On this episode of HealthChangers, we share a conversation with Cambia’s CEO Mark Ganz and Susannah Fox, who serves as a researcher and adviser to health and technology companies. Mark is retiring at the end of 2020; during his tenure as CEO, he’s guided the company and industry along a path of reimagining and reshaping health care to be more empathetic, transparent, and economically sustainable.
Susannah Fox (SF): Mark, as you know, I have been a board member for Cambia since 2017 and you also know that I've been a big fan of yours since before then. I'm really excited to talk with you about your career and the accomplishments that you have been able to bring to Cambia. I'm going to dive right in. I would love to have our listeners go through a brief timeline of your journey at Cambia. You've been CEO for 18 years. I'd love to hear about what that has meant to you.
Mark Ganz (MG): Yes, I've been with the company for 29, or just almost 29 years. I started in early 1992 and applied for a job that I was not qualified to apply for, which was kind of fun. It was one of those "what the heck? I'll give it a go", because I wanted to go work for the company. Not only did I get the job, but I got a job that I didn't think I was applying for. I thought I was applying to be an assistant general counsel, reporting to a general counsel, and only found out during the interview process that I was actually going to be the general counsel. The title they used in the want ad was not clear. And so...
SF: Now hold on. What is a want ad? Remind people what-
MG: I've dated myself. It was the classified ad in the newspaper that advertised for what they called a corporate counsel, which I always thought was going to be like an assistant. But anyway, I ended up, I kind of like, "Well, I'm committed. I'm going to keep going for it." I actually ended up getting the job and had a tremendous leader in the CEO who really allowed me to do my job and innovate. He was not a Mother May I-type of CEO. He was a really good team leader, and we had a tremendous team. I just grew and learned so much.
Do the job you're paid to do first. Don't ambition to the next job or you'll take your eye off the ball of the job you're being paid to do now. But also, realize that in the job you're being paid to do, there are infinite opportunities for innovation, and to turn that job into something that the company never could have imagined it could do and be.
MG: Then four years later, actually, three years later, we formed the Regence Group, which is now Cambia, with three other companies. That was unusual too, and I played a big role in helping bring those four companies together all at once. Usually you think of mergers or acquisitions as being one company with another company. In this case, it was four that came together at one time. We pulled it off. A year after that, I moved to Portland and was the chief legal officer until 2001. Then I became the CEO of the largest subsidiary, Regence Blue Cross Blue Shield of Oregon. At that time, it was a CEO role, full P&L responsibility and the like. Then, two years later, became the CEO of the Regence Group, now Cambia Health Solutions.
That was my journey in a nutshell. What I would say was the fun thing about it is, other than applying for that job in 1992, all the other roles I didn't actually apply for. I was asked in, and it came in an unexpected way. I wasn't gunning for the job or angling for it. It was something that just happened. I often turn that into advice to people who want to "move up" in an organization, and I just say, "Do the job you're paid to do first. Don't ambition to the next job or you'll take your eye off the ball of the job you're being paid to do now. But also, realize that in the job you're being paid to do, there are infinite opportunities for innovation, and to turn that job into something that the company never could have imagined it could do and be."
I think that's why I ended up moving in the organization, because I always did that. Always tried to make the job bigger than it ever had been, because there's always things to contribute in an organization. They're human organizations. They're flawed inherently but that means there's always opportunity to make better, and that's what I've tried to do.
SF: I love that advice that you give to people that you're mentoring and managing. The advice that I have given to people, which I have lived through, is every day is a job interview. You never know. I remember I'd be up on stage giving a speech to 300 people in the auditorium and nobody claps but there's one person in the back of the room who gets what I'm trying to say, and that's the person who follows up later. It's also true in an organization where you don't know what impacts you're necessarily having on people. But just act with integrity. Act as if somebody is actually interviewing for the job that you want to have next, as well as being excellent in the position that you have.
Let's switch gears and talk a little bit about the pandemic, because that has really shifted the landscape for Cambia, for health care in general. Has the pandemic changed how you view health care? I'll also say that the health care industry is innovating at a faster pace in terms of public health, in terms of the science. We're seeing so much innovation, which we're really in dire need of. Do you think this pandemic will change health care forever?
MG: Short answer, yes. Here's how I think about health care just through my long career with it, is that it's an industry that has been particularly resistant to change. I think of it as like a huge ice flow, a sheet of ice out in the polar regions maybe. If you want to make progress with it, you have to get your ice breaker and try to pound against it. You have to know where you're going and you have to be resolute about it, because it's hard to do. Sometimes you crash the ship into it and it just doesn't move. But there's always hope for it tomorrow. There's always hope that something will happen.
In my career, there have been things that have had the effect of breaking up ice flows, cracking them open. So you can navigate your ship through to make progress, but you also have to still respect that the ice is still all around you and that it could simply crush your ship as you try to move it through. You have to go forward with courage and with that sense of vision of where you're trying to go.
I would say the passage of the Affordable Care Act very much had that impact on the industry and it broke up some ice flows, but it also created some new ones. I think that COVID-19 and the worldwide nature of it and the wide impact it's had on everyone, unlike things like the ACA or other things that had more impact on some than others. COVID has had more impact on some than others but it's impacted everybody profoundly. No one's been able to be a spectator. I think it's just had this tremendous force of breaking up ice flows, and I think that the opportunity for innovation that comes out of this, that's already started within the pandemic but is going to continue coming out of the pandemic, is going to be amazing. I think it's high time.
An example's obviously of more virtual health. Health care where health care comes to you instead of you having to go and kneel at the altar of the health care institution so that you can plead for the help that you need and they will deign to give it to you. Now it's going to be quite different. A lot of the movement toward a consumer orientation has been underway. I'd say Cambia's been one of the drivers of that. I'm proud of that. Now, because of the pandemic, it's just accelerated it. It's created a momentum and a critical mass of the usage of it that I'm so excited about.
I think that mental health is the epidemic that has sprung out of the pandemic that will be with us for years, is the mental health crisis that this has created and is creating for so many people. I think that finally perhaps we will finally see the weaving together of a person's physical health, mental health and spiritual health all together.
I think of it as like a huge ice flow, a sheet of ice out in the polar regions maybe. If you want to make progress with it, you have to get your ice breaker and try to pound against it.
SF: I think you're right, that emotional wellbeing and our spirits are now part of the public conversation about health and health care and we can't go back. What I have found so inspiring about working with you, Mark, is that you have brought forward your experiences in life and you've brought forward your experience as a caregiver. You've brought forward your experience attending death into your work as the CEO of Cambia. By doing that, you unlock all of your colleagues' ability to bring their lives forward into their work. I would just love to hear you talk a little bit more about why palliative care is important to you and important to Cambia.
MG: I could give you a right and a left-brain response. I'll give you a little of both. Maybe a heart and mind response, might be a better way to put it. The heart comes all the way from my childhood when I'd go on rounds with my father who was a family physician and that's when primary care docs used to actually have admitting privileges to hospitals and would go and see their patients all the time. Boy, that's talking about the good old days. I would go with him after church on Sundays and I remember it was always a little bit intimidating. I enjoyed the adventure going to the hospital, but also hospitals have that unique smell and you saw a lot of people who were really sick there. I remember it also being somewhat intimidating, but I always felt safe being with my dad.
I remember a few of those times when dad was ministering to someone who was dying. I watched him without knowing what he was doing, without having a name for it. I just thought it was just being a good physician. Not only talking to patients with great compassion and care and with honesty about what they were going through but doing the same with their families. For me, to be able to watch that through the eyes of a child and seeing my dad do that, that left a lasting impression.
I always sat there like a seed that had been planted and it just grew. Then I became CEO in the summer of 2003. I remember it was during October of 2003 when my dad fell ill with a disease that would kill him. Here we are, in the middle of when I'm starting to launch the transformation process in our company and setting a new vision with a new team and at the same time I'm experiencing the reality that Dad was very ill and terminally so.
Watching that experience or being part of it with my brothers and sisters, gave me an insight about the beauty that can come from that. We'd say my dad did maybe his greatest work for our family during the time he was dying. The greatest healing for our family. I know death isn't always a healing experience for families, but it was for ours. I give my dad a lot of credit for making it so. Otherwise I think he raged against the darkness a little bit. The Dying of the Light, that poem by Dylan Thomas. He was very much one who raged against the dying of the light and it was hard for him to let go, but he was a man of great faith and he did it ultimately with grace.
I just thought it was just being a good physician. Not only talking to patients with great compassion and care and with honesty about what they were going through but doing the same with their families.
MG: That re-engaged that seed that had been planted. I think when we formed the Foundation and we knew we wanted to have a signature focus, that really spoke to me. The idea of leaning in, making palliative care as mainstream as physical care and supporting those great practitioners that did that. That was the decision of the heart. The decision of the mind was, if we're going to transform health care in this country, you can't just do it all at once. A wise person once told me that the way to make progress in some ways is to think of a bowling analogy. You don't try to knock 10 pins down by having the ball hit all 10 pins at once. The ball has to hit the center pin and at the right way, and then the center pin is what takes out the rest of the balls. That's how you get a strike.
I think that that's true for transformation of an industry, is that you must pick your center pins. When you think about the poignancy, the importance of the experience that individuals and families go through with serious illness and if you could transform that to be something that is truly focused on the needs of the individual. Where the individual's in charge, not the health care provider. You turn it, because so many people get taken for a ride. They get a diagnosis and then they just enter the machine and the machine just whisks them along and there's not much attention paid to what their own heart needs are. If we could change that so that every individual and their family would be ministered to and feel like they had self-determination about how they were going to go through an illness, whether they wanted to go for a cure all the way, or they wanted to go a different path and just live their very best life every day, in treatment or in not treatment. They would have that choice and they could move forward.
I thought if we could make a change in that, then we could prove to health care and to ourselves that we can change the entire system. That's how I believe real change happens, is you change something that's very powerful. You have a critical mass of people in this country that have that experience and go through that experience. You change that and then you can start instilling a sense of hope. I think so many people, they lack a sense of hope that the health care system can change, be better, be more person-focused and be more economically sustainable. They think, "Oh, it's all lost, so I'll just pass the buck to congress or to the government to take care of it," knowing that it probably won't.
The idea was change people's hearts that are in industry by seeing that change can happen. Change people's hearts that are being served, and not only is it better experience for them but they become believers, and if they say, "If it can be this way when I'm seriously ill, why can't it be this way every time I engage in health care?" So, that was the mind part of it, and it was a perfect marriage.
SF: I hear a through line in our conversation and I see a through line in Cambia's work. There's a through line in Cambia's work in terms of the centering on the individual, centering on the patient, and with the understanding that the more that we can serve people where they are with what they need, the better off they will be. That's behind the Journi platform. I actually see a connection between that focus on the family CEO, which is often a caregiver role, that Journi is focused on, as well as the focus on the family and the caregiver that palliative care is often focused on. This goes right toward what you were saying about the common experience of the COVID-19 pandemic. That it's broken up these ice flows and sort of forced us to confront some of the disparities and some of the old ways of doing things.
This is going to lead me to ask you a question about innovation, because I think that so much of what we're talking about, so much of what Cambia really brings to health care, is the sense of innovation. Could you talk about some of the innovations that you are most proud of across your years?
MG: Maybe one of the most innovative things that I guess I'm proud of is taking a very staid, bureaucratic culture of a large company when I became CEO and figuring out basically by hook and crook, how to lead the company to being a consumer-focused, consumer-obsessed organization. I will tell you, it has taken every ounce of my creativity and leadership to figure out how to reach a very diverse set of colleagues from across multiple states. Bringing in new people and completely revamping our board of directors to one that is much more diverse, in all aspects of diversity. To do it not because it's like, "Well, we're supposed to do that." To make sure that the why was always in front of people, so that it would engage their hearts in the process. It wouldn't be just a thing of check the box, right? But that people would see and understand and be infused with the why, so that they wanted to do it. They saw that there was no other way but to do it. That to me was, that's a personal one.
Maybe one of the most innovative things that I guess I'm proud of is taking a very staid, bureaucratic culture of a large company when I became CEO and figuring out basically by hook and crook, how to lead the company to being a consumer-focused, consumer-obsessed organization.
MG: Beyond that, I would say obviously I'm very proud of all the years of blood, sweat and tears that have gone into creating Journi. I don't think I would've wanted it any other way but to be able to at least be able to say before I was done with my time that we brought it to market successfully, and we have. Now what will be up to Jared, the team and you as a board member, to see that it grows, that the market recognizes it for the greatness that it is and that we're really savvy about how we market and sell it, so it can become the juggernaut that I believe it has the power to be. It is the smart phone to the health insurance old black phone on the desk, if you will. It is so far beyond. It doesn't render the health insurance part of the business obsolete. It just renders it from being the platform, to merely an app on a much more fulsome platform that people will want to interact with.
I'm very proud of the hard work and the constant needing to always be true to the strategy, but change the tactics as necessary, given things like the ACA and all the other things that come at a company. You adjust tactics but you never change the strategy. You have constancy of purpose. I think, gosh. I mean, I would say in the pure play health insurance part of the business, probably the biggest change that we've had that has a legacy throughout the industry, and there is no doubt in my mind that we were the ones that lit the fire and stoked it. And that was the notion that the individual member matters. That is the only customer that really matters. Doing deals to bring on an employer as a customer, as the paying customer, that's more like a business partnership that gives us access to serve the individual and their family.
I'm very proud of the hard work and the constant needing to always be true to the strategy but change the tactics as necessary…you adjust tactics but you never change the strategy. You have constancy of purpose.
MG: I think there was massive confusion in the industry prior to the time that we came along and started driving that. There was this sense of, "Well, no, the customer's the group. It's the employer." Or some would say, "Well, no, the customer is sometimes the member." I saw it in our own company. Because there was that confusion, and some people would say, "Well, no, the customer's the provider." I was like, "Wait a minute. Who's paying whom?" We're paying the provider. We're their customer maybe, but they're not our customer. They're our business partner that helps us ultimately be able to serve our customer, the individual and their family, well.
Having that kind of razor-sharp clarity is what I think began a lot of the innovation and stoked it, not only in our company, but across the industry. I remember not so long ago, Susannah, when I started 18 years ago, I remember I started talking about the customer is the member with my colleagues in the Blues, I got a lot of these pats on the head, "You don't get it. Someday you'll learn, Mark, that that isn't really where the game's at." I just sort of smiled and said, "Well, we'll see."
By us developing products and services that were aimed to serve the individual and their family, and starting there, and then thinking about everything else we do, whether it's with providers, whether it's with groups. It is all because we are wanting to serve that individual as best as we can because they're the ones that are in the center of health care. Now the industry, that's now kind of the common talk. At a time when no one thought the consumer mattered in health care, now everyone talks about the consumer matter. But Cambia's way ahead of a lot of organizations.
By us developing products and services that were aimed to serve the individual and their family, and starting there, and then thinking about everything else we do, whether it's with providers, whether it's with groups. It is all because we are wanting to serve that individual as best as we can because they're the ones that are in the center of health care.
MG: You and I are aware of a couple of organizations that we've encountered, and that was one of the things that we observed very quickly. How far ahead we were in our way of thinking, the culture we built to serve, and the actual products that we serve them with. I'm very proud of that. That was an innovation challenge for sure. I would say Clayton Christenson would call that the innovator's dilemma, and he would say most long-existing organizations can't do it because they convinced themselves it isn't important, because they're so comfortable in their current business model. I think Cambia is a company that not only didn't fall into that trap, although at times it felt like we might be slipping into that trap. I feel like we've really moved. That I hope is the long-term legacy of the business side of the work that we've done.
SF: That's so important. I do believe that Cambia was able to point out a north star and steer by that north star. I think something else that's really important to note is the four western states that make up Cambia are really different from each other, as individual states, as individual markets. I think that that has created a laboratory for innovation, because the board, for example, needs to have members of the board from each of the four states. Bringing together those points of view has been wonderful to see how the company takes advantage of the diversity of the board and of the viewpoints of the executives from all the four states.
That's really a challenge as a CEO, to make sure that you have an understanding of your business, your industry, and your role in it. But also having a view, a more global view, to know where the trends are going.
SF: I also think that this focus on the individual helped Cambia to stay nimble in terms of seeing the possibility of investment, for example. Starting to invest in startup companies, building the pipeline for the kinds of services that Cambia wanted to create. That's really a challenge as a CEO, to make sure that you have an understanding of your business, your industry, and your role in it. But also having a view, a more global view, to know where the trends are going. So, let me ask you now to take out your crystal ball or to look at where the winds are shifting. Can you give us all some advice about where you think health care is going in the future? Or maybe, how would you like to see health care transform? You can pick the timeline, whether you want to say five, 10 or 20 years.
MG: It'd probably be somewhere in that range. Five, 10 or 20. It depends on the thing. I would say a couple of ones that are my hit list of what I think that, where we're headed. My vision would say we will see, and it might be 10 years, basically the full weaving together of the understanding of caring for people, body, mind and spirit. Instead of just body, body, body, body. Oh, that spirit thing. Yeah, well, there's some people over there that do that and maybe we'll get them.
SF: Call the chaplain.
MG: If it's the mind thing, well, golly, there's a pill for that. Otherwise you'll have to go see a psychiatrist over there, kind of thing. That kind of notion of either just willy nilly prescribing antidepressants when somebody needs much more than just a pill, and where there's not enough people who are in the psychotherapy business to meet the demand. We're certainly seeing that this year. Whether it's using telehealth, which has just been probably the most beneficial use of telehealth that we've seen this year has been in the mental health area. I think what's happening is people, there's always that stigma. You go see a mental health provider and you don't want to park in the parking lot because somebody might see your car there. Or you might run into somebody you know and then it's like, "Uh oh."
But with telehealth and the idea of people coming to your house to be able to provide that kind of care, that is going to transform mental health care. It's going to help people overcome that sense of stigma about even going and getting that care. People then will get the kind of counseling that they need, along with if there's a pill that is a good pill for whatever they're suffering from. I'm very bullish on that. I think we're going to see profound change.
It's a cultural change that has to happen that's going to make the difference. That's what's going to create value-based care, is when physicians and clinics think differently about how they serve the individuals they serve.
MG: The second profound change is going to be the notion of, call it "Doctor on Demand". The idea is that we're going to see more and more primary care providers whose primary office is their car. And it'll probably be a battery powered car, an electric car. But it will be one that they will be coming to your house or to your office, and ministering to you there, as opposed to the primary default being that you go to the bricks and mortar office there, and wait in line in their waiting room there. I do think that for specialty care, that'll be more recalcitrant to that kind of change. You'll probably still have to go to bricks and mortars for that. But I think primary care is going to transform fundamentally. I think that's a really good thing.
I'd like to see more innovation and investment there than this endless do loop around value-based financial arrangements that you hear, "Oh, yeah. We're going to transform primary care by having it all be 'value-based'". That's just a money transaction, and I'm not saying that it doesn't have a role, but to say that's the thing that's going to change, that's like saying the fact that you have a computer makes you computer literate. No, it doesn't. It's a cultural change that has to happen that's going to make the difference. That's what's going to create value-based care, is when physicians and clinics think differently about how they serve the individuals they serve.
That's what "managed care" was all about. That experiment didn't work all that well, did it? If the ultimate measure was that health care costs would go down, then it's an abject failure.… I really feel like this notion around mobile care is going to be a very transformative movement that's going to have impact way beyond just primary care, but it's going to start there. I'm excited about that.
MG: It's not how they get paid. It's how they think and operate. Payment can be an incentive for the right behavior. Payment at its best should be that. But to just change the way we pay and hope for the best, that people are going to change, that's been tried now for 50 years in various measures. That's what "managed care" was all about. That experiment didn't work all that well, did it? If the ultimate measure was that health care costs would go down, then it's an abject failure. We should just call it that and have a little funeral for it and stop reinventing the term and saying it's going to be different this time. So, I really feel like this notion around mobile care is going to be a very transformative movement that's going to have impact way beyond just primary care, but it's going to start there. I'm excited about that.
I think the movement around health equity is also a profound one. That one's going to be 20 years at minimum. That's going to be a longer one because it's a cultural transformation that has to happen there and I think there's so many tentacles to it that to do it right means to do it over a long period of time. But I think we're going to need leadership that is going to apply that relentless pressure over time. That kind of change doesn't happen with an explosion. It happens through the relentless flow of creativity and gentle kind of force that says, "This must change. This will change. We can change it. This must change. This will change. We can change it." And just keep at it. But I feel that that one is definitely going to be a third trend, if you will, in health care.
I think the movement around health equity is also a profound one. That one's going to be 20 years at minimum. That's going to be a longer one because it's a cultural transformation that has to happen there and I think there's so many tentacles to it that to do it right means to do it over a long period of time.
SF: I really appreciate how you brought health equity up because it is something that is top of mind for so many people. I don't hear many health care leaders talking about equity in that way. I very much appreciate that, and hope that there can be innovations that bring that closer to us, whether it's to just pockets of people. There's going to be pockets of justice that spread. I'd like to see some immediate progress but to have the long-term progress happen in 20 years I think is a realistic view. Let's talk about next year.
MG: Susannah, can I just say something though?
SF: Yes.
MG: I agree with you. But I just want to point out that when we adopted our cause 18 years ago, our cause was we will transform health care. At the time, we used the term "to remove the tyranny that it creates for individuals and families." But what we said was, "We're going to serve as a catalyst to transform health care to make it more person-focused and economically sustainable." Well, when we did that, we talked openly about the fact that we knew we could not get that if we simply relied on the health insurance legacy that we had inherited from our forebearers in the industry. That wasn't the path. It might have a role in the path, but it was not the path. It would take us in new directions.
Health equity was part and parcel of that, because being more person-focused was about seeing people, literally seeing them in all their diversity, from whatever part they were. And that the health care industry needed to see people. The idea that "the doctor will see you now," that old saying. Well, there were too many places where people were not being seen. They were invisible to the health care reality. The economic sustainability was also personal. It wasn't some grand vision of an economically sustainable system as a whole. Yes, that will be the ultimate maybe outcome. But we have to make health care sustainable for individuals and families at the family level, which is all about getting control of price.
We know with the bringing of Journi to the market, as a primary vehicle for an expression of our cause, it is all about health equity. You can't get there without that focus. That is what our cause is about. Because one of the drivers that makes health care so inequitable, is that everything costs too much. It's way overpriced, and we have a system that actually rewards overpricing products and services. It's called, my stock price goes up, because investors are happy with me, because I got the most I could get out of the drug that I sold or the medical device or the labs that I process, laboratory tests that I process.
We know with the bringing of Journi to the market, as a primary vehicle for an expression of our cause, it is all about health equity. You can't get there without that focus.
MG: That's all wrong. There's nothing wrong with the idea that a company pleases its investors, but to use that as an excuse to rip people off with prices that make no sense at all and then to blame the middleman, the health insurer, for not covering it or not covering it enough or paying the entire price. You know what I mean. That has to be broken up. That's what our cause was about. We've been fighting that for the 18 years I've been CEO, and I think fully that Jared and the team are going to carry that fight forward. I know our board, including you, are on fire about that. But it's going to take a long haul to get there.
To me, that's what it's always been about, is you create equity by creating reasonableness of price and a financial model so that people can actually afford it without having to be so dependent on government programs or health insurers. You do it by focusing on and seeing individuals. Because when you see them, you can't but not be compelled to address their needs. It's the blindness that allows this kind of machine to keep rolling forward and for everyone to look at each other and go, "Yeah, that's okay."
SF: Right, or we can't just give up as you've said previously. That we can't give up. I will just say, I have not heard many health care executives say the word "tyranny".
MG: Yeah. I'm just saying, I think part of what I've tried to be is a truth teller, and to use the words that describe it, and even if they feel harsh. Part of the reason we took tyranny out of our cause, that word, and this was one of those learnings as a CEO about how far you can push a culture how fast, was when we put that in, it offended a lot of our employees. It surprised me that they were offended and it made them feel bad about what they had devoted their life to, because they didn't like saying that they were part of a system that tyrannized people.
Then there was a lot of pushback and saying, it was like well, I didn't want to disillusion people. It was like you boil the frog slowly when it comes to culture change. We removed that word, but we did not remove the fundamental elements and the strength of the cause. I would say ironically, I would say that our employees, our 5000 or so employees, would probably be more open and okay with that word again because now they've evolved so much that they're not afraid of it or it doesn't offend them. It's more like now they see it and it creates a sense of urgency.
That's something that I guess, when I think about my next step, my next chapter as I close out my long chapter here with this company, is being the CEO was never my vocation and it was never my ambition. It was just an incredible honor and responsibility that I received 18 years ago. What a ride it's been. The people I've had the opportunity to work with and the people that I've gotten the opportunity to meet, including you, Susannah. It's just, my heart's really full.
That's something that I guess, when I think about my next step, my next chapter as I close out my long chapter here with this company, is being the CEO was never my vocation and it was never my ambition. It was just an incredible honor and responsibility that I received 18 years ago.
MG: My vocation, however, is by no means completed, because my vocation was not to be CEO. My vocation was to transform health care in this country to make it more person-focused and economically sustainable for families. That will continue to burn brightly. And how I continue to pursue that, there are some things that I know that I'll do. There's probably a lot that I don't know yet and I want to be able to reflect. I think the opportunities will present themselves because they always have in my life. Then it's just a matter of saying yes. But I'll miss Cambia. I mean, I'll obviously miss the great relationships, but I won't be far. I'm sure that when whatever other things that I'm doing going forward, our paths will cross again, because Cambia's going to keep doing the work it's doing, and if I keep doing the work I'm doing, hey, look. We may be in different vineyards, but we're all trying to make the best wine possible for the people we serve.
SF: That's the perfect note to close on. Let me just say thank you for your service to Cambia. Thank you for your service to the United States and the health care system, because what you have done is created the opportunity for everybody else to see the north star, that you've helped to point out. We are all steering toward the horizon of individuals being respected and seen. That is in very large part thanks to you, Mark.
MG: Thank you, Susannah.
