based pricing contracts are gone. But luckily the pharmacy benefits still does well and some of the other items that we did put in.
[00:31:28] Stacey Richter: Do you have any insight into the cost of the plan? Did it go up?
[00:31:32] Marilyn Bartlett: Yeah, the costs have gone up, but they have not been public with the information. I don't have anything since December 2022. There was messaging going out that the plan was about to go broke, but that was proven incorrect. So I'm not really sure how the plan has done since then.
The contract that they are in that I have reviewed is a pretty much standard carrier plan. The first effort they put in place was to do a retroactive review of claims, so they would get to the end of the year and look back and reprice sampling of claims to make sure they had hit targets of a multiple of Medicare.
I personally don't like that approach because I think it's the member that suffers because when you do have those contracts in place, any member out of pocket through coinsurance or deductibles, is based on whatever that contracted rate is. Versus when you do a retroactive look, the plan may receive a little bit of money back in their admin fees.
So, I don't know how that analysis came out. That's not been made public either.
Conclusion and Inspirational Message
[00:32:39] Stacey Richter: Marilyn Bartlett, is there anything that you kind of wanna say in summary here and just to kind of recap, we talked about like what's starting out at the very beginning, making sure the wise is established using the fundamentals of change management, which, you know, sometimes I say the fastest way home is the long way around, right?
Like you, you have to do all of these things because failing to consider what the strategy is here and making sure we've got the right team. Getting some quick wins, talking to members, doing the communication right, making sure that the quality of care isn't being diminished at the same time. You kind of gotta get through all of these different steps. But Marilyn, you have a huge presence and the amount of inspiration I think that you have given over the years that you've been involved doing these kinds of things is, substantial.
What do you just wanna say to the Relentless tribe?
[00:33:28] Marilyn Bartlett: Well, thank you for your kind words. I would want to say to plan administrators, their leadership, you can do this. And actually, we had fun. We knew we were going to get hit, we were going to get slammed. I was going to be called names and things written about me, but we did it.
We knew our focus was the right thing. How can we get that money out of the middlemen, out of the system? And how can we get it back? Because the intermediaries, the TPAs, insurance companies aren't the payers. It's that employer, taxpayer and member. And we knew that we could get it back.
And you know, one of the neatest things about it was just before I left, the union gave me an award and thanked, and so many people at that union function said, I didn't know the health plan changed. I just know I have great benefits. So that was the best, best compliment, is that what we were able to do was make great system changes and not impact the members, but help them.
You can do it. You really can do it. And I think a team of the, the leadership, the HR, the benefits plan, you can do it.
[00:34:43] Stacey Richter: That is probably the perfect way to end on that very inspiring note. Marilyn Bartlett, thank you so much for being on Relentless Health Value today.
[00:34:51] Marilyn Bartlett: Thank you.