Catherine Jacobson

and dramatically reduced in-patients, readmissions, emergency room visits, and saved a lot of money for predominantly the Medicaid program in the state of Wisconsin.

We run a 24-7 cancer clinic because we are the biggest cancer provider in the area so that they can go to a clinic 24-7 if they're having an emergency with the clinicians who know them, the nurse practitioners who know them, and they're not in the emergency room and they don't get admitted.

Right.

You know, I would agree.

I think, number one, our location usually puts us in urban settings where poverty is located.

So we're going to always do that.

And we tend to be the level one trauma centers.

You know, so those are the things that tend to bring in the uncompensated care.

It gets back to social determinants.

And how do you address upstream on that?

It is going to be a continuing cost of carry that we're going to have to do and that we are going to have to continue to find solutions for.

Our high deductible health plan concentration was 20% in Chicago, it was 30% in Milwaukee, and I was all falling to bed.

So that's real about what's going on with the high deductible plans.

I think the other plea that I would make is we got to get over the price per unit conversation, because if I can keep a patient out of the hospital, why am I arguing about the extra 10% that I get on the stay?

We're working to take the utilization out, working to take the length of stay down.

We're working to push them into the outpatient.

I want to stop having the conversation about the unit price.

We have very consciously done at the Academic Medical Center is shift.

We are now at or below the market on most of our outpatient.

And we've increased on the inpatient where we do the things that only we do.