[00:00:00] Stacey Richter: Episode 403, the mix and match with the how doctors get paid. Today I am speaking with Rachel Reid, MD MS.
[00:00:27] Stacey Richter: This is a conversation about physician compensation, which is often oddly misaligned from the way that the whole physician or provider organization is getting paid. Now, first thing to point out, there are lots of different kinds of physicians doing all kinds of different things.
As with most everything in healthcare, lumping everybody together and making general proclamations about what is best is a really cruddy idea. With that disclaimer, if you think about the main models of physician compensation, there are two, and this is oversimplified, but let's call one fee first service, which is really getting paid for generating RVUs relative value units.
In short, getting paid for volume. The more you do, especially the more expensive things you do, the more you get paid. And then we have getting some kind of capitation payment. A capitated payment is some kind of per member, per month-ish flat payment to ideally keep patients healthy and you will make the most money if you can figure out how to have the least volume of expensive stuff.
As an individual doc, getting a salary to care for a patient panel of a certain size, let's just consider commensurate with that. These incentive models obviously have a big impact on any given doctor's ability to get paid to do things that they think they should be doing. For example, the current fee-for-service RVU fee schedule frequently rewards those doing the stuff.
A lot of specialists do much more. Then those doing primarily cognitive work, including those doing work for patients who aren't sitting in the exam room at the time, like a PCP arranging for a patient to go to hospice or answering patient portal questions. In my opinion, the goal here should be to pay docs and others fairly for providing high value care.
These payments also should actually be proven to actually incent that high value care. Here's the obvious problem. Neither of these two things, either the quantifiable definition of high value care and or the best way to pay for it, has any kind of canon. There are no rules which are considered to be particularly authoritative and definitive here really.
So what is the downside of not aligning physician compensation models to what good looks like, meaning to the kind of care that patients really need in that particular community? A couple of downsides for you. One is moral injury. Not the only reason, but a reason for moral injury is getting paid in misalignment with what is best for patients.
That sucks. You wanna help your patients as best you can, and then you can't earn a living and or you get in trouble with the boss if you do what you think is right. This can cause real mental anguish for especially PCPs, but also others who see the need to do anything that doesn't have a billing code.
Here's another downside to not worrying about physician compensation, and it's for plan sponsors, employers, maybe who are trying to get integrated care or a medical home for their employees. I was talking to Katie Lento about this. She was telling me that in ASO contracts there are often line items for value-based care and for capitated payments.
So good news. Well, let's follow the dollar here because we wind up with a disconnect that doesn't help patients, but certainly can earn a nice little kitty for those who can get away with it. Here's where that dollar goes. This VBC value-based care or capitated payment, kitty may go to a health system that the ASO says is to be a medical home for employees or plan members.
But the PCPs mainly who are treating members in those medical homes are getting paid. It often turns out fee-for-service with maybe some quality kickers. So the plan is paying a value-based care payment, but the PCPs are getting paid. FFS Is anyone shocked when the members report that they don't actually feel like they're getting integrated care?
That they're getting rushed in and out? Because maximizing throughput becomes a thing when you're getting paid for volume. Dan O'Neill also talks about this at length in episode 3, 5 9 because IPA's independent physician associations are doing kind of the same thing, getting so-called value-based care contracts with MA plans, Medicare Advantage Plans or CMS or employer groups, I'd imagine, and then paying all the individual practices or the solo practitioners fee-for-service and scooping up the excess payments themselves.
Stocks manage to provide high enough quality care that the contract holder can scoop up the profit off the capitation without actually having to share the capitation to achieve this high enough quality care. Today I am digging into all of this physician compensation BHU with Rachel Reid, MDMS. She was an author on a study at the Center of Excellence in Healthcare Performance at Rands.
This study specifically set out to look at how health systems and provider organizations pos affiliated with those health systems incentivize and compensate the physicians who work there. Short version. Yeah, it's confirmed. Most docs are paid using the classic RVU productivity measures, representing a big chunk of their compensation.
Even PCPs, there's frequently some kickers or extra payments to achieve some kind of quality metric, but this is the icing, not the cake. The cake is still very fee-for-service E. This is true regardless of how the physician organization, the provider organizations themselves are getting paid by payers.
I asked Dr. Rachel Reid a bunch of questions about this, but one of them was, this seems weird, a weird misalignment. Why is this happening? And Dr. Reid listed out five reasons beyond the macro existential question of what is value and do we even know how to change human behavior to get it? See the show notes for these five reasons listed.
I then also asked Dr. Reid what could be done by plan sponsors, for example, to pay docs in alignment with the goals of the contract. And she said, well write physician comp expectations into the contract. Something to think about. We dig into all of this today, shows that you should for sure listen to for additional insights include the one with Dan O'Neill as aforementioned.
Also the show with Brian Klepper, where we dig into how the ruck is behind some of these FFS rates. My guest today is Rachel Reid, MDMS. She is a physician policy researcher at Rands Corporation and a primary care physician at Brigham and Women's Hospital. My name is Stacey Richter. This podcast is sponsored by Aventria Health Group, Rachel Reid, MDMS.
Welcome to Relentless Health Value.
[00:07:12] Dr. Rachel Reid: Thanks so much for having me. Excited to be here.
[00:07:14] Stacey Richter: You recently did a study. You were working with health systems and pos, which stands for physician organizations that are associated with those health systems. You were looking into how are the doctors themselves being compensated and incentivized, which is different from the health system And the physician organization, how they might be being compensated.
IE, they could be being paid, value-based care, something or other. What you wanted to see is the doctors themselves, like where was their bread buttered.
[00:07:44] Dr. Rachel Reid: Exactly. Yeah. I feel like there's a lot of conversation about that first interaction between payers or insurers And the physician organization or the health system, what those payment arrangements look like.
But then once that compensation's in the door at the health system or the PO. How the pos pay their doctors, their frontline doctors who are actually delivering healthcare, putting the orders and writing the prescriptions, doing the procedures. That could be completely different from that first interaction.
[00:08:11] Stacey Richter: Which seems to me like it could be a pretty solid disconnect because the whole point of value-based payments is to incent value-based care IE change behavior at, you would assume the physician level question mark, right? Because like how are you supposed to achieve value-based care and everything that's inherent in that if you're not changing behavior at the point of care? It was that like one reason why you decided to do the study in the first place.
[00:08:42] Dr. Rachel Reid: You're absolutely hitting it. If the motivator behind value-based payment is to change care delivery, then we gotta look at the people who are delivering care and what of it they see. But certainly there are other ways at the organization level that value-based payment may be marshaled brought to bear.
But it felt like a central connection would be okay. How much of this is actually trickling down to the frontline docs.
[00:09:06] Stacey Richter: And how much of it is actually trickling down to the frontline docs?
[00:09:09] Dr. Rachel Reid: What we found in these, and these were again, large health system associated physician organizations, so well resourced large organizations.
Among those that we studied, we found that the vast majority of docs, both primary care and specialists, really had productivity, or that classic RVU representing a big chunk of their compensation. It represented. Well over half of compensation. So to put it into concrete numbers, about 84% of the comp models for primary care docs and 93% of the comp models for specialists included productivity or RVUs.
And when it was there, it represented 68% of compensation for primary care docs and 74% for specialists. So. On net productivity volume, our views, those are still the main foundation of how frontline docs are paid even in these large, well-resourced health system affiliated physician organizations.
[00:10:02] Stacey Richter: Eight out of 10, more than eight out of 10 PCPs working for the organizations that you studied, have still an FFS.
Component, a fee-for-service component in their comp model. And when it's there, it's the majority of their compensation and nine outta 10 specialists. So basically they still are being paid for volume for the most part, with some quality value-based care icing on the cake. That's how I'm taking it.
[00:10:32] Dr. Rachel Reid: That is absolutely how you should take it in that quality, value-based care.
We found that that icing, if you will, was indeed there the vast majority of the time, but when it was there, it averaged less than 10% of comp for both primary care docs and specialists. So it is indeed icing as opposed to the cake itself.
[00:10:49] Stacey Richter: And what impact does that have?
[00:10:51] Dr. Rachel Reid: I think the core impact is that at the foundation of how physicians are paid and ergo structures in clinics and health systems is all still predicated on that volume, still predicated on.
Turning in counters or procedures or billable codes, because that's the core of how physicians are compensated and it's how you pay people is a signal of what's important and what you're trying to prioritize, right?
[00:11:15] Stacey Richter: So if you're paying for volume, then as we all know, you tend to get volume. And even more impactful, really, you're stating to the physician what's important to the organization.
And it sounds like what remains important to organizations who don't change necessarily their comp model to doctors is that they should be worried about through. They should be making sure they're doing jammy time and putting codes in the computer.
[00:11:43] Dr. Rachel Reid: That infamous pajama time.
[00:11:45] Stacey Richter: Yeah. One of the pushbacks that I've heard here is that maybe physicians, PCP specialists, let's just say everybody.
Should be paid for throughput because other people on the team are compensated in different ways. So like maybe there's a pop health person who is compensated much more on salary, or they have maybe quality is a much bigger portion of their compensation. So like you want the doctors to be worried about throughput because somebody else is worried about quality.
The, I know that wasn't necessarily part of your study, but how would you react?
[00:12:19] Dr. Rachel Reid: I would react that it probably depends. It depends on the physician, it depends on the specialist, and it depends kind of on what our goals are for physicians. So when we are taught about compensation, it, we are, we're taught, the classic trade off is between capitation and fee-for-service, right.
Where in capitation your inherit incentives are to bring the capitation in and then do as few encounters as possible. It's the opposite for fee-for-service where you wanna churn as many visits as possible. Both of those would maximize your revenue per effort. It's a fundamental question, and this is me pivoting to my primary care doctor hat as somebody who's in a cognitive specialty.
That's. Not currently necessarily well captured by the resource-based relative value system, right? It currently doesn't measure a whole lot of the non visit based work that I'm already doing in an uncompensated way. Is my biggest value add when I'm in the room churning patients or is it when I'm calling to arrange hospice for a patient?
Or is it when I'm coordinating with the pharmacist And the population health person is, and I think it's probably different for different specialties, what that might look like, whereas. Procedural specialty, maybe it's a different balance because the value is indeed more procedurally oriented. So I think it, it might vary
[00:13:33] Stacey Richter: if you ask an average PCP, what you'll hear over and over again is, I wish I had more time with my patients.
[00:13:41] Dr. Rachel Reid: Well, and I would say that like certain functions of population management are easier to own at the organization level. Like me as an individual doc, if I went out there and hung up a shingle, could I hire a pharmacist to collaborate with on blood pressure and diabetes management? Could I support a whole population health person to run my panel?
Could I. Bring in the support that I needed to do. Embedded behavioral health. Know that all comes with the benefit of scale, of being a part of a larger organization and system. And indeed, some of those kind of dollars or resources that come from value-based payment to support that architecture, very important.
But also like the physicians a part of that or architecture, we're part of the mortar that helps hold those bricks in place.
[00:14:22] Stacey Richter: So then why? If you have a environment that fosters volume and yet you're trying to be providing value, there's kind of a fundamental disconnect. Why though? Like why wouldn't a health system or physician organization pivot and change their comp models?
[00:14:37] Dr. Rachel Reid: I would say the first key reason is when we talk about value-based payment, that first interaction between the insurer And the payer And the health system. A couple of things about that to keep in mind. One is that a lot of times we count that a covered LI life at an organization is a part of a value-based contract.
We're not talking about the strength of that value-based contract necessarily. What proportion of the dollars that are paid for that person is for value. Just that it, it's, yes, no. Is it or is it not? So, so one is that kind of a lot of times like the, the amount of actual dollars that flow in isn't very high, even though value-based covered lives have been growing over time.
So that's one thing about that interaction. The other thing about that interaction, again between payer and health system or PO, is that a lot of those value-based contract. Are still built on that underlying fee-for-service architecture, like that's that or that fee-for-service chassis. So it'll be pay for performance with a bonus or withhold sitting on top of baseline fee-for-service payment, or an adjustment to a subsequent year's fee-for-service rate.
Or it might be a shared savings based on fee-for-service, or it might be a bundled payment arrangement that's calculated based on fee-for-service. So fee-for-service still underlies a lot of the value based payment that we are doing. So those two things, both the strength of the incentive that the organization faces, and indeed the fact that fee-for-service is still part and parcel of a lot of what we're doing in value-based care are that first step at the organization level.
Within the organization itself, there are a few different things that are probably at play. One is that just like inertia, right? We've been doing it this way since R-V-R-B-S rolled out in 1992. Like it takes time to both change contracting with physicians to bring people along, changing compensation for a population of people that you've been paying one way.
Maybe with some tinker around the edges or the icing, as you mentioned earlier, changing the underlying cake recipe and maybe even changing that cake to a pie. That's a big deal. Hard institutionally to do. Physicians are, we're hard to manage where it's difficult, and so I think that is a real challenge for organizations.
Other things are true too, though. One is that sometimes like these. There's a whole conversation around whether individual level, like pay for performance, those bonus type incentives actually change physician behavior in a durable way. There's some question is to, does the icing even work? And some people are reluctant to do more than ice the cake with it.
If. It's not clear that the icing is doing what we want it to in the first place. So do pay for performance incentives really perform the way that we want them to, and should we change the whole comp model if we don't a hundred percent know, know what we're getting into? I think it's a scary transition for people to make.
And then for a lot of different physicians, it can be hard to measure. What is value? What is quality? What is performance? And that's underlying some of the criticisms around MITs, how hard it is to find applicable high quality, well validated measures for a lot of the specialists too.
[00:17:34] Stacey Richter: In your list. The first category is what actually is the incentive?
Coming from the payer that this is for reals, and is that signal strong enough or is the payment big enough that it actually, like, is the juice worth the squeeze if you're a physician organization here, like the upside's not big enough. The downside's not low enough to actually try very.
[00:18:00] Dr. Rachel Reid: Absolutely. And if you talk to health systems or you talk to POS about their balance sheets, a lot of times they'll say, no, the dollars aren't there right now.
There go. Physicians are still compensated the same way and we're not seeing changes.
[00:18:12] Stacey Richter: And as you said, if it still has, this was your number two, this fee-for-service chassis. Which still gives plenty of upside for a physician organization who is so inclined to, and I've heard this term used multiple times, milk the system until we can't anymore, right?
There's still a upside of cranking volume. That's one and two in your list, which is the, the strength of the signal might not be huge in that there's still this fee-for-service chassis anyway, so question mark. Really what is possible to be gained by going through this gigantic endeavor to change comp, which leads us to your three, four, and five in your list, which has to do with actually how difficult it is to change comp models, and that's not just.
Healthcare comp models. There's a whole cottage industry around comp models because they're difficult, but you're dealing with human nature and what you're gonna incense, And if you do it wrong, you can lose a lot of money and not necessarily gain a whole lot. So there's risk here. Inertia was your number four, but then number five, like, okay, we know what we wanna move from, but still it's a little indeterminate.
What. Good looks like relative to compensating for value, and it might be because as you said, there's no great model for pay for performance, but then also there's this underlying question, what is value? Which cannot be probably stressed enough, like we still haven't necessarily come to any sort of consensus for how to define value, and therefore, if we're trying to pay doctors to deliver this amorphous blob.
Especially when their comp is dependent on it. I could see how that certainly becomes an issue.
[00:19:56] Dr. Rachel Reid: And I think we're at a moment of evolution where there was the moment we started measuring quality and you don't know what you've got until you measure it and understanding, oh my gosh, there are gaps. We're not doing that great as important.
And I think it's like we're still at that first and second order thinking where we're like, okay, we see quality gaps. Well, let's pay for that. The dollars are very directly linked to the gaps. But I think what we've been seeing since the early pay for performance studies is that tying dollars to measured quality gaps doesn't necessarily produce results or produce results that you expect or produce results that are durable.
When you kind of take that incentive away and move it to something else, I, I think there are parallels to education, right? Teaching for the test. Maybe doesn't produce durable knowledge. I think we're learning from this whole path, but it's playing out over a long time.
[00:20:40] Stacey Richter: Yeah, and I think what you're referring to there and anyone who's interested should go back and listen to the show with Rebecca Etz.
But to your exact point, sometimes when you pick these quality measures, people will focus a lot of attention on just that one thing, and then forget the larger context. And it might be the larger context, which is actually the most important. Part of this. So you improve this measure, but you don't necessarily improve health.
Is that the, what you're kind of saying?
[00:21:06] Dr. Rachel Reid: There's both the individual physician and you're also talking about maybe we have to support organizations in different ways to achieve those quality goals. My hope is that as patient reported, outcome measures grow and hopefully become less burdensome to collect over time and easier to do in a way that kind of serves diverse populations.
That we can get to some of that, what actually matters to the patient in terms of defining value. Defining quality.
[00:21:31] Stacey Richter: So I'm definitely getting the number five on your original list, which was okay. Well we know that potentially paying for fee-for-service is not optimal here, but like. In the absence of knowing what might be better, we should just stick with the devil that we know.
Or do you have any thoughts, like if I was just gonna ask you right now, how do you pay doctors? What is optimal? Is there any insight or any studies or has any anybody made any progress here?
[00:22:04] Dr. Rachel Reid: I don't think there's a current gold standard for how to pay doctors. I think if you ask doctors how they wanna be paid, you'll get all kinds of different opinions.
For me, I like the idea of just maybe being salaried and having a panel of patients that is of reasonable size and complexity, and being able to make the right choice for the patient at the right time without thinking about the marginal impact on like our views or our quality score. My patient who. I know just got a steroid injection in their shoulder and that's gonna throw off their A1C for the next six weeks.
But the metric tells me that they're due for it now. Right? Like et cetera. I, I think a lot of docs would probably say that, let me care for my panel of patients the way that I want to and not incent me to do one thing or another. Then I think organizations are often thinking about, well, what is the lever?
I have to influence physician behavior? And payers and insurers are thinking the dollars that flow to healthcare organizations are the lever that they have. And so you reach for the lever that is within your reach. When you have a hammer, everything looks like a nail. And I think that's the essential rub.
[00:23:06] Stacey Richter: Yeah, because what's it, Kaiser, that put everybody on salary at the very beginning and it didn't go well? From what I understand. Maybe you know a little bit about that.
[00:23:15] Dr. Rachel Reid: I don't know that situation in particular, but I, you hear anecdotes all the time about, you put everybody on salary and panels shrink and RVUs drop.
Maybe it needs to be something more nuanced with guardrails built in or. Goals. The other thing is that just because you're not incenting something doesn't mean you're not measuring and reporting something because physicians wanna know how they're doing. We're a group of people who are high achieving and maybe a little bit competitive.
I'd like to see how we're doing relative to our peers. So, but yes, I anecdotally have heard of situations. I don't know the Kaiser one in particular.
[00:23:48] Stacey Richter: What seems weird to me about this whole Fandango, frankly, knowing a lot about other organizations, not in the healthcare industry, it would be inconceivable to pay someone a salary and then be like, all right, off you go, call me in a year.
You know what I'm saying? Like as you were talking about levers, there's a lot of different levers that aren't necessarily paying people on commission, right. Basically, it's a commission. Our views, the way that everybody else does it is you have goals and you have. Maybe metrics that you're given, standards, you have a performance review where you are given feedback relative to how you're doing as compared to your peers or just relative to what you're supposed to be doing in your job.
And if you do great, then you get a raise in a promotion, or maybe you get a bonus, you get some kind of kicker or some kind of bump, right? Like there's a, there's more compensation plans than just. Pay people on commission And if you don't pay them on commission then you worry they're not going to do their job.
It just seems weird and slightly myopic. Maybe another example of where the healthcare industry, somehow or another thinks that they cannot learn from other businesses because like it feels like this is not like. The edge where we
[00:24:58] Dr. Rachel Reid: try to reinvent the wheel here every time and think we're unique. I a hundred percent agree with you that there's lots we can learn from other people, but like there's a ton that that exists in that space.
In between pure RVU, pure salary or exactly what you're talking about. There are metrics, there are goals that you're accountable for, but there's not like necessarily a discreet dollar for every metric where everything's so micro. I think part of this is probably historical where RVUs evolved at a time when healthcare organizations were a lot less consolidated than they are now.
The independent position or the small practice was much more prominent. That has changed over time.
[00:25:37] Stacey Richter: It sounds like Job one though would be to figure out what actually. We are trying to incent here.
[00:25:45] Dr. Rachel Reid: I think there is probably a lot of jobs though, right? Like job one is what are we trying to incent? Job two is what actually works to incent that and doesn't contribute to physician burnout and disillusionment because I think that has gone up a lot too.
[00:25:58] Stacey Richter: Maybe we have inertia because what's going on right now, it's working pretty well. But actually it's not. We have doctors across the country leaving practice. We have, nobody wants to be a PCP. We have just like all kinds of issues relative to the individual, the humans, themselves that are being put in these roles and part and parcel to this are a big reason why is because of these, it's not, certainly not the only reason, but we have a compensation model.
That is misaligned with what the personal missions are or what good looks like from the standpoint of these physicians. So like when that misalignment happens, you wind up with cognitive dissonance because you're like, okay, if I wanna get paid more, I need to do this. But if I actually wanna do right by my patients, then I need to do that.
[00:26:50] Dr. Rachel Reid: The other term that I've heard used more even, 'cause I said burnout before, is this like moral injury where the system wants you to do one thing And the structures want you to do one thing, but your actual mission is something else.
[00:27:00] Stacey Richter: What's your advice here? Like is there any, and I'm gonna ask you if you think about this from two perspectives, this advice that you may have.
One of them is from the physician organization standpoint itself. But then also we have on the other side of this house, like for example, employers. Like there's a lot of employers who are being told, oh, well we're gonna get your employees a medical home because we have all these value-based payment contracts.
And frankly, yeah, again, contracts exist. They're being paid value-based payments, but all the doctors are fee-for-service. So there ain't no medical home there really. Uh, when push comes to shove. So how does a physician organization itself start contemplating actually delivering the care that patients and plan sponsors would like while at the same time contending with all of the stuff that we just talked about, all these wrinkles.
[00:27:50] Dr. Rachel Reid: I think it's a challenging thing for physician organization be I, I can't envision a world where physician organization, unless you're like a staff model, HMO, where you've only got one payer for clinic where you don't have a transition period where you're trying to do some of both, like where you still are kind of servicing kind of baseline RVU stuff and fee-for-service oriented stuff while transitioning.
Towards a value-based model. I think a couple of things from the payer or the insurer perspective, their lever is their contracting with the contracted entity. So that's the tin identified physician organization or group of tins or and tin being tax id. Right? So that's who they contract with is the physician organization or the health system.
Maybe it's part of that contracting has to be that. Clause is that you have to compensate your physicians in some way that is not wholly fee-for-service. Maybe that's a part of, instead of a hundred percent quality metrics or whatnot, may maybe part of what payers and insurers have to pay attention to and write into contracts is, is how are you, is the physician organization paying the physicians?
So paying attention to that trickle down. So that's one way that that change could potentially happen from the perspective of the payer And the insurer. And then from physician organization component, I think I'm thinking about them looking in both directions, right? I'm thinking about them looking across to the payer, and I'm also thinking about them looking towards their employed physicians.
And I think. Looking for opportunities to move towards contracting that is not as fee-for-service oriented. 'cause I think that is still the default at a lot of, at a lot of payers, right? Is that things are a percent of Medicare or, or still based on rvu, kind of advocating for opportunities that are not, that from the payers of the insurers makes it easier to roll that down, change your underlying architecture.
For the frontline physicians, I think probably there are kind of hard conversations talking about what does a reasonable comp model look like? Salary goals, there's probably a lot of change management that has to happen because most docs, comp models are. Are still RVU based. Thinking about how to transition that and making sure that you have the data in place to measure what you need to measure.
Because if it's not just RVUs that you've been collecting all the time, that becomes harder too. Thinking about reporting, thinking about change management, thinking about bringing people along
[00:30:18] Stacey Richter: just in some. What you just said there is that if you're an employer or you're a plan sponsor of any kind and you hope to bring to your members value-based care, medical home, et cetera, be very aware of how, who you are signing with compensates their physicians and care teams to incent or create an environment that promotes or is friendly.
Toward value-based care or this idea of medical home, as you just said, the lever that someone writing the checks should have is what's being put in that contract. There could be language in that contract to ensure that you're gonna get what you're think you're paying for. That's your advice for plan sponsors.
But then the physician organization really has to think about this from two directions. For sure. You look up, where's the money? Coming from, and then you look down, where's the money going and how is it going to impact the quality of care And the satisfaction, et cetera, of the people that are working within the organization, IE, the physicians and other clinicians.
[00:31:29] Dr. Rachel Reid: From the payer or the insurer perspective. If you want frontline physicians to be paid differently or be paid in a way that aligns with the goals you have for your employees, your covered lives, then including contracted language about that might be the lever that you have.
[00:31:44] Stacey Richter: Dr. Rachel Reid. If someone is interested in learning more about your work, where would you direct them?
[00:31:51] Dr. Rachel Reid: If you Google. Rachel Reid Rand, you will probably come up with my bio and profile there that has some links to publications and different work that I've done.
[00:32:01] Stacey Richter: Dr. Rachel Reid, thank you so much for being on Relentless Health Value today.
[00:32:04] Dr. Rachel Reid: Thank you so much for the opportunity to talk with you about our work.
I really enjoyed it.
[00:32:08] Stacey Richter: So let's talk about going over to our website and type in your email address in the box to get the weekly email about the show that has come out. Sometimes people don't do that because they have subscribed on iTunes or Spotify and or we're friends on LinkedIn. What you get in that email is a full and unredacted unedited version of the whole introduction of the show transcribed.
There's also show notes with timestamps. Thanks so much for listening.