MGMA Podcasts

Daniel Williams: 00:00

Well, hi, everyone. I'm Daniel Williams, senior editor at MGMA and host of the MGMA Podcast Network. Today, we're back with another one of our MGMA award winners. We're gonna be making a big announcement at our leaders conference. It's gonna be in Orlando, September 28 through October 1, and hope to get to see you there.

Daniel Williams: 00:22

So today, we are celebrating our 2025 Harwick Innovation Award winner, Sean Nguyen. Sean is system director of the interventional pain service line at Ochsner Health. Sean has been recognized for his leadership in transforming how multidisciplinary care is delivered across a large health system and also breaking down silos, improving patient access, and creating a blueprint for coordinated care. Sean and I have had fun getting to know each other offline here, and he's been helping me a little bit with some innovation and technology issues that I was having with my computer. So with all that said, Sean, welcome to the podcast.

Sean Nguyen: 01:11

Thank you for having me.

Daniel Williams: 01:13

Yeah. It's so good to have you here, and I wanna congratulate you again, for receiving the Harwick Innovation Award. That is a really cool award that MGMA does hand out to, an MGMA member each year. And, I've been asking all the award winners, this question. When you first learned that you had won the award, what was that like to you?

Sean Nguyen: 01:40

Oh, goodness. I was in shock for probably a good six hours and had just come off the tails of a really large report out operating energy to our senior executives in the system. And so I honestly didn't think it was real. I got the voice message, and it wasn't until the very next day when I think, your team emailed me about logistics, and I was like, okay. Now it's real.

Sean Nguyen: 02:08

And I feel bad because I didn't call Rebecca back or anything. And I was like, oh, this is legit. It's real. Yeah. I'm I'm floored.

Sean Nguyen: 02:17

I'm I'm honored. I'm humbled. It sucks that, you know, it also just doesn't able to be included full group because none of this was be possible without the full team support at Ochsner Health in the different service lines, our physicians, my physician partner, our APPs. There's so many people that are so worthy of this award as well at Ochsner Health across the entire industry. Yeah, I would not be here without the support of those many people as well.

Sean Nguyen: 02:48

And so, thank you for the shout out. Thank you for, this as well.

Daniel Williams: 02:54

Sean, thanks for sharing that with us. Let's just break down a couple of questions about your background and about your organization, and then we'll get deeper into this Hardwick Innovation Award and what went into you being nominated and actually receiving the award. So first of all, let's just talk about Och Ochsner Health first. Tell us about that organization. Anything you might wanna share, where it's located, the size and scope of it, anything else relative to Ochsner Health.

Sean Nguyen: 03:28

Yeah. We're a, more than 45 hospital health system, based out of New Orleans, Louisiana, but we span across Louisiana, Mississippi, some in Alabama. We also have, 65 plus clinics out along the Gulf Coast towards The Carolinas as well. And so very, very large health system based out of New Orleans. I serve as the interventional pain service line leader.

Sean Nguyen: 03:57

And so I see myself as basically the internal glue everywhere that we have interventional pain services, pain medicine, pain management services. So we have multiple clinics. We do pain procedures both in clinics, hospitals, ASC type settings, across more than half of those campuses across, all of our areas. And so been with the organization now, for, close to seven, eight years, and I've been having so much fun since. It's been a wild ride.

Sean Nguyen: 04:30

Our health system really focuses on innovation, teamwork excellence as well. So our health system really is very multifaceted. We have cancer care, we have primary care, women's and children's, and all the different specialties as well. And so, yeah, the last six years in this role for me has been really just being that glue amongst all of our campuses when it comes to pain medicine. And I've been having a wild ride with it.

Sean Nguyen: 05:01

I think this particular project, that I was nominated for really crosses and cuts through other areas and specialties. So I'm super excited about being, talking about it today and sharing, what we've done at Optional Health as well.

Daniel Williams: 05:19

Yeah. That is wonderful. So thanks for sharing that information. Let's get to know you a little bit better, and then we'll dig into, this particular, project that you were nominated for. So are you a New Orleans native, or how long have you been in New Orleans?

Sean Nguyen: 05:38

I actually grew up down the Bayou in Hobo, Louisiana. It's about an hour South Of New Orleans, and, yes, there are places South Of New Orleans. We are very much closer to the Gulf Of Mexico and grew up there. I've been there most of my life, elementary, middle and high school there and moved to the big city of New after Katrina. And so I grew up very family oriented.

Sean Nguyen: 06:05

My parents immigrated over here from Vietnam during the war. And and so having grown up in Louisiana, very, very well rooted, crawfish boils on the weekends or oysters or always big on seafood. But when Katrina hit, which we're actually coming out to the twentieth year anniversary since, hurricane Katrina made landfall here, being so rooted in community and being so rooted into people, when Katrina hit, FEMA came in and were looking for, different individuals that had so much community connections and knew how to be able to leverage that to disseminate resources and help out in any way. I had barely just started college at that time. And so I was able to, you know, work with FEMA, be employed by FEMA to be able to help out with recovery efforts and help from a mental behavioral health perspective, connecting resources, and and and and helping stand up communities in some of these FEMA trailer parks.

Sean Nguyen: 07:18

And so we talk about, like, you know, a lot of people being displaced due to the hurricane, but they were in these FEMA trailer parks with no ability to be have human connections or being able to talk about their grief and impact. And so being a part of the FEMA organization and the recovery efforts, I was just coming in to not only disseminate information and resources, but create a community for people to feel safe and feel connected in those areas. And so that was my first true. Introduction into health care and into a public health population health behavioral health perspective as well. And so that was over twenty years ago coming up and and and I've been in health care in a form of health care ever since.

Sean Nguyen: 08:14

And it's been a wild ride being here going from something so recovery and disaster and traumatic to now being in such a large health system making systematic impacts and policy changes and and and working with amazing individuals day in, day out.

Daniel Williams: 08:32

That is remarkable. Alright. Well, thank you so much for sharing that. Let's talk about that nomination then. You clearly you were telling us you're rooted in that New Orleans area.

Daniel Williams: 08:45

I've got a lot of family down there and spend a lot of time when I can to get down there and see people and eat great food and just have a lot of fun, listen to great music. So that is a it really is so rooted in community. In fact, I just wanted to share one thing before we get into that. When Katrina did hit, I was already out in I was in California at the time. I was trying to place myself that I was in California at the time, but I have a lot of family that's in Mississippi and Alabama, and so a lot of those cousins stayed with family members, like my direct family either, in Alabama or Mississippi, and they stayed for quite a while, like several weeks, maybe moving into months as well.

Daniel Williams: 09:37

So that was where you see saw people really step up and open up their homes for people. And so were you displaced, or were you at you were in the FEMA side of it, so you were actually helping, work there?

Sean Nguyen: 09:50

We were helping. I was helping. Our home got some wind damage, but no flooding, thankfully. And so, we also have a, convenience store, corner store. And so the power was out for quite some time.

Sean Nguyen: 10:04

And Right. You were seeing these 18 wheelers of of of people all in the 18 wheelers just coming out, and we would flag them down to stop them. And we didn't want any of our our produce or stuff to go bad or, our drinks and everything. So we were just giving things out, to people in need as they were being, transported out of the New Orleans area. And so, again, just helping out wherever we can and and being part of that.

Sean Nguyen: 10:32

And then from there, going down to the Civic Center in Houma, to just play our part and do what we can to help out wherever we can.

Daniel Williams: 10:40

Yeah. That is remarkable, and that is gonna be a powerful moment there when that twentieth anniversary of that tragedy is celebrated because I've I've again, I've got a lot of family down there. I've got a lot of others who I connect with and just to see the city rebuild, both just from a bricks and mortar side of it, but also just from a human standpoint of just recovering from that and pulling together. So thank you so much for sharing that part of it. So let's get into that nomination now.

Daniel Williams: 11:17

One of the things you were nominated for here, I wanna make sure I get this right, that you were highlighting how patients with back pain often enter the system through different specialties. It might be ortho, neuro, pain, PT, PM and R, all these different places they can enter the system. And what you identified was that can really lead to fragmented care. So walk us through what you saw, what you identified, and then some of the other things you did to see change in that way.

Sean Nguyen: 11:52

We've always had this, idea, and we've had a bricks and mortars clinic, what we call back in spine, where these specialties would sit together, and see patients together, collaborate together. I felt like ideally that's the gold standard. But with so many patients coming in for back pain, I believe it's like one in five patients typically have chronic back pain or back pain issues. We know that patients are all over the place getting having back pain issues. But we couldn't replicate having every single specialty in one clinic, every single place across Louisiana, Mississippi, and what have you.

Sean Nguyen: 12:36

And so how do you essentially take that gold standard and apply it across multiple areas, whether it's down the Bayou, in Holland, Raceland, whether it's in Shreveport or large metropolitan like Baton Rouge, New Orleans, Covington as well. How do you scale that without breaking the bank or creating, more bricks and mortars or even taking, our our highly specialized neurosurgeons or orthopedic spine surgeons out of being able to do major clinic and major procedure areas and surgeries as well. And so we tried to figure out how to then disseminate all of that care and break down silos by still being able to work together, but maximizing everybody's access together and leveraging each other. And so this idea of, oh, you're coming in through ortho, you're only going to stay in ortho, or you're coming in through pain medicine and only staying in pain medicine. What we did was kind of removed all those barriers and said, you really just need one reason for a visit and then just line up all the specialists together.

Sean Nguyen: 13:51

So patients are not going to know, I have a back pain, who do I go to? You can technically go to every single one of those specialties, but is it a comprehensive plan of care for you? Same thing with like a rash on your skin. Do you go to a dermatologist? Do you go to an urgent care?

Sean Nguyen: 14:14

Do you go to a pain doc just for pain? Do you go to an allergist or an immunologist? How do patients know who to go to and how do they triage their own issues? And you can't expect that. And so on the system side, what we knew what we had to do was create a singular reason for a visit and then line up all of our specialists to be able to answer that call.

Sean Nguyen: 14:40

I think lining them up was only part of the solution. We wanted to make sure that initial visit for that patient was the same standard of care, no matter where they are and no matter what specialty they're entering the system from. And so every single clinician, regardless of specialty, should be able to triage that patient in the same way to get them addressing their acute issues while still being able to work them up to the right specialists based on that initial assessment with that patient. And so we were definitely looking at this from a multifaceted perspective. And I thought, first, let's get everybody in the room and see if they agree.

Sean Nguyen: 15:26

And secondly, what systems and workflows are patients traditionally using that we can leverage that way and then make it easy and seamless for them and for our clinicians at the same time.

Daniel Williams: 15:40

Going further into this program, you spearheaded something that y'all called, it's what we've been talking about, but this one reason for visit approach for spine care. And anybody that works in the business world and and also in the health care world, we know that there's a tendency to wind up in silos. You know, we're I'm in this group, and this is our silo, and this is this silo over here. You are able to really put together infrastructure for teams to work on this collaborative approach to making things work. Talk about that, that really seeing and identifying this way to approach it, one reason for visit.

Daniel Williams: 16:23

Talk about that, how it came about, and how it's had its success.

Sean Nguyen: 16:29

Yeah. I looked at, we use decision trees when it comes to scheduling, with each of our specialties. And so each specialty has, you know, a reason for visit surrounding back pain, back issues, spine issues. And so in orthopedics, might be back, neck, spine issues. In neurosurgery, it might be a surgical consult for back pain.

Sean Nguyen: 16:57

For pain medicine, it's back pain in general. And physical therapy even, it might just be mobility issues. And so when I knew that each of those service lines or each of those specialties had that reason for visit, What I did was I worked with our EPIC team, which is our electronic health record, medical record system. Our analysts from there, our access to care team, I said, is there a way where we can connect all those dots to one uniform decision tree then based on what those decision trees currently have? There's like, yeah, you technically do it.

Sean Nguyen: 17:43

It's never been done before with us. I said, let's try it. You know? Yeah. But they're like, okay.

Sean Nguyen: 17:48

Well, you can connect those dots, but how do you then fix everything after that? And so then it's like, to their credit, it's like, Okay, well, I guess I do need to get the clinicians all on the same page as well. And so bringing in all the clinicians together and said, clinically speaking, we do operate differently. We all have different modalities on how we treat back pain. And we create some sort of common ground, at least for the initial visit.

Sean Nguyen: 18:18

If we're going to spearhead this, if we're going to say then patients are going to then just go through one reason for visit, will the care be the same if I enter through ortho versus I enter through neuro versus I enter through PT? And so having that one reason for visit really gets the scheduling piece cleaned up and gets the patient to then just the first available based on their location and based on their preferences, and gives you a menu of clinicians and specialties to the patients on the forefront. But then once the patient selects the available time that works for them, the location that works for them, and the specialists, it's the specialists that they want or care for, based on those things, are they still getting that holistic care or that comprehensive care that we talked about, like having that gold standard of having all those specialties in the one place. And so our clinicians helped with that perspective and guided us as the business leaders, as the administrators, how to be able to standardize that initial care by, again, addressing the acute issues while then working up the patients to the appropriate care as well.

Sean Nguyen: 19:46

So multifaceted, so detail oriented. Getting the infrastructure was absolutely a bigger component, being able to connect those decision trees, but then also the clinical decision tree as well, making sure then our clinicians felt comfortable without stepping on each other's toes on how to respect each other's modalities and bringing together something so comprehensive on the clinical aspect for that initial visit as well. It's definitely still always a work in progress, but seeing those two things come together and keeping it simple for our patients, getting the patients to the right care, right place, right time. Our service line CEO, Dawn PV talks about making sure that we have that appropriate care no matter where they are. If it's just New Orleans, if it's in the rural side of Louisiana, if it's in another city or town, even if they don't have neurosurgery services that only have pain services, how do we still have that same high level quality of care no matter where we are at the right place at the right time for our patients?

Daniel Williams: 20:56

Yeah. How in the world did you get buy in? You know, people are in their silos. They have a way that, hey. This works.

Daniel Williams: 21:07

It may be Yeah. Frustrating. It may be challenging, but we've been doing it this way forever, and it works. So, Sean, why in the heck are you trying to get us to do it this new way? So what was the buy in like?

Daniel Williams: 21:20

Because our listeners are probably going, it sounds good, but my group wouldn't do this. So

Sean Nguyen: 21:25

Oh, trust me. There's definitely like, there's differences among specialties, and then there's differences amongst the locations and the regions and, like, the flavor from from one corner of Louisiana to the other corner of Louisiana to the one corner of Mississippi as well. Absolutely. It took a lot of interactions, a lot of conversations, a lot of it took over two years of just shaking hands, getting to know people. I I that is also my approach when it comes to making any impactful change is to get in person, connect the dots, get to know people, and understand the why behind everything.

Sean Nguyen: 22:11

I think most of our our physicians, our APPs, anybody in health care can get behind the why, because it's for the betterment of our patients. Right? And and so getting behind the why was easy, but, building the trust, that this is the right thing to do for our patient and this is how we're we're gonna make it happen, I think that absolutely took a lot longer. And giving the reassurances that was necessary. During that entire tour of getting in front of people, getting connected with our clinicians and our teams and the clinics and procedure areas.

Sean Nguyen: 22:48

I was picking up a lot more information, lot more nuggets to polish some of those processes, to polish and be more empathic and considerate of things that were laid out in certain regions that were did not apply in other regions. And so how do you take all those things into consideration? Absolutely. It's not perfect. It's never going to be a 100% perfect, but the more centered we get or close to centered that we can get people on the same page, I think the results of that really do benefit the patients and our teams more so than where we are or where we were previously.

Sean Nguyen: 23:31

And so we're not all on the same page, but we are absolutely much closer to center than we have been previously. The patients get to win at the end of the day for that. Yeah. And and so a lot of handshaking, a lot of just getting in front of people and and talking through, the nuances of that and getting the team also there with me. And so that buy in started off small and eventually became more of a ripple effect that got more people in on it and then winning over early adopters and champions of certain areas as well, and using that grassroots approach of being able to make change impactfully.

Sean Nguyen: 24:18

My personal philosophy when it comes to change, when it comes to operations and management has always been using a public health perspective of like that sociological model. Absolutely, I wanna change patients, but if I cannot impact their family or in this case, if I can't, if I can change the clinicians, but I can't change the unit or department or the clinic to get on board, then that change won't be reinforced outside of the clinic and the unit, then is the campus on the same page? And then across this campus is the system on the same page? Do we have policies that reinforce the things that we're trying to build? And so it was very multifaceted from that perspective and making sure that we have reinforcements on every single level to truly make systematic change that reinforces this change on every single level.

Sean Nguyen: 25:14

Using that socio ecological model was really what was part of my blueprint in get sustaining this change as well. Outside of communication, outside of building the trash trust, outside of being able to talk through it and getting all those infrastructures in place, we wanted to make sure that every single level was reinforced for this change, to make sustainable changes and lasting end changes.

Daniel Williams: 25:42

Yeah. And it took a lot of work. It took a lot of empathy. It took a lot of, you know, transparent communication, it sounds like, to get that buy in. But once you got it, what I'm seeing from the nomination is that now you have proof of concept because in the nomination, it says, because of this initiative, patient satisfaction increased, wait times have decreased, same day availability is more accessible.

Daniel Williams: 26:14

So you can take that to other departments or to other initiatives moving forward to go, hey. When we get this buy in, when we're working together in this way, these, metrics, have all improved, of those metrics, of those measurables, what's the one that stood out to you the most?

Sean Nguyen: 26:34

I still get the occasional calls from either physicians or team members in some of the other parts of Louisiana, Mississippi. Hey, I called and the patient got an availability tomorrow, even though they were looking for orthopedic spine, neurosurgery was available or pain medicine was available to see me tomorrow as well, and I got seen, that next day availability, the ability to still see the patient, close to their home or close to where they work, to give them that option, I think that has been at least reinforcing for me, that it's working as well. Yes, the metrics are all there as well, and we're absolutely getting those metrics in and, that reinforcement, but still being able to get a phone call from one of our clinicians and the team to hear back about how this is working or how there's still opportunities for improvement means they're still buying on this. And that for me is my own personal satisfaction in all this as well. I know again, statistically, that most patients that come in with back pain, maybe two out of the ten are going to be surgical cases that get escalated to that availability.

Sean Nguyen: 27:57

And then our payers already, a lot of insurance companies are already allowing direct access for physical therapy. So patients don't know, oh, I am in back pain. I actually can go to physical therapy first and get care from a conservative therapy perspective. And they should, you know? So building that into the decision tree is a, again, changing culture and also educating our patient populations that it's okay.

Sean Nguyen: 28:26

We all are all the same people, same team trying to treat for the same things, and we're here to support you and be able to make it easy for you as well. That has been one of the biggest results in all this is the slow culture change for me that stands out for me through the work that we've done. To your point, absolutely. I can see this being applied for diabetic care, where endocrine, GI, primary care, even our pain team, our neurology team, all working together around diabetic care a lot more seamlessly and even physical therapy as well. Working all in tandem around diabetic care, hypertension, put all the cardio team with primary care and others together, taking our major chronic diseases across multiple areas, making slow impacts in those areas by having more of a concert of specialties and primary care teams working a lot more in unison and harnessing the systemness of coordinated care.

Sean Nguyen: 29:36

I think that is absolutely a lot of what our private practice teams are doing, but to be able to scale that, it's going to be harder for our private practice groups to be able to do that. And so being in a health system, you get to leverage that footprint a lot bigger as well. And so taking a page from them, I think was something that we can learn from each other constantly, whether you're in a large health system, whether you're a mom and pop clinic based care as well. I think we can absolutely leverage and learn from each other constantly.

Daniel Williams: 30:11

Okay. So you alluded to it, and I brought it up as well. This is something this is a model that can be adopted across the system. You identified, diabetic situations. There's also asthma, joint pain, women's health, cancer services, and other services as well.

Daniel Williams: 30:32

So if any of our listeners are out of practice or listening and wondering, okay. Well, how do I do this? What what might be a friction point, a challenge, anything there related to it or maybe even just a first step where they want to adopt this in their practices? What is something you would share with any of our listeners right now to make sure, this at least gets off the ground in the right way?

Sean Nguyen: 30:58

I am so used to starting from the ground up, being boots on the ground, and and being able to get everybody on the same page. When we're talking about such a large initiative Mhmm. It what I did for me was I got, a couple of subject matter experts on the same page with me and then went straight to the top. And then from the top, we were able to get more people on board to reinforce the things that we were trying to do or implementing the changes that we saw and then getting then more buy in from more leaders that got their teams on the same page as well. I think being able to leverage certain leaders or certain subject matter experts because they have the trust already built into their teams or their regions was able to help me as the project leader to be able to scale this project as quickly and as far as I did.

Sean Nguyen: 31:55

And so I would say, get your subject matter experts on board, get, some boots on the ground, get the voice of the customers in on this, and go straight to the top to get buying in to be able to cascade down. I I think you can absolutely work either way, either top down approach or bottom up approach, but there has to be a a concerted effort of both sides coming together, and being able to be in unison together to to be able to scale this either across either other reasons for visits, other across other disease states as well to be able to, again, effectively look at coordinated care and population health from that perspective as well.

Daniel Williams: 32:37

That is the nuts and bolts of your innovation that got you rewarded in this, Hardwick Innovation Award. So we're gonna end with a couple of fun questions. So, Orlando, that's just right down the old coastline for you, and then take a left into the Central Florida there. So are you gonna be there in person to accept your Alright.

Sean Nguyen: 33:06

Looking forward to it. It's gonna be my second MGMA leaders conference. My first one was last year, and I was completely blown away about just being able to be seen and be able to be amongst colleagues and peers across the entire industry. It was an amazing oh, and actually overwhelming a bit for me, but it was nice to see like minded individuals in the room. I got to take so much back from that conference, hearing from both other health systems and private practice groups and and multi specialty groups, some of their best practices and share, again, misery less company.

Sean Nguyen: 33:48

It would share war stories

Daniel Williams: 33:49

with each

Sean Nguyen: 33:50

other as well, about what they're doing. That was a very, very immersive experience as well. I'm actually also actively going through the, CMPE process, and I was able to, get the opportunity to go to the pre conference workshop. So I'm excited to go back again and get more nuggets from that and and and and connect with different colleagues that have gone through that process as well. So super excited to be returning to MGMA Leaders Conference this year in Orlando.

Sean Nguyen: 34:22

Be there the entire time for the pre conference as well. So I'm excited. And I might sneak in some time to either visit the mouse or, you know, go out to one of the other theme parks as well. I'm always excited to get in some of that time because my kid at heart always and will always be a kid at heart. Yeah.

Sean Nguyen: 34:42

I'm excited for a silhouette.

Daniel Williams: 34:43

That is so exciting. So the last question. So for our video viewers, they'll certainly be able to see this pin on your lapel. It's a big a. I recognize that for people who are hearing this only.

Daniel Williams: 34:58

It appears to be the Avengers emblem. What is the story behind this? You're in the MCU or something. What is happening with the pin there?

Sean Nguyen: 35:12

I I I can't divulge all trade secrets with the MCU team, But I can say, having previously worked at a children's hospital and working in pediatrics, I needed to desensitize the suit and Yeah. As much as I can. So at first, it became me buying a few pins, Disney pins or other character pins. But then it became team members getting me pins because they saw different wins. And then patients started getting me different pins as well as I was rounding on the different areas.

Sean Nguyen: 35:44

And so I have a huge pin collection of different characters and and different, areas. And, I thought it would be appropriate wearing the Avengers pin today because this particular project came with so many different amazing heroes coming together to make such a big impact for, different pay this patient population. And so, I thought it was appropriate to wear the the Avengers pen for this particular one. So that's where that Avengers pen came from for sure.

Daniel Williams: 36:16

That that is an incredible story. Is there an Avenger you most identify with?

Sean Nguyen: 36:22

I'm probably a Thor, big person, sometimes also, doctor Strange just because how, quirky I can get Yeah. With some of the characters. But, yeah, I I more so, a big head, nerd and all of that. Yeah.

Daniel Williams: 36:43

That is incredible. Well, Sean Wynn, thank you so much for sharing your story with us today.

Sean Nguyen: 36:49

Daniel, thank you so much for having me, and thank you to the MGMA entire team for, recognizing Ochsner Health, recognizing me as part of, this entire organization to do what's right for our patients and for the innovations that we've done.

Daniel Williams: 37:05

Yeah. That's just an incredible story, and congratulations to you for receiving that 2025 Harwick Innovation Award. And special congratulations to all of those team members who you are sharing this with as well. And to our listeners, you can learn more about the Harwick Innovation Award and this year's winners at mgma.com/leaders. You can learn, also, and I'll put it in the episode show notes, learn how you can go out and, either learn more about the award winners for this year or look how you can nominate someone for next year or suggest to them a gentle nudge to nominate you for one of our awards next year.

Daniel Williams: 37:53

So I'll put that information about our awards page in our episode show notes. So until then, thank you all for joining us on the MGMA podcast, and I hope to see you all and see Sean at this year's leaders conference. Thank you so much.