Leveraging Virtual Health For Addiction Recovery

Transcript

Bryce 

Welcome to Digital Health Transformers, a podcast series. This podcast will explore the dynamic world of healthcare innovation, one conversation at a time. I’m your host, Bryce Barger, and today, we have an all-inspiring guest at the forefront of transforming the healthcare landscape.

We are honored to have Amanda Wilson joining us today. Amanda is the co-founder and CEO of NorthStar Care. She leads innovative healthcare initiatives focused on scientific excellence and compassionate care delivery, which is all important.

Dr. Amanda Wilson, a leading figure in addiction treatment, established Clean Slate Centers in 2009, pioneering office-based programs for opioid addiction. Drawing from her Clean Slate experience, Dr. Wilson co-founded VulvarCare in 2017, a national telehealth solution for opioid use disorders. In 2020, Dr. Wilson established NorthStar Care to solve the challenge of limited treatment options for alcohol use disorder patients. NorthStar offers personalized care through initiative technologies such as virtual reality, telehealth, wearables, monitoring devices, and pharmacogenomics. Virtual realities, telehealth, wearable monitoring devices, and pharmacy… Oh, my heavens.

What is it one more time? It’s separate. Telehealth, wearable monitoring devices, and pharmacogenomics treatments.

Revolutionizing treatment outcomes, NorthStar Care is on a mission to revolutionize healthcare delivery through cutting-edge research initiatives and an unwavering commitment to patient well-being and satisfaction. In today’s podcast, we have the incredible opportunity to gain insight from Amanda and learn more about her remarkable journey in driving healthcare innovation. Thank you for joining us today, Amanda.

How are you today?

Amanda 

Thank you, Bryce. I’m really happy to be here, and I’m doing well. Appreciate it.

Bryce 

Yeah, I’m so excited for this conversation. I know when we spoke offline a couple of weeks ago; I shared my background with addiction, alcohol addiction, and my background and even opioid and kind of all of that. So, I’m so excited to have this conversation with you today. I’m just getting started with your professional and personal story.

Could you share a moment in your career that inspired your interest in leveraging virtual healthcare for addiction recovery?

Amanda 

Sure, sure. So, going back to the mid-2000s, 2006, and 2008, I worked as a hospitalist, physician, and internal medicine physician in a hospital setting. In 2008 or so, we started seeing a huge uptick in the number of people who were getting admitted to our hospital who struggled with opioid dependence.

They were young, and they were getting admitted for weeks at a time because they needed IV antibiotics because of complications that could come from IV drug use. And we were struck by that. So I began having conversations with one of my colleagues who had started working in the opioid addiction space, and she was telling me about how rewarding that work was.

I decided to join her at her clinic and meet some of her patients. I was just moved by the dramatic change that medication treatment could have in someone’s life. So I decided to leave hospital medicine and create and found the very first office-based opioid treatment program led by physicians that was completely outpatient and enabled us to provide this care without people having to go into detox and rehab. And that company has treated 110,000 patients now.

There are 80 some-odd clinics across the country. I was inspired to do telehealth to answer the last part of your question. I was inspired by telehealth because we are opening many clinics, and even in small states like Massachusetts, we need 17 clinics.

It hit me that the challenge of patients getting to a clinic repeatedly was real. We’ve learned since COVID that telehealth is a viable, completely reasonable, and effective method for delivering mental health and substance use services to patients. And so it inspired us to build Boulder, the first telehealth program.

And now we’re just translating all of that learning from opioid use disorder, clinical care in a clinic to V.R., I’m sorry, to telehealth with opioid use. Now, we translate that into how we can use alcohol better similarly.

Bryce 

That’s incredible. It’s such a different approach than what’s out there, too. The initial options out there are very behind the ball regarding technology.

So this is such a breath of fresh air. What are some of the challenges? There have to be some challenges that you encounter with integrating virtual healthcare into addiction treatment.

What are some of those challenges, and how have you overcome them?

Amanda 

Yeah, you know, a lot of people ask me, is it possible to treat a patient at home who has addiction? And that’s because there’s this widely held belief that the only solution to treat this disorder is to go away, to go away, to be in a facility where you can’t get access to the substances, and then you’ll come back, and you’ll be fine. You know, I’m here to say that technology enables us to do this care in the home and that while there are challenges, and I’ll talk about those, the benefit far outweighs the loss.

The benefit of doing it in the home and over a long period is you’re there with the patient while they’re in their life, while they’re living, working, dealing with stressors, having family things come up, having events come up, even, like happy things that happen, just all variety of life events that are occurring in that person’s life, they’re distanced from that when they’re in inpatient rehab.

They are present in their life when we’re meeting with them at home, right? In an ongoing way. And that day-to-day engagement with them and knowing what’s going on and how they react to certain stressors gives us information to help us further and further enhance and improve the care we’re doing.

The challenges are often limited to technological barriers. For example, we had a patient in Niger, Africa, who contacted us interested in getting care, and his internet access was completely limited. We’re looking at alternative ways to get through satellites and things to get Wi-Fi to patients who don’t have it.

So that’s one barrier. But translating medical care into in-home treatment through telehealth, at least in the behavioral space, is very doable. And as long as they can access the technology, we can bring this care to them.

Bryce 

Yeah, absolutely. And I know this North Star and the kind of technology you guys have is so great. I want people to be able to see this. Could we go through it? I know this is different than we normally do, but I would love to go through it briefly; go through your slide deck if you have it, and then we can pick back up the conversation if that’s okay.

I would love to have people be able to see this visually.

Amanda 

100%, thank you. I’d be happy to do that. Now, let me pull up a few of these slides.

I’m happy to walk through the program at a high level. So North Star was built really to address the gap in treatment today. There are 49 million people who struggle with alcohol or opioid use, but most of them, 46 million, struggle with alcohol use.

And only 8% of people are getting any treatment at all. Of them, less than 1%, only 0.4%, are getting put on any medications. So, we have a medical disorder that’s a massive problem in the country.

We have more people with this issue than cancer, diabetes, and heart disease combined. And none of them are getting any medical care. None of them.

They are getting purely counseling and group support. In no way do I want to disparage counseling and group support. They are tremendously helpful.

But in isolation, without addressing this medical illness, we’re not going to be able to do a good job. They don’t do as well. There was a study that just came out that I’ll share very briefly that showed that people returned to use after leaving rehab very quickly.

In fact, within a week, almost a third of them. Within a month, half of them. And by month six, 86% of them have returned to use.

So, this can be confirmed by what we have learned in the literature that, unfortunately, treatment without addressing medical issues sets people up to fail. So, this is one of the most important slides I will show. It gives you a visual about why not to address the medical issues and not to address brain health, creating a scenario where it’s no win for the patient. This is what a normal, healthy brain looks like. The yellow and red areas are the activity in the brain. But this is what the brain looks like of someone who’s consistently been consuming alcohol and then abruptly stops.

And what you can see that’s interesting is that there’s very little activity anywhere, especially not in the frontal lobes. The frontal lobes of our brain are where we make decisions, think about our future, and learn from our past. Learning with frontal lobe function is possible.

And yet we’re sending patients who have brains that look like this into an inpatient facility where they’re not receiving any brain support and where they’re being asked to learn life skills, and learning isn’t something they can do.

Bryce 

In that state.

Amanda 

Yeah, a hundred days later, it still needs to be better. So, if we don’t do something to expedite this brain health process, we’re not setting people up to succeed. So, to build this program, we took a really deep dive into the science.

We read 2,600 papers. We read every publication in the medical literature on alcohol use disorder, both here in the U.S. and abroad, because, in other countries, they’re doing things in a bit more advanced way than we do here in the U.S. For sure. And so, a couple of key things that we learned are that medication treatment works.

Patients rarely get it. In the opioid space, they are now. In the opioid space, patients get medication treatment, and that’s pretty standard care now.

But the alcohol space has not come this far yet. And unfortunately, very few people get placed on medication treatment. And it helps.

There are a couple of different ways that it helps. First, we can stop cravings. Number two, we can help people not feel the withdrawal feelings that they typically go through.

We can solve some of the symptomatology that they have coming off of alcohol. And number three, it’s almost universal that people struggle with sleep. So, we can often address their sleep deficiency by using certain medication combinations.

The second thing we learned is that enormous disruptions happen to brain health because of nutritional depletion. And with alcohol, in particular, you’re wiping out the healthy bacteria that live in our gut. And those healthy bacteria help us digest our food.

So, if we’re not digesting properly, we can’t absorb certain nutrients that we need to create neurotransmitters, which are how our brain functions. So you saw what the brain looks like without those nutrients, right? It’s shut down.

So we need to restore that brain health. What we do is that we send over 20 different key nutrients to patients. We get their laboratory data and construct a personalized nutrient plan for each to help restore their brain health.

Within one month, we see a 35% improvement in brain health on testing. Wow. Their cognition improves.

Wow. We use genetic testing. We use genetic tests to help us know what medications will work best for patients, which nutrients they are likely deficient in, and how to replace those nutrients for them.

Some people need help absorbing B12 orally. So, for them, we need injectables, and that’s something we can do with genetic testing. So it’s the state of the science.

We’re using all of the science out there today to help us pick these key strategic interventions that can help. Another intervention that can help is peer support. We know peer support can be helpful, but we wanna make it available at home.

And we’ll talk about that briefly more in a moment. And then remote monitoring. You mentioned some of the technologies we’re using.

We’re using remote monitoring with breathalyzers to track how patients are doing, not in a punitive way, but to help us know when they’re having struggles so we can adjust the treatment. And similarly, virtual reality. That’s how we’re doing peer support.

Again, it is a completely novel way. I’ll touch on how we do this with an interdisciplinary team. If you think about how heart disease or diabetes are managed, there’s typically a supervising physician; there’s a nurse practitioner that you might see with that doctor sometimes, a nurse that helps you manage your care that you call and arrange things with.

We’d have a navigator who helps you determine what providers you need to see and when. What you don’t often have is behavioral support, and that’s why we added that. We added peer support, mental health professionals, and licensed mental health counselors.

In addition, our nurse practitioners are psych nurse practitioners. Oh, wow. So, we bring a medical and behavioral team because bringing both together can be successful.

Yeah, that’s fun. The team uses technology, the team’s telehealth, to have these visits, much like we’re talking about now, and they use V.R. to participate in the groups I mentioned earlier. The cool thing about groups is that people come in as avatars, so they can be completely anonymous.

We can have specific groups for people like veterans and other people. So it’s very cool. So I’m proud to say that from the 13% success rate, that is what is, on average, how well rehabs do in the country; unfortunately, we have almost an 86% success rate.

It’s a massive improvement over that. People’s alcohol levels come down dramatically in just four and a half weeks. We have an 86% drop in alcohol use just in that first month.

So we know that we’re having a huge impact on patient outcomes. Lastly, I’ll show that we ship this to every patient. They start care in a day.

They don’t have to go anywhere, right? They don’t have to leave home. They don’t have to leave work.

They don’t have to leave their children. They can do all of this care from home. So, in our year-long program, we work around their livelihood and day-to-day lives.

We work with them to find times that work for them to meet with them. We give them the first 30, I’m sorry, the first 90 days of nutrients, the breathalyzer, the V.R. headset, all of that’s included. We also bring the genetic kit to them and blood pressure and heart rate monitor so that we can taper them off of alcohol successfully.

And we taper them using a novel method. No one’s done this before. We call it drink substitution therapy.

It is a widely held belief that if people who struggle with alcohol use drink a non-alcoholic beverage, they will have a problem. And that turns out to not have any data to support that belief at all. That’s not true.

The opposite is true. When you use drink substitutes, you’re giving them an alternative, something that’s safe, something that’s non-alcoholic, something that they can choose, and it works. So we taper people off of alcohol at home by going down one drink each day and going up on a non-alcoholic version of that drink every day until they’re completely off and safe.

Bryce 

Wow, that is so interesting. And touching just briefly on the alcohol, that’s something I’ve never seen before. So, I would like to speak more about how that works.

How does it, so they, you go one less and then you substitute it with a drink that is, is it, I saw that they almost look like they’re in kind of alcohol bottles as well to kind of help curve that craving, I’m sure. Are they similar in taste, and do they try to match everything except for the alcohol?

Amanda 

Yeah, so we find out what that person’s favorite things are. It could be that someone loves IPA beers and whiskey. What we do is we send them a non-alcoholic IPA beer and a non-alcoholic whiskey.

There’s a company that makes a beverage called Kentucky 74. It’s the same way you make typical bourbon; they only take and heat it so that all the alcohol blows off. So, it’s a non-alcoholic version that tastes identical.

Wow. So when patients are coming down, you know, our typical patient is drinking anywhere from five to 15 standard drinks every day. So when we taper them down, again, if they’re drinking, you know, wine is their choice.

We send them a non-alcoholic version of their favorite wine, and then if they’re drinking five glasses of wine, you know, three glasses of wine every night, we can go down by, you know, five and then go down to four drinks of wine and then have one non-alcoholic and three and then two and climb up like that until they get to five non-alcoholic versions. Interestingly, it releases some dopamine. There’s not a habit, but a ritual, right?

When people come home from work, sometimes there’s a ritual. They come home; they make a gin and tonic. That’s just what they’ve been doing for years.

That ritual, in and of itself, releases some calming hormones like dopamine. We know we’re still giving them that little bit.

Bryce 

Yeah, it’s interesting that you say that. I had when I was working with Alliance in the addiction and mental health field, I had a very interesting conversation with a young man who was my exact age, and I had just called him on the phone. He or his reached out to his mother, and they reached out.

He was on his last leg. He had been getting into a ton of trouble, and he was, funny enough, and he was addicted to weed, marijuana. And he kept telling me, and I talked to him on the phone, he’s like, I know it’s not possible to be addicted to weed.

You just can’t be addicted to marijuana. I said, but it’s so much more than that. He said, I just, it’s the process of getting it, breaking it down, and rolling it.

It’s everything. It’s not just me. He said, once I smoke it, he says, it’s almost gone.

He said it’s almost everything beforehand that I crave. And I found that so interesting. So hearing that approach that you guys take is, wow, that’s very, very, very cool.

Amanda 

Yeah, I mean, we treat all types of addiction. So we’re not just treating alcohol. We have patients in our program who are addicted to alcohol, cannabis, and benzodiazepines, and they smoke.

Right, so there are numerous things. You can be addicted to cannabis. And to your point, there’s this whole ritual and being able to give them that ritual.

We had someone in our program who struggled with gambling, and we had them; instead of a drink substitution, we had them use non-financial games. There’s gaming you can do on your phone that doesn’t risk losing money, right?

Bryce 

Man, that’s so cool.

Amanda 

Create a substitute for him to have an outlet for something instead of just having to stop something cold turkey. That’s too hard.

Bryce 

Yeah, that is. And that makes sense. And what’s more, it’s very interesting about some of them, like when you go through your slideshow and some of the slides that you touched on, for example, 0.4% of people receive medication for alcohol addiction. Then, looking at the brain was the most eye-opening for somebody with a background. I am nowhere a professional or a clinical expert at all, but I am someone who has some knowledge; it makes so much sense that when they come off of alcohol, how their brain shuts down for a little bit, it’s kind of almost in recovery mode. It’s almost like it’s in sleep mode.

And, but then we send them immediately to these inpatient rehabs for 27 days, or however long Medicare and their insurance will take them, right? And we expect them to like a crash course, drink from a fire hose, and learn all this information, these coping skills, and all these things. And it’s just like, they’re asleep.

Amanda 

Yeah, their brain is not able. They are not able to.

Bryce 

Yeah, I had something; I had no idea. I had just no idea. And is that kind of the same effect whenever you’re coming off of an opioid as well?

Is it the same type?

Amanda 

Yeah, that study came many years ago. Nora Volkow, the director of the National Institute of Drug Abuse, did it. And she had these PET scans done. And if you look at them, whether it’s alcohol or cocaine, it doesn’t matter what the substance is; you see that shutdown response.

So, we have to think about how we address brain health and do it in a much more holistic way. And we can’t just ignore this medical care over here. I often use the example of cancer treatment, and if someone has a loved one who’s suffering from cancer, they might have it recommended to them to participate in a breast cancer support group, for example, right?

However, people think the support group is outside the core of the treatment.

Bryce 

Yeah.

Amanda 

You would never say to someone, oh, you have stage one breast cancer; I’m so sorry. Well, here’s a support group. That’s all you’re gonna need.

Good luck.

Bryce 

Yeah.

Amanda 

If it spreads, let us know, and then we’ll put you in the hospital.

Bryce 

Okay, right.

Amanda 

And that’s what we’re doing today. We’re putting people in the hospital first, and we’re waiting until their lives fall apart to do it. People don’t go into treatment until they’ve had a DUI, they’re facing losing their job, they have a major medical complication, and their spouse is about to leave them.

They wait till stage four because leaving your life for 30 days is a hard thing to do.

Bryce 

Sure. And you know what? That leads me into a natural kind of segue into a kind of teletherapy and the addiction treatment kind of it.

In your experience, what role does teletherapy play in addressing barriers such as stigmas and geographical limitations? We touched on being able to send them all over, but what about the stigma?

Amanda 

Yeah, well, you know, at least in this moment, in the country, in general, people who struggle with addiction are blamed. People don’t think about them having, you know, an addictive disorder that’s genetic, even though the genetic contribution to developing an alcohol problem, for example, is the same as the risk of your genetics risking you developing heart disease or hypertension. Roughly 40 to 60% of the risk is genetic for all of those things: alcohol, hypertension, and heart disease.

So people don’t know that. So they assume that someone’s making bad life choices who genuinely doesn’t care about those choices or the results of those actions. And that’s just not at all true.

This is a genetic disease; it’s treatable. So because it’s widely believed that this is their fault and that the patients who aren’t succeeding just aren’t trying hard enough, there’s a lot of judgment. So people are apprehensive, right?

They don’t want anyone to know. I appreciate that people can attend a community support group, but it’s not technically anonymous. It’s true.

So when you go away into treatment, that’s not anonymous either. So there’s a huge risk in that. So, I see telehealth as being a solution in addiction treatment in particular because you’re removing the risk.

You’re removing the risk that other people will know. They don’t need to leave their home. No one needs to know they’re in treatment.

They continue with their lives. They still show up at family events. They’re still able to go to work every day.

So they can engage in anonymous treatment. They can engage in anonymous peer support in V.R.. Still have the chance to meet other patients, but they never know who they are.

So, technology enables people to feel safe. We have seen that it can be transformative in enabling people to feel safe to go into treatment in the first place. But then we’ve been blown away by being able, to be honest in V.R., not be worried, embarrassed, or afraid; it creates a safe space that’s so freeing that patients, I think, share more than they ordinarily would and feel safe to do it.

Bryce 

And another thing that I think is cool, speaking more to that, to the V.R. headset and the accessibility of it is, I know there are resources on the headset. If it’s two o’clock in the morning and you’re going through something that triggers you or you start having a major craving, you might not be able to jump into a peer support group 24-7; that makes sense. But as far as some of the available resources, when you, I don’t know if anybody listening has used a V.R. headset, but you truly like travel into this little, your world if you will.

And I think it’s so cool that if it’s two o’clock in the morning, if it’s four o’clock in the morning or 6 a.m. or 9 a.m., whatever time, that if you need some resources, you can pop that on, you’re transported to your world where you can kind of deal with what’s going on and calm yourself down or battle those demons, whatever you need to kind of get yourself back on track. And you can take that off, and you’re back. You’re back; like you’re saying, you’re back in your home.

You don’t have to travel anywhere else. You’re home, picked back up with your life, and keep moving. With one, that was another eye-opener when we talked offline; it was so interesting and so cool.

That I loved a lot; by looking into the mobile health applications for recovery support, can you provide an example of a digital tool that has shown promise in supporting addiction recovery? What is that traditional? How does that compete with some of the traditional methods?

Amanda 

So, there are various methods people are offering, right? To support patients who struggle with addiction. Traditional treatment is in-person, right?

You go into a detox, or you go into an A.A. meeting, or you walk into rehab. So technology allows the option of not being in person for that kind of human contact to help you do well. So that’s one category, virtual treatment, which isn’t technically an app, but it’s leveraging technology to bring those services to patients and V.R., as we’ve just discussed.

There are apps, though, that help patients. Some apps are drink counters so people can decrease their use independently. And if that worked, then we wouldn’t have an alcohol problem in the country.

So, it’s not enough, but that can be helpful with support like we offer at Northstar. Another organization, though, is doing something wonderful, and it will scale and become more and more available. It’s a company called Dynamic Care, and they have an app that enables patients to engage and get rewards for their success. So yeah, it’s wonderful. So, if someone achieves a specific goal, they can enter it into the application.

They’re giving rewards for success. And it can be something as simple as a $25 gift card, or it can be, it’s just, you know, anything that helps tag success in a moment in time, gives someone, you know, really positive reinforcement and motivates them to continue is huge. They’ve had huge success in helping patients with addiction.

We have to figure out how to implement care systems like that with payers and insurers because everyone wins if it helps motivate patients. They do better in care, their lives are restored, and the insurer benefits because the patient’s doing well. They don’t have as many medical complications as from alcohol use, liver failure, or other issues; we avoid that.

So, there are some really neat options out there. No one-point solution is going to solve it. You know, one of the things that we’ve built is a multi-point solution.

There are 20 different kinds of interventions, and, you know, one patient might benefit from these five things, and another patient benefits from a completely separate five things, which is why care must be personalized.

Bryce 

And that’s why I think Northstar does such a great job of personalizing that care because, you know, of the way the steps you guys have and the different options you guys have, and kind of, you can play, it’s kind of, you can plug and play. I’m sure if you didn’t need the drinks, you don’t have them; there are ways it’s purely customizable. You are; you have full autonomy and access to it 24 seven.

You, it’s just in every sense of the way, which is better than an in-person and that traditional approach of where, you know, you’re coming out of inpatient help. You’re just in there for 27 days, in a very structured program, and then they dump you out. Case management, you know, has your case, and they say, okay, you’re doing, you did well.

Congratulations. You’re better. Gone back, go back, go back home, and you go back into those same stressors.

Often, they need to be set up with, or they’re given a referral to an outpatient program, but whether they follow up on that or whether the outpatient reaches out, why not just give them something they take home with them? You have this with you, or you know, give them the information where they can sign up, and it’s sent right to your door. You don’t have to do anything else.

Please take all the stressors away from it and start your care right there in your home.

Amanda 

And that is such the same team through that whole year, too. I understand why, if you leave an inpatient program and are asked to go to an outpatient program, generally, you’re meeting a whole new team of people. That’s hard.

It’s scary and something where people feel vulnerable understandably because of stigma. So they’re nervous about what that’s going to be like. Meanwhile, with us, they sign up there with the same core team of professionals throughout the year.

Bryce 

Yeah. Yeah. I answered the last question I had for you about some of the benefits you see for the V.R.

Are there any other benefits that the V.R. goggles have that we haven’t touched on and that you’d like to touch on briefly?

Amanda 

I do. So, when you think about the model with A.A., for example, people have a sponsor. When they meet, sometimes they’ll go out for coffee, park, or do something.

Right. Our vision with V.R. was that patients could meet in groups and that every patient needs access to those groups. They have their peer guides, which are their one-on-one peer guides.

They talk to them every day in the beginning. They meet with them on Zoom periodically. There’s a real relationship that’s built over time.

We have many patients who, like you, appreciate the cool feature of going into your space and exploring something. So we’ve had patients meet in V.R. with one of our peer guides and go do a group gaming event. Oh, wow.

Because, you know, or you can walk, Google has all of these three-dimensional places where you can walk and experience walking through a city you want to explore. You can walk on a beach. There are meditation classes.

There are yoga classes. There’s a variety of things where people can meet up and go do an activity and share that experience. And while they’re doing it, you know, they can be playing a, you know, a shooter video game together, but they can be talking about what’s happening in their lives.

Yeah. And that creates a natural rapport and, you know, a connection that creates a safe space to feel comfortable talking.

Bryce 

Yeah. And if they just kind of a, just a shameless plug here to end this, because I write where, how, who can if you’re dealing with addiction right now and you’re watching this, how can they, how can they reach out to Northstar? How can they get this treatment in their hands?

Amanda 

Well, thank you for that. So the easiest way is to go to our website, Northstarcare.com. There, you’ll see the phone number that you can click on, and it will connect you and make you dial right away.

You can explore more information about our program there, but going to Northstarcare.com is your safest bet. I’m also happy to give the phone number, 855-302-9191. So please feel free to call directly, too.

We have people who will be able to answer your questions right away, whether you’re the person struggling or it’s someone that you love and care about. We talk to families all the time.

Bryce 

Yeah. This can be utilized with insurance as well. So, if that’s the case, please call Amanda and her team, speak with a representative, and learn more.

If you have any questions, you know they can answer them. And, you know, it’s, it’s, it’s okay to ask for help. As somebody who’s dealt with this and my own family, I know asking for help is okay.

It’s such a weird stigma people have nowadays, whether it’s ego or embarrassment, but it’s just okay. It’s okay to ask for help and have somebody give you a helping hand. So Amanda, thank you for sharing that valuable insight with us.

I’ve been super excited to have this conversation. And as now the listeners, you guys see why this is a company that’s, you know, we always talk about in digital health transformers, pushing, pushing the envelope and pushing boundaries forward. It’s truly what you guys are doing.

And I, I want to shake your hand and pat you on the back because, you know, this is what it takes to, to, this is what it takes for, for us as a country and us as a world to make this place better, which we all want. We all want to make this place better, but it takes innovation. It takes thinking like this out of the box.

And to see you guys do that at Northstar is so impressive. And thank you so much for your time.

Amanda 

Thank you so much. Truly, Bryce, it is such a pleasure. Appreciate you.

Thanks. All right.