Integration Along the Value Chain – Redesigning Care Around the Patient

- You very much welcome everyone. I think we have an amazing panel today. I'll start with a quick overview of the topic. At hand care delivery is often designed around how systems want to deal with the patient and that has grown historically over time and not necessarily around the patient's needs.

From the point of view of an integrated provider or patient, you could almost say these existing pathways or care models are broken. Hospitals in many systems remain too often the the gatekeepers to assist them. And I think we are in a world now where in understand that that shouldn't be that way and many hospitals are also investing in outpatient facilities to capture the patient early on. It's essentially a loose lose situation.

And I have amazing panelists today that are changing these pathways, that are redesigning pathways and that will talk a lot around it. We have many investors in the room and many of your businesses are investor backed and they are paving the way to change this value chain integration. And just to to point towards a few of these providers. Now the slides are, yeah, we have an amazing panel participation also of this, of this group.

We have Hendrick from Ante, we have Stefano from Nita, we have Fadi and we have Clements. And they're all gonna to share their views. How Regina Maria, how gig, how Ramsay, Santi and HU Anita is changing this pathway and demonstrate in case studies how was done against, yeah, almost all odds of the systems. And I'm looking forward to the sessions and I'm passing on now the clicker to Stefano who's gonna start with Italian view of it.

- Thank you very much. Thank you Tobias. Thank you all. I'm a, I'm an outsider to, to the sector.

I've been in the group for one year only. I come from 20 plus years of financial services and I'll try to give you a bit my and Humanitas view around why and you said it so I will mention you why the healthcare delivery is broken. Before we start, just like very quickly for those of you not knowing us, Humanitas is the leading Italian teacher research hospital. We have research, we have a university at 11 hospitals.

We are the first one in terms of size by revenue in the private healthcare market. And we now have 22 medical care, which is the business I manage. So our outpatient operations that are growing very fast. Just to give you a few KPIs on top of what's already in the slide, around 20% CAGR over the last four years, organic growth.

So it's a sort of a startup entering the maturity phase 350,000 unique patients served every year, 1000 visits, sorry, 1 million visits and 1000 clinical doctors operating in our facilities. 52% of which are structurally part of Humanitas group. So this is the first interesting part of, of the business I run. We are follow integrated with the hospitals and with the rest of the group.

So we try to build around the clinical excellence of Humanas Humanas hospital and then not just deliver, you know, the standard accessibility last mile care and diagnostic to the market, but we try to build in hub and spoke model a system that brings the best of the clinical excellence of Humanas that has been for three years in a row, the best hospital in Italy to, to the community. The underlying idea is to bring, to move away from the hospitals centricity that, you know was the, the history and the excellence of the group towards a a, a more patient-centered and community-based care how we're gonna do it.

We are building a, of course a bigger network. We're gonna double it in the next three years through selective and profitable growth. So it's a mix of greenfield, brownfield and m and a. We are building around, let's say our already excellent customer experience, but we are trying to continuously ameliorate and follow what are the customer needs around the patient experience, both on the digital and on the digital side.

We're a strong believer or the fial approach and we believe it's sort of in the brand that human will be at the center of the care delivery. And then topic of today we are building innovative patient-centered care pathways. How we are doing that, we are sort of putting, once again the, the the, the brand is suggesting it. We are putting the patient at the center and I would say also our internal customer, which is the clinician at the center of this redesign of pathways.

We already have a, a program up and running on psychology, we call it psycho care. We are now in these days launching a new one around gastroenterology and I'll be elaborating in a second, but then we are building other pathways around obesity and overweight management, sleep disturbances, pain, ortho and rehab, women's health. We are studying one on longevity. Of course you must have a longevity offer at some point in this market and potentially also ophthalmology.

But this is just, let's say to say the way we are approaching the, the pathway, so how, how we are prioritizing them, I would say based on epidemiology. So it's strongly data driven. So why gastro for example, of which I will be speaking in a second because 40% of people suffer from, in Italy from one or another gastrointestinal issue, 50% of those are functional. So it's severely impacting their lifestyles and less than half of those actually one third tries to have an access to cure.

How we are gonna do that, once again we, we need to sort of change the paradigm of current care models which are siloed and very fragmented, bringing to low patient experiences and low adherence to cures. So in the end they're not delivering the quality and not really solving customer problems to a model that is multidisciplinary. So we force different specialists with specific privileges to work together. And in a cluster model, oftentimes we make them sit together, you know, in the same centers and we are specializing some of the centers to have all the potential answers to the patient problems at the same time.

So this is a, a factor number one. Factor number two is creating this continuity of care. We've seen it yesterday, many panels and presentations. The pathways are broken and they have many blocks and let's say breaking points.

We are trying to create a discontinuity thanks to a continuous administrative support. So for the moment we, we are building secretaries basically that are helping the customer follow the plan. In the future we will implement also of course automation and ai and last but not least, it needs to be comprehensive. So how we make the comprehensive care and we address, you know, all the issues that you see here in the slide.

We integrate the medical care therapy with daily counseling. So we are building a team of, and we already have many actually of nutritionists and psychologists that work aside the clinical doctors so that they can, you know, build the correct answer to the patient problems. So this is our way of looking at integration.

- Oh, very impressive Stefano and some very encouraging outcomes. I think we'll come back to a couple of those items with questions I might pass over to Henrik to talk about how, how Ramsay ante implemented your approach.

- Oh, hello everyone and thank you so much for having me. Ramsay ante is what you see on the slide here is the mix of our service lines in our five countries of operation. And you can see it's fairly diverse along the value chain or the patient pathway. We are really embarked a journey a couple of years back where we wanted to really build our own ecosystem in the countries where we are and we are gradually doing that along the patient pathway.

So the word integration is really important to us where we try to serve the patient not just in a transactional care coming and going out and never see you again, but building loyalty and relationship even before the patient becomes a patient. So that is what we really try to achieve in our countries. You can say that in France we are fairly hospital focused in patient business in the Nordic countries and Italy it's more of an outpatient kind of setting. Going one step further, this is a few examples, how we build service offerings, taking care of the patient in along the patient pathway.

So in the prevention area we do a lot of digital contact, health advice and stuff like that. Monitoring of chronic ill patient and so forth. A lot of use of digital functionality, primary care we now investing in primary care in all our countries of operation. The last one is France, building up a structure where we add on to our network of hospitals in our clusters in France, in the hospital setting.

We are doing a lot of outpatient and day care business here in France. Being hospital focused, I think it's important to really drive the outpatient side of the business. We have in Sweden introduced in one of our hospitals an AI tool for mammography, which is also published in the cent years ago where we have driven productivity up to 50% moving out one radiologist from screening the imaging and the AI is very accurate and we are further building on that at home growing for us. We do a lot of advanced home care where we follow the patient from hospitalization back home and a lot of remote monitoring too.

Then obviously we build a lot on integration with digital tools. I will talk about that just in a minute. And we are obviously a lot focused on the medical quality outcomes. So here it is an example how the people actually or the patient really enter our ecosystem, whether the digital front door, but we also go further in the value chain in order to drive referrals between our different care settings.

So we do referrals both digital and physical. So we really try to leverage the fact that the patient can go in a physical care setting. And what you see here is that we have, I think it says yes, 60% of the bookings within caprio's own sort of settings, which means that we keep the patient in our ecosystem and can follow the patient. And that is good not only for us but mostly for the patient to have this continuity of care.

Finally, this is an example of what we do with the digital service. We have built a platform, and this is a Swedish example where the patient can enter in all our care centers proximity care center that is, is have a digital access for patients and they can access and answer questions, do that anesia and then get access digitally or physically for that matter. And when the care centers are closed, we move them digitally into a sort of national digital service where they get advice or treated and if they need physical care, they are booked in Monday morning at the care center. This is a very effective and seamless patient pathways for for our patients.

And we are also now starting to integrate the secondary care side of things where you can actually in transfer the patient to digitally into a secondary care treatment from the proximity care. And finally to say that in the primary care setting you don't have physical access to all the expertise that you might need. But this system does also allow us to invite, let's say a cardiologist and an orthopedic surgeon or any other specialties into a patient interaction in order to expand on the competencies and advice around the patient. So we are on the journey, we are continuing to build and I think we, we we have done good so far and but there is a lot more to do when it comes to digital services.

It's a huge potential. Thank you. Thank - You Rik. Moving on further south and east again to Fadi who built with his team an amazing proposition to the Romanian payer but also to the Romanian patient.

Over - To you. Thank you. And good morning to everybody. So let me just, yeah, so we are the largest, the leading healthcare provider in Romania and also the leading healthcare provider in Serbia operating under medi group as a brand in Serbia, Regina Maria in Romania.

I will talk a little bit about our digital assets, but first just one slide about who we are. We are an integrated healthcare provider. We started what Stefana was saying that they started with hospitals and now they're developing their outpatient network. We started actually the other way around.

We started with our out outpatient network and building up the infrastructure for hospitals. And now we operate roughly in both countries. We, we are roughly 14,000 people in hundreds of locations and having more than 5 million visits every year in Romania and in or our organic growth is very similar to your organic growth in terms of in both countries. I think what is most important, and I will start my presentation with asking the audience one question, can you tell me how many of you have already a healthcare app that enables patients to look at their electronic medical record and do bookings?

Can you just raise your hands? Okay, so we, someone not me asked this thing at HBII think four or five years ago and there were three people in the audience. Now we are more that have done that and I think, and I do encourage everybody to look at that, I think it's extremely valuable and it really pays off. It's a big headache, but I think it really pays off and I'll just go to what we do and I think just this is an effect I would say and not a cause.

This is how our patients recognize our service and brand. And the red part, if you look it's regional area, the others, the other colors are our competitors. We are in a privately paid setting quite a lot. So our mindset is very focused on getting patients and convincing patients as a brand, as our, as a brand powerhouse.

And it shows, again, we think truly about our digital assets. That helped us a lot getting to this numbers and what we do. We've been doing for quite a lot of years a digital pathway. So we worked together with a lot of medical teams, management teams, finance, marketing teams on what does it mean integrating healthcare and how we create create value.

And the most important question that we asked as a team was how can we empower patients and let patients do a lot of stuff and not tell them what to do? And everybody's talking about empowering patients and everybody's talking about putting patients in their center of activities and so on. But at the end of the day, very few of hospital operators or integrative operators are really doing that. So we structured in three parts what we can do for medical integration, what we can do for the operations and what we can do on it because there were other presentations about it, legacy systems, cybersecurity, privacy and so on.

So we structured this patient digital PA pathways and we said how are we going to construct our digital assets? So we, we went through all these many years ago we looked at, you know, what are is our wishlist, what is our north star, what others are doing in US or in Europe? And we started our own pathway. So where are we right now?

We are right now at 62% of all our interactions and you've seen that we do more than 5 million per year. 62% of them have an electronic referral. So that means that we can really capture what doctors are suggesting as treatments, as follow-ups to patients. In 62% of all our interactions, even more than that, 56% of our patients are not having a transactional relationship with us.

We consider a transactional relationship. They come for a blood test or for a consultation and then they go out of the system or they go somewhere else. So we track also from the consultation, from the diagnostic, if there is a referral, how many of them are coming back, how many of them are using our services? And we are trying through patient pathways, trying to match their needs with also the capabilities of our network to offer that need in their location in their city or in their region.

And what we consider, we established, to be honest from other sectors, retail sectors, that if you have more than three other segments, so segments for us mean meaning how we are internally organized, so labs, imaging, hospitals, outpatient and so on. If you have more than three of products access it, that means that we've done something right. And we are right now at almost 30% of our whole patients are using more than that, which is great. We are working on that quite a lot.

And the only thing that I will show, I'm, I'm going to end my presentation, is all the digital infrastructure. Our key one is related to our healthcare app, which is in our region, the most downloaded app both on Google and Apple store. And when I say that it's a living organism that we invest quite a lot in significant CapEx I would say. But we are now in the millions of bookings, millions of downloads and we've reached the limit where 48% of our own appointments are done completely by the patients.

So we don't interact, they're doing it by themselves, they're watching, they're talking with us, they're doing their own appointments. And our focus is very, very much on how can we empower patients to handle their own care, of course with our digital pathways done behind the scenes, but trying to get as much as feedback as possible from our patients. Thank you.

- Thank you Fadi. Truly amazing how you're shaping the Romanian healthcare system and how patients interact with the providers. Now passing on to Clements, who obviously is yeah, has to tear down some walls in an existing healthcare system in Germany, which are very siloed and yeah, look forward to see how, how you're doing it.

- Yeah, yeah, good morning and thank you for having me. I'm gonna cover the rest of Europe now or pitching with Germany. We are GIG we are an outpatient provider focused on internal medicine and basically the challenges we face in Germany are probably quite similar to other countries in that it's very siloed and obviously healthcare has always been thought of as from the delivery side. But yes, of course we should think about the patient because where does the value get created?

It's the medical condition of the patient that we treat. And Germany is special in that, that there's a massive over capacity of hospital care. There's no other country in the western world that has as many hospital beds than Germany and there's a lot of service being delivered in hospitals that in every other country is being done as an outpatient service. And the outpatient service in Germany, again is hyper fragmented.

So most of the physician work in a single practice and while that worked many, many times years ago, that's now difficult medicine become too complex for a single doctor to serve a patient fully. Also the German model outpatient model is based on self-employment. So it's all the baby boomers that work 50, 60 hours a week serving these patients and the newer generation just doesn't want to follow that model. Care is increasing, our demand is increasing and the overall result is while Germany spends a lot on it, 13% of GDP, it's just not sustainable in terms of cost.

Patients are reasonably unhappy and worst of all outcomes are average. Now if you were to say if we spend a lot of money and get great outcomes, that would be okay, fair enough. It's a, it's a decision to take but to spend a lot of money and to get average outcome work needs to be done. And that's where we pitch in.

What we are trying to do is shift care into the outpatient setting and what what is needed in our mind is obviously integrated approach. It is not gonna be the single doctor in a single practice that's gonna treat the patients. And we've seen great examples of care how care should be integrated and that's what we're trying to do with our group. The the challenge there is trying to, how how do you get people work together?

You need to get people a co-located, it's easier to work together if you are nearby. It's easier to work together if you have a common IT infrastructure and backbone and ways to exchange data and, and, and, and medical knowledge. And that's what we're trying to do within the group. Within the, within the practices.

Also the model of self-employment is probably very unique to Germany that that most of the doctors than managers and physicians and that would rather be physicians rather than managers. So a lot of people seek employment and it makes total sense because obviously the division of labor we can do better during the admin side and we can free up the doctors actually serving the patient. And that's where AI and technology and all these things come into play and that's what we're trying to build up in the group. It's a very strong centralized service where we help the doctors focus on the actual clinical care rather than the admin side.

And all of this in my mind is the only way to solve the German healthcare crisis. The, it's way too expensive and way too costly. Most hospitals are, the hospital sector is chronically underfunded and not only do we have too many and too many inpatients, but we also competing for the same staff. So wouldn't it be better to move it into the outpatient setting and it'll be more convenient for the patients, it's more cost efficient and outcomes are better.

And for the overall system I think will, that will have a great benefit the way we think about it, and we started with cardiology being the kind of the mother of internal medicine and we group all the other internal medicine around it because internal medicine provides about for 30% of all hospital admissions and compared to other countries we could probably save on half of them. And that's what we do and that's the network we're building obviously with services along the value chain of the patients being the be it the lab or be it the telemedicine. And where we at today is 55 locations, 175 doctors.

We're not quite at your size yet, but it's working well and I truly believe that's the way forward to solve the German healthcare. Thank you.

- Thank you. Great. Thank you to the panelists for a short overview of how you are integrating your pathways. We're gonna open up now to the audience to raise questions.

We have microphones in the room, so whoever wants to go first, raise your hand and ask any questions around this, this topic to the panelists. If there are no questions to start with, I can maybe start and have prepared some questions and you can think about a couple of, but Adrian, do you wanna go first?

- Thank you to all the panelists for really interesting presentations. We've been talking about integrated care pathways for many, many years, decades even. Could the panelists comment on why we haven't made more progress quicker? How can we really accelerate through this?

- So first Henrik, I I think the way you design the patient pathway and still it's just as mentioned in silos and bi specialty and you don't look cross, cross the patient pathway. I think that is a sort of a, an attitude that the industry have had. The other thing is the explosion of technology now, which can really support the patient pathway to make things easier, both for the patient and the service offering. The access not only the first way as I mentioned or the first contact, but also further along the patient pathway and combining this digi physical pathways is really powerful.

So I think technology will drive more and more of these more coherent patient pathways, but it's obviously up to the, to the industry and to us and others to, to be brave and take this on.

- I can I integrate quickly. I don't know if I'm the best position to talk since I'm in the sector. Only since a year, but maybe exactly because of that I, I developed my, my my feelings about this topic, the sector, and I think this is something we all in the room need to admit is lagging very much behind other sectors in terms of digitalization. So I very welcome what has been just said.

We are waiting for this wave, you know, to hit. And funny enough, like I've done 10 years in banking and 10 years in insurance and every time I move sector I say this last sector is 10 years behind the previous one. So given that banking is not exactly yet at Amazon level, this gives us more or less know where we stand. Of course you need to have a pathway or many pathways that are longitudinal now we call them longitudinal.

And the problem here is in absence of digitalization and you know, of continuous data exchange between, you know, the different facilities and the different operators taking care of the customer or or, or the patient. As we, as we say, it's very difficult. And the second thing is that I, I think it's being said in another panel this morning, it's very much a change management issue because there's human in the loop patient, they want to see a person and when you have a person taking care, you know, all the digitalization is much more difficult and all the orchestration of the pathway, actually all the burden of the orchestration is left to the patient typically is not the clinician taking care of it.

The clinician is sending you the, at best know the medical record and then it disappears and you know, the patient is left with the burden of orchestrating the, the care pathway. So no surprise that then adherence is lower than 50% because you, you forget you don't do the medication, you don't do the follow up visit, et cetera, et cetera. So I think a lot has to be done together with clinicians. So that's also part of the paradigm shift I was mentioning before, we need to work with the clinicians that they want to do, and I totally agree the clinicians and not the managers and you know, take off a part of the administrative burden on their side and at the same time do the same with the, with the patients.

- If I can add to this historic being a medic myself, the the training in itself is very siloed. So you, you produce a lot of doctors coming out of the system, that thing in these categories, cardiology, gastroenterology, oncology, and the training needs to change. We need to have positive examples. Obviously digitalization can be huge accelerator on, on top of it.

You have all sorts of entrenched stakeholder interest, a highly regulated system and to top it all, often a reimbursement system that favors doing things in your silo and doing a lot of volume. Now it's more than often showed in, in Germany is, is a prime example for this. Consuming more healthcare doesn't mean better healthcare. Just because you go to the doctor more often than other people doesn't mean you are healthier.

What should really matter is outcomes, clinical outcomes, and of course we can produce better clinical outcomes working together, but there, there needs to be something in it for everybody. And if the incentives are misaligned keeping you in the hospital and you get three, 4,000 euros for it versus having you in the outpatient setting for a hundred euros. Now people or some people may be inclined to keep them in the hospital, but it's changing.

- And, and I just, just super quickly on incentives because I think it's really a matter of incentives here to doctors especially, you know, because if we keep, you know, incentivizing them in their own silos on the specific pathology, nobody's really taking care of the person as a person. No. And so all the burden in this case of administering the, the different pieces that will need to go together, you know, other healthcare professionals such as psychologist or nutritionist to solve the patient need because that's customer centricity, solving the patient need that, solving the patient problem.

It's on us administrative staff, you know, so it's like giving incentives between patient, the, the administrative staff running operations and the doctors are not aligned at all - For us. If I, if I can answer a little bit different to your question. I think we see patient pathways very well done in some areas like breast cancer, IVF ophthalmology, we've seen them all over Europe, US and so on, very well executed. Where is the pain?

The pain is on the finance system. There is no incentive to do patient care integration of that because you are paid transactionally, you are paying transactionally doctors. So there is no need for integrated healthcare. We run a value-based healthcare, so we run subscriptions, we have subscriptions more than 1 million people who are subscribed to us.

So we are highly incentivized financially and not only financially and also clinically to take very well care of a certain large population. So we have a financial incentive, let's say as an organization to look at patient pathways. So I think to your question, why we are so slow, as long as the payment system, you know, follow the money, if the payment system is not changed, things are not going to change so easily.

- Yeah, I mean it's interesting to say why are we so slow? I think what you created in, in Romania is actually is moving in in in Lightspeed in in healthcare services terms. And you obviously had the opportunity and you didn't need to break as many barriers as in, in more developed systems. For example in, in Germany, which i, I know I know best, but I think it's truly amazing to see how you can disrupt and you can be disruptive versus existing other systems if you have that wide space opportunity and if you are truly, truly innovative, - Yeah, but even if you have that, you still have the challenges that everybody had said here on doctors for instance, making them working together or on great doctors who have long list of patients that they don't need to work with anyone because anyway they are the star or the, you know, the superstars of a country.

So why bother at the end of the day? So you are trying, as you said, through management, through administrative and so on to, to look at these patient pathways and try to do a change management of optics, which is very hard after you've been trained 25 years or how many years that you know, you are just there to treat a certain thing. And the issue is, going back to your question, I think the issue that we all have in healthcare right now is even deeper because it's a catch up on integrating, but now patients want from us personalized healthcare. Everybody's talking now about I want personalized healthcare genetics.

I want a doctor who understands more broader my healthcare issues, prevention, preventive care, not disease care. So I think it's another catch up that now everybody I think is trying to play in the next 10 years.

- Thank you very much. Any additional questions from the audience? The front?

- Thank you. Thank you to all the panelist question about integration along the value chain. It, it seems like you, you've all opted for a very integrated model at the end. Is it possible to do the same through cooperation between different players?

So it's the, the path that you've chosen, but is it possible - Who wants to start? I can, yeah, Fady, do you integrate other providers?

- Yes. So for instance, I'll give you a very quick example. We do a lot of oncology, chemo surgery, consultations, diagnostic post pre we, we were not doing radiotherapy or nuclear medicine and we have partnered up with three players who are doing that. They are part of the medical boards, two more boards we do seamlessly patient pathways, we have a contact there, we do the appointments for our patients to them and so on.

We decided this year to enter that as well. There is, there are benefits of controlling the quality, clinical quality and so on once it's under your roof. But we see also the benefits of incubating an idea with partners as well as long as I go back, as long as the incentives are aligned. And for, for us, for me it was very clear that if you align financial incentives then everybody's aligned.

If you are not aligning financial incentives, no matter how people will say that they really care about patients at, at the end of the day they will track financial - And Henrik. Stefan, any other examples where you integrate other providers where you collaborate?

- Yeah, I think the same goes for us. I don't, I don't think you can not, you need the, the whole value chain and we work very closely with hospitals and on the slide says 10 plus we probably have even more where we, we we exchange, we have same medical standards, we're financially aligned. Some of our staff work part-time there, they work part-time with us and that works very well as long as you've got the same goal and the same information basis. That's totally works.

- Just to quickly add on this, so the short answer is yes, it's definitely possible. I fully sponsor Fadi that you need to have financial incentives aligned and the clinical incentives I would say, and this is the reason why we don't, because given that our north star is quality, we want to have full control. So we'd rather lose a bit of opportunities but be fully integrated in the value chain and keep short of everything in house. My fear is that even if you align incentives, then aligning clinical quality when working with a partner can be tricky and of course you lose a bit of control - Question there in the back.

Can we have a mic please? Can you just raise your hand again?

- Hello? I have a question for Mr. Farry. Thank you. I've actually been a user of your chain in the past and I've used your app and I was curious if patients are also interested in the interactive tools like self-diagnosis or telemedicine or they're strictly interested in checking up their patient file, their results and they strictly use it when they have a need.

Are you interested in making the app more usable from a day-to-day basis or just using it for consulting and only strictly checking their re their results? That's my question.

- Thank you for that question. Very good question. So in the life of an app, the the number one question that peop you know, you ask yourself how much do you want the app to be used on your phone? Because we all know we have a lot of apps on our phones that are not being used and how, how often does a healthcare app should be used?

Nobody knows the answer we tried. I mean if anybody knows it, it'll be great. We tried in us to, you know, what's the, we decided that it's very expensive for us as an operator to start doing APIs with all the wearables and we decided that due, there are so many wearables, you know, from aura to different winners or losers on, on, on the wearable market that we are not going to integrate them because we said it'll be a late entrant on, on this market due to cost. So we are very much focused on making sure that patients are getting access not only to their electronic medical record, not only to their lab tests, not only to appointment booking to telemedicine, we have more than 2 million now per year telemedicine consultations.

But also what we are doing now, we are doing a lot of patient pathways where we are trying to help them of with popups and different things and it, it's working very well. We implemented it last year where if you went to a doctor, you have a referral to some lab test or imaging, you just receive a notification of saying, hey, you have this lab test, would you like to schedule an appointment? Or you have already done it outside of the network. So we are not invasive, but we are trying to help them.

So this is completely done what we were doing with nurses or people. Now we are doing it through the app. So this is our focus and this is how we want to do it. The most research thing on our app is info about doctors.

So also on our website, also on our app, because we have 3,600 doctors in Romania, people are looking at, you know, in, in a city we might have 100 gynecologists. So ladies are going to look at, okay, what's the difference between the 100 gynecologists, how should I choose one? So there is a lot of looking at doctors. So I hope I answered your question - Very much.

Any final question from the audience in the back? I think we have one minute to answer then. Yeah.

- I'm just interested, given that we're in quite a risk averse industry, if not very risk averse industry from a change management management point of view for changing, you know, pathways changing behavior of doctor, what has some of the kind of biggest challenges that you've done and any tips as we all try to make changes in this, you know, risk averse industry?

- Thank you. We clements as a medical doctor, do you wanna wanna answer that?

- And, and thank God they're risk averse or we are risk averse because it's the life of our patients that we're dealing with. So I, I think it's communication, sitting the right people together, doing small pilots and obviously feedback loops. So I don't think there's more magic to it than that. It's getting people along in on this road and the journey and aligning them on the same kind of North star has worked really well for us, but their doctors want to be heard.

- If I just can build on that. Sure. I I think for sure that's the way, I mean you need to involve people and I don't think one should underestimate the power of change management when you digitize your patient pathway or use other terms of technology. If you don't have a plan and you really know what to change, don't invest, depend in digital functionality because then people will continue to work the way they were always done.

So involving people in, in the way you want to change working procedures and all those things and give them the why to bring people to work with it and tell the why. That I think is a very, very important thing that we are working a lot with when it comes to changing the way we work with the patient and our staff in order to benefit from what technology actually gives us.

- Telegraphically. If I can echo, it's in this sector, you don't sell the opportunity, this is what I learned, but you sell the reason why Toco, what has been said, you need to change it. So sell the issue and not the opportunity because with the opportunity you're not gonna move a lot of people. Everybody's too scared of changing.

- Thank you very much. Thank you to the audience and apologies to the ophthalmology panel who's two minutes we now stole. But thank you to panelists. Thank you for the good discussion.