Ep. 23 Balancing the Scale: Obesity, Rx Costs, & Healthcare

Dive into an episode that's all about the big issues hitting our health and wallets: skyrocketing prescription costs and the obesity epidemic. Two co-authors of the 2024 Employee Health Trends report from Springbuk take you through the ins and outs of how these challenges are reshaping the landscape of employer healthcare spending and what it means for all of us.

Janet Young, MD, Clinical Analytics Advisor at Springbuk, and co-host Jennifer Jones,  Vice President of Strategic Partnerships and Population Health Practice Leader, explore the tangled web of drug pricing, unravel why your medicine costs keep going up, and discuss steps employers can take to reduce costs. Plus, we're not shying away from the weighty issue of obesity. Jennifer takes a deep dive into how it's impacting healthcare costs in ways you might not expect.

This episode is a must-listen for anyone involved in employee health benefits, offering actionable strategies and a comprehensive understanding of the current landscape.

What You Will Learn:

  • The significant role of prescription drug pricing in increasing employer healthcare costs, with a particular focus on brand name and specialty drugs.
  • Insights into the obesity epidemic and its direct and indirect impacts on healthcare spending and employee well-being.
  • Strategies for employers to manage rising healthcare costs, including the adoption of generics, biosimilars, and comprehensive health programs.
  • The importance of a data-driven approach to health benefits planning, leveraging insights from healthcare analytics to inform strategies.
  • Emerging treatments and approaches for managing obesity, highlighting the role of GLP-1 agonists and the need for multifaceted treatment strategies.

Stay in Touch!


[00:00:00] David: Hello and thanks for joining "Healthcare on the Rocks: Employee Benefits with a Twist." I'm David Pittman, Senior Director of Marketing at Springbuk, and normally my co-host is Jennifer Jones, our Vice President of Strategic Partnerships and Population Health Practice Leader. But today she is pulling double duty as both co-host and guest. 

That's because we are once again covering two more topics from our recently released fifth annual Employee Health Trends Report, and Jen is one of the authors of that fabulous report. If don't yet have a copy, I'm gonna give you a second to head over to springbuk.com/eht24 to get one. The report draws on analysis and findings from more than 5,600 employers on the Springbuk platform. So Jen, how does it feel to be answering questions as well as asking them?

[00:00:58] Jennifer: Well, I guess you would expect some kind of quippy remark from me here, David, but, it, it'll be interesting. I'm happy to be a part of today's session on both sides of the fence today. And as you mentioned, our previous show, was with Janet as we were talking about high-cost claimants, which I think everyone will find extremely valuable, and as you said, this is the second episode in our 2024 employee Health Trends Report, and if you did miss that episode, you can listen to it of course after you finish today's episode, and you can find that at springbuk.com/podcast. 

Today though Janet is joining us once again to talk about drug costs and obesity, which are the other two major topics in the report. Janet is Springbuk's Clinical Analytics Advisor, and she has an MD degree from Yale University and more than 30 years of experience providing clinical expertise and oversight to the development of healthcare analytics and guiding clinical content development of new models, methods, and applications.

Once again, Janet, welcome to the show. 

[00:02:04] Janet: Yeah, thanks for having me back 


[00:02:07] Jennifer: So Janet, we'll we'll start off with you. Focus around the drug costs. Do we know about the contribution of drug costs to the overall increase in the employer healthcare costs? 

[00:02:18] Janet: Since 2021, we've seen drug costs for employers increasing at a much faster rate than medical costs. So between 2021 and 2022, medical costs stayed flat, and drug costs went up about 10%. And then in the next year between 2022 and 2023, there was about a 4% increase in medical costs, but there was over an 11% increase in drug costs.

The rapid rate of increase is causing a lot of concern for employers because there doesn't seem to be an end in sight. Even as generics and biosimilars become available, drug companies are marketing newer drugs that are either more effective or have other advantages over older drugs like ease of administration.

[00:03:15] David: Well, no end in sight doesn't sound very positive for us. So, what do you think is driving this increase in prescription drug costs?

[00:03:24] Janet: David, I think this question is going to take me back to my economics 101 class. So when we think about what causes increased costs, we usually think about price and volume. So either the cost per unit is increasing or the number of units is increasing, or both. But looking at what's driving drug costs becomes a little more complicated than that.

In addition to the cost per unit, which might be something like the cost for a day of a specific drug, we also have to think about the mix of drugs. In other words, the cost of each drug might be identical to what it was before, but maybe there's a shift to use of more expensive drugs to treat the same condition.

We're finding that several factors are causing drug costs to rise, but one of the main ones is a shift to prescribing more expensive drugs for the same conditions. And that could be switching to specialty drugs or more expensive brand-name drugs. To a smaller degree, the cost for the same drugs is often increasing.

[00:04:38] Jennifer: And Janet, you mentioned the switch to specialty or brand name, and I think traditionally in the past we've had the mindset that this is all driven by specialty, but we did a deeper look and really identified some additional trends. So how are brand name drugs specifically affecting healthcare spending? 

[00:04:58] Janet: When we looked at the year-over-year increase in drug spending, that occurred, we found that brand name drugs account for about half of the year-over-year increase. And then when we drilled down, we found that most of the increase is due to a higher cost per script. So the average cost per script in our most recent time period for brand name drugs was over $700, and that's compared to about $470 four years ago.

We know that many drugs have gone up in price, which is part of the reason, but the main reason for the increase in spend due to brand name drugs appears to be the shift in the mix of drugs that make up. The brand name drug spending. So 39% of brand name scripts are now for antihyperglycemics, compared to only 27% four years ago.

Antihyperglycemics include drugs like insulin and also the GLP-1 agonists. And here's why this change in the mix of drug matters. If more of the drugs being prescribed are from a high cost category, the average cost goes up. As it turns out, hypoglycemics are a very costly group of drugs with an average cost per script of about $900.

So the shift to a higher percent of brand name drugs from this group is really one of the main drivers of increased brand name drug cost.

[00:06:37] Jennifer: And I know we'll talk about GLP-1s in our second segment around obesity too. So don't worry, everyone, we'll dig that. But we can't ignore specialty drugs. Um, so why don't you walk us through the observations as far as how that spend has changed over the past few years. 

[00:06:57] Janet: Sure. Specialty drug spending continues to increase. Some of this, again, is due to an increased cost, um, per script for the same drug, but most of it is due to an increase in the number of members who are taking at least one specialty drug. We're getting close to having one out of every 50 members taking at least one specialty drug. 

Specialty drugs are typically used for a chronic condition. So once someone reaches the point of needing one of these drugs, it's likely they're going to keep taking them, um, as long as they're effective. Two of the areas where we continue to see growth in use of Rx channel specialty drugs in the commercial population is in treatment of psoriasis and inflammatory bowel disease.

But another area that seems to be growing is treatment of eczema. And I think this condition exemplifies one of the ways drug companies are able to increase utilization of a costly drug, which is through expansion of who's eligible to take the drug. 

So as an example, the specialty drug Dupixent was originally approved for treatment of eczema in individuals over 12. But then in 2020, the manufacturer received approval for treatment in individuals over age six. And then in 2022, they received approval to treat individuals as young as six months.

[00:08:35] Jennifer: Dupixent for everyone and costs just keep going up. All right, so really good background on, on the brand and specialty and what's really driving that, but how do generics and biosimilars then compare to brand name drugs in terms of cost and effectiveness and are, is there hope really that's out there as far as to help control costs? 

[00:08:58] Janet: Generic drugs and biosimilars are as safe and effective as their brand name or reference product counterparts, but are significantly less costly. In the case of generic drugs, they usually cost about 80 to 85% less than their brand name counterparts. We know that the discount of biosimilars compared to the original biologic drug is generally a smaller discount in terms of percent, often between 10 to 30% less than the reference product.

But because the specialty drugs or biologics are so expensive, use of biosimilars, rather than the reference product, may represent a significant savings. We see a lot more adoption of generic drugs than we do of biosimilars, although, use of biosimilars is increasing. 

So not all drugs have a generic or biosimilar, but sometimes it's possible for someone taking a drug that doesn't have a generic or biosimilar to switch to a drug for treatment of the same condition that does have a generic or biosimilar, which can result in large savings. 

I just want to take a moment to put in a plug for some important generic drugs and biosimilars that are available now or coming soon. In our study, we found that one of the top 10 conditions driving drug costs was ADHD, and much of that cost is related to a brand name drug Vyvanse. But a generic for Vyvanse arrived on the market in August of 2023, and that should offer significant savings. 

Then we also found that the specialty drug Stelara was one of the top drugs driving increase in drug cost. In fact, it's number four out of all drugs, which was, um, probably a little bit of a surprise to us. But here's some good news. We expect to see several biosimilars for Stelara, on the market in April of 2025. So we know that there's potential savings if members use the biosimilar, but additionally, there should be greater market pressure on Stelara in terms of pricing and rebate offers, as their manufacturer attempts to maintain their market share after the launch of the new biosimilars.

[00:11:38] David: Excellent. Let's let the markets work their magic and bring some of these costs down. , Janet, thanks for giving us some of those tips there on those generics. And Jen, I'm gonna turn the tables and put you on the hot seat now for a little bit. What are some of the other strategies that you talked about in the Employee Health Trends report – strategies that employers can use to control some of these drug costs. 

[00:12:01] Jennifer: Sure. Well, with most things, we always encourage people to understand and know their baseline spend. So what are the conditions that are driving the high-cost pharmacy spend? I. You know what's going for specialty drugs? Where's the brand name? What percent are generics? What are the biosimilar adoption rates?

So just understanding your overall landscape within your membership. That's important because you have to be able to measure success and know what that baseline is. Then we always recommend that you have a good understanding of your PBM contracts. So as Janet mentioned, there are a lot of generics and biosimilars that are out there and you need to be able to make sure that you know, are those on the formulary?

Are they in a position where those are favored over the specialty or the brand name? Do you have step therapy or prior authorization in place for those particular types of drugs as well? And I think what is also really important from a member education standpoint as well is knowing, like Janet mentioned, some of these biosimilars that we anticipate to see for Stelara, now is the time to educate members about that biosimilar that's coming to market or these alternatives that are coming to market as well.

Because you're going to have a better adoption rate of people who currently aren't taking that drug, but. If they have conditions that Stelara is treating for, if they're not on it. They are the ones that have the best likelihood of just starting out on a biosimilar to begin with, and, and it's understanding kind of the whole ecosystem that goes around there as far as educating your, your members.

They need to know those price differentials, not only for themselves, but how that affects the plan as well, what the employer is paying out of that, which. Can have a, a effect as far as with everything else that they're spending. Healthcare is, you know, usually now one or two as far bottom line as far as a cost expense.

And so if the company needs to continually dump more and more money to cover cost for healthcare, they can't pay for other things. So it's again, a whole education component that needs to go into that. And then lastly, one point that within the full report, Janet does an excellent job of really reemphasizing how much drug spend goes to chronic conditions.

And I think historically, as we've thought about some specialty drugs and, and even some brand name drugs, we've always thought that a high drug spend has been attributed to more acute types of conditions. But knowing that the majority of that spend is going to chronic conditions, it's gonna be imperative that we continue to work with ways to get members under control for those chronic conditions. 

Sure, people are going to need drugs to treat their conditions, but we need to make sure that they're taking it appropriately and taking it as they should, refilling when they need to so they can get that, you know, their, but it's their diabetes or GI condition under control to prevent flareups, which then cause more issues where they most likely need more drugs or higher doses. And be able to understand that medical costs and pharmacy costs really do go hand in hand together and ensure that we're really treating the chronic conditions holistically to be able to hopefully control that drug spend going forward. 

[00:15:22] David: Great. So a couple of key takeaways there, just in a nutshell. Communication and education, very important. 

[00:15:30] Jennifer: Yep, absolutely. 

[00:15:32] David: There's much, much more in the full report, so again, I do encourage you to download that and give it a read. Now I'm gonna ask both of you to address this next one. How significant is the impact of obesity on healthcare costs and drug spending? And Janet, why don't you go first?

[00:15:53] Janet: Okay. I'm going to start with what we saw in our analytics. When we looked at the per member per month spending for members who were overweight, obese, or severely obese, we saw a stepwise increase in PMPM as the BMI increased compared to members who don't have these diagnoses. Members who are severely obese on average have healthcare costs that are almost three times that of members who don't have a diagnosis of obesity or being overweight.

The increase in healthcare costs, members who are obese or overweight are mainly due to the associated comorbid conditions. The risk of having these comorbid conditions tends to increase with BMI. And the types of conditions go beyond some that we might typically think of being associated with obesity like diabetes and heart disease. For instance, there's an increased risk of psoriasis, several types of cancer and depression. 

In terms of drug spending, as comorbid conditions increase, so will the drug spending to control these conditions. And then there's the cost of treating obesity itself. The spend on drugs to treat obesity has gone up rapidly.

The average annual drug spend for someone with an obesity episode four years ago was under $60, but now it's over $300. And even so, most members who are, who are obese are not receiving drug treatment. So there's potential for the drug costs to get even much higher. Jen, what would you like to add?

[00:17:52] Jennifer: I think you definitely hit the highlights there. Just a couple things. I would add that obesity as a whole is not new. It's not a new challenge essentially, that employers have been facing much like the rising pharmacy costs. But I think where the challenge has always come in is people just don't know how to treat it because we've always focused on it as a lifestyle issue and what I think we did really well in this year's report, like you mentioned as far as outline the impact that the various levels of obesity have on other conditions. 

We always hear heart disease and diabetes, but there's a whole host of other conditions that it can severely impact. And when you think about what a modest weight loss impact can have on any type of condition, it's, it's really amazing that we haven't come further in treatments with obesity.

Historically, again, it's always been focused around lifestyle, physical activity, and nutrition. Bariatric surgery was, you know, a big new thing but that was, gosh, I don't know what, like 25, 30 years ago when that actually started happening? And that's been it as far as, you know, real innovation in the space of obesity until we've had, you know, the around GLP-1s and the utilization of those to be able to treat obesity.

Obviously they're originally designed to treat and and manage diabetes. And then we saw this tremendous side effect that people were losing weight on them too. And now we've developed and opened up this whole, um, opportunity to potentially treat obesity with that too. 

But there is, as you mentioned, some cost factors that are really, prohibitive not only from an individual standpoint, but also from an employer standpoint as well with the hefty price tag that can come with that. 

[00:19:41] David: Jen, you promised that we would circle back to GLP-1s at some point, so this great point to come back to that. Janet, how about you start by just giving us, , a, an overview definition of what GLP agonists are, GLP-1 agonists are, and how are they influencing the treatment strategies for diabetes and obesity.

[00:20:06] Janet: GLP-1 agonists are drugs that. mimic a naturally occurring hormone called Incretin. They have a number of effects including lowering glucose levels in the blood, slowing stomach emptying, and affecting areas of the brain that tell us whether we're hungry or not. As Jen mentioned, their initial use about 20 years ago was for the treatment of diabetes due to their ability to lower glucose levels. And then as it turned out, many individuals with diabetes who were taking these drugs lost weight.

But it wasn't until 10 years ago in 2014 that a GLP-1 agonist, Saxanda, was approved for treatment of obesity. Since that time, we've had two more GLP-1 agonists that have been approved for treatment – Wegovy in 2021, and then Zepbound at the end of 2023.

We've seen the utilization of GLP-1 agonists increase over the last four years for both treatment of diabetes and obesity. They've become really popular in treatment of diabetes due to better glycemic control. And they also, um, inferred decreased adverse cardiac events. But in the last few years, as will come to no surprise to, to anyone, their use has skyrocketed in treatment of obesity.

Current statistics in the United States show that over 40% of adults are obese, and that's despite many individuals' attempts to lose weight by exercising more and eating better, and some undergoing bariatric surgery. So effective drug therapy is the newest tool in the toolbox to help with this epidemic. 

[00:22:08] David: Jen, you've blogged and talked on some of our other podcasts and videos about how lifestyle and environmental factors contribute to these conditions, diabetes and obesity. As a registered dietician, this is something that I know is, is close to your heart. So why don't you explain how you are looking at this now.

[00:22:31] Jennifer: Yes, it is a topic very near and dear to my heart that I'm extremely passionate about, which I'm sure you'll be able to tell by the inflection in my voice as we go through this so, um, yeah, where to start? Well, there, there is. certainly space to talk about physical activity and nutrition as we think about treating obesity and, and diabetes essentially too.

But I think where we begin to lose sight is we think that's really like people just need to eat better and they need to get out and get more physical activity. But the point in time where we are now as Janet mentioned with the obesity rate over 40%, it is not all just a matter of what goes in and what we burn off. There is a substantial impact from what our food is, the makeup of our food today anyways, just from agricultural changes and toxins that are just in our food, even if it's healthy food, you know, we have the dirty dozen list as far as it should be organic because of pesticides and everything else that's on there.

The environmental toxin component is really quite large when you think about it as far as the exposure that we put upon ourselves. From everything from food sources to beverages, household products that we use, everything from aluminum foil and maybe aluminum pans that you're using to the deodorant that may have aluminum in it.

And mercury from, you know, if you are over 40 like me and still potentially have mercury fillings in your teeth. Like all of those things that we just didn't know how that toxicity builds up into our system. And there are substances called endocrine disruptive chemicals, which they're not mutually exclusive to one another, but they are these compounds that essentially can wreck havoc on your hormones and how you process, um, and the all the normal functions that should be occurring within your system.

These disruptors can be caused by the various toxins that we're exposed to, again, from food to environmental factors as well. There's really a fascinating book that I actually read for my RD credits last year. It's called The Obesogen Effect, which was really eye-opening to walk through everything as it lists what some of these exposures can be to you.

And I know we're thinking as we think about plastics and we think about BPAs and we think about food source stuff as far as with MSG and soy artificial sweeteners, again, all those things that over time if we're exposing ourselves to them on a daily basis, can continue to build up. It can wreak havoc within our system. 

I also mentioned as far as just general lifestyle habits too, we can't ignore that. We are definitely a society that sits more than anything else, and so yes, physical activity is still imperative. We still need to get active. We need to not be sitting in front of a computer screen and, and we need to take breaks and get out and get exposure to daily sunlight.

 It's important I think, to just understand that if you're an individual, that you're eating all your fruits and vegetables as you should. You're eating lean meats and avoiding artificial sweeteners, and you're getting your exercise, but you can't seem to lose weight.

There truly can be another issue that's happening to you. And I think that's where there's been a disconnect as far as. Just, as a whole as far as understanding the impact of everything else that we've done to make our lives more convenient, and how that can truly be disrupting our own systems and our body. How's that for a nice, long answer for you, David? 

[00:26:09] David: Goodness. I, I think I wasn't quite prepared for all of that, no, it it, that's great insight. I agree with many of those points. Janet, do you have anything else that you would add onto that?

[00:26:20] Janet: I think Jen had a very thorough response, particularly as it comes to how the environment affects us. We can't change our genetics, and I think that really leaves us trying to improve our lifestyles and environment. 

One thing I would say, I know that it has been a, an issue to try to get people, you know, to make lifestyle changes and keep them, and I'm not sure that it's realistic to expect people to make huge changes, but I think we can keep promoting even making small changes, which I think could improve member health.


[00:27:05] David: Good point. Speaking of changes there and guidance, Janet, what should employers consider when they're designing their health plans that include obesity treatment?

[00:27:16] Janet: Employers are really faced with some tough decisions due to how costly the GLP-1 agonists are. Because of obesity's impact on so many health conditions, I do think employers need to try to promote healthy living and offer services that can help members who are obese lose weight. To me, this is really part of secondary prevention, which is preventing conditions that will develop due to obesity.

Whether to include GLP-1 agonists in obesity treatment as part of member benefits, that's going to be a decision each employer will need to make. I look at offering them as an investment in the future health of their employees. 

And surveys have shown that offering these drugs can help with employee retention. Due to the challenges around obesity treatment, it may help to partner with a clinical program that has a comprehensive approach to obesity. Our Springbuk customers can look at potential partners within Activate on our platform. 

And Jen, I'm sure you have some additional thoughts.

[00:28:34] Jennifer: I think you captured a lot of the main concepts there at just understanding that what we have tried to do in treating obesity in the past has kind of just been a, a broad swipe. We think it's the same for everyone, and I think what we have learned, particularly even with GLP-1 results, they don't work for everyone. So it's not this miracle cure as far as everyone should be on a GLP-1. It's really this multi-pronged approach, knowing that every individual really is unique in what might work. So I think ensuring that you have programs in place that cover lifestyle and nutrition and physical activity, everyone needs those basics, as you mentioned. 

That is gonna be key regardless of if you end up having bariatric surgery or someone is on a GLP-1 We don't necessarily want them on that for life. It should be used as a tool to. Safely reduce weight within a timeframe and then ideally wean them off of that. But if they haven't learned the proper lifestyle to live by as far as with healthy eating and nutrition and exercise, they're gonna gain the weight back.

So it needs to be, again, a multifaceted approach to be able to ensure long-term success that will ultimately, hopefully impact the other chronic conditions that these individuals have too. So I think to your point, you know, from an employer standpoint, it really needs to be thought out as a comprehensive strategy as you think about the rest of your benefit offerings around chronic conditions.

as you think about diabetes and MSK, from a holistic standpoint, obesity needs to be rolled into that strategy as well.

[00:30:18] David: Jen, we've been leaning on your population health side of your role here at Springbuk's quite a bit in this podcast. Janet just mentioned Springbuk Activate. Could we look at the other half of your job and could you just explain to our listeners maybe a little bit more about what Springbuk Activate is and how an employer might use it in this context around obesity and program planning? 

[00:30:42] Jennifer: Absolutely. So what's unique about our Activate marketplace is it is a data-driven way for employers to see how, which programs could potentially have an impact within their population. So we've talked a lot about obesity. One of our partners is Noom and they offer their full metabolic solution as far as through our activate marketplace. 

What is so important and unique about Activate is within a client's population. We're running Noom's identification algorithm on their own data so they can truly see the opportunity as far as how many people could potentially qualify for that program. What's the anticipated engagement rate based upon Noom's regular engagement as, far as with other companies that they've seen. And then we provide a potential savings opportunity. 

That is really impactful for an employer as you're looking for solutions that we've uncovered for them within our own insights as far as from a cost-savings perspective or a risk-mitigation perspective, they then can move right over to our Activate page and see what potential solutions to help address those insights that we've just uncovered. We have a whole host of them, from weight loss to MSK, health navigation, Rx repricing. 

 And the last piece I'll mention about that because this again is another unique piece to Springbuk, we know that getting data from those ancillary solutions sometimes can be challenging in the context of understanding the impact on overall healthcare spend. So as a part of being in Activate, those partners agree to send data back to Springbuk once the group has started to engage with them. 

So we can close the loop on reporting and understand that we will now see who all has engaged in those particular programs and be able to match that up with their healthcare claims to help the vendor and to help our partners and clients understand the real impact of those programs.

[00:32:49] David: Thank you. That was a great overview. Jen, I'm gonna stick with you on this last question, and it may get you cranked up again, so just be prepared. How has the treatment and overall approach to managing obesity evolved and where do you see it going? 

[00:33:09] Jennifer: I think until GLP-1s really started, I don't think it had evolved much for quite some time. I think it was pretty stagnant and which is shocking to me, knowing how. we continue to see the rate of obesity rise. We're seeing it in kids, in adolescents, and everyone just seemed to be okay with status quo. 

I think the development and, you know, understanding the impact of GLP-1s on obesity will hopefully, at least open the floodgates to other opportunities of treating obesity. Again, it's not a one size fits all even with GLP-1s, again, that's not necessarily the right solution for everyone that's overweight. 

I think hopefully though it will allow us to continue to evolve and think about various treatments and the continuum of obesity and the impact of overall conditions from a holistic standpoint, and we'll start to see new opportunities hit the market. 

What I am fearful of, though, I will admit, is that people are always still tending to look for that quick fix. And that's not a solution to the problem either. I think just like any benefit leader, you're always projecting out, traditionally a three to five-year strategy. It needs to be the same. As far as we think about weight loss, it's not something that should occur in three months. It's a slow progress, which I know can be really frustrating for individuals, but slow and steady really does win the race here too, and that's really, I think, the best way to think about it, to be able to be successful and hopefully bend the trend, and start to have some decreased claims costs related to obesity and overall chronic conditions.

[00:34:51] David: Okay, so earlier I talked about education and communication. I'm going to add two more catch words here: patience and perseverance.

[00:35:01] Jennifer: Oh, I like that.

[00:35:03] David: Thank you. 

[00:35:04] Jennifer: Like bumper sticker or something on there.

[00:35:07] David: All right. That brings us to the end. Janet and Jen, thank you both for coming on and, and sharing your expertise here. This is, of course, a very important topic for us all individually and all the employers who are footing so much of the bill for healthcare these days. 

It has significant direct consequences for nearly half of the U.S. population, and really for all of us, when you think about the overall impact of the healthcare costs and how they're taken into account. 

That is it for this episode of Healthcare on the Rocks: Employee Benefits with a Twist. Remember to get your copy of that In-depth 70-page Employee Health Trends report that we've talked so much about over the last two episodes. Or you can get a high-level executive summary at springbuk.com/eht24.

[00:35:59] Jennifer: And you can find all of our previous episodes at springbuk.com/podcast or in your favorite podcast player while you're loading up all those other episodes, hit the subscribe button so you won't miss any in the future. And we certainly have a busy season plan, which we're all looking forward to. 

Finally, we would appreciate it if you would take a minute to leave us a five-star rating and review and leave a comment to let us know what other topics you'd like us to cover. 

Janet, thanks again for joining us and thanks so much to everyone for listening today.​